Planning, guidance, and quality assurance of pelvic screw placement using deformable image registration.
Planning, guidance, and quality assurance of pelvic screw placement using deformable image registration.
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DOI：
10.1088/1361-6560/aa954f
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发表时间：
2017-11-13
影响因子：
3.5
通讯作者：
Siewerdsen JH
中科院分区：
文献类型：
--
作者：
Goerres J;Uneri A;Jacobson M;Ramsay B;De Silva T;Ketcha M;Han R;Manbachi A;Vogt S;Kleinszig G;Wolinsky JP;Osgood G;Siewerdsen JH
经皮骨盆螺钉置入具有挑战性，因为脆弱结构周围的骨通道狭窄，并且难以在2D X射线投影图像中对复杂的解剖形状进行视觉解释。为了解决这些挑战，提出了一种用于规划、引导和质量保证（QA）的系统，其提供类似于手术导航的功能，但是基于使用常规工作流程中已经采集的荧光透视图像的鲁棒3D-2D图像配准技术。该系统的两个新的方面进行了研究：骨盆螺钉轨迹的自动规划和手术器械变形（克氏针偏转）的能力。在术前CT中，基于血管的配准用于计算螺钉轨迹的患者特定计划。3D-2D配准在术中荧光透视的投影几何结构内将患者与CT对齐。可变形已知组件配准（dKC-Reg）定位手术器械，计划和器械位置的组合用于提供指导和QA。留一法分析评估了自动规划的准确性，尸体实验比较了dKC-Reg与刚性方法的准确性（例如，光学跟踪）。手术计划在骨皮质内符合3-4 mm的最西走廊（上级耻骨支）和>5 mm的最宽走廊（泪滴）。dKC-Reg算法将克氏针头端定位在1.1 mm和1.4°范围内，并且始终比刚体跟踪更准确（误差高达9 mm）。该系统被证明可以自动计算可靠的螺钉轨迹，并准确定位变形的手术器械（克氏针）。这种能力可以改善骨科手术中的指导和QA，其中工作流程受到手动计划的阻碍，传统的工具跟踪器增加了复杂性和成本，刚性工具假设通常不准确，并且从2D投影对复杂解剖结构的定性解释易于在延长的荧光透视时间内试错。
Percutaneous pelvic screw placement is challenging due to narrow bone corridors surrounded by vulnerable structures and difficult visual interpretation of complex anatomical shapes in 2D x-ray projection images. To address these challenges, a system for planning, guidance, and quality assurance (QA) is presented, providing functionality analogous to surgical navigation, but based on robust 3D-2D image registration techniques using fluoroscopy images already acquired in routine workflow. Two novel aspects of the system are investigated: automatic planning of pelvic screw trajectories and the ability to account for deformation of surgical devices (K-wire deflection). Atlas-based registration is used to calculate a patient-specific plan of screw trajectories in preoperative CT. 3D-2D registration aligns the patient to CT within the projective geometry of intraoperative fluoroscopy. Deformable known-component registration (dKC-Reg) localizes the surgical device, and the combination of plan and device location is used to provide guidance and QA. A leave-one-out analysis evaluated the accuracy of automatic planning, and a cadaver experiment compared the accuracy of dKC-Reg to rigid approaches (e.g., optical tracking). Surgical plans conformed within the bone cortex by 3–4 mm for the narrowest corridor (superior pubic ramus) and >5 mm for the widest corridor (tear drop). The dKC-Reg algorithm localized the K-wire tip within 1.1 mm and 1.4° and was consistently more accurate than rigid-body tracking (errors up to 9 mm). The system was shown to automatically compute reliable screw trajectories and accurately localize deformed surgical devices (K-wires). Such capability could improve guidance and QA in orthopaedic surgery, where workflow is impeded by manual planning, conventional tool trackers add complexity and cost, rigid tool assumptions are often inaccurate, and qualitative interpretation of complex anatomy from 2D projections is prone to trial-and-error with extended fluoroscopy time.
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影响因子：
10.9
作者：
Jimenez-Delgado, Juan J.;Paulano-Godino, Felix;Roberto Jimenez-Perez, J.
通讯作者：
Roberto Jimenez-Perez, J.
影响因子：
6.8
作者：
Hansen, N;Muller, SD;Koumoutsakos, P
通讯作者：
Koumoutsakos, P
影响因子：
3
作者：
GOWER, JC
通讯作者：
GOWER, JC
DOI：
10.1016/s0002-9378(33)90194-5
发表时间：
1933-07-01
影响因子：
9.8
作者：
Caldwell, WE;Moloy, HC
通讯作者：
Moloy, HC
影响因子：
4.4
作者：
Clark, Kenneth;Vendt, Bruce;Prior, Fred
通讯作者：
Prior, Fred