Objectives 1) Develop a less invasive but accurate enough registration strategy for otological surgical navigation. 2) Evaluate the new system in phantom study. 3) Evaluate the new system in cochlear implant surgeries. Methods A new registration method was developed for otologic surgery. Previously, the registration for accurate image-guided surgery often required invasive fiducial markers attached on patient's bone. We utilized the template of the bone surface to transfer the pre-made virtual bone-anchored markers to the patient's bone intraoperatively and eliminated the necessity for preoperative marker positioning or preoperative additional CT scan. Results We tested this Surface Template-Assisted Marker Positioning (STAMP) method using 5 temporal bone replicas, and in 5 ear surgeries (2 cochlear implants, 3 translabyrinthine acoustic neuroma surgeries) to investigate whether this method improves, or at least retains, the accuracy of image- guided surgery (IGS). The fiducial registration errors and target registration errors in the phantom study was ∼0.7 mm and ∼1.5 mm, respectively. The target registration errors in replicas were always less than 2 mm. In actual ear surgeries the fiducial registration errors were ∼0.6 mm and the target registration errors were less than 2 mm in 4 of 5 surgeries. All patients received successful cochlear implantation or tumor removal. Conclusions The new method reduced the preoperative procedures for patients but did not reduce the accuracy of the surgical navigation. Our method would be a useful IGS method in the field of otology where both accuracy and non-invasiveness are required.
A phantom study to evaluate three different registration platform of 3D/3D, 2D/3D, and 3D surface match with 6D alignment for precise image‐guided radiotherapy
