Intraoperative patient registration using volumetric true 3D ultrasound without fiducials.
Intraoperative patient registration using volumetric true 3D ultrasound without fiducials.
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使用体积真实 3D 超声进行术中患者登记，无需基准点。
DOI：
10.1118/1.4767758
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发表时间：
2012
期刊：
影响因子：
3.8
通讯作者：
Paulsen,KeithD
中科院分区：
文献类型：
--
作者：
Ji,Songbai;Roberts,DavidW;Hartov,Alex;Paulsen,KeithD
目的：准确的患者登记是开放颅骨手术中有效的图像引导的关键。通常，它是通过将在手术室（OR）中人工识别的皮肤贴基准点与术前图像中的相应基准点进行匹配来完成的，这不仅消耗了手术室的时间和人力资源，而且还依赖于术前扫描（直到手术开始）中基准点的存在（以及随后的固定）。在这项研究中，作者提出了一种完全自动的、基于体积图像的患者注册技术，该技术不依赖于基准，通过将跟踪的（真实的）3D超声（3DUS）直接与术前磁共振（MR）图像进行注册。方法在不包含US换能器接触点位置或方向的先验信息的情况下，首先执行二进制3DUS和MR体积之间的多起点配准，以生成初始起点，然后通过最大化互信息（MI）或相关比（CR）在灰度3DUS和MR之间进行配准。然后通过空间转换的串联计算患者注册。结果在10例（N= 10）患者中，使用MI或CR登记获得的平均基准（标记）距离误差（FDE）为5.0 mm和4.3 mm（10例中有8例CR比MI的FDE更小），这与典型的基于基准或基于表面的患者登记报告的值相当。双配准的平移和旋转捕获范围分别为24.0 mm和27.0°（最大32.8 mm和36.4°），MI配准的12.2 mm和25.6°（最大18.3 mm和34.4°），CR配准的22.6 mm和40.8°（最大48.5 mm和65.6°）。在并行处理下，完成患者登记的执行时间为12-15分钟，通过在登记前将3DUS换能器位置限制在MR开颅中心，可以显著减少患者登记的执行时间（可实现5分钟的执行时间）。由于使用了脑深部和整个手术感兴趣区域的共同特征，术中可以根据需要进行较少的患者登记，这对于术前患者登记受损（例如，皮肤贴底的基准丢失/移动）或不可能（例如，在紧急情况下，外部基准没有及时放置）的情况是有吸引力的。CR注册比MI更稳健（捕获范围约为MI的两倍），并且似乎更准确，尽管在评估的患者病例中，这两种方法都与基于基准的注册相当或更好。本文的研究结果表明，基于3DUS图像的患者注册在未来的临床应用中具有前景。
PurposeAccurate patient registration is crucial for effective image‐guidance in open cranial surgery. Typically, it is accomplished by matching skin‐affixed fiducials manually identified in the operating room (OR) with their counterparts in the preoperative images, which not only consumes OR time and personnel resources but also relies on the presence (and subsequent fixation) of the fiducials during the preoperative scans (until the procedure begins). In this study, the authors present a completely automatic, volumetric image‐based patient registration technique that does not rely on fiducials by registering tracked (true) 3D ultrasound (3DUS) directly with preoperative magnetic resonance (MR) images.MethodsMultistart registrations between binary 3DUS and MR volumes were first executed to generate an initial starting point without incorporating prior information on the US transducer contact point location or orientation for subsequent registration between grayscale 3DUS and MR via maximization of either mutual information (MI) or correlation ratio (CR). Patient registration was then computed through concatenation of spatial transformations.ResultsIn ten (N= 10) patient cases, an average fiducial (marker) distance error (FDE) of 5.0 mm and 4.3 mm was achieved using MI or CR registration (FDE was smaller with CR vs MI in eight of ten cases), which are comparable to values reported for typical fiducial‐ or surface‐based patient registrations. The translational and rotational capture ranges were found to be 24.0 mm and 27.0° for binary registrations (up to 32.8 mm and 36.4°), 12.2 mm and 25.6° for MI registrations (up to 18.3 mm and 34.4°), and 22.6 mm and 40.8° for CR registrations (up to 48.5 mm and 65.6°), respectively. The execution time to complete a patient registration was 12–15 min with parallel processing, which can be significantly reduced by confining the 3DUS transducer location to the center of craniotomy in MR before registration (an execution time of 5 min is achievable).ConclusionsBecause common features deep in the brain and throughout the surgical volume of interest are used, intraoperative fiducial‐less patient registration is possible on‐demand, which is attractive in cases where preoperative patient registration is compromised (e.g., from loss/movement of skin‐affixed fiducials) or not possible (e.g., in cases of emergency when external fiducials were not placed in time). CR registration was more robust than MI (capture range about twice as big) and appears to be more accurate, although both methods are comparable to or better than fiducial‐based registration in the patient cases evaluated. The results presented here suggest that 3DUS image‐based patient registration holds promise for clinical application in the future.
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