Extended Intraoperative Longitudinal 3-Dimensional Cone Beam Computed Tomography Imaging With a Continuous Multi-Turn Reverse Helical Scan.
Extended Intraoperative Longitudinal 3-Dimensional Cone Beam Computed Tomography Imaging With a Continuous Multi-Turn Reverse Helical Scan.
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DOI：
10.1097/rli.0000000000000885
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发表时间：
2022-11-01
影响因子：
6.7
通讯作者：
中科院分区：
文献类型：
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作者：
锥形束计算机断层扫描（CBCT）成像正在成为术中不可或缺的工具；然而，目前的视野阻碍了长解剖部位的可视化，限制了临床应用。在这里，我们展示了术中CBCT视野的纵向扩展，使用了多圈反向螺旋扫描，并评估了在介入手术中的潜在临床应用。一个固定房间的机器人CBCT成像系统，具有额外的实时控制，用于实施多圈反向螺旋扫描。扫描由c形臂旋转组成，通过一系列顺时针和逆时针旋转，结合同时编程的表平移。利用简单几何模体对多圈反螺旋成像轨迹的运动特性和几何精度进行了检测。为了评估潜在的临床应用，我们对一具羊尸体进行了T1至T12胸椎椎弓根螺钉后路固定手术。2名观察人员通过皮质缺口分级和平均螺钉角度误差测量（轴向和矢状面），使用多圈反向螺旋扫描提供螺钉置入的术后评估。对于所有螺钉角度测量，计算类内相关系数（ICC）以确定观察者的信度。多圈反向螺旋扫描耗时100秒，纵向覆盖范围从17厘米增加到80厘米，增加了370%。通过将测量值与简单几何模体的实际尺寸（0.2±0.1 mm）和角度（0.2±0.1°）进行比较，检验几何精度，表明多圈反螺旋扫描可提供亚毫米和度精度，无畸变。在一具羊尸体的椎弓根螺钉手术过程中，多圈反向螺旋扫描发现了4个皮质缺口，并通过术后CT扫描证实。直接比较术后多转反螺旋和CT扫描测量的螺钉插入角度（n = 22）， 2名专家观察者的轴向角和矢状角的平均差异为3.3±2.6°和1.9±1.5°。所有扫描类型（常规CT、多转反螺旋和常规CBCT）的所有测量值（轴向和矢状）ICC均高于0.900，表明观察者之间的可靠性很高。在临床机器人CBCT成像系统上，采用多圈反向螺旋扫描的术中扩展纵向三维成像是可行的，可以在单个图像中可视化长解剖部位，包括在金属硬件存在的情况下。
Cone Beam Computed Tomography (CBCT) imaging is becoming an indispensable intraoperative tool; however, the current field-of-view prevents visualization of long anatomical sites, limiting clinical utility. Here, we demonstrate the longitudinal extension of the intraoperative CBCT field-of-view using a multi-turn reverse helical scan and assess potential clinical utility in interventional procedures. A fixed-room robotic CBCT imaging system, with additional real-time control, was used to implement a multi-turn reverse helical scan. The scan consists of C-arm rotation, through a series of clockwise and anticlockwise rotations, combined with simultaneous programmed table translation. The motion properties and geometric accuracy of the multi-turn reverse helical imaging trajectory were examined using a simple geometric phantom. To assess potential clinical utility, a pedicle screw posterior fixation procedure in the thoracic spine from T1 to T12, was performed on an ovine cadaver. The multi-turn reverse helical scan was used to provide post-operative assessment of the screw insertion via cortical breach grading and mean screw angle error measurements (axial and sagittal) from 2 observers. For all screw angle measurements, the intraclass correlation coefficient (ICC) was calculated to determine observer reliability. The multi-turn reverse helical scans took 100 s to complete and increased the longitudinal coverage by 370% from 17 cm to 80 cm. Geometric accuracy was examined by comparing the measured to actual dimensions (0.2 ± 0.1 mm) and angles (0.2 ± 0.1 °) of a simple geometric phantom, indicating that the multi-turn reverse helical scan provided sub millimeter and degree accuracy with no distortion. During the pedicle screw procedure in an ovine cadaver, the multi-turn reverse helical scan identified 4 cortical breaches, confirmed via the post-operative CT scan. Directly comparing the screw insertion angles (n = 22) measured in the post-operative multi-turn reverse helical and CT scans revealed an average difference of 3.3 ± 2.6° in axial angle and 1.9 ± 1.5° in the sagittal angle from 2 expert observers. The ICC was above 0.900 for all measurements (axial and sagittal) across all scan types (conventional CT, multi-turn reverse helical and conventional CBCT), indicating excellent reliability between observers. Extended longitudinal field-of-view intraoperative 3D imaging with a multi-turn reverse helical scan is feasible on a clinical robotic CBCT imaging system, enabling long anatomical sites to be visualized in a single image, including in the presence of metal hardware.
影响因子：
1.6
作者：
Mathew, Jacob E;Mok, Kelvin;Goulet, Benoit
通讯作者：
Goulet, Benoit