Neuro-surgeons use 3D Virtual Reality Dextroscope technology to assist in pre-operative planning

Singapore 10 May 2001The most difficult Siamese twin separation to date, performed in Singapore last April, benefited from rehearsals using the Dextroscope, a neuro-surgical planning system. This futuristic system was developed by Singapore-based Volume Interactions and is powered by high-performance Silicon Graphics Onyx family systems. The Dextroscope transforms two-dimensional images of patients' bodies into three-dimensional graphics, allowing neuro-surgeons to plan the best way to perform complex surgeries in advance.

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"SGI, an expert in modular high-end servers and graphics computing, as well as in medical imaging and health sciences technology, together with Volume Interactions, has given neurosurgeons the power of 3D virtual reality to help them conduct complex operations with the highest level of accuracy", stated Dr. Almos Elekes, SGI marketing manager for medical applications. The 97-hour operation took place starting on Friday afternoon, April 6, and was completed the following Tuesday morning. The Nepalese twins, Jamuna and Ganga Shrestha, were connected at the tops of their heads and shared the same brain cavity. The successful separation surgery was complicated by the fact that their brains, partially fused, shared many overlapping blood vessels.

For the operation, pre-planning was often conducted collaboratively on two different continents over the course of six months, with two key surgeons simultaneously observing the same data, in this case virtual versions of the babies' bodies. With the help of the Dextroscope, the surgery team leader, Singapore-based Dr. Keith Goh, was able to discuss complex questions with Dr. Benjamin Carson, a surgeon based on the other side of the world at the Johns Hopkins University in Baltimore.

Featuring patients' bodies which have been re-created from data from two-dimensional magnetic resonance (MR) and computer tomographic images, this advanced technology allows medical teams to plan interventions by manipulating computer-generated 3D images. The system has no mouse or keyboard. Using stereoscopic goggles and manipulating a 3D positioning system with a toggle bar and stylus, neuro-surgeons utilising Dextroscope enter into a virtual world, exploring surgical scenarios well in advance of actual operations. Surgeons can work with all the key features inside a patient's body, measuring them, manipulating them from different angles, and slicing into them with a virtual scalpel.

"SGI is proud to be powering Dextroscope. The application helps neuro-surgeons to make better decisions on surgical procedures, resulting in greater successes. This is in line with our corporate objective to harness 3D graphical technology for the benefit of mankind", stated Lawrence Lee, general manager, SGI Singapore. "As the application involved huge volumes of data, we needed sophisticated hardware to render the interactive 3D graphics. The Silicon Graphics Onyx family of systems was the best platform available. With SGI hardware advances providing more texture memory, we should be able to deliver better, more accurate and complete data in our solutions", explained Dr. Luis Serra, president and chief technical officer of Volume Interactions.

SGI's commitment to health care and medical solutions includes the computing hardware for such computer-aided, computer-guided surgeries and simulations, as well as high-performance and graphics systems for diagnostic imaging devices, digital image management, and picture archiving and communications solutions. The Dextroscope system is one example of the many ways in which SGI technologies facilitate virtual and enhanced visual procedures for improved pre-operative planning and simulations, reducing the need for more invasive diagnostic and surgical procedures.

The Dextroscope running on Silicon Graphics Onyx family systems has been used successfully in more than forty operations at the Singapore National Neuroscience Institute and Singapore General Hospital. In addition to neuro-surgery, the Dextroscope can be used in other industries that would benefit from the visualisation of 3D multimodal data sets, enhanced interaction, and the capacity to support advanced planning. These industries include drug design, geophysical exploration, education, microchip defect inspection, and cell biology visualisation.

Volume Interactions spun off from a Singapore research institute in July 2000 and established its operations in Singapore. The immediate objective is to bring the Dextroscope and DextroBeam technology in combination with VizDexter 1.0, to selected vertical markets. More information about this neuro-surgical planning system is available in the VMW May 2001 article VizDExter 3D imaging system enables successful brain separation of Siamese twins.


Leslie Versweyveld

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