Predicting Target Vessel Location for Improved Planning of Robot-Assisted CABG Procedures Daniel S. Cho 1,2 , Cristian A. Linte 1,2 , Elvis Chen 1 , Chris Wedlake 1 , John Moore 1 , John Barron 4 , Rajni Patel 3 , and Terry M. Peters 1,2,3 1 Imaging Research Laboratories, Robarts Research Institute 2 Biomedical Engineering Graduate Program, University of Western Ontario 3 Canadian Surgical Technologies and Advanced Robotics 4 Department of Computer Science, University of Western Ontario, London, Ontario, Canada Abstract. Prior to performing a robot-assisted coronary artery bypass grafting procedure, a pre-operative computed tomography scan is used to assess patient candidacy and to identify the location of the target vessel. The surgeon then determines the optimal port locations to ensure proper reach to the target with the robotic instruments, while assuming that the heart does not undergo any significant changes between the pre- and intra-operative stages. However, the peri-operative workflow itself leads to changes in heart position and consequently the intra-operative target vessel location. As such, the pre-operative plan must be adequately updated to adjust the target vessel location to better suit the intra- operative condition. Here we propose a technique to predict the position of the peri-operative target vessel location with ∼ 3.5 mm RMS accuracy. We believe this technique will potentially reduce the rate of conversion of robot-assisted procedures to traditional open-chest surgery due to poor planning. 1 Introduction The quest for alternate approaches to conventional cardiac therapy has increased the number of minimally invasive procedures being performed, leading to less trauma, shorter hospital stays, faster return to normal activities, and improved cosmesis [1,2,3,4]. Robot-assisted (RA) surgery represents a paradigm shift in the delivery of health care for both the patient and the surgeon [5] and it has been adopted as standard of care at many institutions worldwide [5]; one of the popular cardiac interventions performed under robot-assistance is the coronary artery bypass grafting (CABG) procedure. In current clinical practice, a pre-operative computed tomography (CT) scan of the patient is used to assess his/her candidacy for undergoing a RA-CABG procedure. Based on the pre-operative scan, the surgeon identifies the location of the surgical target — the left anterior descending (LAD) coronary artery, ex- amines whether there is sufficient workspace inside the chest wall for the robot arms, and ultimately estimates the optimal locations of the port incisions to T. Jiang et al. (Eds.): MICCAI 2010, Part III, LNCS 6363, pp. 205–212, 2010. c  Springer-Verlag Berlin Heidelberg 2010