3D visualisation in the operating room to improve accuracy of tumour removal

Mountain View 05 September 2002In a successful experiment which could help to benefit the way surgery is performed, surgeons have begun viewing and manipulating 3D medical images of the very patients on whom they are operating while the operation is in progress. Early results indicate the potential for improving success rates on such procedures as the removal of cancerous tumours.

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In the first procedure of its kind, doctors at Britain's Manchester Royal Infirmary used a standard laptop computer in the operating room last April to project and manipulate in real time a complex, three-dimensional image of a patient's organ.

The tumour's boundaries were pinpointed and the visualisation was used to target the location of a needed biopsy. The extraordinary processing power necessary to generate this imagery came not from that laptop but from the Silicon Graphics Onyx2 visualisation system with InfiniteReality graphics that was housed in the university's supercomputing centre more than one mile away and networked into the operating room.

The surgeon was able to transfer and manipulate the rendered three-dimensional representation of the patient's organ via a network connection and then employ a standard off-the-shelf computer to project the images onto the operating room's wall. Since then, the hospital's Onyx2 system has been upgraded to a powerful SGI Onyx 300 visualisation system, increasing the institution's visualisation capabilities even more.

Thanks to SGI's Visual Area Networking, a centralised 3D imaging facility in the basement of a hospital or at a regional facility supporting many hospitals can now deliver interactive visualisation into operating rooms over a wide area. Now the process is becoming part of the Manchester Royal Infirmary's arsenal of operating room tools, with two subsequent operations in June and July and others expected in the near future. It serves as a replicable model for hospitals around the world.

"In oncology, it is important not to cut across a tumour", noted the University of Manchester's Dr. Rory McCloy, the surgeon who first used the new SGI technology this past April. "But with flat, two-dimensional scans available to surgery today, it has been difficult to accurately extrapolate the third dimension of depth to avoid that happening. Thanks to this new SGI advance and visualisation software written by the Manchester Visualisation Centre, I can now view intricate three-dimensional medical scans right in the operating theater on a simple laptop machine. I can see all around a tumour before I attempt to remove it. One day, this type of three-dimensional visualisation in the operating room will become commonplace."

Visual Area Networking defines a set of tools that allow computer users to access and manipulate highly complex, graphically rich images created by and housed on an SGI visualisation server situated at a remote location. SGI Visual Area Network technology utilises the company's OpenGL Vizserver computing solution to transfer the rendered data from a server to the most basic of clients via a network link. To keep the files small, only the pixels of the rendered graphic are transmitted, rather than the raw data itself. As a result, OpenGL Vizserver can operate on virtually any type of client, including laptops, workstations and, soon, even personal digital assistants and wearable "eye-piece" computers.

OpenGL Vizserver also supports networked collaboration, allowing multiple network sessions to view and manipulate the same image. For instance, a surgeon could consult with a colleague remotely to discuss the best course of action, with both surgeons able to visualise the same patient data in real time. This saves the surgeon time and increases his or her efficiency and effectiveness to the benefit of the patient.

Smaller hospitals do not require their own dedicated visualisation systems, but rather can now leverage the capabilities of regional centres or major hospitals, bringing remotely located experts into their emergency diagnostic and surgical environments on a moment's notice. With Visual Area Networking, users separated by continents can view and manipulate the same images in real time, enabling new forms of collaborative visualisation and decision making in such diverse industries as oil exploration, drug discovery, and automobile manufacturing.

"SGI is enhancing the way surgery is done", noted SGI's Chodi McReynolds, director, Industry Marketing, Sciences. "SGI Visual Area Network technologies are improving the accuracy of surgery, giving surgeons and physicians separated by hundreds of miles or even continents the ability to visualise, manipulate and share complex data in a way that was impossible just a few months ago. Using SGI Visual Area Networking tools, medical professionals now have, right in the operating room or medical office, the visualisation capabilities previously available only on high-end graphics computers."

The advantages of Visual Area Networking in the operating room were brought home by Dr. McCloy's operation, which marked the first-ever development of a custom application for use in a Visual Area Network. Once the data was received in the operating room, the surgeon was able to manipulate the images using nothing more than a joystick covered with a sterile plastic bag.

One of the major challenges of manipulating the image from an operating theater is controlling the input to the computer system while performing surgical procedures. The surgeon does not have enough hands to operate the computer and on the patient, and there are also hygiene considerations. SGI has recently filed patent on a new method for intuitive, interactive 3D navigation in virtual environments that can be controlled from simple gestures or voice control. This system assists surgeons in getting to the location, view and orientation required with the minimum of fuss, enabling them to concentrate on the job while having seamless access to the visualisation data needed to make the right decisions.

The team at Manchester is entering into a broader collaboration with SGI to develop a visualisation grid. Grids provide distributed computing environments in which advanced computers and scientific instruments are networked together to facilitate collaboration, tackle the most difficult problems, and maximise the utilisation of valuable assets. Since OpenGL Vizserver extends the usefulness of advanced visualisation to network clients, it is ideal for use on grids.

The project will integrate OpenGL Vizserver with the Globus Toolkit, a de facto standard for grid middleware development, to support remote visualisation and provide secure transmission of data on a grid. In addition to partial funding, SGI will provide development assistance and early access to new SGI technologies as necessary to ensure success. SGI's commitment to health care and medical solutions includes the computing hardware for computer-aided, computer-guided surgeries and simulations, as well as high-performance and graphics systems for diagnostic imaging systems, digital image management, and picture archiving and communications solutions.


Leslie Versweyveld

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