@article{Gauvin2019,

title = {Real-time electromagnetic navigation for breast-conserving surgery using NaviKnife technology: A matched case-control study},

author = {Gabrielle Gauvin and Caitlin T Yeo and Tamas Ungi and Shaila Merchant and Andras Lasso and Doris Jabs and Thomas Vaughan and John Rudan and Ross Walker and Gabor Fichtinger and C. Jay Engel},

doi = {10.1111/tbj.13480},

year  = {2020},

date = {2020-09-01},

urldate = {2020-09-01},

journal = {The Breast Journal},

volume = {26},

number = {3},

pages = {399-405},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{fichtinger2020c,

title = {Real‐time electromagnetic navigation for breast‐conserving surgery using NaviKnife technology: A matched case‐control study},

author = {Gabrielle Gauvin and Caitlin T Yeo and Tamas Ungi and Shaila Merchant and Andras Lasso and Doris Jabs and Thomas Vaughan and John F Rudan and Ross Walker and Gabor Fichtinger and Cecil Jay Engel},

url = {https://onlinelibrary.wiley.com/doi/abs/10.1111/tbj.13480},

year  = {2020},

date = {2020-01-01},

journal = {The breast journal},

volume = {26},

issue = {3},

pages = {399-405},

abstract = {Breast‐conserving surgery (BCS) is a mainstay in breast cancer treatment. For nonpalpable breast cancers, current strategies have limited accuracy, contributing to high positive margin rates. We developed NaviKnife, a surgical navigation system based on real‐time electromagnetic (EM) tracking. The goal of this study was to confirm the feasibility of intraoperative EM navigation in patients with nonpalpable breast cancer and to assess the potential value of surgical navigation. We recruited 40 patients with ultrasound visible, single, nonpalpable lesions, undergoing BCS. Feasibility was assessed by equipment functionality and sterility, acceptable duration of the operation, and surgeon feedback. Secondary outcomes included specimen volume, positive margin rate, and reoperation outcomes. Study patients were compared to a control group by a matched case‐control analysis. There was no equipment failure or …},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{fichtinger2019m,

title = {Surgery Tutor for computational assessment of technical proficiency in soft-tissue tumor resection in a simulated setting},

author = {Caitlin T Yeo and Justine Ring and Matthew S Holden and Tamas Ungi and Ayca Toprak and Gabor Fichtinger and Boris Zevin},

url = {https://www.sciencedirect.com/science/article/pii/S1931720418306135},

year  = {2019},

date = {2019-01-01},

journal = {Journal of Surgical Education},

volume = {76},

issue = {3},

pages = {872-880},

publisher = {Elsevier},

abstract = {Background 

In competency-based medical education, progression between milestones requires reliable and valid methods of assessment. Surgery Tutor is an open-source motion tracking platform developed to objectively assess technical proficiency during open soft-tissue tumor resections in a simulated setting. The objective of our study was to provide evidence in support of construct validity of the scores obtained by Surgery Tutor. We hypothesized that Surgery Tutor would discriminate between novice, intermediate, and experienced operators. 

Methods 

Thirty participants were assigned to novice, intermediate, or experienced groups, based on the number of prior soft-tissue resections performed. Each participant resected 2 palpable and 2 nonpalpable lesions from a soft-tissue phantom. Surgery Tutor was used to track hand and instrument motions, number of tumor breaches, and time to perform each resection …},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Yeo2017b,

title = {Utility of 3D Reconstruction of 2D Liver Computed Tomography/Magnetic Resonance Images as a Surgical Planning Tool for Residents in Liver Resection Surgery},

author = {Caitlin T Yeo and Andrew MacDonald and Tamas Ungi and Andras Lasso and Diederick Jalink and Boris Zevin and Gabor Fichtinger and Sulaiman Nanji},

url = {https://labs.cs.queensu.ca/perklab/wp-content/uploads/sites/3/2024/02/Yeo2017.pdf},

doi = {http://dx.doi.org/10.1016/j.jsurg.2017.07.031},

year  = {2018},

date = {2018-08-01},

urldate = {2018-08-01},

journal = {Journal of Surgical Education},

volume = {75},

number = {3},

pages = {792-797},

abstract = {<div class="content" style="line-height: 1.5em; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 12px;"> 

<h3>Objective</h3> <div class="content" style="line-height: 1.5em;"> 

<p>A fundamental aspect of surgical planning in liver resections is the identification of key vessel tributaries to preserve healthy liver tissue while fully resecting the tumor(s). Current surgical planning relies primarily on the surgeon’s ability to mentally reconstruct 2D computed tomography/magnetic resonance (CT/MR) images into 3D and plan resection margins. This creates significant cognitive load, especially for trainees, as it relies on image interpretation, anatomical and surgical knowledge, experience, and spatial sense. The purpose of this study is to determine if 3D reconstruction of preoperative CT/MR images will assist resident-level trainees in making appropriate operative plans for liver resection surgery.</p> 

</div> 

</div> <div class="content" style="line-height: 1.5em; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 12px;"> 

<h3>Design</h3> <div class="content" style="line-height: 1.5em;"> 

<p>Ten preoperative patient CT/MR images were selected. Images were case-matched, 5 to 2D planning and 5 to 3D planning. Images from the 3D group were segmented to create interactive digital models that the resident can manipulate to view the tumor(s) in relation to landmark hepatic structures. Residents were asked to evaluate the images and devise a surgical resection plan for each image. The resident alternated between 2D and 3D planning, in a randomly generated order. The primary outcome was the accuracy of resident’s plan compared to expert opinion. Time to devise each surgical plan was the secondary outcome. Residents completed a prestudy and poststudy questionnaire regarding their experience with liver surgery and the 3D planning software.</p> 

</div> 

</div> <div class="content" style="line-height: 1.5em; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 12px;"> 

<h3>Setting and Participants</h3> <div class="content" style="line-height: 1.5em;"> 

<p>Senior level surgical residents from the Queen’s University General Surgery residency program were recruited to participate.</p> 

</div> 

</div> <div class="content" style="line-height: 1.5em; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 12px;"> 

<h3>Results</h3> <div class="content" style="line-height: 1.5em;"> 

<p>A total of 14 residents participated in the study. The median correct response rate was 2 of 5 (40%; range: 0-4) for the 2D group, and 3 of 5 (60%; range: 1-5) for the 3D group (p < 0.01). The average time to complete each plan was 156 ± 107 seconds for the 2D group, and 84 ± 73 seconds for the 3D group (p < 0.01). A total 13 of 14 residents found the 3D model easier to use than the 2D. Most residents noticed a difference between the 2 modalities and found that the 3D model improved their confidence with the surgical plan proposed.</p> 

</div> 

</div> <div class="content" style="line-height: 1.5em; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 12px;"> 

<h3>Conclusions</h3> <div class="content" style="line-height: 1.5em;"> 

<p>The results of this study show that 3D reconstruction for liver surgery planning increases accuracy of resident surgical planning and decreases amount of time required. 3D reconstruction would be a useful model for improving trainee understanding of liver anatomy and surgical resection, and would serve as an adjunct to current 2D planning methods. This has the potential to be developed into a module for teaching liver surgery in a competency-based medical curriculum.</p> 

</div> 

</div>},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{fichtinger2018k,

title = {Augmented reality assistance in training needle insertions of different levels of difficulty},

author = {Caitlin T Yeo and Tamas Ungi and Regina Leung and Eric Moult and Derek Sargent and Robert McGraw and Gabor Fichtinger},

url = {https://www.spiedigitallibrary.org/conference-proceedings-of-spie/10576/1057614/Augmented-reality-assistance-in-training-needle-insertions-of-different-levels/10.1117/12.2293575.short},

year  = {2018},

date = {2018-01-01},

volume = {10576},

pages = {266-271},

publisher = {SPIE},

abstract = {PURPOSE 

Virtual reality and simulation training improve skill acquisition by allowing trainees the opportunity to deliberately practice procedures in a safe environment. The purpose of this study was to find if there was a difference in the amount of improvement the Perk Tutor, an augmented reality training tool, provided depending on the complexity of the procedure. 

METHODS 

We conducted two sets of spinal procedure experiments with different levels of complexity with regards to instrument handling and mental reconstruction – the lumbar puncture and the facet joint injection. In both experiments subjects were randomized into two groups, Control or Perk Tutor. They were guided through a tutorial, given practice attempts with or without Perk Tutor, followed by testing without Perk Tutor augmentation. 

RESULTS 

The Perk Tutor significantly improved trainee outcomes in the facet joint experiment, while the Perk Tutor …},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{fichtinger2018g,

title = {HoloLens in suturing training},

author = {Hillary Lia and Gregory Paulin and Caitlin T Yeo and Jessica Andrews and Nelson Yi and Hassan Haq and Steve Emmanuel and Kristian Ludig and Zsuzsanna Keri and Andras Lasso and Gabor Fichtinger},

url = {https://www.spiedigitallibrary.org/conference-proceedings-of-spie/10576/1057628/HoloLens-in-suturing-training/10.1117/12.2293934.short},

year  = {2018},

date = {2018-01-01},

volume = {10576},

pages = {544-550},

publisher = {SPIE},

abstract = {PURPOSE 

A training module for basic suturing training called Suture Tutor was developed by combining video instruction and voice commands with the Microsoft HoloLens software. We put forth two hypotheses: Trainees find the HoloLens helpful and 2.) HoloLens helps the trainees to achieve a better score in objective skill assessment tests. 

METHODS 

Software module was developed to show instructional video in the HoloLens under voice command. Thirtytwo participants were split into the control group or the HoloLens group. The control group used videos displayed on a computer during training while the HoloLens group practiced with Suture Tutor. Each group was given seven minutes to train with their assigned training method before testing. Testing involved replication of a running locking suturing pattern with a time limit of five minutes and was video recorded. The videos were expert reviewed. Participants …},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{fichtinger2018c,

title = {Utility of 3D reconstruction of 2D liver computed tomography/magnetic resonance images as a surgical planning tool for residents in liver resection surgery},

author = {Caitlin T Yeo and Andrew MacDonald and Tamas Ungi and Andras Lasso and Diederick Jalink and Boris Zevin and Gabor Fichtinger and Sulaiman Nanji},

url = {https://www.sciencedirect.com/science/article/pii/S1931720417303847},

year  = {2018},

date = {2018-01-01},

journal = {Journal of surgical education},

volume = {75},

issue = {3},

pages = {792-797},

publisher = {Elsevier},

abstract = {Objective 

A fundamental aspect of surgical planning in liver resections is the identification of key vessel tributaries to preserve healthy liver tissue while fully resecting the tumor(s). Current surgical planning relies primarily on the surgeon’s ability to mentally reconstruct 2D computed tomography/magnetic resonance (CT/MR) images into 3D and plan resection margins. This creates significant cognitive load, especially for trainees, as it relies on image interpretation, anatomical and surgical knowledge, experience, and spatial sense. The purpose of this study is to determine if 3D reconstruction of preoperative CT/MR images will assist resident-level trainees in making appropriate operative plans for liver resection surgery. 

Design 

Ten preoperative patient CT/MR images were selected. Images were case-matched, 5 to 2D planning and 5 to 3D planning. Images from the 3D group were segmented to create interactive …},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Yeo2017,

title = {3D Segmentation as a Surgical Planning Tool for Residents in Liver Resection Surgery},

author = {Caitlin T Yeo and Andrew MacDonald and Tamas Ungi and Andras Lasso and Diederick Jalink and Gabor Fichtinger and Sulaiman Nanji},

year  = {2017},

date = {2017-01-01},

abstract = {<p>Introduction: Liver surgery requires identification of tumor(s) in relation to key vessels to preserve healthy tissue, while obtaining negative margins. Current planning is mentally strenuous for residents as it relies on mental 3D reconstruction, anatomical knowledge, spatial sense, and experience. The purpose of this study is to determine if 3D segmentation improves resident ability to devise appropriate liver resection plans.</p> 

<p>Methods: Senior general surgery residents were recruited. Pre-operative CT/MR images were selected if they reflected actual surgeries performed. Images were segmented to create interactive 3D models. Residents were asked to devise surgical plans for case-matched 2D and 3D models in an alternating, randomly generated order. Primary outcome was correct preoperative plan based on actual surgery performed. Secondary outcome was time (seconds(s)) to devise plan. Planning data was analyzed using Wilcoxon test, time was analyzed using paired t-test.</p> 

<p>Results: All 14 senior residents from our institution participated. The average correct response was 1.7 of 5 (34%; range 1 to 4) for the 2D group, and 3.1 of 5 (62%; range 0 to 4) for the 3D group (p<0.01). The average time to complete each plan was 156±107s for the 2D group, and 84±73s for the 3D group (p<0.01).</p> 

<p>Conclusions: The results show that 3D segmentation increases accuracy of surgical planning and decreases amount of time required. 3D segmentation is useful as a teaching tool as it reduces cognitive load required to mentally reconstruct 2D images, allowing the resident to focus on surgical planning. It improves understanding of spatial liver anatomy and serves as an adjunct to current 2D planning methods. This has the potential to be developed into a module for teaching liver surgery relevant to a competency-based curriculum.</p>},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{McGraw2015a,

title = {Development and evaluation of a simulation-based curriculum for ultrasound guided central venous catheterization},

author = {Robert C McGraw and Tim Chaplin and Conor McKaigney and Louise Rang and Melanie Jaeger and Damian Redfearn and Colleen Davison and Tamas Ungi and M. Holden and Caitlin T Yeo and Zsuzsanna Keri and Gabor Fichtinger},

doi = {10.1017/cem.2016.329},

year  = {2016},

date = {2016-11-01},

urldate = {2016-11-01},

journal = {Canadian Journal of Emergency Medicine},

volume = {18},

number = {6},

pages = {405-413},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{fichtinger2016o,

title = {Canadian Society of Surgical Oncology Annual Scientific MeetingReal-time electromagnetic navigation in breast-conserving surgery: clinical feasibility study on palpable …},

author = {Gabrielle Gauvin and Alison Laws and David Berger-Richardson and Kristyn Buchko and Ashlie Nadler and Jean-Michel Aubin and Tamas Ungi and Caitlin T Yeo and Andras Lasso and John Rudan and Ross Walker and Gabor Fichtinger and C Jay Engel and Mantaj S Brar and Antoine Bouchard-Fortier and Brad Leong and May Lynn Quan and Anand Govindarajan and Rebecca A Gladdy and J Andrea McCart and Carol J Swallow and K Alok Pathak and Karen J Ruth and Jeffrey Farma and Sanjay Reddy and Francis SW Zih and John Hoffman and Elin Sigurdson and Tariq Al-manasra and Elizabeth Tobola and Santiago Salazar and Derek Leugner and Francis R Sutherland and Chad Ball and Elijah Dixon and Vickie Baracos and Oliver F Bathe},

url = {https://www.canjsurg.ca/content/59/3_Suppl_4/S75?utm_source=TrendMD&utm_medium=cpc&utm_campaign=Can_J_Surg_TrendMD_1},

year  = {2016},

date = {2016-01-01},

volume = {59},

issue = {3 Suppl 4},

pages = {S75-S77},

publisher = {Canadian Journal of Surgery},

abstract = {Background 

Breast cancer is treated in its early stages with breast-conserving surgery. Current strategies still lead to a re-excision rate for positive margins as high as 47%. We proposed using NaviKnife, a real-time electromagnetic (EM) navigation system connected to a wire-localization needle and an ultrasound to define the desired tumour resection margins and allow the surgeon to follow its movement during surgery. The goal of this prospective phase 1 study was to assess the feasibility of using an EM navigation system in the operating room. 

Methods 

Female patients with a single palpable tumour were recruited to undergo a partial mastectomy. Intraoperatively, an ultrasound was used to define the tumour contour, which was displayed on a computer screen using NaviKnife navigation. Feasibility was assessed via 3 components: confirmation of safety and sterility, measurement of the duration of the operation …},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Yeo2015a,

title = {Examination of learning trajectories for simulated lumbar puncture training using hand motion analysis},

author = {Caitlin T Yeo and Colleen Davison and Tamas Ungi and M. Holden and Gabor Fichtinger and Robert C McGraw},

doi = {10.1111/acem.12753},

year  = {2015},

date = {2015-10-01},

urldate = {2015-10-01},

journal = {Academic Emergency Medicine},

volume = {22},

number = {10},

pages = {1187-1195},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Ungi2015b,

title = {Navigated breast tumor excision using electromagnetically tracked ultrasound and surgical instruments},

author = {Tamas Ungi and Gabrielle Gauvin and Andras Lasso and Caitlin T Yeo and Padina Pezeshki and Thomas Vaughan and Kaci Carter and John Rudan and C. Jay Engel and Gabor Fichtinger},

url = {http://www.ncbi.nlm.nih.gov/pubmed/26302503

https://labs.cs.queensu.ca/perklab/wp-content/uploads/sites/3/2024/02/Ungi2015b.pdf},

doi = {10.1109/TBME.2015.2466591},

issn = {0018-9294},

year  = {2015},

date = {2015-08-01},

urldate = {2015-08-01},

journal = {IEEE Transactions on Biomedical Engineering},

abstract = {<h4>OBJECTIVE:</h4> 

<p>Lumpectomy, breast conserving tumor excision, is the standard surgical treatment in early stage breast cancer. A common problem with lumpectomy is that the tumor may not be completely excised, and additional surgery becomes necessary. We investigated if a surgical navigation system using intraoperative ultrasound improves the outcomes of lumpectomy, and if such a system can be implemented in the clinical environment.</p> 

<h4>METHODS:</h4> 

<p>Position sensors were applied on the tumor localization needle, the ultrasound probe, and the cautery, and three-dimensional navigation views were generated using real time tracking information. The system was tested against standard wire-localization procedures on phantom breast models by eight surgical residents. Clinical safety and feasibility was tested in six palpable tumor patients undergoing lumpectomy by two experienced surgical oncologists.</p> 

<h4>RESULTS:</h4> <p>Navigation resulted in significantly less tissue excised compared to control procedures (10.3 ± 4.4 vs. 18.6 ± 8.7 g},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Gauvin2014b,

title = {Real-time electromagnetic navigation for breast tumor resection: proof of concept},

author = {Gabrielle Gauvin and Caitlin T Yeo and Tamas Ungi and Gabor Fichtinger and John Rudan and C. Jay Engel},

year  = {2014},

date = {2014-06-01},

address = {Kingston, ON, Canada},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Yeo2011,

title = {The Effect of Augmented Reality Training on Percutaneous Needle Placement in Spinal Facet Joint Injections},

author = {Caitlin T Yeo and Tamas Ungi and Paweena U-Thainual and Andras Lasso and Robert C McGraw and Gabor Fichtinger},

url = {http://ieeexplore.ieee.org/xpls/abs_all.jsp?arnumber=5739103&tag=1

https://labs.cs.queensu.ca/perklab/wp-content/uploads/sites/3/2024/02/Yeo2011.pdf},

doi = {10.1109/TBME.2011.2132131},

issn = {0018-9294},

year  = {2011},

date = {2011-07-01},

urldate = {2011-07-01},

journal = {IEEE Transactions on Biomedical Engineering},

volume = {58},

pages = {2031-7},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{fichtinger2011c,

title = {The effect of augmented reality training on percutaneous needle placement in spinal facet joint injections},

author = {Caitlin T Yeo and Tamas Ungi and U Paweena and Andras Lasso and Robert C McGraw and Gabor Fichtinger},

url = {https://ieeexplore.ieee.org/abstract/document/5739103/},

year  = {2011},

date = {2011-01-01},

journal = {IEEE Transactions on Biomedical Engineering},

volume = {58},

issue = {7},

pages = {2031-2037},

publisher = {IEEE},

abstract = {The purpose of this study was to determine if augmented reality image overlay and laser guidance systems can assist medical trainees in learning the correct placement of a needle for percutaneous facet joint injection. The Perk Station training suite was used to conduct and record the needle insertion procedures. A total of 40 volunteers were randomized into two groups of 20. 1) The Overlay group received a training session that consisted of four insertions with image and laser guidance, followed by two insertions with laser overlay only. 2) The Control group received a training session of six classical freehand insertions. Both groups then conducted two freehand insertions. The movement of the needle was tracked during the series of insertions. The final insertion procedure was assessed to determine if there was a benefit to the overlay method compared to the freehand insertions. The Overlay group had a better …},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{fichtinger2011n,

title = {Augmented reality needle guidance improves facet joint injection training},

author = {Tamas Ungi and Caitlin T Yeo and U Paweena and Robert C McGraw and Gabor Fichtinger},

url = {https://www.spiedigitallibrary.org/conference-proceedings-of-spie/7964/79642E/Augmented-reality-needle-guidance-improvesfacet-joint-injection-training/10.1117/12.877830.short},

year  = {2011},

date = {2011-01-01},

volume = {7964},

pages = {718-724},

publisher = {SPIE},

abstract = {PURPOSE 

The purpose of this study was to determine if medical trainees would benefit from augmented reality image overlay and laser guidance in learning how to set the correct orientation of a needle for percutaneous facet joint injection. 

METHODS 

A total of 28 medical students were randomized into two groups: (1) The Overlay group received a training session of four insertions with image and laser guidance followed by two insertions with laser overlay only; (2) The Control group was trained by carrying out six freehand insertions. After the training session, needle trajectories of two facet joint injections without any guidance were recorded by an electromagnetic tracker and were analyzed. Number of successful needle placements, distance covered by needle tip inside the phantom and procedural time were measured to evaluate performance. 

RESULTS 

Number of successful placements was significantly …},

keywords = {},

pubstate = {published},

tppubtype = {article}

}