Ultrasonic Registration of Knee Anatomy to MRI Images

描述(申请人提供)：拟议的研究将调查使用术中超声(US)图像的可行性，以非侵入性地将膝盖骨表面配准到术前磁共振(MR)图像。CASurgica正在开发一种名为KneNav的手术导航系统，用于在术中规划韧带附着点和钻孔隧道的正确位置，然后指导外科医生执行该计划。尽管在正确的插入点上达成了一致，但外科医生之间的隧道放置存在很大的差异，据报道，前交叉韧带重建手术中隧道错位的比率在10%-40%之间。骨隧道错位是翻修手术的主要原因。这项拟议的研究将提高程序的准确性，而不是目前的视频技术，或者是与竞争图像制导系统相比。这项拟议研究的目标是继续开发一种依赖磁共振(MR)成像和跟踪超声的微创手术导航平台。该项目将在第一阶段取得的里程碑的基础上，重点开发一个外科导航站，全面支持这一新集成技术在手术室中的使用。拟议项目的临床重点是前交叉韧带(ACL)手术。然而，该系统开发和集成的技术将适用于任何图像引导的骨科微创手术。拟议项目的第二阶段将侧重于以下新挑战：(1)开发基于统计图谱和可变形3D蛇的高度自动化的磁共振(MR)图像分割程序；(2)开发用户界面，以确保为术中登记可靠地收集超声数据；(3)开发导航车，将跟踪超声与光学跟踪系统和其他标准手术导航硬件集成到单个手术室可部署单元中。

DESCRIPTION (provided by applicant): The proposed research will investigate the feasibility of using intra-operative ultrasound (US) images to non-invasively register the bone surfaces of the knee to preoperative magnetic resonance (MR) images. A surgical navigation system, KneeNav, is being developed by CASurgica for intraoperatively planning the proper location of ligament attachment sites and drill tunnel locations and then guiding the surgeon to execute the plan. Despite agreement on the correct points of insertion, great variability exists in tunnel placement among surgeons and the rate of misplaced tunnels in ACL reconstruction surgery has been reported to be between 10-40 percent. Malpositioning of the bone tunnels is the main reason for revision surgery. The proposed research would increase the accuracy of the procedure versus current videoscopic techniques or versus competitive image guidance systems. The goal of the proposed research is to continue development of a minimally invasive surgical navigation platform that relies on magnetic resonance (MR) imaging and tracked ultrasound. The project will build on the milestones achieved during Phase I, and focus on development of a surgical navigation station that would fully support the use of this newly integrated technology in the operating room. The clinical focus of the proposed project is anterior cruciate (ACL) ligament surgery. However, the technologies developed and integrated in the system will be applicable to any image guided minimally invasive surgical procedure in orthopaedics. Phase II of the proposed project will focus on the following new challenges: (1) Development of highly automated procedure for magnetic resonance (MR) image segmentation, based on statistical atlases and deformable 3D snakes; (2) Development of user interfaces to ensure reliable collection of ultrasound data for intraoperative registration; and (3) development of a navigation cart that will integrate tracked ultrasound with the optical tracking system and other standard surgical navigation hardware into a single operating room deployable unit.