Kolibrir cranial/ENT · igation pointer inside of the cranial cavity, e.g., for distance measurement or point collec-tion. How to reduce the likelihood: Fully reprocess instruments

Copyright 2009, BrainLAB AG Germany. All rights reserved.

Software User GuideRevision 1.0

Kolibrir cranial/ENTVersion 2.7

Software User Guide Rev. 1.0 Kolibri cranial/ENT Ver. 2.7 3

Table of Contents

Table of Contents

General Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Chapter Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Contact Data & Legal Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Contact Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Legal Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Symbols Used in This Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Using the System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Compatibility with Medical Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

BrainLAB Medical Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

BrainLAB Software . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Non-BrainLAB Medical Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Non-BrainLAB Software . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Training & Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

System Startup & Shutdown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25


Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Opening a Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

About Data Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Starting the Software . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Workflows for Data Transfer and Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Workflow for Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Loading Patient Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Shutting Down . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Closing the Software and Shutting Down the System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

4 Software User Guide Rev. 1.0 Kolibri cranial/ENT Ver. 2.7

Table of Contents

Software Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37


Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

About the Software . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

User Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Main Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Menu Bar Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

General Dialog Buttons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Tracking System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Tracking Status Displays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Tracking Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Camera Positioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

System Information and Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Adjusting Sound Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Configuring a Live Video Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Registration Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55


Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

About Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Preparation for Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Restoring a Previous Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Standard Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61


Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Introduction to Standard Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

About Standard Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

Registration Instruments and Software Guidance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Performing Standard Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Activating Standard Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65


Table of Contents

Planning Registration Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Unsequential Registration (Registering Fiducial Markers) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Sequential Registration (Registering Fiducial Markers and Preplanned Landmarks) . . . . . . . . . . . . . . . . . . 71

Registration Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

About Registration Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Verifying Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

Detailed Registration Accuracy Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

Surface Matching Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79


Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Introduction to Surface Matching Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

About Surface Matching Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

Activating Surface Matching Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Registration Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Adjusting Threshold Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Softouch Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Performing Softouch Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

z-touch Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Ensuring Successful z-touch Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Performing z-touch Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

Surface Matching Registration Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

About Registration Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

Verifying Accuracy: Standard Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

Verifying Accuracy: Overview of Advanced Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

How to Verify Accuracy using Advanced Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Additional Guidelines for z-touch Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Additional Point Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Effects of Scan Areas on Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Intraoperative Landmark Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

Chapter Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103


Table of Contents

Introduction to Intraoperative Landmark Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

About Intraoperative Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

Registration Instruments and Software Guidance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105

Acquiring and Registering Intraoperative Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

Acquiring Intraoperative Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

Registering Intraoperative Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

Configuring Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111


Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

Navigation Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

About the Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

View Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

Accessing View Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

Inline and Probe’s Eye Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120

3D View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121

Adjusting the Threshold of 3D Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

Live Video Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124

Auto Pilot View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

Windowing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

Adjusting Windowing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128

Calibrating Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129


Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

Introduction to Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

About Calibration and Verification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

Handling Instrument Adapters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132

Accessing Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134

Accessing Calibration in the Tools Dialogs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135

Loading Precalibrated Geometries and Restoring a Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136

Calibration Using the Reference Array . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138


Table of Contents

Performing Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

Calibration Using the ICM4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141

Calibration and Verification Using Pivot Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142

Calibration and Verification Using Receptacles (Holes) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

Calibration and Verification Using the V-Inset (Notch) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145

Calibrating Suction Tubes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

Calibration Using the ICM 2.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149

Calibration and Verification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150

General Navigation Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151


Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

Accuracy Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152

Verifying Navigation Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152

Verifying the Pointer and Softouch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154

Patient Orientation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155

Defining Patient Orientation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155

Measurement Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156

Accessing Measurement Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156

Displaying a Scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

Displaying Distances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158

Freeze Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160

Using Freeze Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160

Tooltip Offset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161

Setting a Tool Tip Offset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161

Trajectories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

Acquiring Trajectories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

Eraser Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169


Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169


Table of Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170

About Eraser . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170

Eraser Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171

Instrument Calibration and Verification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171

Using Eraser . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173

Eraser Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173

Modifying the Eraser Object . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174

Navigating Alignment Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177


Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177

VarioGuide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178

Verifying Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179

Defining the Initial Position and Performing Rough Adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181

Aligning the VarioGuide to the Planned Trajectory and Verifying Accuracy . . . . . . . . . . . . . . . . . . . . . . 184

Navigating the VarioGuide with General Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187

Preparing the VarioGuide for Navigation with the Disposable Biopsy Needle . . . . . . . . . . . . . . . . . . . . . 188

Frameless Biopsy System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191

Verifying Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192

Aligning the Biopsy Tube and Calculating the Instrument’s Insertion Depth . . . . . . . . . . . . . . . . . . . . . . 195

Disposable Biopsy Needle Type A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200

Navigating the Disposable Biopsy Needle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200

Microscope Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203


Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203

Introduction to Microscope Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204

About Microscope Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204

Initializing the Microscope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205

Activating and Selecting the Microscope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205

Verifying the Microscope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207


Table of Contents

Verifying the Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209

Recalibrating the Microscope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211

Microscope Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213

Accessing Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213

Navigation Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214

Microscope Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216

Microscope Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217

Configuring Microscope Video . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218

Microscope Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220

Displaying Microscope Video Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223


Table of Contents


General Information

General Information

Chapter Overview

Contents

Topics Covered

Section See

Contact Data & Legal Information page 12

Symbols Used in This Guide page 14

Intended Use page 15

Compatibility with Medical Devices page 18

Training & Documentation page 23


Contact Data & Legal Information

Contact Data & Legal Information

Contact Data

Support If you cannot find information you need in this guide, or if you have questions or problems,contact BrainLAB support:

Feedback Despite careful review, this manual may contain errors.

Please contact us at [email protected] if you have suggestions as to how we canimprove this manual.

Manufacturer BrainLAB AG

Kapellenstr. 12

85622 Feldkirchen

Germany

Region Telephone and Fax Email

United States and Canada Tel: (800) 597-5911Fax: (708) 409-1619

[email protected], Asia, Australia, Europe

Tel: +49 89 991568-44Fax: +49 89 991568-811

Latin America Tel: +55 11 3256-8301Fax: +55 11 3256-4968

Japan Tel: 03-5733-6275

France & French-speakingregions Tel: +33-800-67-60-30 [email protected]


General Information

Legal Information

Copyright This guide contains proprietary information protected by copyright. No part of this guidemay be reproduced or translated without express written permission of BrainLAB.

BrainLAB Trademarks

• KolibriTM is a trademark of BrainLAB AG, registration pending.• Softouch® is a registered trademark of BrainLAB AG in Germany and/or the US.• StarLink® is a registered trademark of BrainLAB AG in Germany and/or the US.• VarioGuideTM is a trademark of BrainLAB AG, registration pending.• z-touch® is a registered trademark of BrainLAB AG in Germany and/or the US.

Non-BrainLAB Trademarks

• Mayfield® is a registered trademark of OMI, Inc.• Microsoft® and Windows® are registered trademarks of Microsoft Corporation in the

United States and other countries.• MultiVisionTM and PenteroTM are trademarks of Carl Zeiss Surgical GmbH. • OPMI® is a registered trademark of Carl Zeiss Surgical GmbH.

Integrated 3rd-Party Software

This software is based in part on the work of the Independent JPEG Group.

CE Label

Disposal Instructions

Only dispose of electrical and electronic equipment in accordance with statutory regula-tions. For information regarding the WEEE (Waste Electrical and Electronic Equipment) di-rective, visit:

brainlab.com/weee

Sales in the US US federal law restricts this device to sale by or on the order of a physician.

The CE mark shows that the BrainLAB products comply with the essen-tial requirements of the Medical Device Directive.

According to the MDD (Council Directive 93/42/EEC), Kolibri cranial/ENT is a Class IIb product.


Symbols

Symbols

Symbols Used in This Guide

Warnings

Warnings are indicated by triangular warning symbols. They contain safety-critical information regarding possible injury, death or other serious conse-quences associated with equipment misuse.

Cautions

Cautions are indicated by a circular caution symbol. They contain safety-criti-cal information regarding possible problems with the device. Such problems in-clude device malfunctions, device failure, damage to device or damage toproperty.

Notes NOTE: Notes are formatted in italic type and are used to indicate additional useful hints.


General Information

Intended Use

Using the System

Indications for Use The BrainLAB Kolibri IGS system is intended to be an intraoperative image guided local-ization system to enable minimally invasive surgery. It links a freehand probe, tracked by amagnetic sensor system or a passive marker sensor system to a virtual computer image spaceon a patient’s preoperative diagnostic image data set being processed by the Kolibri com-puter workstation. The system is indicated for any medical condition in which the use of stereotactic surgerymay be appropriate and where a reference to a rigid anatomical structure, such as the skull,a long bone, or vertebra, can be identified relative to a CT, X-ray, MR based model of theanatomy.

Example image guided cranial surgery procedures include, but are not limited to:

• Tumor resections• Skull base surgery• Cranial biopsies• Craniotomies/Craniectomies• Pediatric Catheter Shunt Placement• General Catheter Shunt Placement

Example image guided ENT surgery procedures include, but are not limited to:

• Transphenoidal procedures• Maxillary antrostomies• Ethmoidectomies• Sphenoidotomies/Sphenoid explorations• Turbinate resections• Frontal sinusotomies• Intranasal procedures

Place of Use The Kolibri cranial/ENT system is to be used in the operating room.


Intended Use

Instrument Contact to Brain Tissue and Spinal Fluid

Only specified BrainLAB instruments are intended for direct contact withbrain tissue and spinal fluid. For a list of such instruments, refer to the Instru-ment User Guides.

What is the risk?Direct contact to brain tissue and cerebrospinal fluid by instruments not intended for suchcontact may cause damage to the patient’s brain or severe shock by delivering endotoxicsubstances to the patient’s body.

BrainLAB instruments are designed and manufactured to minimize the risk of damage tothe patient’s brain tissue. Therefore, it is unlikely that patient injury will occur during nor-mal instrument use. However misuse of instruments, or the use of damaged instruments, cancause severe patient injury.

Standard reprocessing methods are not fully effective for endotoxic contaminated instru-ments. Endotoxic contamination can only be removed using aggressive treatments, e.g.,very high temperatures. Such parameters may damage highly accurate manufactured instru-ments. Contact to brain tissue or cerebrospinal fluid with instruments that are not intendedfor such contact can cause severe patient injury.

In which situations might unintentional contact occur?Situations where unintentional contact to brain tissue may occur are in general all situationsin which instruments are used in close proximity to brain tissue. Examples are using the nav-igation pointer inside of the cranial cavity, e.g., for distance measurement or point collec-tion.

How to reduce the likelihood:Fully reprocess instruments as described in the Cleaning, Disinfection and SterilizationGuide. Store and handle instruments as described.

Except in the case of specified instruments, avoid direct instrument contact to brain tissueand contact to cerebrospinal fluid.

Careful Handling of Hardware

System components and accessory instrumentation comprise precise mechani-cal parts. Handle them carefully.

Only trained medical personnel may operate system components and accessoryinstrumentation.


General Information

Symbols on the System Hardware Components

The following symbols may be found on the system or on the instruments.

Plausibility Review

Before patient treatment, review the plausibility of all information input to andoutput from the system.

Symbol Explanation

Type B Applied Part according to IEC 60601-1

Type BF Applied Part according to IEC 60601-1

Attention! Consult accompanying documents

Potential equalization point

MR Unsafe

<XYmT

MR Conditional: The number shown on each label specifies the MR envi-ronment in which the device can be used with caution


Compatibility with Medical Devices


BrainLAB Medical Instruments

Compatible BrainLAB Medical Instruments

Kolibri cranial/ENT is compatible with:

• Biopsy Alignment Array and Biopsy Tube• Blakesly Clamp• BrainLAB Pointer, Sharp Tip and Blunt Tip• Disposable Reflective Marker Spheres• Disposable Registration Marker CT, MR, OR• Disposable Biopsy Needle Type A• Frameless Biopsy System• Instrument Calibration Matrix (ICM4 and ICM 2.0)• Mayfield Reference Array• Mayfield Reference Clamp• Microscope Adapters and Microscope Arrays• Multiple Tip Pointers • Reference Headband and Reference Headband Array• Skull Reference Set• Softouch• Instrument Adapter Kit, StarLink Interface:

- Instrument Adapter Arrays (sizes S, M, ML, L, XL)- Instrument Adapter Clamps (sizes S, M, L, XL)

• Sterilization Trays (Cranial, ENT, Frameless Biopsy System, VarioGuide)• Suction Tube• VarioGuide• Vario Reference Arm• z-touch


General Information

Other BrainLAB Instruments

Additional instrumentation may become available after release of this manual. ContactBrainLAB support if you have any questions regarding instrument compatibility with Brain-LAB software.

Only use instruments and spare parts specified by BrainLAB with Kolibri cra-nial/ENT. Using unauthorized instruments/spare parts may adversely affectsafety and/or effectiveness of the medical device and endanger safety of patient,user and/or environment.

System Compatibility

NOTE: The software is not compatible with the Kolibri system Revision 1.0.



BrainLAB Software

Authorization

Only authorized BrainLAB employees may install software on the BrainLABsystem. Do not install or remove any software applications.

Compatible BrainLAB Medical Software

Kolibri cranial/ENT is compatible with:

• iPlan Cranial Versions 1.0, 1.1, 1.5, 2.5 and 2.6• iPlan ENT Versions 1.0, 1.1, 2.5 and 2.6• iPlan Flow Version 2.6• iPlan Stereotaxy Versions 2.5 and 2.6• PatXfer Versions 5.2

Other BrainLAB Software

If you are running software versions other than those specified above, please contact Brain-LAB support for clarification regarding compatibility with BrainLAB devices.

Only BrainLAB medical software specified by BrainLAB may be installed andused with the system.


General Information

Non-BrainLAB Medical Devices

Compatible Non-BrainLAB Medical Devices

Compatible Non-BrainLAB Surgical Microscopes

Other Non-BrainLAB Devices

Using medical device combinations which have not been authorized by Brain-LAB may adversely affect safety and/or effectiveness of the devices and endan-ger safety of patient, user and/or environment.

Medical Device Model Manufacturer

Screwdriver 1.5 mm KLS Martin GmbH + Co. KGAm Gansacker 1B79224 Umkirch Germany

Self-Drilling Screw 1.5x6 mm

Drill Bit 1.1 mm

Drill Handle

Model Manufacturer

Olympus

• OME-9000 • OME-8000• OME-7000

Olympus Medical Systems Corp.2951 Ishikawa-cho, Hachioji-shiTokyo 192-8507 Japan

MOELLER-WEDEL

• Hi-R 1000• Hi-R 700• VM 900 (lenses 1, 2 and 3)• MMS 900 (lenses 1, 2 and 3)

MOELLER-WEDEL GmbHRosengarten 1022880 Wedel Germany

Leica

• M720• M525• M520• M500-N

Leica Microsystems (Switzerland) AGMax Schmidheiny-Strasse 201CH-9435 Heerbrugg Switzerland

Zeiss

• OPMI Pentero C• OPMI Pentero • OPMI Neuro MultiVision• OPMI Neuro CRT• OPMI Vario

Carl Zeiss Surgical GmbHA Carl Zeiss Meditec CompanyCarl-Zeiss-Str. 2273447 Oberkochen Germany



Non-BrainLAB Software

Authorization

Only authorized BrainLAB employees may install software on the BrainLABsystem. Do not install or remove any software applications.

Compatible Non-BrainLAB Software

Kolibri cranial/ENT is compatible with Microsoft XP operating system. For information re-garding compatible service packs please contact BrainLAB support.

Other Non-BrainLAB Software

Only software specified by BrainLAB may be installed and used with Kolibricranial/ENT.


General Information

Training & Documentation

Training

BrainLAB Training To ensure safe and appropriate use, before using the system all users should participate in atraining program held by a BrainLAB representative.

Supervised Support Before using the system for surgical procedures where computer-aided navigation is con-sidered essential:

• Simulate a sufficient number of complete procedures on sawbones and/or cadavers.• Use the system in operations where computed-aided navigation may be desirable but

not essential. A BrainLAB representative must be present at such operations to provideguidance where necessary.

Responsibility

This system solely provides assistance to the surgeon and does not substitute orreplace the surgeon’s experience and/or responsibility during its use.


Training & Documentation

Documentation

Intended Audience This user guide is intended for neuro, ENT and CMF surgeons or their assistants when usinga BrainLAB navigation system.

Reading User Guides

The user guides describe complex medical devices and surgical navigation software thatmust be used with care.

It is important that all users of system, instruments and software:

• Read the user guides carefully before handling the equipment• Have access to the user guides at all times

Available User Guides

Quick Reference Guides

Quick Reference Guides are available for most software applications and for some complexinstruments. They provide condensed information on using the software or hardware, andare intended as a supplement to the User Guides.

NOTE: Quick Reference Guides do not replace reading the User Guides.

User Guide Contents

Software User Guides

• Overview of treatment planning and image-guided nav-igation

• Description of OR system setup• Detailed software instructions

Instrument User Guides Detailed instructions on instrument handling

Cleaning, Disinfection & Sterilization Guide

Details on cleaning, disinfecting and sterilizing instru-ments

System User Guides Comprehensive information on system setup

Technical User Guide Detailed technical information on the system, includingspecifications and compliances


System Startup & Shutdown


Chapter Overview

Contents

Topics Covered

Section See

Opening a Session page 26

Shutting Down page 33


Opening a Session

Opening a Session

About Data Flow

Data Flow Options When you start the software, two options are available to transfer patient data from the CT/MR scanner to the Kolibri system.

Option 1

The scan data is transferred via network, CD-ROM/DVD, etc. to theKolibri system.

After treatment planning and navigation, the scan data, treatmentplan, and screenshots are stored to the selected storage medium (e.g.CD-ROM).

Option 2

The scan data is transferred via network, CD-ROM/DVD, etc. to anexternal planning station, where the treatment is planned.

Next, the scan data and the treatment plan are transferred via an ex-ternal USB flash drive or network to the Kolibri computer.



Starting the Software

How to Open the Software

NOTE: Some system configuration settings can also be performed in the Application Se-lection dialog. Details are provided via the Help button in this dialog.

Selecting the Workflow

Figure 1

NOTE: Availability of the above options depends on your system configuration. If only oneapplication is installed on your system, the application starts automatically.

Steps

1. Start the system (see System User Guide).

2. In the Application Selection dialog which opens, select Kolibri cranial or KolibriENT.

The Select to Begin dialog opens.

Options

To transfer patient data from PatXfer to the navigation system, press Data Transfer (seepage 28).

To plan patient data locally on the navigation system using iPlan, press Planning (seepage 28).

To load patient data and begin navigation using the navigation software, select Naviga-tion (see page 30).


Opening a Session

Workflows for Data Transfer and Planning

Preplanned Data

To navigate preplanned data, select Planning rather than Data Transfer. Other-wise, all preplanned data will be lost.

Workflows

NOTE: For information on transferring data using PatXfer, see the PatXfer Clinical UserGuide. For information on planning cranial or ENT treatments using iPlan, see the relevantiPlan Software User Guide.

Option Workflow Steps

Transfer patient data via DICOM and perform naviga-tion

• Select Data Transfer to open PatXfer.• In the Send to... dialog, export the patient to To

Navigation. • PatXfer closes and the Navigate Now dialog opens. • To begin navigation, press Now.

Transfer local patient data andperform navigation

• Select Data Transfer to open PatXfer. • In the Archive selection dialog, select Local Pa-

tients. • Select the patient. In the Send to... dialog, export

the patient to To Navigation. • PatXfer closes and the Navigate Now dialog opens. • To begin navigation, press Now.

Export a preplanned treatmentplan and perform navigation

• Select Planning to open iPlan. • In iPlan, export the treatment plan to the navigation

system. • Once you exit iPlan, the Navigate Now dialog

opens. • To begin navigation, press Now.

Transfer patient data viaDICOM and perform plan-ning

• Select Data Transfer to open PatXfer. • In the Send to... dialog, select Local Patients. • Once you exit PatXfer, select Planning to open iP-

lan.

Perform planning on local pa-tient data

Select Planning to open iPlan.

Transfer patient data via DICOM to the local system

• Select Data Transfer to open PatXfer. • In the Send to... dialog, select Local Patients.



iPlan Restrictions

Only CT and MR image sets can be exported to Kolibri cranial/ENT and used forregistration and navigation. PET and SPECT images can be loaded to iPlan, butnot exported to Kolibri cranial/ENT.

Kolibri cranial/ENT software can only handle one image set. Therefore, iPlanonly exports one MR or CT image set, even though two or more image sets arefused.

Names of objects and trajectories preplanned using iPlan may be shortened inthe Kolibri cranial/ENT software.

Objects (markers, trajectories, outlined objects) preplanned using iPlan whichdo not belong to the exported image set are not imported to Kolibri.


Opening a Session

Workflow for Navigation

Workflow If you selected Navigation in the Select to Begin dialog, the Select the Patient DataSource dialog opens.

Figure 2

Options

To load data:

• Press USB if patient data is on a USB flash drive (see page 32). • Press Network if patient data is on the hospital network. (See page 31 if multiple pa-

tients are available on the network. See page 32 if one patient is available on the net-work).

To exit the procedure, press Cancel to open the Close Program dialog.



Multiple Patients on Network

Depending on your system configuration, the network folder may contain multiple patientdata sets.

In this case, when you select Network in the Select the Patient Data Source dialog, thesoftware prompts you to select the patient.

Figure 3

Steps

1. Once you have selected Network, the software displays the Loading PatientData dialog if multiple patients are available a.

Select Network in this dialog.

2. The Network Patient Load Overview dialog s opens displaying the availablepatient data sets (sorted by date).

Select the correct patient from the list.

3. Review the data in the Patient Information dialog (see page 32).

a s


Opening a Session

Loading Patient Data

Confirming Patient Data

You can now load the patient’s data (containing CT/MR images, preplanned trajectories,markers, etc.).

Figure 4

Image sets which were localized with the VectorVision Cranial Planning 1.3 soft-ware, or where the scaling feature of the image fusion was used, cannot be load-ed to Kolibri cranial/ENT 2.x.

Options

If the correct patient data is shown, press Load Patient to transfer data to the navigationsystem.

Once the data has loaded, the main screen is shown (see page 47).

To load data from a different patient, press Change Patient and insert Zip disk or USBflash drive.

To start the software without loading data, e.g., for standalone ultrasound (see page 291)or intraoperative imaging (see page 355), press Skip.

NOTE: Availability of this option depends on your system configuration.

If you would like to exit the procedure, press Close to open the Close Program dialog.



Shutting Down

Closing the Software and Shutting Down the System

Proper Shutdown

Make sure only one USB flash drive is connected. Otherwise the software can-not save the data to the drive.

Always close the software before shutting down the system. Never use the powerswitch to exit the software, as data may be lost.


Shutting Down

How to Close the Software

Figure 5

NOTE: If you select CD, it may take approximately 30 seconds for the CD burning processto begin. Data stored to CD can be used for archive purposes only.

NOTE: Screenshots taken in iPlan are not exported to the navigation system. To storescreenshots created using iPlan, open the Windows Explorer, go to C:\brainlab\screenshotsand copy the screenshots to another storage medium.

Steps

1. Press the shutdown button a.

2. In the Close Program dialog, press Close Program.

3. In the Choose the Patient Data Storage dialog, select the relevant storage me-dium.

NOTE: Availability of storage options depends on your system configuration.

a



Additional Options in the Close Program Dialog

How to Shut Down the System

Storing Screenshots

Upon closing the software, all screenshots acquired during the session using the Screenshotbutton are automatically saved to the storage medium.

Options

If you have initiated program shutdown, but wish to cancel and return to the program,press Cancel.

To restart the software, press Restart.

Steps

1. Once the software is closed, remove the storage medium.

2. Turn off the system (see System User Guide).


Shutting Down


Software Overview

Software Overview

Chapter Overview

Contents

Topics Covered

Section See

Introduction page 38

User Interface page 39

Tracking System page 43

System Information and Configuration page 50


Introduction

Introduction

About the Software

Overview Kolibri cranial/ENT is a touchscreen-based intra-operative planning and navigation soft-ware.

Kolibri cranial/ENT can only be used for neurosurgery and ENT treatments. Donot use the software for any other treatments.

Kolibri cranial/ENT uses scan images of the patient which are acquired beforethe operation is performed. The actual anatomy of the patient could differ fromthe preoperative scan data due to e.g. brain shift or resections.


Software Overview

User Interface

Main Screen

Screen Layout The main screen opens once patient data has been loaded.

Figure 6

No. Explanation See

a Patient’s name

s Image Views page 111

d Camera view windows page 44

f Camera status bars page 45

g Menu bar page 40

a

d

f

g

s


User Interface

Menu Bar Overview

Patient Registration and Tools

Adjusting Views

Button Function See

Register activates patient registration page 55

-

Tools opens the Tools dialog which provides access to:

• Hotline information page 50

• System settings (sound output) page 51

• Microscope navigation page 203

• VarioGuide page 178

• Tool calibration/verification- Biopsy needle (use with VarioGuide) page 180- Biopsy needle (use with Frameless Biopsy System) page 192- Alignment tools page 193- VarioGuide page 179- Calibration/verification page 134

• Live video settings page 52

• Measurement functions page 156

• Trajectories page 167

• Orientation page 155

Button Function See

Windowing allows you to adjust windowing in image sets page 127

The Zoom buttons change the magnification of displayedimages page 117

Freeze locks the navigated display page 160


Software Overview

Tooltip Settings

Navigation Functions

General Functions

Button Function See

Tooltip enables virtual extension or retraction of a navigat-ed instrument tip page 161

Tip Extension + extends the tool tip offset

page 162

Tip Extension - retracts the tool tip offset

Button Function See

Acquire allows you to acquire a trajectory page 164

Eraser allows you to modify patient data, e.g., trace surgi-cally removed tissue volumes page 169

Button Function See

Screenshot takes a screenshot of the current screen page 117

The shutdown button shuts down the software page 33


User Interface

General Dialog Buttons

Available Buttons Depending on the dialog, various buttons are available.

NOTE: Additional buttons with specific functionalities are described with the correspond-ing step in this guide.

Button Function

Branches you to the next step

Confirms settings and closes the dialog

Returns you to the previous dialog

Allows you to repeat a step

Exits the dialog without applying changes

Exits the dialog


Software Overview

Tracking System

Tracking Status Displays

Overview For successful registration and navigation, the camera must have an unobstructed view ofthe instruments and reference arrays.

The status displays give you real-time feedback about the visibility of instruments and ref-erence arrays to the camera. Dots in the display indicate the relative positions of instrumentsand reference arrays that are visible to both camera lenses.

Status Displays

Figure 7

No. Component

a Camera view windows

s Status bars

a

s


Tracking System

Camera View Windows

The camera view windows display dots which represent the marker sphere geometries of thereference arrays and navigated instruments. The color-coding of the dots is specific to eachreference array and instrument. You can use the camera view windows to check whether aninstrument or array is visible to the camera

Instrument Display

Color blind users may not be able to clearly distinguish color differences of therepresented instruments.

Make sure that the instrument marker arrays are not displayed too closely to-gether and that they do not block other markers from being detected by thecamera. Otherwise the system may not be able to differentiate between instru-ments, resulting in incorrect instrument navigation.

Dot Color Represented Element

Red Reference array (e.g., Mayfield Reference Array) if the patient has beenregistered

Yellow Calibrated StarLink Instrument Adapter marker spheres or the ICM

Orange

Calibration devices (during instrument calibration):

• ICM

• Reference Array

Green Pointer or Softouch

Blue Microscope adapters

Pink• Disposable Biopsy Needle Type A and Biopsy Alignment Array

• VarioGuide

White Uncalibrated instruments or reference array before patient registration

Gray (filled)

Marker spheres of an array are visible to both camera lenses, but cannotbe assigned to a specific instrument

Gray (open) Array is only visible to one camera lens and cannot be interpreted


Software Overview

Status Bars The status bars indicate whether the camera is able to track the instrument.

Once a status bar is yellow, accurate tracking can no longer be guaranteed.

Status Bar Color Interpretation

Bottom GreenNormal tracking mode. The reference array and at leastone instrument with a known marker sphere geometryare visible to the camera.

Bottom Yellow

Camera has just lost sight of an active array. Status barremains yellow for 30 seconds unless normal trackingresumes. If visibility is not established after 30 seconds, statusfield turns red.

Top RedNo tracking possible. Patient registration has not beenperformed, or marker spheres of a critical array are notvisible to camera.

Both BlackCamera communication error during startup. If cameracommunication fails during use, a warning message ap-pears.


Tracking System

Tracking Instruments

Tracking Priority The software updates the navigation views based on the position of the instrument with thehighest priority. Lower priority instruments are displayed but are not used by default to up-date the views.

The list shows the tracking priority, starting with high priority instruments at the top:

• Softouch

• Pointer

• StarLink Instrument Adapter XL

• StarLink Instrument Adapter L

• StarLink Instrument Adapter ML

• StarLink Instrument Adapter M

• Disposable Biopsy Needle Type A

• Biopsy Alignment Array/VarioGuide

• Microscope Adapters

NOTE: To update the navigation views to the position of a lower priority instrument, re-move the instruments of higher priority from the camera field of view.


Software Overview

Tracking Identical Instrument Geometries

The software is not able to distinguish between instruments with identical tracking array ge-ometries. For example, if you have attached a StarLink Instrument Adapter, size ML to twodifferent instruments (see image below), the software may interpret them as being the sameinstrument.

Figure 8

Do not use pointers, microscope adapters or instrument adapters of the samesize simultaneously as the navigation software cannot distinguish between theindividual calibrations of identical geometrical arrangement of markerspheres.


Tracking System

Camera Positioning

Tracking System Alignment Dialog

This dialog shows the position of the reference and tracking arrays within the camera fieldof view.

Figure 9

NOTE: The color conventions of the spheres and circles is the same as in the camera viewwindows.

How to Optimize the Camera Field of View

No. Explanation

a Blue cone represents camera field of view

s Colored spheres represent marker spheres on reference and tracking arrays

d Colored rings represent distance of the arrays from camera lenses

a

s

d

Steps

1. Press one of the camera view windows in the menu bar to open the Tracking System Alignment dialog.

2. Adjust camera distance and angle so that all necessary arrays are represented inthe blue cone. The rings representing the reference array (e.g., Mayfield Refer-ence Array) should be as close to the center as possible, so that there is sufficientspace for navigation instruments.

If an array is no longer visible to the camera, the spheres disappear from view in-dicating that the array can no longer be tracked.


Software Overview

Sound Output Activating the Sound Output button provides acoustic guidance during positioning.

Beep Explanation

High pitched Reference array is close to the center of the camera field of view

Low pitched Reference array is further from the center of the camera field of view


System Information and Configuration


Overview

About System Configuration

A BrainLAB support specialist performs the initial system configuration. You can configureadditional settings in the Tools dialog.

Tools Dialog

Figure 10

No. Function

a

Hotline provides access to:

• BrainLAB support and hotline numbers• Software version information

s Use System to adjust sound settings (see page 51)

d Use Live Video to configure video settings (see page 52)

d

a

s


Software Overview

Adjusting Sound Settings

How to Adjust Sound Configuration

Figure 11

Steps

1. Open Tools > System > Sound.

2. To activate or deactivate system sounds, such as error beeps and other confirma-tion tones (e.g., when a dialog is opened or closed), toggle Sound Output to on(yellow frame) or off (blue frame).

3. To activate sound when you press buttons, toggle Button Sound to on (yellowframe) or off (blue frame).

4. Select volume level by adjusting the Sound volume level slider bar.

5. Press Close to apply settings and close the dialog.



Configuring a Live Video Connection

About Live Video/Video Connections

Live Video allows you to configure the settings for a real-time endoscope video connection.When video connections are configured, you can adjust the screen to display a video viewin any navigation view (see page 124).

Before You Begin Connect the cable between the video source and the navigation system, following the in-structions in the relevant BrainLAB System User Guide and the user manual for the videosource. Make sure that you have a signal in order to adjust the video settings.

How to Configure a Live Video View

Figure 12

Steps

1. Press Live Video in the Tools dialog.

2. In the Video Source tab a select signal type (PAL or NTSC).

NOTE: Composite is the standard BrainLAB connector.

3. In the Image Settings tab s, adjust image view settings as needed using the slid-er bars.

NOTE: Video image settings are described on page 53.

4. Press Accept to confirm settings.

a s


Software Overview

About Video Image Settings

Setting Description

Brightness Overall intensity of light in image.

ContrastDistribution range of light intensity. A higher contrast represents anarrower range. This sharpens the boundaries between areas ofgreatly different brightness, but reduces subtle grades of intensity.

Saturation

Determines amount of color in video image.

• High: Produces vivid colors• Low: Makes the colors look faded• Zero saturation: Images are displayed in black & white

HueDetermines whether a color is basically red, orange, yellow, green,etc. By changing the hue, you can adjust the color tone of the videoimage.

Gamma

If video images appear too bright or too dark, they may have thewrong gamma correction, i.e., they are not corrected for the nonlin-ear relationship between the pixel value and displayed intensitythat is typical for a color monitor. Changing the gamma level re-sults in a perceived image difference similar to changing thebrightness. Increasing gamma increases overall brightness with aslightly greater effect on mid-tones.

NOTE: This setting is available for microscope video views (seepage 220).




Registration Overview


Chapter Overview

Contents

Topics Covered

Section See

About Registration page 56

Preparation for Registration page 58

Restoring a Previous Registration page 60


Introduction

Introduction

About Registration

Explanation of Registration

Patient registration enables the software to map the patient’s preoperative image data to thephysical anatomy of the patient’s head. Usually registration is performed in an unsterile en-vironment.

Make sure that the patient’s anatomy is the same as in the diagnostic imaging!

The software uses scan images of the patient which are acquired before surgery.The patient’s actual anatomy could differ from the preoperative scan data, dueto e.g., brain shift or resections.

Before You Begin Refer to the Instrument User Guide for complete details on registration instruments.



The Registration Selection Dialog

All registration functions are available in the Registration Selection dialog. Availability ofregistration methods may vary depending on your software license.

Figure 13

Method Explanation

Standard RegistrationRegister fiducial markers worn by patient during scanningor preplanned landmarks in image set

Surface Matching Registration

Acquire points on patient’s skin using Softouch, z-touchor pointer

Restore Registration Restore an already performed registration

Acquire IntraoperativeLandmarks

Acquire landmarks to use for intraoperative registration(available if registration has already been performed)

Register IntraoperativeLandmarks Register intraoperatively acquired landmarks


Introduction

Preparation for Registration

Reference Arrays To enable registration and navigation, attach a reference array (e.g., the Mayfield ReferenceArray) to the patient. This allows the system to track the location and movement of the pa-tient’s head throughout the procedure.

The reference array must be visible to the camera at all times.

Camera Positioning When you select a registration method, the software displays the following dialog if the ref-erence array is not visible to the camera:

Figure 14

NOTE: For information on camera positioning, see page 48.

Sound Output Activating the Sound Output button provides acoustic guidance during positioning.

Step

Adjust camera distance and angle so that the reference array (indicated by colored ringsand spheres) is represented in the center of the blue cone. The rings should be as close tothe center as possible, so that there is sufficient space for navigation instruments.

Beep Explanation

High pitched Reference array is close to the center of the camera field of view

Low pitched Reference array is further from the center of the camera field of view



Establishing Good Visibility

Check reflectivity of marker spheres. The selected instruments must be clearly visible to thesystem. The reflective marker spheres must be securely attached.

If a reference array cannot be detected by the camera, verify that the markerspheres are clean, dry and undamaged, and that the reference array is not bent.

Reflection Artifacts

Artifacts caused by reflections - especially during image acquisition and regis-tration - can cause inaccuracy. Make sure that light sources or items which arehighly reflective do not affect the camera field of view.

The camera and/or the z-touch may affect the infrared detectors of devices (e.g.,OR tables, remote controls, etc.).

Verifying Accuracy

Always verify the registration accuracy as prompted by the software.


Introduction

Restoring a Previous Registration

When to Restore a Registration

If you have successfully performed a complete registration and subsequently restart the soft-ware, e.g., after a power failure, you can restore the registration.

How to Restore

Patient Positioning

Do not restore a registration if the patient position has changed relative to thereference array.

Steps

1. Press Register in the menu bar.

2. In the Registration Selection dialog, press Restore Registration.

3. In the Restore Registration dialog, press the button for the registration youwould like to restore.

4. In the Patient Registration dialog, check the accuracy of the restored registra-tion.


Standard Registration


Chapter Overview

Contents

Topics Covered

Section See

Introduction to Standard Registration page 62

Performing Standard Registration page 65

Registration Accuracy page 73


Introduction to Standard Registration


About Standard Registration

About the Registration Method

Standard registration uses a paired point matching technique in which you first plan pointsin the patient’s image set, and then use the registration instrument to acquire the point on thepatient. Thus the software can correlate the image set to the actual patient.

The points can be:

• Markers (fiducial markers worn by patient during scanning) or preplanned landmarks planned in iPlan

• Markers/preplanned landmarks planned in the navigation software• Markers detected by the navigation software

Colors of registration points are set to a single standard color during the trans-fer from iPlan to the navigation software. Registration points are always dis-played in blue (landmarks) and red (fiducial markers) in the navigationsoftware. Use registration marker positions to identify registration points.Names of registration points specified in iPlan are not displayed in the naviga-tion software.

Standard Registration Variations

Various types of standard registration methods are available. The software activates the ap-propriate registration depending on the image set you select for registration.

Registration Type Overview

Planning Registration Points

Points must be planned in the image set before registration. Ifyou have not already planned markers or landmarks in iPlan(e.g, if the image set is imported to the navigation system di-rectly from PatXfer), you must plan them in the navigationsoftware in the Registration Points step.

UnsequentialRegistration

The software prompts you to unsequential registration if theimage set contains only fiducial markers either preplanned iniPlan or planned/detected in the navigation software.

You can register markers in any order.

Sequential Registration

The software prompts you to sequential registration if the im-age set contains at least one preplanned landmark. This meth-od is also activated if unsequential registration fails.

You must register markers/landmarks in the order defined bythe software.



Workflow Overview

Before You Begin Fasten Disposable Registration Markers OR to the marker plates as described in theInstrument User Guide.

CT and MR marker sockets must be removed from the patient after the scan-ning procedure. If markers are still attached, remove them now, taking care notto burst the green MR markers.

Do not remove marker plates from the patient until patient registration hasbeen performed. Otherwise, standard registration is not possible.

Workflow

1. Select the image set (if more than one is available).

2. Plan registration points. If points were already planned in iPlan this step is notnecessary. Proceed to step 3.

3. Register points using either sequential or unsequential registration.

4. Verify registration accuracy.



Registration Instruments and Software Guidance

Registration Instruments

You can perform standard registration using the pointer or the Softouch.

• Markers are registered by placing the pointer/Softouch tip in the indent of the registra-tion marker and slowly pivoting the instrument while keeping the tip in place.

• Landmarks are registered by holding the pointer/Softouch tip to the landmark andslowly pivoting the pointer while keeping the tip in place.

Avoiding Skin Shift When registering fiducial markers and preplanned landmarks, hold the pointer/Softouchperpendicular to the marker/landmark. This prevents inadvertent skin shifting caused by theforce of the instrument.

Safety Considerations

When using the pointer for registration, take care that the pointer tip does notinjure the patient. Blood vessels, eyes, etc., are not suitable for landmark regis-tration.

Visual Software Cues

The number of markers or landmarks which can be registered is indicated by spheres in theregistration dialog.

Figure 15

Auditory Software Cues

The software emits a beep each time you register a marker or landmark.

If you attempt to register the same marker and landmark more than once, the software emitsa lower toned “beep” and does not re-register the point.

Sphere Color Explanation

Blue Registered markers and landmarks

Gray Unregistered markers and landmarks



Performing Standard Registration

Activating Standard Registration

How to Activate

Figure 16

Steps


2. In the Registration Selection dialog, press Standard Registration.



Planning Registration Points

Overview Before performing standard registration, registration points (fiducial markers and/or pre-planned landmarks) must be planned in the image set. If you did not already plan points iniPlan, the Registration Points dialog appears when you activate registration, prompting youto now plan points.

Registration Points Dialog

Figure 17

How to Automatically Detect Markers

Use this option if the fiducial markers worn by the patient have not already been planned inthe image set.

NOTE: Automatic marker detection can only be used in combination with BrainLAB mark-ers.

Steps

1. Use the Threshold and Precision options to adjust the detection settings as need-ed (see page 69).

2. Press Detect.

Detected markers are shown as red circles in the image set. Previously definedmarkers in the image set are deleted.



How to Add Markers

If a fiducial marker could not be detected in the image set, use this option to add one man-ually.

How to Add Landmarks

Use this option if you would like to manually add a landmark to the image set.

Additional Options

Steps

1. Press Add Marker.

2. A cross-hair circled in red appears in the center of the image set.

3. To position the marker, press the screen at the desired location.

Steps

1. Press Add Landmark.

2. A cross-hair circled in blue appears in the center of the image set.

3. To position the landmark, press the screen at the desired location.

• Surround the center of the region of interest with the landmarks• Place landmarks where skin or tissue shifting is not likely to occur

Landmarks should have a minimum distance of 10 mm from each other.

Options

To switch between different markers and landmarks, press Toggle.

The currently selected marker/landmark is shown as a circled cross-hair in the center ofthe image set.

To remove a marker/landmark, toggle to the marker/landmark and press Delete.



Adjusting Marker Detection Settings

For automatic marker detection, use the Threshold and Precision slider bars to adjust thedetection settings.

NOTE: If you make any adjustments, pressing Reset restores the default settings definedin the software.

Next Steps Once you have modified landmarks and markers, you must register them.

Threshold

Determines how clearly the software can distinguish marker spheresfrom normal cell or bone tissue in the image set. When a suitablethreshold is set, the software recognizes all markers and shows themas white spheres.

• For CT markers, density information is expressed in internationalHounsfield Units. Recommended range: 1200-1800.

• For MR markers, gray level values are used. Recommendedrange: 200-220.

Precision

Determines how far the shape of a marker sphere can deviate fromthe default value and still be detected by the software.

• A value of 1.0 detects objects with a spherical shape. • Higher values detect objects with increasingly elliptical shapes.

The recommended value is 1.20.

Steps

1. Press Proceed.

2. • If the image set contains fiducial markers only, the software prompts you toregister the markers using unsequential registration (see page 69).

• If the image set contains at least one landmark, the software prompts you to se-quential registration (see page 71).



Unsequential Registration (Registering Fiducial Markers)

Overview If the image set contains planned fiducial markers only, the software prompts you to per-form unsequential registration.

Registration Dialog .

Figure 18

How to Register Markers

Steps

1. Pivot the pointer/Softouch tip in the marker and register markers one after theother. You can register markers in any order.

2. Once you have registered the number of markers indicated at the top of the dia-log, press Proceed.

3. Verify registration accuracy in the dialog that opens (page 73).



Additional Options

If Registration Fails If the software cannot proceed due to insufficient accuracy, a corresponding dialog opens.

Options

To repeat registration, press Try Again.

To add markers to the image set, or to redetect markers in the image set, press DefinePoints.

The Registration Points dialog opens (see page 66).

Options


To proceed using a different standard registration workflow, press Proceed.

The software prompts you to perform sequential registration (see page 71).

If you wish to exit standard registration in order to e.g., perform surface matching regis-tration, press Cancel.



Sequential Registration (Registering Fiducial Markers and Preplanned Landmarks)

Overview If the image set selected for registration contains both planned fiducial markers and pre-planned landmarks, or preplanned landmarks only, the software prompts you to perform se-quential registration.

Registration Dialog

Figure 19

The circled cross-hair indicates the current landmark/marker to register:

• Markers are red• Landmarks are blue

Once you register a marker/landmark, it is shown as a circle.

The color representation of the markers/landmarks might be different fromthose chosen in the planning software.



How to Register Markers/Landmarks

Additional Registration Options

Steps

1. Pivot the pointer/Softouch tip in the marker/landmark one after the other as indi-cated by software.

2. If a marker/landmark is not accessible e.g., due to the surgical setting, press Skipand proceed to the next marker/landmark.

3. • Register a minimum of four markers and press Proceed, or • Register all markers so that the software automatically proceeds to the next

step.

4. Verify registration accuracy in the dialog that opens (see page 73).

Options


To add markers to the image set or to redetect markers in the image set, press DefinePoints.

The software opens the Registration Points dialog.



Registration Accuracy

About Registration Accuracy

Overview Following registration, the software calculates the precision of the match. This representsthe average deviation between the registered markers/landmarks and the actual position ofthe markers/landmarks in the image set.

Use this information, along with a visual verification of the anatomical information, to de-termine the overall error.

Possible Results

NOTE: Be aware that the precision calculated by the software only provides informationon how well the software was able to match the acquired points to the planned markers andlandmarks. This value does not necessarily represent the overall error.

Decreased Navigation Accuracy

To ensure sufficient accuracy, the scan (e.g., CT, MR) must be suitable for ste-reotactic navigation procedures (as described in the scan protocol).

Due to possible distortions in MR image sets, navigation accuracy may be de-creased at the point of interest, even if registration has been satisfactorily veri-fied.

Due to error propagation, navigation accuracy may be degraded compared tothe accuracy achieved at the landmark positions, and at the areas where the ac-curacy was checked.

Result Deviation

Good accuracy < 3.0 mm

Medium accuracy 3.0 mm - 8.0 mm

Registration failed > 8.0 mm



Verifying Accuracy

Patient Registration Dialog

The software displays the Patient Registration dialog when registration is complete. Thisdialog provides information on the general registration accuracy, i.e., how well the softwarewas able to match the patient data to the overall area of registered points. The example be-low shows a registration with good accuracy.

Figure 20

How to Visually Verify Accuracy

Step

Hold the pointer to at least three known anatomical landmarks and verify that the posi-tion of the pointer displayed in the image views corresponds with the actual point on thepatient’s anatomy.



Next Steps Based on the precision calculated by the software and the visual verification, you can pro-ceed as follows:

Options

If accuracy is sufficient, press Accept.

The main screen opens and you can begin navigation.

If a medium registration accuracy was achieved, you can:

• Press Accept

• Press Try Again to repeat registration • Press Details to check accuracy of individual points and/or re-acquire points that may

have been inaccurately acquired (see page 76)

NOTE: You can also check the pointer accuracy in the reference array cone as describedon page 154.

NOTE: If during visual verification a deviation of more than 3 mm is observed, we rec-ommend that you select Try Again or Details, and/or check the pointer accuracy.

If has registration failed, press Try Again to repeat registration.



Detailed Registration Accuracy Information

Overview You can review detailed information which shows the accuracy of each individual point thatwas registered. You can see the combination of points that the software algorithm used tocalculate the registration and resulting accuracy. For example, the software may “ignore”certain points where accuracy was insufficient.

How to Access Detailed Information Step

Press Details in the Patient Registration verification dialog (see page 74).



Detailed Dialog

Figure 21

No. Explanation

aList showing each registered point and the deviation between the registered pointand the actual position of the point in the image set

s

The Consider column shows which points the software took into account for theoverall accuracy calculation:

• If a checkmark is shown, the software used the corresponding point• If no checkmark is shown, the software ignored the corresponding point as the

accuracy was insufficient

NOTE: If you skipped points during registration, this is indicated by Skipped inthe Deviation column.

d

When you place the pointer on the skull, the software displays:

• The deviation from the pointer tip to the point you acquired during registration(Acquired point)

• The deviation from the pointer tip to the point planned in the data set (Plannedpoint)

a

s

d



Reviewing Individual Points

Next Steps

Options

Hold the pointer to a registered point. The software displays the deviation from thepointer tip to the acquired and planned points.

To locate a specific point, press the corresponding button in the Item list. The point isshown centered in the image view.

You can also hold the pointer to the point in the image view. The button for the corre-sponding point is then enabled.

To re-register a point (e.g., if the position of the acquired point is obviously incorrect orthe deviation to the planned point is high), hold the pointer/Softouch to the relevantpoint and pivot the pointer.

To include an “ignored” point in the accuracy calculation, press the corresponding but-ton in the Consider list.

NOTE: If you include a point, the accuracy of the other points may decrease (indicatedin the Deviation column). For example, if you include a less accurate point that was tak-en on the back of the head, the accuracy calculation of the points taken from the front ofthe head may decrease.

Options

If you make changes, such as re-registering a point, press Accept. The software opensthe previous Patient Registration dialog so that you can review the overall error.

To return to the previous Patient Registration dialog without applying any changes,press Cancel.




Chapter Overview

Contents

Topics Covered

Section See

Introduction to Surface Matching Registration page 80

Activating Surface Matching Registration page 82

Softouch Registration page 85

z-touch Registration page 86

Surface Matching Registration Accuracy page 91

Additional Guidelines for z-touch Registration page 99


Introduction to Surface Matching Registration

Introduction to Surface Matching Registration

About Surface Matching Registration

Overview With surface matching registration, you scan anatomically important surfaces of the pa-tient’s head using z-touch or Softouch.

The software uses a surface matching algorithm to match the patient’s anatomy to the pre-operative CT/MR images. Only anatomical surface points included in the CT/MR imagesets can be acquired and used for the surface matching algorithm.

Before You Begin

Make sure that the patient’s anatomy has not changed from the scan. Thiswould result in incorrect registration and navigation.

Verify that the registration device (z-touch/Softouch) is functioning properly.

Advantages • Skin shift is reduced (when using z-touch or Softouch)• CT/MR (fiducial) markers are not required

NOTE: The pointer can also be used for surface matching registration, however for bestresults, we recommend using the z-touch or Softouch.

Surface Matching Methods

Method Description

z-touchz-touch emits an infrared laser beam which is detected by the cam-era. You acquire points by scanning the patient’s head.

SoftouchSoftouch is an electronic pointer with a skin detection sensor. Aninfrared signal emitted from Softouch triggers the camera to regis-ter the point the moment the pointer touches the skin.

Combiningz-touch and Softouch

You can use z-touch and Softouch point acquisition in combina-tion with each other. This is useful if characteristic surface match-ing points are not accessible with z-touch (e.g., required areas arecovered by hair or locations where the infrared laser point cannot bedetected by the camera).

You can switch between registration modes by pressing either z-touch or Softouch in the Patient Registration dialog.



Acquiring Additional Points During z-touch Registration

During z-touch point acquisition, you can also acquire additional points using the pointeror Softouch.

The acquisition of additional points, especially at the back of the skull, is important duringz-touch registration as this helps to improve the overall accuracy. If you do not acquire ad-ditional points during z-touch registration, the software automatically prompts you to do so.

Image Set Requirements

• The image set must contain the area to be acquired on the patient’s anatomy, includingthe entire nose

• Slice thickness should be less than 3 mm• To achieve highest registration quality, use MR T1, CT or CTa image sets• Using MR T2 image sets leads to reduced registration quality

MRa image sets cannot be used for surface matching registration.

Workflow Overview

Workflow

1. Open the Registration Selection dialog and select Surface Matching Registra-tion.


3. Verify the scannable surface and if necessary, adjust the threshold.

4. Acquire surface matching points using Softouch or z-touch.

5. If you are performing z-touch registration, acquire additional points at the backof the skull.

6. Verify registration accuracy.


Activating Surface Matching Registration


Registration Selection

How to Activate

Figure 22

Steps


2. In the Registration Selection dialog, press Surface Matching Registration.




Figure 23

Verifying the Scannable Surface

To verify the scannable surface, you can press directly in the image view to rotate the 3Dconstruction. Check the following:

• The surface of the face should be clearly visible• The skin surface should be smooth without breaks or major artifacts• The surface model should look like your patient• Look for tubes, tape and other devices that may change the appearance of the face since

the patient was scanned

The quality of the surface reconstruction may be improved by adjusting the threshold.

NOTE: Be aware that skin shift may have occurred during scanning due to the patient fix-ation device.

Next Steps

No. Description

aThree dimensional reconstruction based on the image set. You can use this toverify the scannable surface.

sCrosses indicate areas which are generally useful for successful surface match-ing.

a

s

Option See

To optimize surface matching results by adjusting threshold values, pressAdjust Threshold. page 84

To activate registration using z-touch, press z-touch. page 86

To activate registration using Softouch, press Softouch. page 91



Adjusting Threshold Settings

Overview The correct display of the skin surface is essential for optimal matching results. In theThreshold Adjustment dialog, you can define a density value (Hounsfield units for CT im-age sets and gray values for MR image sets) for soft tissue by adjusting the threshold slideruntil the complete skin surface is displayed.

How to Adjust the Threshold

Figure 24

Additional Options

Steps

1. Press Adjust Threshold in the Patient Registration dialog.

2. In the Threshold Adjustment dialog, use the slider bar to adjust the values so thatthe required skin surface can be clearly seen.

Reduce unwanted information in image set by increasing the threshold.

The image data taken into account is shown in color.

3. Use the up/down arrows to scroll through the slices to check the settings.

4. Press Proceed to apply changes.

The software recalculates the three dimensional reconstruction in the PatientRegistration dialog.

Options

To optimize values for MR or CT, press Auto.

To restore settings to those stored the last time you left this dialog, press Reset.



Softouch Registration

Performing Softouch Registration

Before You Begin

Carefully read the Softouch chapter in the Instrument User Guide.

Guidelines for Point Acquisition

• Do not use the Softouch on soft tissue that may shift position (e.g., loose skin). • Generally, all (bony) structures with a surface which does not generally change during

anaesthesia are appropriate for point acquisition. • To ensure optimum accuracy, acquire points on both sides of the patient’s face.

How to Perform Registration

Steps

1. Press Softouch in the Patient Registration dialog.

NOTE: When the Patient Registration dialog is open, you can also activate Softouch registration by holding the Softouch in the camera field of view.

2. Gently touch a point on the patient with the Softouch tip and hold the instrumentstill.

Acquisition of the point is indicated by a “beep” and a progress bar.

3. When a sufficient number of points is acquired, Proceed is enabled.

4. Press Proceed to start the surface matching calculation. The calculation maytake a few moments.



z-touch Registration


Ensuring Successful z-touch Registration

About Successful Registration

Successful z-touch registration depends on the area of the patient’s head which can be ac-cessed for laser point acquisition.

If access to suitable areas is restricted due to the surgical setting, try to scan as much of thesurface of the patient’s face as possible.

In some cases marker-based registration may be preferable, e.g., posterior fossa approach.

NOTE: Before you begin, consider carefully whether z-touch registration is suitable forthe current treatment, or if marker-based registration should be performed instead.

Suitable Scan Regions

NOTE: Generally, all (bony) structures with a characteristic surface that does not changeduring anaesthesia are appropriate for scanning.

Optimal

• Zygomatic bone: complete zygomatic bone• Frontal bone: complete regions of the frontal bone which are not cov-

ered by hair• Nose: bridge of the nose or nasal cartilages• Ear: tragus

Possible

If the patient has been shaved, or using a pointer:

• Parietal bone• Occipital bone

Avoid

• Eyes: Eyes must be taped carefully to prevent damage e.g., swelling.Do not tape areas important for scanning.

• Ears (except tragus)• Mouth and jowls: these areas are either not included in the scan or are

distorted by the intubation.



Important Tips for Scanning

• Do not use areas which may change depending on patient position, or when the patientis relaxed.

• Scan areas where skin is clearly visible. If necessary, shave areas covered with hair.• If skin surface does not sufficiently reflect the light, moisturize it.• Scan both sides of the patient’s face.• If necessary, adjust the camera during z-touch registration.

How to Optimize Registration Accuracy

1. Acquire more than just one circle using the laser (e.g., around one eye).Why? A circle fits anywhere on a spherical shape, like the human head.

2. If there is limited access to the entire face, use the pointer to acquire points on sur-faces not visible to the camera. Why? Points are necessary from as many significant skin shapes as possible. Althoughit is not as efficient as when using the z-touch, the pointer helps acquire points fromhidden surfaces.

3. Always include the entire nose in point acquisition.Why? The more unique a shape is, the more easily the patient scan and the actualpatient’s anatomy can be matched. The bridge of the nose is not deformed by intubationor tape and therefore retains its unique shape.

4. For parietal or occipital access, acquire additional points from the parietal oroccipital area using the pointer. Why? The surface matching on the face generally results in very high accuracy in thefrontal part of the skull. However, the further away the face is, the higher the deviationdue to the distance between the face and the back of the head. Additional points fromthe back of the head will reduce this deviation.



Performing z-touch Registration

Before You Begin

Carefully read the z-touch chapter in the Instrument User Guide including thesafety considerations.

Preparing Patient

Before pointing the laser beam towards the patient, you must close the patient’seyes and tape them with adhesive, non-reflective tape.

NOTE: Make sure that the tape does not cause any skin deformation and that access to an-atomically significant areas is maintained.

Camera Field of View

During acquisition:

• The infrared laser sensor and the laser point must be visible to the camera• Keep other infrared sources out of the camera field of view as this may hinder the cam-

era in detecting the z-touch laser point• Keep the Softouch out of the camera field of view as the software automatically

switches to Softouch mode as soon as the Softouch appears in the camera field ofview



How to Acquire Points using z-touch

Figure 25

Steps

1. Press z-touch in the Patient Registration dialog.

2. Switch on the visible laser beam by pressing (and keeping pressed) the first levelof the two-level switch. The visible laser is displayed as a red point.

3. Point the visible laser to area of interest on the patient’s head and simulate scan.

4. Activate the infrared laser beam by pressing (and keeping pressed) the secondlevel of the switch. A green LED indicates that the laser is active.

5. To acquire points, slowly move the z-touch laser over the area of interest.

NOTE: Hold z-touch perpendicular to scanned surface so that the laser beammeets the skin as a point.

6. Point acquisition is indicated by a “beep” and a progress bar.



How to Acquire Additional Points

If you have not already acquired additional points with the pointer or Softouch, the soft-ware prompts you to do so once sufficient points have been acquired with z-touch.

This step is important for successful z-touch registration, as it will help improve overall ac-curacy. Although you can choose to skip this step, we recommend performing it.

Figure 26

Steps

1. The number of points that should be acquired is indicated by spheres on the leftside of the dialog. Make sure to acquire the points at the back of the skull.

• If you are using the pointer, hold pointer tip to a point on patient’s skull andslowly pivot pointer while keeping the tip in place.

• If you are using Softouch, hold Softouch tip to a point and keep instrumentstill during acquisition.

NOTE: Further information on additional point acquisition is provided onpage 99.

2. Press Proceed (enabled when sufficient points are acquired) to start the surfacematching calculation. The calculation may take a few moments.




Surface Matching Registration Accuracy

About Registration Accuracy

Overview The software displays the verification dialog when registration is complete. This dialog pro-vides information on the surface matching registration accuracy, i.e., how well the softwarewas able to match the patient data to the overall area of registered points.

Possible Results

NOTE: Be aware that the precision calculated by the software only provides informationon how well the software was able to match the acquired points to the patient data. This val-ue does not necessarily represent the overall error.

Decreased Navigation Accuracy

To ensure sufficient accuracy, the scan (e.g., CT, MR) must be suitable for ste-reotactic navigation procedures (as described in the scan protocol).

Due to possible distortions in MR image sets, navigation accuracy may be de-creased at the point of interest, even if the registration has been satisfactorilyverified.

Due to error propagation, navigation accuracy may be degraded compared toaccuracy achieved at the landmark positions, and at areas where the accuracywas checked.

Result Deviation

Good accuracy < 1.5 mm

Medium accuracy 1.5 mm - 2.5 mm

Registration failed > 2.5 mm



Verifying Accuracy: Standard Procedure


The software displays the Patient Registration dialog when registration is complete. Theexample below shows a registration with good accuracy.

Figure 27

Next Steps Based on the precision calculated by the software and the visual verification, you can pro-ceed as follows:

NOTE: If during visual verification a deviation of more than 3 mm is observed, we recom-mend that you select Modify, and/or check the pointer accuracy.

Step

Hold the pointer to known anatomical landmarks (e.g., nasion, tragus) and verify thatthe position of the pointer displayed in the image views corresponds with the actualpoint on the patient’s anatomy.

The software displays the deviation (distance to surface) from virtual pointer tip to cal-culated surface.

Options

If accuracy is sufficient, press Accept.

The main screen opens and you can begin navigation.

If accuracy is insufficient, or if you would like to review accuracy information in moredetail, using advanced options, see page 93.



Verifying Accuracy: Overview of Advanced Features

Overview Page 92 describes accuracy verification using basic features. The more advanced verifica-tion features offered by the software are described below.

How to Access the Advanced Features

Step

Press this button in the sagittal view of the Patient Registration accuracy di-alog (see page 92) to display a reliability (color-coded) map in all views.




Figure 28

No. Explanation

a

The map is based on the distribution of surface matching points and their calcu-lated distance to the skin surface. Areas where points are spread out increase thelikelihood of good accuracy. When you hold the pointer to landmarks on the pa-tient’s skull, the accuracy deviations (indicated by the distance to surface value)are generally:

• Smaller in green areas• Moderate in yellow areas • Larger in non-colored areas

NOTE: The map shows an estimated error probability related to the calculatedmatch, rather than an absolute accuracy.

sPressing Overview changes the display so that you can review individual pointsacquired during surface matching in a 3D view (page 95). You can press Over-view to toggle between the overview and the axial, coronal, and sagittal displays.

a

s



Patient Registration Dialog (Overview Display)

Figure 29

No. Explanation

a Reliability map in axial view

s

3D view displays individual points acquired during surface matching. Points arecolor-coded according to their distance to the skin surface based on the surface-matching algorithm.

• Green points: < 0.7 mm • Yellow points: < 1.4 mm• Orange: < 5.0 mm• Red: > 5.0 mm

NOTE: For example, a red point may indicate that you acquired a point on anarea of the patient that is not included in the scan.

a

s



Additional Options

Options

To freeze the image view display, press Freeze. You can use the arrows in the axialview to scroll through the image set in order to access the region of interest.

To toggle between the current and previous registration (if you modified a registration),press Last Solution.

To open the surface matching registration dialog where you can acquire additionalpoints using e.g., the pointer, press Modify.

To deactivate the reliability map and return to the first Patient Registrationaccuracy dialog, press this button.



How to Verify Accuracy using Advanced Features

Step 1: Check Alignment

Step 2: Check Color-Coding of Points

Step 3: Check Distance of Points

Steps

1. Check overall accuracy by holding the pointer to known anatomical landmarks.Verify that position displayed on screen corresponds with the actual position onthe patient’s skull.

2. • If the alignment is acceptable, continue to step 2. • If the alignment is incorrect, press Modify and repeat surface matching regis-

tration.

Steps

1. Press Overview to show the 3D view.

2. In the 3D view, check individual points to determine whether color-coding is rea-sonable based on where you acquired the points during registration.

3. • If the color-coding is reasonable, continue to step 3. • If you suspect that the color-coding does not correctly correspond to your reg-

istration, press Modify and acquire additional points.

Steps

1. In either the ACS (axial, coronal, sagittal) or overview display, hold the pointerto various points on the patient’s skull and check the displayed deviation (dis-tance to surface) in the view based on the current pointer position.

2. • If the displayed distances are acceptable, continue to step 4. • If the displayed distances indicate unacceptable inaccuracies, you can press

Modify and acquire additional points.



Step 4: Review Reliability Map

Determine whether the region of interest is within an acceptable area of the reliability map.

Step 5 (Optional): Toggle Solutions

If you modified the registration, you can switch between the modified and previous regis-trations in order to compare them.

Make sure you verify the accuracy of the selected registration solution using thereliability map.

Steps

1. In either the ACS or overview display, hold the pointer to the patient’s skull asclosely as possible to the region of interest and view the reliability map. In theACS display, view the reliability map in axial, coronal and sagittal views.

2. Check the distance to surface shown in the views.

3. If required, press Freeze to freeze the image view display and use the arrows inaxial view to scroll through image set to access the region of interest.

4. • If the region of interest is inside an acceptable area of the map, press Accept toconfirm accuracy.

• If the region of interest is outside of an acceptable area of the map, press Modify and acquire additional points to shift the map to the area of interest.

Steps

1. Press Toggle to switch between registration solutions.

2. Review each registration by performing steps 1 - 4 as previously described.

3. • If one of the solutions is acceptable, press Accept to confirm the accuracy ofthe selected registration.

• If neither solution is acceptable, you can press Modify and acquire additionalpoints or repeat surface matching registration.



Additional Guidelines for z-touch Registration

Additional Point Acquisition

Overview If the patient position limits access to areas needed for successful z-touch registration, youcan acquire additional points using the pointer or Softouch.

The information in this section describes how you can acquire points using the z-touch andthe pointer or Softouch based on the patient’s position.

Acquiring Points with Pointer/Softouch

When acquiring additional points with the pointer or Softouch:

• Hold the pointer or Softouch perpendicular to the patient’s head• Hold the pointer or Softouch to the patient’s skin with minimum force to prevent skin

shift

Frontal/Transcallosal Approach

Frontal/transcallosal positioning of the patient enables access to all scan areas recommend-ed for z-touch registration.

Scanning two circles around the patient’s eyes, also including the nose, should result in anaccurate registration.

Additional points can be acquired using the pointer or the Softouch.

Patient Position z-touch Scan Regions Point Acquisition using the Pointer or Softouch

Can be combined



Temporal/Pterional Approach

If the patient is in the temporal/pterional position, access to the surface relevant for z-touchscanning might be limited (due to the Mayfield headrest or the camera field of view). In thiscase, perform registration as follows:

Steps

1. Scan a circle around the accessible eye using z-touch; the circle should also in-clude the nose.

2. Scan a semi-circle around the partially-accessible eye using z-touch.

3. Acquire 10-15 additional points using the pointer or Softouch. Acquire points inthose areas which are circled around the eye and the crown.




Occipital/Suboccipital Approach

If the patient is in the occipital/suboccipital position, the surface available for z-touch scan-ning is limited to the back of the head. This area will not provide sufficient skin surface forz-touch registration. In this case, perform registration as follows:

Steps

1. Scan the shaved area at the back of the patient’s head using z-touch.

2. Scan the region around the partially accessible eye using z-touch.

3. Acquire 15 additional points using the pointer or the Softouch. Points should beacquired around the eye and the bony part of the nose.


Scan the shaved area us-ing z-touch



Effects of Scan Areas on Accuracy

Example of Accurate Registration

The scanned region includes both sides of the zygomatic bone, the forehead, and the nosebone.

Figure 30

Example of Inaccurate Registration

The scanned region covered only one side of the patient’s head.

Figure 31

Understanding the Images

a s

a s

No. Component

a Shows points acquired during z-touch registration.

sShows the accuracy achieved when using these points for surface matching. Thelines indicate the accuracy or deviation: each line represents a deviation of 0.5mm from center circle.


Intraoperative Landmark Registration


Chapter Overview

Contents

Topics Covered

Section See

Introduction to Intraoperative Landmark Registration page 104

Acquiring and Registering Intraoperative Landmarks page 106


Introduction to Intraoperative Landmark Registration

Introduction to Intraoperative Landmark Registration

About Intraoperative Registration

About the Registration Method

If you have already performed registration (standard or surface matching), you can acquireintraoperative landmarks which can be registered at any point during surgery.

If intraoperative registration is necessary, acquire the intraoperative land-marks after the initial registration. This is the only way to re-register the patientif, for example, the reference array has been unintentionally moved.

Workflow Overview

Workflow

1. If intraoperative registration is needed, open the Registration Selection dialogand select Acquire Intraoperative Landmarks.


3. Define the intraoperative landmarks.

4. Open the Registration Selection dialog and select Register IntraoperativeLandmarks.

5. Register the intraoperative landmarks.

6. Verify the registration accuracy.

7. If intraoperative registration is needed, open the Registration Selection dialogand select Acquire Intraoperative Landmarks.



Registration Instruments and Software Guidance

Registration Instruments

You can perform intraoperative landmark registration using the pointer or the Softouch.Landmarks are acquired/registered by holding the Softouch or pointer tip to a landmark andslowly pivoting the pointer while keeping the tip in place.

Avoiding Skin Shift When registering intraoperative landmarks, hold the pointer or Softouch perpendicular tothe marker/landmark. This prevents inadvertent skin shifting caused by the force of the in-strument.

Safety Considerations

When using the pointer for registration, take care that the pointer tip does notinjure the patient. Blood vessels, eyes, etc., are not suitable for landmark regis-tration.

Visual Software Cues

The number of intraoperative landmarks which can be registered is indicated by spheres inthe registration dialog.

Figure 32

Auditory Software Cues

The software emits a beep each time you register a landmark.

If you attempt to register the same landmark more than once, the software emits a lowertoned beep and does not re-register the point.

Sphere Color Explanation

Blue Registered landmarks

Gray Unregistered landmarks


Acquiring and Registering Intraoperative Landmarks


Acquiring Intraoperative Landmarks

How to Activate

Figure 33

Steps


2.In the Registration Selection dialog, press Acquire Intraoperative Landmarks.

The acquisition dialog opens.



How to Acquire Landmarks

Figure 34

NOTE: Pressing Delete removes the most recently acquired landmark.

Steps

1. Define landmarks one after the other, making sure to define points which can beeasily identified during registration.

Use the magnified views (lower views) to zoom in on the images.

The acquired landmarks are indicated by blue crosses in the image views. Youmust define at least four landmarks. A maximum of seven can be defined.

2. Once at least four landmarks are defined, press Proceed to return to the mainscreen.



Registering Intraoperative Landmarks

How to Activate Registration

Figure 35

Steps


2.In the Registration Selection dialog, press Register Intraoperative Landmarks(available once you have acquired intraoperative landmarks).

The registration dialog opens.



How to Register Intraoperative Landmarks

Figure 36

Accuracy

An intraoperative reregistration may not be as accurate as the first (preopera-tive) registration as the errors from both registrations are compounded. Verifythe intraoperative reregistration carefully by holding the pointer to known an-atomical landmarks and verify the position displayed on the screen.

If you delete intraoperative landmarks, you may not be able to re-register thepatient if the initial registration is lost (e.g., if a reference array is moved). Inthis case, navigation cannot be continued.

Steps

1. Register the landmarks in the order defined by the software. The circled cross-hair (blue) in the image views indicates current landmark to be registered.

Pivot the pointer or Softouch tip in each landmark one after the other as indicat-ed by software.

2. If a landmark is not accessible, press Skip and proceed to next landmark.

3. • Register a minimum of four landmarks and press Proceed, or • Register all landmarks so that the software automatically proceeds to the next

step.





Configuring Views

Configuring Views

Chapter Overview

Contents

Topics Covered

Section See

Navigation Views page 112

View Configuration page 118

Windowing page 127


Navigation Views

Navigation Views

About the Views

Main Screen The navigation screen displays the patient’s anatomical information on the screen in fourdifferent views.

Figure 37

a

s

d

f


Configuring Views

Screen Elements

NOTE: In the axial, coronal and sagittal views, the software displays the slice in which theinstrument tip is currently being navigated.

NOTE: The images are interpolated and may differ from the scanned images. Additionally,axial, coronal, and sagittal reconstructions may differ from the true axial, coronal, and sag-ittal image orientation due to the patient position in the scanner.

Image Labeling Depending on the displayed image, views are labeled with the image orientation:

No. View Description

a 3D OverviewThree-dimensional reconstruction of the image set. You can configure different view types here using the eye icon (see page 118)

s Axial Displays image in axial position relative to current instrument position

d Coronal Displays image in coronal position relative to current instru-ment position

f Sagittal Displays image in sagittal position relative to current instru-ment position

Label Orientation

A Anterior

P Posterior

L Left

R Right

H Head

F Foot


Navigation Views

Display of Planned Objects

Objects that were planned in iPlan are generally displayed as:

• Outlined structures in axial coronal and sagittal views a• Filled in structures in 3D views s

Figure 38

NOTE: When viewing objects in 2D views, smaller objects may not be displayed whenscrolling through image slices if the object is located between two image slices.

Colors of objects may change during the transfer from iPlan to the navigationsoftware. Review objects and points carefully after loading. It is not possible toreassign object colors in the Kolibri software.

Once you have loaded patient data, make sure that all objects required for theprocedure are visible.

The display of object contours may be of lower resolution than the underlyingscan data. Review the object carefully to make sure it properly represents thearea of interest.

a s


Configuring Views

Display of Data The speed of the software depends on the number of objects and their complexity, the num-ber of trajectories displayed, and on whether objects are displayed in the 3D views.

Instrument Display When the navigated instrument is in the camera field of view, the instrument representationis displayed in green in the image views.

Figure 39

No. Component

a Cross-hair indicates the instrument tip

sWhen the pointer or navigated instrument is inline with the view (meaning theinstrument axis is in the image plane), a prolongation of the instrument is shown.The prolongation is always shown in inline views.

a

s


Navigation Views

Buttons in Image Views

Button Explanation

Scroll buttons allow you to scroll slice-by-slice through the views. Thebuttons appear in the axial, coronal and sagittal views when you open asession or when Freeze is activated.

You can also scroll using an invisible scroll bar between the buttons.

The magnifying glass allows you to display a view as full-screen. Press-ing this button again switches back to a multi-view screen.

The eye icon allows you to assign different images to the upper left view(see page 118).

This button is shown in 2D inline and probe’s eye views, and allows youto flip the view to match the actual patient orientation.

NOTE: The availability of this button depends on your system configura-tion.

This button is shown in 2D inline and probe’s eye views, and allows youto rotate the view clockwise in order to match the actual patient orienta-tion.

NOTE: The availability of this button depends on your system configura-tion.


Configuring Views

Zoom Buttons The Zoom buttons in the menu bar allow you to change the magnification of displayed im-ages. All 2D views are zoomed in or out by the same factor. The 3D Overview is not affect-ed.

How to Take Screenshots

The patient name appears on each screenshot. To maintain patient confidenti-ality, restrict screenshot access to the relevant medical personnel.

Button Explanation

Press this to zoom in all views

Press this to zoom out all views

Steps

1. Press Screenshot in the menu bar to take a screenshot of the cur-rent screen.

2.

• If patient data has been loaded from a removable storage medium (e.g., USBflash drive), the image file is stored to the relevant medium.

• If patient data has been loaded from the network, the image file is stored in thedirectory from which the data was loaded. This is configured by BrainLABsupport.


View Configuration

View Configuration

Accessing View Options

Overview By default, a 3D overview of the image set is shown in the upper left view when you startthe software. You also have the option of assigning different view types to this window.

How to Assign Views

Figure 40

Steps

1. Press the eye icon in the upper left view to open the dialog above.

2. Press the desired view. The dialog closes and the view is updated with the select-ed image.


Configuring Views

Available Views

NOTE: Availability depends on your system configuration and licenses.

Option See

Inline 1 page 120

Probe’s Eye page 120

3D Overview page 121

Microscope page 220

Live Video page 124

Auto Pilot page 125


View Configuration

Inline and Probe’s Eye Views

Inline 1

Figure 41

Inline 1 displays a reconstruction plane spanned by the instrument axis and the feet-head di-rection. This results in a reconstruction which ranges from a coronal to a sagittal view plane.

Probe’s Eye

Figure 42

Probe’s Eye displays a view perpendicular to instrument axis according to the Inline I view.The probe’s eye plane contains the instrument tip.

Adjusting the Orientation

In the above views, use the optional flip/rotate arrows buttons to adjust the orientation.


Configuring Views

3D View

3D Overview

Figure 43

3D Overview is available for MR and CT image sets. This view displays a three-dimensionalreconstruction of the total image set. You can turn the 3D image in any direction by pressingdirectly in the image view.

NOTE: The navigation system may take longer to update while calculating the 3D view.

Inspect 3D Overview after calculation and adapt the threshold (see page 127) ifthe surface is not represented correctly.


View Configuration

3D Image Quality and Display

The quality of the displayed surface in 3D Overview depends on the MR se-quence.

The perspective of the 3D views, instruments, trajectories, objects and pointsmay differ from reality. Rotate the 3D view until the 3D relations of all dis-played information are clear.

The resolution of displayed objects is reduced and not as exact as the underlyingscan data.

The 3D reconstruction is not displayed with the full resolution of the originalimage data.

Intersecting or enclosed objects are not completely visible in some 3D views.

The 3D views are displayed with a parallel projection that is not comparable toa perspective view of the patient as perceived by the human eye or imagingequipment.

Objects, instruments, points, trajectories, etc. are displayed transparently withrespect to the 3D surface, but not with regard to other objects, instruments,points, trajectories, etc. Thus objects, instruments, points, trajectories, etc. maycover each other.


Configuring Views

Adjusting the Threshold of 3D Images

Overview If you assigned 3D Overview to the upper left view, the Threshold tab is available when youpress the eye icon.

In this tab, you can optimize the display of the skin or bone surface by adjusting the thresh-old.

How to Adjust Threshold

Figure 44

Additional Options

Steps

1. Press the eye icon and select the Threshold tab.

2. Use the slider bar to adjust values so that skin or bone surface can be clearly seen.

• Reduce unwanted information in the image set by increasing the threshold.• The image data taken into account is shown in color.


4. Press Close. The software recalculates the three dimensional reconstruction inthe view.

Options

To optimize values for MR or CT, press Auto.

To restore settings to those stored the last time you left this dialog, press Reset.


View Configuration

Live Video Views

Overview Live Video allows you to display video images from any source, such as endoscopes, con-nected to the system.

Before you Begin Make sure that the video connection is configured (see page 52).

Video Display

The display of video images may be delayed if the system is being used to fullcapacity.

We recommend displaying video images separately on an additional monitor.

In accordance with DIN 6868, the video images are not suitable for diagnosticuse, as they may appear distorted. Additionally, the colors are not calibratedand the resolution is too low. Color image injection from external devices maydisplay the objects in a different color as seen on the navigation screen. We rec-ommend that you use context information such as size and position to identifythe objects.


Configuring Views

Auto Pilot View

Overview Auto Pilot is a three-dimensional, funnel-shaped view used for navigating an instrumentalong a trajectory. This function is useful e.g., for the catheterization of trauma patients orfor guiding freehand biopsies.

Before You Begin To access the Auto Pilot view, a trajectory must be displayed in the image view (seepage 164).

Opening Auto Pilot

Steps

1. Press Auto Pilot in the Other Views tab.

2. The dialog closes and a 3D reconstruction is calculated showing the entry point ofthe trajectory.

3. If necessary, rotate the 3D reconstruction until it matches the actual patient orien-tation by pressing directly in the upper corners of the view.

4. Hold the navigated instrument to the entry point. The Auto Pilot view is dis-played when:

• The instrument is within 50 mm of the entry point• The angle deviation of the instrument from the trajectory is less than 30°


View Configuration

Auto Pilot View

Figure 45

NOTE: Once the instrument reaches the target plane, the Auto Pilot display appears red.A warning tone is emitted if the instrument penetrates beyond the target.

No. Explanation

aThe green cross-hair indicates the entry point

The red cross-hair indicates the target point

s The red cross-hair indicates the instrument tip

dThis arrow shows the distance and direction in which to move the instrument tipto align it with the trajectory

fThis arrow shows the direction and angle in which to rotate the instrument toalign it with the trajectory

g

The scale shows the distance from the tool tip to the target plane

NOTE: The scale only displays the actual distance to the target when the instru-ment is aligned with the trajectory.

f

d

g

a

s


Configuring Views

Windowing

Introduction

About Windowing You can adjust the windowing of images in the iPlan software and then save the images withthese settings. These preplanned windowing settings are then available on the navigationsystem.

You can also adjust the windowing of an image set in the navigation software.

Windowing Settings

Changing Windowing Settings

Changing the windowing settings may reduce the details displayed in the imageset. Before beginning patient treatment, verify that all details in structures aredisplayed correctly.

If the windowing is set to 0 in MR image sets, the software will automaticallyadjust it to 30.

Transferring Windowing Settings

Secondary or inverse windowing cannot be transferred from the planning soft-ware to the navigation software.

Image Type Settings

CT

Density information is evaluated in Hounsfield units with a scalefrom -1024 to 3071. Good initial values for best visibility of braintissue and a contrast-enhanced tumor are 0 for the left and 100-150 for the right parameter.

You cannot adjust all Hounsfield units, but only a subset in a cer-tain width.

MR

An arbitrary scale from 0 to 255 is used. Within this scale, thereis no direct relationship to any physical density values. Instead,the values are a function of the parameters defined on the MRscanner.


Windowing

Adjusting Windowing

How to Adjust Windowing

Figure 46

Resetting Values Pressing Reset restores the windowing values to those with which the data was imported.

How to Rename the Image Set (Optional)

Steps

1. Press the Windowing button in the menu bar to open the Windowingdialog.

2. Use the slider bars to adjust the settings to the required values. The image in thedialog is updated accordingly.


4. Press Close to save settings and return to the main screen.

Steps

1. Press Label.

2. Enter a name in the dialog that opens.

3. Press Proceed to confirm the name and return to the windowing dialog.


Calibrating Instruments


Chapter Overview

Contents

Topics Covered

Section See

Introduction to Calibration page 130

Accessing Calibration page 134

Calibration Using the Reference Array page 138

Calibration Using the ICM4 page 141

Calibration Using the ICM 2.0 page 149


Introduction to Calibration


About Calibration and Verification

Overview Instruments must be calibrated (unless they are precalibrated) and verified in order to navi-gate them. Depending on the instrument, and the selected calibration method, you can cali-brate the instrument tip, trajectory and diameter.

The following types of instruments are available for use with the software:

• Precalibrated instruments which must only be verified• Instruments to which you attach a StarLink instrument adapter and then perform cali-

bration and verification. These include:- Non-BrainLAB instruments such as biopsy needles - BrainLAB instruments, e.g., Multiple Tip Pointers and Suction Tubes

NOTE: For information on attaching StarLink instrument adapters, refer to the Instrument User Guide.

Calibration/Verification Methods

Using the reference array for calibration of large or irregularly shaped instru-ments can result in inaccurate tip or trajectory calibration.

Using Multiple Instruments

The software can simultaneously track instruments with different-sized arrays attached. Ifyou introduce an instrument with a new geometry (not previously used in this session), thesoftware opens the calibration dialog.

Method Explanation Use For

Calibration using the Reference Array

Perform calibration/verification by holding the instrument tip in the cal-ibration cone of the reference array

Instruments with a pointed tip

Instrument Calibra-tion Matrix, Rev. 4.0 (ICM4)

Perform calibration/verification us-ing the pivot points, receptacles or notch of the ICM4 Any tool, including

large or irregularly shaped instrumentsInstrument Calibra-

tion Matrix, Rev. 2.0 (ICM 2.0)

Perform calibration/verification by holding the instrument tip in the cal-ibration receptacles of the ICM 2.0



Instrument Rigidity and Calibration Accuracy

The table below describes the effects of instrument rigidity on calibration accuracy.

Do not calibrate flexible instruments.

Verification of Calibration

To prevent errors due to incorrect instrument handling, make sure to verify thecalibration accuracy of the instrument tip, trajectory and diameter. Performverification after calibrating an instrument, loading a precalibration, or restor-ing a calibration.

To verify the accuracy of the instrument calibration during surgery, repeatedlypoint the calibrated instrument to known anatomical landmarks and verify theposition displayed on the screen.

Instrument Type Comment

Rigid

Rigid instruments are those in which the position of the instru-ment tip remains fixed in relation to the tracking array during itsuse.

Rigid instruments can be calibrated with the best accuracy.

Bendable

A bendable instrument may bend under its own weight or withminimal force. This could potentially result in significant track-ing errors if not handled properly.

Bendable instruments can be calibrated as long as the instrumentis handled properly, and/or mechanical support is used to ensurethat bending is minimized (e.g, using a guiding tube with a biop-sy needle).

FlexibleFlexible instruments are those instruments for which the instru-ment tip must move to fulfill its intended use.

Flexible instruments cannot be calibrated.



Handling Instrument Adapters

Attachment of Instrument Adapters

To help ensure successful calibration, make sure that:

• You have attached an adapter that is large enough for the instrument. The larger theinstrument, the larger the adapter you should use. Using an adapter that is too small canresult in imprecise calibration.

• The long arm of the adapter’s tracking array runs parallel to the long axis of the instru-ment to which it is attached, as shown in the image below.

Figure 47

Unsuccessful Calibration

If the software recognizes that an instrument adapter is too small for an instrument, the di-alog below is displayed.

Figure 48

You can now attach a larger adapter, or change the adapter position on the instrument andpress Try Again to repeat calibration.

No. Component

a Long arm of tracking array

s Long instrument axis

a s



Proper Handling of Instrument Adapters

Do not move the instrument adapter relative to the instrument tip after calibra-tion. This will affect the entire measurement coordinate system and lead to anincorrect instrument tip display.

Exchanging an array and/or adapter clamp and using it on a different instru-ment requires a new instrument calibration.

Exchanging an array and/or adapter clamp and using another instrumentadapter for an already calibrated instrument requires a new instrument cali-bration.

Rotating an array and/or a clamp on a pre-calibrated instrument requires anew instrument calibration.

Exchanging an instrument tip (e.g., Multiple Tip Pointer tips) requires a new in-strument calibration.


Accessing Calibration


Introduction

Options You can access calibration by:

• Holding the instrument and ICM (if you are calibrating using the ICM) in the camerafield of view

• Holding the instrument in the camera field of view, ensuring that the reference array isalso visible (if you are calibrating using the reference array)

• Opening the Tools > Tool Calibration/Verification dialog via the Tools button in themenu bar (see page 135)

Before You Begin Make sure that only the instrument to be calibrated is in the camera field of view.

Carefully read the following sections in the Instrument User Guide:

- Reference Arrays- Instrument Adapter Kit, StarLink Interface- Skull Reference Set

- Reference Headband and Reference Headband Array

- ICM4- ICM 2.0



Accessing Calibration in the Tools Dialogs

How to Access Calibration via Tools

Options

Figure 49

Step

Open Tools > Tool Calibration/Verification to access options for calibrating and verify-ing instruments.

Option Explanation See

Biopsy Needle Verify the precalibrated Disposable Biopsy Needlepage 180

page 192

Alignment Tool Verify the precalibrated biopsy tube and Biopsy Align-ment Array

page 193

VarioGuide Verify the precalibrated VarioGuide page 179

Calibration/Verification

Activate calibration and/or verification of instrumentsto which a StarLink instrument adapter is attached.

You can also load precalibrated geometries, e.g., forthe Eraser instruments (see page 171).

page 138



Loading Precalibrated Geometries and Restoring a Calibration

Loading Precalibrated Geometries

Some instruments are precalibrated. When held in the camera field of view, the softwarerecognizes that a precalibration is available for the instrument.

Figure 50

Steps

1. To load a precalibration, press the button a in the Instrument Calibration dia-log.

NOTE: If only one precalibrated instrument is available, then the button is namedaccordingly, e.g., Eraser. If more than one precalibrated instrument is available,the button is named Load, and you must select the required instrument in a sepa-rate dialog.

2. Verify the calibration in the verification dialog that opens.

a



Restoring a Calibration

If you calibrated an instrument for the same patient in a previous session (e.g., if the soft-ware crashed), the software recognizes the calibrated instrument when you hold it in thecamera field of view. In this case the following dialog is displayed:

Figure 51

If you Restore a Calibration

Make sure that you have not exchanged the instrument or repositioned theadapter since the previous calibration. Verify the restored calibration.

If the instrument has been exchanged or the adapter moved, do not restore thecalibration. Instead perform a new calibration.

Options

To load the already performed calibration, press Restore.

The software prompts you to verify the calibration.

To perform a new calibration and verification, press Calibrate.


Calibration Using the Reference Array


Introduction

About the Reference Array

Figure 52

You can perform instrument calibration and verification using the reference array cone a.

Suitable Instruments

Reference Array Position

Make sure that the reference array position does not change during calibrationverification.

a

Suitable Instruments with a pointed tip

Not suitable

Instruments with:

• A round tip• A large diameter that does not fit correctly into the cone of the reference

array

NOTE: Curved instruments can be accurately calibrated, however, theaxis of these instruments remains uncalibrated. To calibrate curved instru-ments or to gain information about the diameter of the instrument, use theICM4 or ICM 2.0.



Performing Calibration

How to Calibrate and Verify

Figure 53

Instrument Trajectory

After calibrating an instrument using the cone, the plane of the instrumentadapter array is orthogonally transferred until it intersects with the instrumenttip. Thus, the calibrated instrument trajectory may not correspond to the actualinstrument axis.

Steps

1. Hold instrument with StarLink tracking array attached in camera field of view.

If you are calibrating the instrument for the first time, the Instrument Calibrationdialog opens.

NOTE: If the instrument has already been calibrated in this session, proceed tostep 4.

2. Hold instrument tip to reference array cone and slightly pivot instrument.

3. Once calibration is complete, the Verification of Calibration dialog opens.

4. Pivot instrument in reference array cone to display tip deviation.

5. To confirm calibration, press Accept, or press Recalibration to repeat calibra-tion.



Setting the Instrument Diameter (Optional)

You can define the instrument diameter before verification. Once an instrument diameter isdefined, the software displays a representation of the instrument with the set diameter.

Figure 54

Steps

1. Press Set Diameter in the Verification of Calibration dialog.

The Set Instrument Diameter dialog opens.

2. Select the diameter on the scale. Fine-tune the diameter in 1 mm increments us-ing the +/- buttons.

To set the value back to 0, press Reset.

3. Press Accept to confirm the value.

The software prompts you to verify the calibration.



Calibration Using the ICM4

Introduction

About ICM4 Calibration

You can use the ICM4 to calibrate and verify large or irregularly shaped instruments. ICM4calibration also allows you to accurately calibrate the axis of instruments.

ICM4 Features

Figure 55

Verifying Calibration

Each instrument calibration using the ICM4 requires a deviation check of thetrajectory, diameter and instrument tip. This will show whether these parame-ters accurately represent the actual instrument.

No. Component Function

a V-inset (notch)

Calibrates the instrument axis

Suitable for instruments which cannot fit into recep-tacles (due to a large instrument diameter or the shapeof the tip)

sCalibration receptacles(holes)

Calibrates the instrument tip and axis. Suitable for in-struments with a straight tip.

Can also be used for instruments that do not have astraight shaft

NOTE: The use of insets in the receptacles is not com-patible with the cranial/ENT navigation software.

d Pivot points Calibrates the tip of pointed instruments

d

sa



Calibration and Verification Using Pivot Points

How to Calibrate and Verify Using Pivot Points

Figure 56

Other Options You can define an instrument diameter by pressing Set Diameter in the Verification of Cal-ibration dialog (see page 140).

Steps

1. Hold ICM4 and instrument with StarLink tracking array attached in camera fieldof view.

The Instrument Calibration dialog opens.

2. Insert instrument tip into a pivot point and rotate instrument slightly.

3. Once tip calibration is complete, the Verification of Calibration dialog opens.

4. Insert instrument tip into same pivot point used for calibration and slightly rotateinstrument to display the tip deviation.

5. To confirm calibration, press Accept, or press Try Again to repeat calibration.

6. Remove ICM4 from camera field of view.



Calibration and Verification Using Receptacles (Holes)

The Calibration and Verification Dialogs

Figure 57

a s

d



How to Calibrate and Verify Using Receptacles

Other Options If the instrument diameter is not the same as that of the selected receptacle, you can adjustthis by pressing Set Diameter in the Verification of Calibration dialog (see page 140).

Steps


The Instrument Calibration dialog a opens.

2. Press Holes to open the receptacle calibration screen s.

3. Select instrument diameter by pressing the corresponding receptacle in the dia-log. Select the smallest diameter into which the instrument fits.

4. Insert instrument tip into ICM4 receptacle with correct diameter. Make sure thatinstrument tip reaches bottom of receptacle.

5. Hold instrument completely still until calibration is complete.

The Verification of Calibration dialog d opens.

6. Hold instrument tip in same receptacle and slightly rotate instrument to displaytip and trajectory deviations. Make sure that displayed diameter corresponds toinstrument diameter and to receptacle used.


8. Remove ICM4 from camera field of view.



Calibration and Verification Using the V-Inset (Notch)

Overview With notch calibration, you can verify the tip and axis of instruments that were not suitablefor calibration using the receptacles (e.g., due to a large diameter).

To calibrate the tip and the axis, calibration is performed in two steps:

• The tip is calibrated in the pivot points • The axis is calibrated in the V-inset

The Calibration and Verification Dialogs

Figure 58

a s

d f




Other Options You can define an instrument diameter by pressing Set Diameter in the Verification of Cal-ibration dialog (see page 140).

Steps


The Instrument Calibration dialog opens.

2. Press Notch to open the first calibration dialog a.

3. Insert instrument tip into a pivot point and rotate instrument slightly.

4. Once tip calibration is complete, the second calibration dialog s opens.

5. Place shaft of instrument in V-inset and hold it still. Make sure that instrumentfits tightly in V-inset.

6. Once axis calibration is complete, the Verification of Calibration dialog opens.

7. Hold instrument in V-inset and slightly rotate it to display trajectory deviation(see dialog d).

8. Insert instrument tip into same pivot point used for calibration and slightly rotateinstrument to display tip deviation (see dialog f).


10. Following calibration, remove ICM4 from camera field of view.



Calibrating Suction Tubes

Calibration Options You can calibrate suction tubes using:

• Receptacles for standard suction tubes with a straight tip (perform calibration asdescribed on page 143)

• Pivot points for suction tubes with angled tips

Calibration Using Pivot Points

To calibrate and verify suction tubes with angled tips, follow the instructions on page 142.Additionally, keep the following in mind:

Calibration Tips

Make sure that the suction tube tip is perpendicu-lar to the pivot point.

Rotate the suction tube in the pivot point withouttilting the tip.



Tip Deviations Pivot point calibration results in the following tip deviation depending on the shape of thesuction tube tip and the size.

Suction Tube Tip Deviation Charr 8 Deviation Charr 10

Pear-shaped (Rev. 1) 1.06 mm 1.29 mm

Pear-shaped (Rev. 2) 0.77 mm 1.10 mm

Frazier 0.83 mm 1.07



Calibration Using the ICM 2.0

Introduction

About ICM 2.0 Calibration

The ICM 2.0 has calibration receptacles of various diameters. Using these you can calibratethe axis and diameter of instruments with diameters between 2 -30 mm.

The 30 mm receptacle can only be used for pointed instruments as it is conically-shaped at the bottom.

The ICM 2.0

Figure 59


Calibration Using the ICM 2.0

Calibration and Verification


Figure 60

Other Options If the instrument diameter is not exact, you can adjust this by pressing Set Diameter in theVerification of Calibration dialog (see page 140).

Steps

1. Hold ICM 2.0 and instrument with StarLink tracking array attached in camerafield of view.

The ICM dialog opens.

2. Select instrument diameter by pressing corresponding receptacle in the dialog.Select the smallest diameter into which the instrument fits.

3. Insert instrument tip into receptacle with correct diameter on ICM 2.0. Make surethat instrument tip reaches the bottom of the receptacle.

4. Hold instrument completely still until calibration is complete.

The Verification of Calibration dialog opens.

5. Hold instrument tip in same receptacle and slightly rotate instrument to displaythe tip and trajectory deviations. Make sure that displayed diameter correspondsto the instrument diameter and to the receptacle used.


7. Remove ICM 2.0 from camera field of view.


General Navigation Functions


Chapter Overview

Contents

Topics Covered

Section See

Accuracy Checks page 152

Patient Orientation page 155

Measurement Functions page 156

Freeze Mode page 160

Tooltip Offset page 161

Trajectories page 164


Accuracy Checks

Accuracy Checks

Verifying Navigation Accuracy

About Accuracy Checks

The Accuracy Check feature is available after patient registration. During navigation, thesoftware displays a dialog periodically prompting you to verify registration accuracy.

How to Verify Accuracy

Figure 61

To detect any system malfunctions, you must verify accuracy repeatedly throughout the procedure.

Step

Hold the BrainLAB Pointer, Blunt Tip or Softouch to three known anatomical land-marks and verify that the position of the pointer displayed in the image views corre-sponds with the actual point on the patient’s anatomy.

NOTE: If you point to a marker or a preplanned landmark, the system recognizes thepoint and displays the deviation from the pointer tip to the marker/landmark.



Decreased Accuracy

Brain shift may cause a discrepancy between preoperative patient data and theactual position.


Accuracy Checks

Verifying the Pointer and Softouch

About Verification You can verify the accuracy of the pointer and Softouch in the cone a of the reference ar-ray.

Figure 62:


Do not use an inaccurate pointer or Softouch.

a

Steps

1. Hold instrument tip in reference array cone.

2. The distance between the pointer/Softouch tip and the cone is displayed in thenavigation screen.



Patient Orientation

Defining Patient Orientation

Overview The Orientation function allows you to set the orientation of patient scan data so that itmatches the patient’s position in the OR.

How to Define the Orientation

Figure 63

To make sure that the patient orientation was set correctly in the scan protocol,verify that the image labeling (see page 113) matches the actual patient orienta-tion (anterior-posterior, left-right, and head-foot direction).

Step

In Tools > Orientation, select the required orientation.


Measurement Functions


Accessing Measurement Functions

How to Access Measurement

Figure 64

Step

Open the Tools > Measurement dialog.



Displaying a Scale

How to Display Scale

Figure 65

Do not use Display Scale for actual measurement as the displayed structure maynot represent the real structure, due to e.g., windowing.

Step

In Tools > Measurement, press Display Scale to activate a scale in all image views(except 3D and video views). When you zoom in and out of views, the scale is updatedaccordingly.



Displaying Distances

Displayed Distances (Examples)

Figure 66

No. Explanation

a Distance to a point

s Distance to the default target

d Distance to the target of a trajectory

a s

d



How to Measure Distance to a Planned Target

How to Measure Distances Between Two Unplanned Points

Figure 67

Steps

1. In Tools > Measurement, press Display Distances.

2. Hold the pointer to the point from which you would like to measure. The soft-ware displays the distance from the point to the planned target in standard 2Dviews.

Steps

1. In Tools > Measurement, press Display Distances.

2. Hold the pointer to the first measurement point.

3. Press Freeze.

4. Move the pointer to the second measurement point. The software displays thedistance between the points in standard 2D views.


Freeze Mode

Freeze Mode

Using Freeze Mode

Overview

Figure 68

The Freeze button allows you to freeze the displayed slices and reconstructions in order toreduce trembling in the image views. This is useful e.g., when focusing on specific struc-tures in the scan, especially with a high zoom factor.

How to Use Freeze

Instrument Tracking

When Freeze mode is activated, the instrument is tracked, however the images are not up-dated (i.e., centered in the navigation views).

Using Freeze with Eraser

If the Eraser function is activated, Freeze mode is not available.

Steps

1. Press the Freeze button.

2. You can continue to navigate the instrument, while slices and reconstructions re-main frozen.

NOTE: While Freeze is activated, you can scroll through image slices using thearrows or the invisible scrollbar in the views (see page 116).



Tooltip Offset

Setting a Tool Tip Offset

Overview

Figure 69

The Tooltip button allows you to virtually lengthen or retract the tip of the navigated instru-ment. This function is useful for:

• Reviewing anatomy at deeper depths• Planning instrument trajectories

How to Set an Offset

Figure 70

Steps

1. Press Offset in the menu bar. The Tool Tip Offset dialog opens.

2. To extend or retract the instrument, select the required value on the scale.

3. Use -/+ buttons to fine-tune the value in 1 mm increments.

NOTE: Pressing Reset sets the offset back to 0 mm and closes the dialog.

4. Press Close to apply values and return to the navigation screen. The actual offsetis shown above the Tooltip buttons.


Tooltip Offset

Navigating with a Tip Offset

Figure 71

Adjusting the Offset You can adjust the offset using the Tooltip buttons in the menu bar.

Element Represented by

Instrument offset Red line

Instrument offset tip Red cross-hair

Actual instrument Green line

Actual instrument tip Green cross-hair

Options

To virtually extend the instrument tip in increments of 1 mm, press the Tip Extension + button.

To virtually retract the instrument tip in increments of 1 mm, press the Tip Extension - button.



Working with a Tooltip Offset

If you have set a tool tip offset for the pointer or Softouch and then activate registration, thesoftware ignores the offset and performs registration with the known pointer/Softouch ge-ometry.

After working with an altered tool tip offset, do not forget to reset it to zero inorder to avoid confusion during navigation. Always proceed with caution whenthe tool tip offset is set to a value other than zero.

If an instrument trajectory was incorrectly calibrated, the offset will also be in-accurate.

The reconstructions and all other views are updated to the virtual tip.

Do not use the tip offset function for instruments which have been calibrated us-ing the calibration cone of the reference array or the pivot points of the ICM.


Trajectories

Trajectories

Acquiring Trajectories

Overview

Figure 72

The Acquire button allows you to create a trajectory in the image set. A trajectory is re-quired, for example, in order to use the Auto Pilot view.

How to Create a Trajectory

How to Create a Target Point Only

You can also use Acquire to create a target point without a corresponding trajectory. In thiscase, you do not set a tool tip offset.

Steps

1. Set a tool tip offset (see page 161). The end of the offset will represent the targetpoint once a trajectory is set.

2. Place the instrument tip on the desired entry point on the patient’s anatomy.

3. Press the Acquire button to create the trajectory.

4. In the Tool > Intraop. Trajectory dialog which opens, you can now modify thetrajectory as required (see page 165).

Steps

1. Make sure that no tool tip offset is set.

2. Place the instrument tip on the desired point on the patient’s anatomy.

3. Press the Acquire button to create the point.

4. In the Tool > Intraop. Trajectory dialog which opens, the point is displayed as ared cross-hair.

You can now modify the point using the same options available for modifyingtrajectories (see page 165).



Tools > Intraoparative Trajectories Dialog

All trajectories created intraoperatively and preplanned in iPlan are available for selection.In this dialog, you can select, reposition and delete trajectories.

Figure 73

• The red cross-hair represents the target point (defined by end of tool tip offset)• The green cross-hair represents the entry point (defined by tip of instrument)

NOTE: If you defined a target point only, the red cross-hair represents the tip of the instru-ment.

Colors of trajectories may change during the transfer from iPlan to the naviga-tion software. Trajectories are always displayed in green in the navigation soft-ware.


Trajectories

Options for Modifying Trajectories Options

To leaf through and select available trajectories, press Toggle. Trajectories and pointsare identified by consecutive numbering in the dialog.

NOTE: Only one trajectory or target point can be selected at a time for display. If morethan one trajectory is planned, make sure to select the actual trajectory you would liketo use.

To reposition trajectories:

• Press Target and press directly in image to position target point. • Press Entry and press directly in image to position entry point.

NOTE: To best position the target and entry points, press the upper axial, coronal andsagittal views. Each time you press, the data set is recentered. Once you are close to thearea of interest, use the lower, zoomed views to more precisely place the point.

To restore the position of a trajectory, press Reset.

• Intraoperatively planned trajectories are reset to the center of the image set• Preoperative trajectories are reset to the preoperative position

To display a trajectory in Inline 1, Inline 2 and Probe’s Eye views, press Inline.

Press Inline again to return to axial, coronal and sagittal views.

To delete the displayed trajectory, press Delete.

To apply settings, press Close to return to the navigation screen or press Back to returnto Data > Points.



Accessing Trajectories in the Tools Dialog

Once a trajectory or an individual target point is defined, you can access them at any timevia the Trajectory button in the Tools dialog.

Figure 74

NOTE: The Trajectories button is only available if at least one trajectory or target pointhas been defined.

a


Trajectories


Eraser Navigation

Eraser Navigation

Chapter Overview

Contents

Topics Covered

Section See

About Eraser page 170

Instrument Calibration and Verification page 171

Eraser Navigation page 173

Modifying the Eraser Object page 174


Introduction

Introduction

About Eraser

Overview Using Eraser, you can trace surgically removed tissue volumes on the patient’s anatomy.The traced information can then be viewed in the image data on the screen.

The traced volume can be shown in black, or in any other color so that it is visible as a dis-tinct object within the patient image sets.

Eraser Use Cases The Eraser feature is useful for such cases as the resection of polyps, tumors, or tissue ingeneral (e.g., sinus cavity walls). Eraser is specially designed for navigation on rigid struc-tures, rather than for a tumor located deep in tissue where brain shift can occur.

Once tissue has been resected, you can use Eraser to trace the resected area to create an ob-ject which overlays the patient’s image set. This creates a visual impression of the patient’schanged anatomy following resection. If there is e.g., polyp tissue still visible in the imageset which is not covered by the Eraser object, you may want to ensure that all polyps havebeen successfully removed.

NOTE: The accuracy of the displayed Eraser object position depends on the navigationaccuracy in general. The use of the Eraser feature does not substitute intraoperative imag-ing.

Situations that include anatomical structures that are subject to movement rel-ative to the navigated rigid anatomy are not appropriate for use with the Eraserfeature.

The accuracy of Eraser objects depends on registration, calibration and instru-ment tracking accuracies, and the quality of the scan data. This feature shouldonly be used to segment structures that can be reliably displayed and navigatedafter considering these limitations.

Eraser Instruments The Eraser function can be used with the Eraser instrument (Multiple Tip Pointer in com-bination with specially designed Eraser tips). The tips are spherical to avoid intraoperativetissue damage.

NOTE: You can also use any other calibrated instrument to create Eraser objects. For in-struments without a diameter, such as the pointer, a spherical brush of 4 mm is used by thesoftware to trace the volume. For instruments with a given diameter, a cylindrical brush isused with the same height and width as the instrument diameter.


Eraser Navigation

Eraser Instruments

Instrument Calibration and Verification

Overview The Eraser instruments are precalibrated. This means that the software contains calibrationinformation optimized for the Eraser instrumentation. Further calibration by the user is notnecessary.

To use the Eraser instrument, you must load the calibration and verify its accuracy using anICM or a reference array.

Calibration and Verification Dialogs

Figure 75


Eraser Instruments

How to Load a Precalibration

Always load the precalibrated instrument geometry when using the Eraser in-strument as a manual calibration will not be accurate.

Steps

1. Hold the Eraser instrument and ICM (if an ICM is being used) in the camerafield of view.

2. To load a precalibration, press Load in the Instrument Calibration dialog.

NOTE: The button name varies depending on the available precalibrated instru-ments. If only one precalibrated instrument is available, then the button is namedEraser.

3. If precalibrations for more than one tool are available, select Eraser in the Preca-librated Tools dialog which opens.

NOTE: Make sure you have attached an appropriately sized StarLink tracking ar-ray as indicated in the dialog.

4. Verify the calibration as described in the Calibrating Instruments chapter onpage 129.

NOTE: When verifying accuracy using the reference array, the tip deviation is atleast 2.8 mm due to the spherical tip on the Eraser instrument. To determine theactual tip accuracy, hold the Eraser tool upright in the reference array cone andsubtract 2.8 mm from the displayed tip deviation.


Eraser Navigation

Using Eraser

Eraser Navigation

Before You Begin • The patient must be registered and navigation accuracy verified• The navigated instrument calibration must be loaded and verified

The navigation and registration accuracies directly influence the accuracy ofthe Eraser function.

Freeze and Target Modes

The Eraser function cannot be used if Freeze mode has been activated.

How to Use Eraser

Steps

1. Press the Eraser button in the menu bar to initiate an Eraser session.

2.

Bring the instrument into the camera field of view and mark the region on pa-tient’s anatomy where tissue was removed.

The marked area is displayed accordingly in the image views. The default color isblack, however you can modify this later.

If the object color is black, a message is shown in the navigation views alertingyou that the displayed patient data no longer matches the diagnostic images(Eraser overlay enabled).

3.Once the object is created, press Eraser again to end the session.

The Eraser Changes dialog opens in which you can modify the object (seepage 174).


Using Eraser

Modifying the Eraser Object

Eraser Changes Dialog

The Eraser Changes dialog shows the resulting Eraser object.

If you have performed more than one Eraser session, the modifications from the most recentsession are added to the modifications from the previous sessions, resulting in one compos-ite object.

Figure 76

How to Modify the Eraser Object

Other Options

Steps

1. If you would like to select a new color for the object, select a color from the pal-ette.

2. Use the Opacity slider bar to adjust the opacity of the object to the desired level.

3. Press Accept to confirm the modifications from the latest session.

The dialog closes and the object is displayed accordingly in the image views.

Options

To delete the most recent modifications, press Reject.

To delete the entire object, press Delete all.


Eraser Navigation

Example Eraser Object in Image Views

Figure 77


Using Eraser


Navigating Alignment Instruments


Chapter Overview

Contents

Topics Covered

Section See

VarioGuide page 178

Frameless Biopsy System page 191

Disposable Biopsy Needle Type A page 200


VarioGuide

VarioGuide

Introduction

About VarioGuide Navigation

The VarioGuide is a precalibrated instrument that you can use to perform frameless biopsiesand catheter placements, guided by the navigation software.

You can navigate:

• The precalibrated Disposable Biopsy Needle Type A to a trajectory pre-planned withiPlan or the navigation system

• Other tracked instruments (e.g., standard biopsy needles with an instrument adapterattached) and non-tracked instruments

Before You Begin Assemble the VarioGuide as described in the Instrument User Guide.

Workflow Overview

Workflow See

1. Verify VarioGuide accuracy. page 179

2. Verify Disposable Biopsy Needle Type A (if applicable). page 180

3. Bring the VarioGuide into the initial position. This sets the joints ofthe VarioGuide into a center position providing the basis for subse-quent adjustments.

page 182

4. Use coarse adjustments to align the VarioGuide with the planned en-try point and trajectory. page 183

5. Use precise adjustments to align the VarioGuide to the trajectory. page 184

6. Verify alignment, and if required, perform further fine adjustments. page 186

7. Navigate instrument to planned target point:

• General instruments• Disposable Biopsy Needle Type A

page 187

page 188



Verifying Instruments

How to Verify the VarioGuide

Figure 78

Troubleshooting VarioGuide Verification

If the accuracy is insufficient, make sure that:

• The VarioGuide is correctly assembled• The guide disk is properly attached • The VarioGuide array is not bent

Steps

1. Open Tools > Tool Calibration/Verification and press VarioGuide.

The VarioGuide Verification dialog opens.

2. Place sharp tip pointer in pivot points a one after the other on guide disk. Thesoftware displays the deviation. The guide disk contains eight pivot points. Youshould verify at least three points, depending on accessibility due to the VarioGuide position.

When the overall deviation is less than 1.0 mm, the light s is shown green indi-cating that the accuracy is sufficient.

3. Press Close to return to the Tool Calibration/Verification dialog.

as


VarioGuide

How to Verify the Disposable Biopsy Needle

Figure 79

Troubleshooting Needle Verification


• The tracking array on the needle and the VarioGuide tracking array are visible to thecamera

• The reflective surfaces are not soiled or damaged• The needle is not bent

Steps

1. Open Tools > Tool Calibration/Verification and press Biopsy Needle.

The Biopsy Needle Verification dialog opens.

2. Position guide disk so that you can insert the needle vertically.

3. Insert Disposable Biopsy Needle Type A into guide disk until Stop is highlight-ed in blue.

The arrows indicate the direction in which to adjust the needle until the insertiondepth is achieved.

4. Tighten lock ring to secure needle in guide disk.

5. The software calculates and displays the trajectory deviation of the biopsy needlebased on the coordinates of the needle’s tracking array and the VarioGuide track-ing array.




Defining the Initial Position and Performing Rough Adjustments

Before You Begin Make sure you have defined a trajectory (see page 164).

How to Activate VarioGuide Navigation

Figure 80

Step

Open Tools and press VarioGuide.

The Initial Position dialog opens.


VarioGuide

How to Define Initial Position

Figure 81

NOTE: It is helpful to have these adjustments set when the device is assembled after ster-ilization.

Steps

1. Slide array holder in disk joint until end of the array holder reaches line on diskjoint.

Align horizontal and vertical lines on both components a.

2. Align lines on array holder with lines on VarioGuide array s.

3. Lock all joints by tightening screws.

4. Press Proceed to continue to coarse adjustment steps.

a

s



How to Coarsely Adjust VarioGuide

Steps

1.

Using central tension handle d, adjustVarioGuide in order to align trajectory andmatch displayed cross-hair to planned en-try point in image view.

NOTE: If necessary, rotate the displayed3D image until it matches the orientation ofthe patient (press the upper left and rightcorners of the image view).

Once cross-hair and entry point are alignedand the instrument is roughly aligned totrajectory, the software displays Lock joint!.

The software displays minimum instru-ment length required to reach planned tar-get point.

2. Turn central tension handle clockwise to lock it.

3. Press Proceed to continue to the alignment steps.

d


VarioGuide

Aligning the VarioGuide to the Planned Trajectory and Verifying Accuracy

Before You Begin So that the software can detect the VarioGuide position, rotate the disk joint on theVarioGuide by 60°.

Once the software recognizes the instrument, the first alignment dialog opens.

About the Adjustment Steps

Three adjustment joints (Joint 1, Joint 2 and Joint 3) must be adjusted to align the VarioGuide. To perform each adjustment:

• Loosen the joint indicated in each dialog. The software recognizes the correspondingjoint and displays the value by which to adjust the joint.

• When the deviation is close to 0°, the software displays Lock joint! in the dialog andthe light is shown in green

• The software prompts you to the next adjustment step. You can also move to subse-quent steps by pressing Proceed.

NOTE: The software allows you to proceed to the next step even if the light is not showngreen. Make sure that the accuracy is sufficient before proceeding.

Realigning the VarioGuide

If you modify the guide disk, or if you change the instrument diameter, youmust realign the VarioGuide to the trajectory.



How to Align VarioGuide to Planned Trajectory

Once all adjustment steps are completed, the Adjustment completed dialog opens in whichyou can verify the accuracy of the alignment.

Steps

1. Adjust Joint 1 until deviation is close to0°.




VarioGuide


Figure 82

Steps

1. Verify that the VarioGuide (pink) is correctly aligned to planned trajectory(green).

2. The software displays the estimated deviation from the VarioGuide to theplanned target point of the trajectory.

If the accuracy is close to 0°, the corresponding light for each joint is shown ingreen.

3. • If the alignment is satisfactory, press Close. The navigation view opens. • If there is a large deviation in the accuracy, or if you would like to repeat align-

ment, press Try Again. The Initial Position dialog opens.



Navigating the VarioGuide with General Instruments

Overview Once you have aligned the VarioGuide, you can use the guide to navigate an instrument(e.g., a standard biopsy needle) to the planned target point of the trajectory.

The Navigation Screen

For best results, we recommend using the Auto Pilot view to guide the instrument along thetrajectory to the target point.

Figure 83

The VarioGuide is displayed in the image views already aligned to the trajectory. The soft-ware displays the distance from the bottom of the guide disk (indicated by the pink cross-hair) to the target point.


VarioGuide

Preparing the VarioGuide for Navigation with the Disposable Biopsy Needle

How Needle is Tracked

The software tracks the insertion depth of the needle using the two reflective discs on theneedle’s tracking array. The trajectory of the needle is tracked using the VarioGuide track-ing array.

Before You Begin

Steps

1. Make sure that the needle has been verified (see page 180).

2. Configure navigation screen. In most cases, the Auto Pilot view is useful.

NOTE: The Auto Pilot view is available only if a trajectory is planned and dis-played.



How to Calculate Stopper Position on Needle

To ensure the correct penetration depth of the Disposable Biopsy Needle TypeA, it is important to follow steps 3 and 4. If the tracking array on the needle be-comes hidden from view during navigation, the position of the stopper preventsthe needle from penetrating beyond the planned target.

Steps

1. Note the distance to target value dis-played on the screen.

Keep in mind that the 10 mm cuttingwindow a on the Disposable Biop-sy Needle Type A is 1.5 mm awayfrom the tip of the needle s.

2.

To calculate stopper position on nee-dle, add the distance to target value(shown on navigation screen) to di-ameter of guide disk (50 mm).

3.Measure calculated stopper positionon Disposable Biopsy Needle TypeA using ruler.

4. Secure stopper d on biopsy needle at calculated position.

5. Insert biopsy needle into guide disk and navigate needle to planned target point(see page 200).

a

s

50 mm

Guide Disk = 50 mm +

Distance to target

Measure stopper position with ruler

d


VarioGuide

Handling the Guide Disk

Figure 84

Be aware that when you remove the lock ring a of the guide disk (e.g., to re-move the inserted instrument), the outer disk s will also loosen. Make sure tohandle the guide disk components carefully when removing them.

a s



Frameless Biopsy System

Introduction

About the Frameless Biopsy System

You can use the Frameless Biopsy System to perform frameless biopsies and endoscopicexaminations, guided by the navigation software.

You can navigate:

• The precalibrated Disposable Biopsy Needle Type A to a trajectory pre-planned withiPlan or the navigation system

• Other tracked instruments (e.g., standard biopsy needles with an instrument adapterattached) and non-tracked instruments

About This Section This section provides information on using the Frameless Biopsy System to navigate theDisposable Biopsy Needle Type A.

If you would like to navigate another tracked instrument, you must attach an instrumentadapter and calibrate the instrument as described in the Calibrating Instruments chapter onpage 129.

Before You Begin Assemble the Frameless Biopsy System as described in the Instrument User Guide.

Workflow Overview

Workflow See

1. Verify Disposable Biopsy Needle Type A (if applicable). page 192

2. Verify biopsy tube (alignment tool). page 193

3. Align biopsy tube to planned trajectory (if one has been planned). page 196

4. Calculate insertion depth of biopsy needle. page 198

5. Navigate needle to planned target point. page 200



Verifying Instruments

How to Verify Disposable Biopsy Needle

Figure 85

Steps

1. Open Tools > Tool Calibration/Verification and press Biopsy Needle.

The Biopsy Needle Verification dialog opens.

2. Insert Disposable Biopsy Needle Type A into biopsy tube with Biopsy Align-ment Array attached until Stop is highlighted in blue.

The arrows indicate the direction in which to adjust the needle until the insertiondepth is achieved.

3. Secure needle in biopsy tube by tightening fixator screw on tube.

4. Bring biopsy tube and needle into a vertical position.

5. The software calculates and displays the trajectory deviation of the biopsy needlebased on the coordinates of the tracking array on the needle and the BiopsyAlignment Array.




Troubleshooting Needle Verification


• The tracking array on the needle and the Biopsy Alignment Array are visible to thecamera

• The reflective surfaces are not soiled or damaged• The needle is not bent

NOTE: The flat markers on the needle require a more direct angle to the camera than theDisposable Reflective Marker Spheres.

How to Verify Biopsy Tube

Figure 86

Steps

1. Open Tools > Tool Calibration/Verification and press Alignment Tool.

The Alignment Tool Verification dialog opens.

2. Make sure that inserts are screwed firmly into biopsy tube.

3. Attach Biopsy Alignment Array to biopsy tube.

4. Insert biopsy tube into 10 mm receptacle of ICM4 (see page 143) making surethat the end of the tube touches the bottom of the receptacle.

5. The software calculates and displays the tool tip and tool trajectory deviationbased on the coordinates of the ICM4 and the Biopsy Alignment Array.

Review the values displayed and decide whether they are acceptable for the cur-rent procedure.




Troubleshooting Biopsy Tube Verification


• The biopsy tube is correctly assembled• The biopsy tube is properly placed in ICM receptacle



Aligning the Biopsy Tube and Calculating the Instrument’s Insertion Depth

Before You Begin Configure the navigation screen. In most cases, the Auto Pilot views is useful.

NOTE: The Auto Pilot view is available only if a trajectory is planned and displayed.

Screenshot Showing Alignment

Figure 87

a

s



How to Align Biopsy Tube with Planned Trajectory Steps

1. Insert biopsy tube into sleeve of Frameless Biopsy System. A virtual represen-tation of the tube is shown on the navigation screen a.

2. Grip biopsy tube and open central tension handle.

3. Rotate biopsy tube around A-P axis and shift it parallel until it is aligned to pre-planned trajectory according to Inline 1 view. Use the arrows displayed in theAuto Pilot view to help with the alignment.

4. Rotate biopsy tube around H-F axis and shift it parallel until it is aligned to pre-planned trajectory. Use the arrows displayed in the Auto Pilot view to help withthe alignment.

If necessary, repeat steps 3 and 4 until biopsy tube is correctly aligned.

5. Check the alignment in the Probe's Eye view. To ensure that the biopsy tube iscorrectly aligned, the cross-hairs representing the target, entry and tool tip mustlie on top of each other s.

6. Make sure that lesion can be reached with intended instrument, keeping in mindthat 70 mm of instrument is inserted into the biopsy tube (see page 198).

7. Tighten central tension handle of Frameless Biopsy System to secure biopsytube into position.

8. Verify the adjustment quality by zooming in on each view. The target of the in-tended biopsy must be located in the middle of the virtual biopsy tube.

9. The distance to target is now displayed at the bottom of the navigation views.



How to Position Biopsy Tube without Trajectory

If a trajectory has not been planned:

Steps

1. Adjust Tooltip Offset (see page 161) to a value which slightly exceeds depth ofintended biopsy.

2. Insert biopsy tube into sleeve of Frameless Biopsy System. A virtual represen-tation of the tube is shown on the navigation screen.

3. Grip the biopsy tube and open the central tension handle.

4. Adjust the Frameless Biopsy System until the virtual tool axis meets the target-ed lesion.

5. Make sure that lesion can be reached with intended instrument, keeping in mindthat 70 mm of instrument is inserted into the biopsy tube (see page 198).

6. Tighten central tension handle of Frameless Biopsy System to secure biopsytube into position.

7. Fine-tune Tooltip Offset until virtual tool tip is inside the targeted lesion.

NOTE: This now represents distance to target.

8. Verify the adjustment quality by zooming in on each view. The target of the in-tended biopsy must be located in the middle of the virtual biopsy tube.



How to Calculate Stopper Position on Instrument Steps

1. Make sure that the instrument has been verified (see page 192).

2. Note the distance to target valuedisplayed on the screen.

Keep in mind that the 10 mm cut-ting window a on the DisposableBiopsy Needle Type A is 1.5 mmaway from the tip of the needle s.

3. To calculate stopper position on instrument, add distance to target (shown on nav-igation screen) to length of the biopsy tube (70 mm). The example below illus-trates the calculation for the Disposable Biopsy Needle Type A.

4.

Measure stopper position on instru-ment using ruler.

5. Secure stopper a on instrument at calculated position.

6. Insert instrument into biopsy tube and navigate instrument to planned target point(see page 200).

a

s

Tube = 70mm Distance to target

Measure stopper position using ruler

a



Navigating Instruments

To ensure the correct penetration depth of the Disposable Biopsy Needle TypeA, it is important to follow steps 3 and 4 in the previous table. If the trackingarray on the needle becomes hidden from view during navigation, the positionof the stopper prevents the needle from penetrating beyond the planned target.

When using needles other than the Disposable Biopsy Needle Type A, keep inmind that the instrument tip is not necessarily its operational center. For exam-ple, the operational center of a Sedan biopsy needle is the window on the side ofinstrument. In such cases, the instrument must be inserted beyond the navigat-ed target so that its operational center can be positioned into the structure of in-terest.

If you are using a biopsy needle with a StarLink instrument adapter, note thatflexible instruments with a StarLink instrument adapter attached may inadvert-ently activate the recalibration when you insert the instrument into the biopsytube. This would result in incorrect calibration. To prevent oscillating move-ments at the end of the instrument from activating recalibration, insert the in-strument in a straight virtual line, making sure that the distal end of theinstrument does not move freely.


Disposable Biopsy Needle Type A


Navigating the Disposable Biopsy Needle

Overview Once the disposable biopsy needle has been correctly assembled with the VarioGuide (seepage 188) or the Frameless Biopsy System (see page 198), you can navigate the needle tothe planned target point.

How the Needle is Tracked

The insertion depth of the needle is tracked by the two reflective discs on the needle’s track-ing array.

The trajectory of the needle is tracked by:

• The VarioGuide tracking array if you are using the VarioGuide

• The Biopsy Alignment Array if you are using the Frameless Biopsy System

Tracking Guidelines Both reflective discs of the needle’s tracking array must be in the camera’s direct field ofview.

Position the needle’s tracking array at a right angle to the camera and in the center of thecamera volume.

The VarioGuide tracking array or Biopsy Alignment Array must be visible to the camera atall times.

The Pointer is not tracked while the Disposable Biopsy Needle is in the camerafield of view. It can be tracked again if the Disposable Biopsy Needle is hiddenfrom the camera field of view for at least 2 seconds.



The Navigation Screen

Figure 88

NOTE: The biopsy window on the Disposable Biopsy Needle is represented by a pink line(1.5 mm from the tip of the needle).

Be aware that the software calculates the distance from the tip of the DisposableBiopsy Needle to the planned target point. However, the biopsy window is notlocated at the tip of the needle.

No. Explanation

a Pink represents either biopsy tube of Frameless Biopsy System, or VarioGuide

s Brown represents Disposable Biopsy Needle

as



How to Navigate Needle

NOTE: Once the biopsy needle has been navigated to the target point, the biopsy can beperformed according to standard surgical procedure.

VarioGuide Navigation

The VarioGuide tracking array must be visible to the camera at all times. During navigation,the software displays the message “needle not aligned” in the image views if the biopsy nee-dle and VarioGuide are not correctly aligned (e.g., if needle is bent or not inserted correctlyinto the guide disk). If this happens, you should verify the accuracy of the biopsy instru-ments as described on page 179.

Steps

1. If you are navigating the Frameless Biopsy System, match the pink cross-hair(representing the end of the biopsy tube) to the planned entry point.

2. Match the brown cross-hair (representing the tip of the needle) to the planned tar-get point.

The distance from the navigated instrument to the planned target point is dis-played in the image views.

Biopsy Needle Display Distance to Target Point

Visible to camera The software displays the distance from the tip of theneedle to the target point.

Not visible to camera

• VarioGuide navigation: The software displays the dis-tance from the end of the disk to the target point.

• Frameless Biopsy System navigation: The softwaredisplays the distance from the end of the biopsy tube tothe target point.


Microscope Navigation


Chapter Overview

Contents

Topics Covered

Section See

Introduction to Microscope Navigation page 204

Initializing the Microscope page 205

Verifying the Microscope page 207

Microscope Navigation page 213

Microscope Tools page 216

Microscope Images page 220


Introduction to Microscope Navigation

Introduction to Microscope Navigation

About Microscope Navigation

Overview The software supports navigation of most common surgical microscopes. During naviga-tion, the microscope can be used as a virtual pointer with its tip at the center of the focalplane.

Before You Begin • The patient must be registered. • The microscope must be set up and a Microscope Adapter Set attached to the micro-

scope (see Instrument User Guide). • Microscope calibration must be performed (by BrainLAB support).

Carefully read the Microscope chapter in the Instrument User Guide before us-ing the microscope features.

Workflow Overview

Workflow See

1. Initialize the microscope. page 205

2. Verify microscope calibration. page 207

3. Recalibrate the microscope (optional). page 211

4. Navigate the microscope. page 213



Initializing the Microscope

Activating and Selecting the Microscope

How to Activate the Microscope

Figure 89

Steps

1 Open Tools > Microscope and press Connect Microscope.

2. In Tools > Microscope > Model, select the button that corresponds to your mi-croscope model.

NOTE: If only one microscope is configured, this dialog is skipped.

3. In the Microscope Detection dialog, select the button for the microscope config-uration to be used.

The microscope is now initialized and the Microscope Calibration Verificationdialog is displayed.


Initializing the Microscope

Selecting the Correct Microscope

Make sure to select the microscope calibration which corresponds to the mount-ing position of the microscope adapter (standard or 90°). Otherwise the micro-scope will be interpreted incorrectly and the image data incorrectly displayed.

Microscope Detection

If the microscope is not detected, make sure that the microscope is:

• Properly connected to the navigation system (see Instrument User Guide)• Turned on and fully booted• In navigation mode (see documentation from microscope manufacturer)

NOTE: If microscope communication cannot be established, it may help to switch the mi-croscope off and on again.



Verifying the Microscope

Introduction

Overview The microscope is calibrated to work as a pointer with its tip at the focal plane. You can ver-ify the calibration by focusing on a landmark in the center of the field of view and comparingthis to the data shown in the navigation view.

NOTE: Always verify the accuracy of the microscope calibration.

The Verification Dialogs

Figure 90

No. Component

aMicroscope Depthview: Displays a reconstruction of the microscope’s field ofview (see page 208).

s Microscope video view (if available, see page 220)

d Distance from microscope to center of reference array (cone)

fVideo Verification button: Press to toggle between the microscope views and ax-ial, sagittal and coronal views

a s

d

f



Microscope Depthview

The Microscope Depthview reconstructs 3D image data to correspond to the live view inthe microscope oculars. The data is displayed as a probe's eye view of the center of the focalplane. The data is scaled and rotated to account for the microscope's zoom factor and posi-tion. This view is useful to compare structures seen in the microscope to the image setsavailable in the navigation station.

NOTE: When using the Olympus microscope, be aware that the orientation of the micro-scope depthview may not be correct, as the OME-9000/OME-8000/OME-7000 observercan be moved in a way so that the view orientation through the microscope changes.



Verifying the Calibration

Verification Methods

You can verify the calibration using either the reference array cone or anatomical or pre-planned landmarks. Verification using the cone verifies both the tracking calibration and theHUD calibration.

You can verify calibration at any time during navigation.

NOTE: BrainLAB provides cross-hair oculars for integrated microscopes. Using thecross-hair aids in the verification and calibration of the microscope. The ocular may be re-placed with a standard, clear one after calibration.

How to Verify Using the Cone

Steps

1. Focus the microscope at maximum zoom on the bottom of the reference arraycone.

For best results, position the microscope directly over the reference array. Try tofocus as perpendicular as possible to the plane of the array to avoid distortions.The angle between the axis of the array and the focal axis of the microscope isdisplayed in the microscope video view.

2. The distance from the navigated focal point to the cone is displayed at the bottomof the views. This value shows the deviation of the current calibration.

Verify that the deviation is within an acceptable range.

3. The displayed outlines should match the actual reference array and cone.

Verify that the match of the outlines is acceptable.

4. Repeat the above steps at different distances between the microscope and the ref-erence array.

5. • If accuracy is sufficient, press Next. • If accuracy is insufficient, press Recalibrate to open the Microscope Calibra-

tion dialog.



How to Verify Using Landmarks

Steps

1. Focus the microscope at maximum zoom on a marker or a preplanned or anatom-ical landmark.

2. Press the Video Verification button to toggle to the axial, coronal and sagittalviews.

3. The distance from the navigated focal point to the planned point is displayed atthe bottom of the views. This value shows the deviation of the current calibration.

Verify that the deviation is within an acceptable range.

4. • If accuracy is sufficient, press Next. • If accuracy is insufficient, press Recalibrate to open the Microscope Calibra-

tion dialog.



Recalibrating the Microscope

Overview Before navigating with a microscope, the focal length and axis of the microscope must beproperly calibrated. BrainLAB completes a service calibration during installation of the mi-croscope adapter. You can perform a user calibration to compensate for slight calibrationinaccuracies that occur over time.

How to Activate Calibration

The Microscope Calibration Dialog

Figure 91

Step

Press Recalibrate in either of the Microscope Calibration Verification dialogs, or

Press Calibrate Microscope in the Tools > Microscope dialog.



How to Perform Calibration

Check Calibration

Always check the microscope accuracy after calibrating by testing if the micro-scope’s focus point is correctly displayed in the patient’s data. This can be doneby focusing on a marker sphere or on an anatomical landmark (see page 209).

Steps

1. Install the cross-hair ocular, if supplied.

2. Position the microscope directly over the reference array cone. For best resultstry to position the microscope as perpendicular as possible to the plane of the ref-erence array.

3. Set the focus to a position within the optimal region indicated by green in the di-alog.

NOTE: All microscopes, except Olympus, set the focus automatically in this re-gion.

4. Raise or lower the microscope until the bottom of the cone is in focus. This en-sures that the focus remains in the optimal calibration range.

5. Zoom to the maximum level.

6. Check that the cross-hair is centered on the bottom-most point of the cone andthat it is clearly focused. Use the focus buttons to finely focus if required.

7. Press Recalibrate. The Microscope Calibration Verification dialog opens.

NOTE: The Recalibrate button will not be active if the zoom is not set to maxi-mum or the reference array and/or microscope tracking array are not visible tothe camera system.




Accessing Navigation

Beginning Navigation

Once you have verified calibration, the Tools > Microscope > Options dialog opens.

Figure 92

Options

Press Close to exit this dialog and begin microscope navigation.

Press Back to open the Tools > Microscope dialog (see page 216).



Navigation Views

Microscope Navigation Views

Figure 93

The focus point of the microscope is generally the pointer tip, while the other pointer end isthe center of the lens system.

The microscope-related trajectory is displayed in blue. The microscope’s focal axis and thefield of view are indicated in the 3D display by a line and a circle. If a target has beenplanned, the distance from the focus point to the target can be displayed.

Further details on microscope images and how to display them is provided on page 220.

Overlaid Objects Overlaid objects are always displayed at the focal point. This may lead to misinterpretationof the position of an overlaid object (relative to the actual object) if a wide field of depth isused. If the correct position of the overlaid object is critical, use a shallow field of depth.

The Microscope Working Area

The minimum and maximum working area (the focus distance of the microscope) is mea-sured when the microscope is calibrated for the first time by BrainLAB support.

If the microscope moves outside of the calibrated focus range during navigation:

• A beep sounds • A message is displayed in the image views warning you that the microscope is in an

uncalibrated focus position• The blue dots (representing the microscope tracking array) in the camera view windows

turn white



Microscope Tracking

If the microscope cannot be tracked during navigation (e.g., because it is outside of the cal-ibrated focus range, the microscope is not connected, or the microscope tracking array is notvisible):

• A corresponding message is displayed in the microscope navigation views• The blue dots (representing the microscope tracking array) in the camera view windows

turn white

All Olympus microscopes do not transmit updated focus/zoom data while youare changing the focus/zoom. This leads to a delayed update of data on the nav-igation system.

Tracking Priority The instrument adapters and the pointers take precedence during navigation. To perform mi-croscopic navigation, make sure that the pointer and instrument adapters have been removedfrom the camera field of view.

Be aware that neither the tracking nor the transmission of the microscope’s fo-cus and zoom positions are performed in real-time. To judge the microscope po-sition via navigation screen and to obtain up-to-date information about overlaidobjects, do not modify focus, zoom or microscope position for a few seconds.


Microscope Tools

Microscope Tools

Introduction

Available Settings Once you have verified the calibration, various settings are available in the Tools > Micro-scope dialog.

Figure 94

Option Explanation See

Connect Microscope Initialize microscope connection page 206

Options Select microscope navigation features page 217

Calibrate Microscope Recalibrate microscope page 211

Video ConfigurationAdjust settings for microscope video display(If microscope video is available and calibrat-ed)

page 218



Microscope Options

Smart Auto-Focus Depending on your software license, Smart Auto-Focus is available via Tools > Micro-scope > Options. When you activate this feature, the focus is exactly on the tip of thetracked instrument.

NOTE: If the instrument tip is out of the working range of the microscope, the microscopecannot focus completely.

NOTE: If the microscope is not focusing, double check that the instrument, the referencearray, and the microscope tracking array are in the camera field of view.

How to Activate

Figure 95

Steps

1. Open Tools > Microscope > Options.

2. Press Smart Auto-Focus.


Microscope Tools

Configuring Microscope Video

How to Configure a Video View

Figure 96

The installation and calibration of the video hardware must be performed byqualified BrainLAB personnel. Removing and remounting or modifying thehardware from the microscope or replacing the complete microscope will sig-nificantly reduce the accuracy of the contours displayed in the video overlaywindow or image injection unit. Thus, the calibration of the video overlay win-dow must be renewed in these cases.

During each intervention, make sure that the video is connected to the same in-put selected during calibration. Using a different input may result in an incor-rect calibration.

Steps

1. Press Video Configuration in the Tools > Microscope dialog.

2. In the Input tab, press Input 1 or Input 2 (depending on to which Kolibri userpanel the microscope video is connected).

By default, Input 1 is linked to the microscope video input. See also the SystemUser Guide.

3. In the Settings tab, adjust image view settings as needed using the slider bars.

NOTE: Video image settings are described on page 52.

4. Press Accept to confirm settings.



Video Display

The video display may be delayed if the system is being used to full capacity.

We recommend that the microscope video image be displayed separately on anadditional monitor.


Microscope Images

Microscope Images

Displaying Microscope Video Views

Overview Each surgical microscope has a built-in video camera for documentation purposes. You canadd this video to the navigation system display once you have configured the microscopevideo (see page 220). This makes it possible to document the position of the microscope andits field of view with a single screenshot.

Contours of planned objects, trajectories and labeled points are overlaid onto the micro-scope video. Objects in the focal plane are represented by a solid contour line. Extensionsof these objects above and below the focal plane are displayed as a dotted line.

NOTE: The rectangular field of view of the video camera is smaller than that of the micro-scope. This may lead to differences in scaling between the microscope video view and othernavigational views. Also, some cropping of the video may occur depending on the size andshape of the selected navigation window.

How to Display the Microscope View

Steps

1. Press the eye icon.

2. Select the Other Views tab.

3. Press Microscope.

The dialog closes and the view is updated with the microscope view.



Displayed Microscope Video View

Figure 97


Microscope Images

Displayed Images

Set the microscope to maximum zoom before adjusting the focal plane on pa-tient structures. This leads to a lower field of depth and enables the best possibledisplay of the injected solid object outlines. These outlines represent the borderof the planned object on this plane. Dashed lines represent the complete exten-sion of the object located below the focal plane and serve as rough overviewonly.

Injected 3D objects serve as an overview, but do not relate exactly to the under-lying patient structure.

As injected objects are based on the pre-operative image set, the current posi-tion of the real object may differ due to e.g., brain shift or resection.


Index

Index

Numerics3D Overview ................................................. 121

adjusting threshold ......................................... 1233D views

image quality ............................................... 122

AAccept button.................................................. 42accuracy

standard registration ........................................ 73surface matching registration............................... 91

Accuracy Check.............................................. 152acquire intraoperative landmarks ........................... 104acquire target point........................................... 164acquire trajectory............................................. 164Add Landmark ................................................ 67Add Marker.................................................... 67Adjust Threshold

surface matching registration............................... 84Auto button .............................................. 84, 123Auto Pilot ..................................................... 125

BBack button .................................................... 42Biopsy Alignment Array ............................. 135, 193biopsy tube

verifying .................................................... 193BrainLAB hotline ............................................. 50Brightness ..................................................... 53Button Sound .................................................. 51

Ccalibrate microscope ......................................... 211calibration

attaching instrument adapters ............................. 132BrainLAB instruments..................................... 130how to access ............................................... 134instruments with pointed tip............................... 130large and irregularly shaped instruments ................. 130loading precalibrated geometries.......................... 136non-BrainLAB instruments................................ 130overview of calibration methods .......................... 130restoring..................................................... 137set instrument diameter .................................... 140using ICM 2.0 .............................................. 149using ICM4 ................................................. 141

using Reference Array..................................... 138camera

status bars .................................................... 45status displays ................................................ 43

camera positioning............................................. 48camera tracking system

colored dots .................................................. 43camera view windows .................................... 43, 44Cancel button .................................................. 42Close button.................................................... 42close software .................................................. 34compatible BrainLAB medical instruments ................. 18compatible BrainLAB medical software ..................... 20configuring views............................................ 118Contrast......................................................... 53CT

windowing settings ........................................ 127

DData

Orientation ................................................. 155Data Transfer................................................... 27display distance

between two points ........................................ 159to planned target ........................................... 159

Disposable Biopsy Needle .................................. 135biopsy window ............................................. 201calculating stopper position ......................... 189, 198navigating with Frameless Biopsy System............... 200navigating with VarioGuide......................... 188, 200verifying .............................................. 180, 192

disposal instructions ........................................... 13documentation ................................................. 24

EEraser ......................................................... 170

creating eraser objects ..................................... 173freeze and target modes ................................... 173instruments ................................................. 170loading a precalibration ................................... 171modifying eraser objects .................................. 174

eraser button.................................................... 41extend tool tip button .......................................... 41eye icon....................................................... 118

assigning views ............................................ 118


Index

Ffiducial markers .......................................... 69, 71flip images .................................................... 116Frameless Biopsy System

activating navigation....................................... 191navigating Disposable Biopsy Needle .................... 200Using with Disposable Biopsy Needle ................... 195verifying biopsy tube ...................................... 193

freeze button................................................... 40freeze image views........................................... 160

GGamma......................................................... 53Guide Disk

50mm ................................................ 189, 198guides .......................................................... 24

HHue ............................................................. 53

IICM 2.0

instrument calibration...................................... 149ICM4

instrument calibration...................................... 141pivot point calibration...................................... 142receptacle (hole) calibration ............................... 143V-Inset (notch) calibration ................................ 145

identical instrument geometries .............................. 47image orientation

labeling...................................................... 113Inline 1 ........................................................ 120Inline I view .................................................. 120instrument

calibration................................................... 130verification.................................................. 130

instrument display............................................ 115instrument tracking

priority ....................................................... 46instruments

Biopsy Alignment Array.................................... 18Biopsy Tube ................................................. 18Blakesly Clamp.............................................. 18Blunt Tip..................................................... 18brain tissue and spinal fluid contact ....................... 16BrainLAB Pointer, Sharp Tip .............................. 18Disposable Biopsy Needle Type A ........................ 18Disposable Reflective Marker Spheres .................... 18Disposable Registration Marker, MR, CT, OR ........... 18Frameless Biopsy System .................................. 18Instrument Calibration Matrix.............................. 18marker sphere geometry .................................... 44

Mayfield Reference Array .................................. 18Mayfield Reference Clamp ................................. 18Microscope Adapter Sets.................................... 18Multiple Tip Pointers ........................................ 18Reference Headband......................................... 18Reference Headband Array ................................. 18Skull Reference Set .......................................... 18Softouch ...................................................... 18StarLink Instrument Adapters .............................. 18Suction Tube ................................................. 18Vario Reference Arm........................................ 18VarioGuide ................................................... 18z-touch........................................................ 18

LLight Interference.............................................. 59Live Video ................................................... 124

configure ..................................................... 52connections................................................... 52

Mmagnifying glass............................................. 116main screen

views........................................................ 113manuals......................................................... 24Measurement

Display Distances.......................................... 159Display Scale............................................... 157

menu bareraser.......................................................... 41extend tool tip ................................................ 41Freeze.................................................. 40, 160register ........................................................ 40retract tool tip ................................................ 41screenshot .................................................... 41tool tip ................................................. 41, 161tools ........................................................... 40trajectory ..................................................... 41windowing............................................. 40, 128zoom .......................................................... 40

microscope ................................................... 204activating ................................................... 205depthview................................................... 207navigation views ........................................... 214options ...................................................... 217recalibrate .................................................. 211selection .................................................... 206Smart Auto-Focus ......................................... 217tracking ..................................................... 215tracking priority............................................ 215troubleshooting detection ................................. 206verification overview ...................................... 207verification using landmarks .............................. 210verification using the cone ................................ 209Video Verification ......................................... 210


Index

working area................................................ 214microscope video

configuring ................................................. 218microscope views

video view .................................................. 220MR

windowing settings......................................... 127MRa image sets ............................................... 81Multiple Tip Pointer ......................................... 170

Nnavigation

Disposable Biopsy Needle................................. 200Eraser ....................................................... 170Frameless Biopsy System ................................. 191microscopes................................................. 204VarioGuide ................................................. 178

navigation accuracyverify ........................................................ 152

navigation views ............................................. 112

Oobjects

color representation ........................................ 114preplanned in image set.................................... 114

offsetadjusting .................................................... 162defining ..................................................... 161navigating with an offset .................................. 162

Opening a Treatment Plan.................................... 27

Ppatient orientation

defining ..................................................... 155precalibrated instruments

loading a calibration ....................................... 136preplanned landmarks ........................................ 71Probe’s Eye view............................................. 120Proceed button................................................. 42

RReference Array

calibrating instruments..................................... 138verifying instruments ...................................... 154

reflections...................................................... 59register button ................................................. 40register intraoperative landmarks ........................... 108registration

acquire intraoperative landmarks ......................... 104camera positioning .......................................... 58

Details ........................................................ 76instruments ............................................ 64, 105intraoperative landmarks .................................. 109overview...................................................... 56planning registration points ................................. 66pointer ................................................. 64, 105preparation ................................................... 58restore......................................................... 60sequential ..................................................... 71Softouch ............................................ 64, 80, 85standard methods ............................................ 62standard workflow ........................................... 63surface matching methods................................... 80surface matching workflow ................................. 81unsequential .................................................. 69z-touch................................................... 80, 86

registration accuracydetailed overview ............................................ 76standard registration ......................................... 73surface matching registration ............................... 91verify standard ............................................... 74verify surface matching ..................................... 92

registration accuracy results ............................. 73, 91registration points

Add Landmark ............................................... 67Add Marker .................................................. 67Detect ......................................................... 66marker detection settings.................................... 68Precision...................................................... 66Threshold ..................................................... 66Toggle ........................................................ 67

restoring a calibration ....................................... 137retract tool tip button .......................................... 41rotate images ................................................. 116

SSaturation....................................................... 53scale in image views......................................... 157screen

assigning views ............................................ 118display of planned objects................................. 114eye icon..................................................... 116instrument display ......................................... 115magnifying glass ........................................... 116scroll buttons ............................................... 116zoom in/out................................................. 117

Screenshot button....................................... 41, 117scroll buttons ................................................. 116Softouch registration .............................. 64, 80, 105sound

configuration ................................................. 51volume........................................................ 51

Sound Output ........................................ 49, 51, 58standard registration ........................................... 65start software ................................................... 27Starting Navigation ............................................ 27Sterilization Trays ............................................. 18


Index

suction tubescalibration................................................... 147tip deviations ............................................... 148

support ......................................................... 12surface matching registration................................. 80

acquiring additional points ................................. 80Adjust Threshold ............................................ 83advance accuracy check .................................... 93check anatomical landmarks ............................... 97check color-coding .......................................... 97check deviation of points ................................... 97check surface model ........................................ 82image set requirements ..................................... 81methods ...................................................... 80reliability map ............................................... 94Softouch ..................................................... 80Toggle........................................................ 98z-touch ....................................................... 80

Systemsettings ....................................................... 50

Ttarget point

acquire ...................................................... 164threshold

optimizing values ..................................... 84, 123threshold settings............................................. 123tool tip button.................................................. 41Tools

Alignment Tool............................................. 135Biopsy Needle .............................................. 135Calibration/Verification ................................... 135Hotline ....................................................... 50Measurement ............................................... 156Microscope .......................................... 205, 216System ....................................................... 50trajectories .................................................. 167VarioGuide ................................................. 135

Tools - System - Sound....................................... 51Tools button ................................................... 40tracking priority ............................................... 46tracking system alignment.................................... 48training......................................................... 23trajectory

color ......................................................... 165create ........................................................ 164manage ............................................... 165, 166

trajectory button............................................... 41Transferring Data ............................................. 27Try Again button .............................................. 42

Uuser guides..................................................... 24user interface

main screen .................................................. 39

VVarioGuide ............................................. 135, 178

activating navigation ...................................... 181align to planned trajectory................................. 185defining the initial position................................ 182Joint 1 adjustment.......................................... 185Joint 2 Adjustment......................................... 185Joint 3 adjustment.......................................... 185navigation .................................................. 187Using with Disposable Biopsy Needle ................... 188verifying .................................................... 179verifying alignment ........................................ 186

verification of calibration ................................... 130verifying

pointer accuracy............................................ 154Softouch accuracy ......................................... 154

videoimage settings ................................................ 53signal.......................................................... 52source ......................................................... 52

video connections.............................................. 52video images

DIN 6868 ................................................... 124view........................................................... 118

3D Overview ............................................... 121Auto Pilot................................................... 125Inline 1...................................................... 120live video ................................................... 124microscope ................................................. 214Probe’s Eye................................................. 120

WWEEE .......................................................... 13windowing

settings...................................................... 127windowing button.............................................. 40

Zzoom buttons ................................................... 40zoom image views ........................................... 117z-touch

acquire points ................................................ 89z-touch registration ............................................ 80

acquire additional points ............................... 81, 90camera field of view ......................................... 88frontal/transcallosal approach............................... 99Golden Rules................................................. 87guidelines..................................................... 99occipital/suboccipital approach ........................... 101suitable scan regions......................................... 86temporal/pterional approach .............................. 100

z-touch registration accuracyscan areas................................................... 102

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