This document discusses basic software research in image-guided therapy. It describes how research progresses from algorithms and prototypes, to tools for translational research, and eventually to commercially available clinical devices. It emphasizes that open-source software can help reduce duplication of efforts, facilitate collaboration between researchers, and provide a platform for interfacing research applications with clinical devices. The document also provides an overview of the Advanced Multimodality Image Guided Operating suite and some of the clinical research it enables.

1. Surgical Planning Laboratory
a teaching affiliate of
Brigham and Women’s Hospital
Harvard Medical School
Boston, Massachusetts USA
Basic Software Research in
Image Guided Therapy
Ron Kikinis, M.D.
Robert Greenes Distinguished Director of Biomedical
Informatics
Professor of Radiology, Harvard Medical School
Founding Director, Surgical Planning Laboratory, Brigham and Women’s Hospital
Principal Investigator, National Alliance for Medical Image Computing (a National Center for Biomedical
Computing), and Neuroimage Analysis Center (a NIBIB National Resource Center)
Research Director, National Center for Image Guided Therapy

2. Acknowledgments
• F. Jolesz, S. Wells, CF. Westin, S.
Pieper, S. Aylward, R. Whitaker, C.
Tempany, the Slicer community, and
many more….
©2012 Surgical Planning Laboratory, ARR Slide 2

3. Questions
• What is the difference between basic
research and industrial development
• Why is there very little basic
research into surgical methods?
• Why does open source work well in
research?
©2012 Surgical Planning Laboratory, ARR Slide 3

4. From Algorithms To Tools
• Can it be done?
– Prototypes
• Is it worth doing?
– Tools for translational
research
• Standard of care
– Commercially available
clinical “devices” with
regulatory approval
Image provided by Kikinis
©2012 Surgical Planning Laboratory, ARR Slide 4

5. Is It Worth Doing?
• Well-engineered software tools are needed for this
stage
• But: “Valley of Death”
– Science agencies: its not innovative
– Companies: no proven clinical utility, too risky
Pre-procedural MRI Intra-procedural CT Registered MRI
©2012 Surgical Planning Laboratory, ARR Oguro et al, Int J Comput Assist Radiol Surg, 2011 Slide 5
Elhawary et al, Acad Rad, 2010

6. The OR As A Laboratory
• Regulatory requirements
– Make it difficult to do research
– Result in duplication in the OR
(every product comes with its own
computer and screen)
• Many vendors are present in the OR
– Competition
• Solution: Open research platform
©2012 Surgical Planning Laboratory, ARR Slide 6

7. API’s and Standards
• Interfacing research and clinical
devices is necessary
• Standards require understanding of
the problem
©2012 Surgical Planning Laboratory, ARR Slide 7

8. Why Open Source?
• Reduce duplication
• Collaborate freely
– Proprietary software allows collaboration only
among customers of that package
– In multi-vendor scenarios, open source can
provide a neutral territory
• Improved communications
– Web-based infrastructure facilitates
collaborations
• Extensible
©2012 Surgical Planning Laboratory, ARR Slide 8

9. Interfacing Research and Clinic
• Co-existence of FDA
approved and
research applications
• Example:
Slicer+ Brainlab
• Intraoperative Fiber
Tracking
• Relies on pre-op data
©2012 Surgical Planning Laboratory, ARR Slide 9
Images courtesy Golby

10. Amigo Overview
Siemens
3T
Verio
Advanced
Mul,modality
Image
Guided
Opera,ng
(AMIGO)
Suite
P41
RR019703
–
Na-onal
Center
for
Image
Guided
Therapy
(NCIGT)
2005-­‐2015
Ferenc
Jolesz,
MD
Clare
Tempany,
MD
©2012 Surgical Planning Laboratory, ARR Slide 10

11. AMIGO: A Clinical Laboratory
Close to 100 vendors are present
• OR
• MRI
• PET/CT
• Conebeam
• US
• Microscope
• Video
©2012 Surgical Planning Laboratory, ARR Slide 11
Image: courtesy Balasz Lengyel

12. Basic Research in a Clinical Setting
100 procedures between August
2011and April 2012)
Procedure Name Count
Neurosurgery 20
Tumor Ablation (with 27
biopsy)
Abdominal Biopsy 9
Prostate Biopsy 15
Gynecologic Brachytherapy 22
Cardiac EP Ablation 6
Prostate Brachytherapy 1
©2012 Surgical Planning Laboratory, ARR Slide 12

13. Slicer URL
www.slicer.org
©2012 Surgical Planning Laboratory, ARR Slide 13