Ultrasound-MRI Registration for Minimally Invasive, Radiation-Free Spine Surgery

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Medical doctors look for technological innovations in minimally invasive and radiation-free solutions. Typical spine surgery relies on two main imaging components; (i) Preoperative imaging : A high quality diagnostic technique using MRI or CT and (ii) Intraoperative imaging: Real time imaging and visualization using either fluoroscopy, C-Arm or ultrasound, used for guidance of the procedure and typically selected for its low cost or/and real time feedback. Current problems with these procedures are that they rely heavily on human factors such as the physician's expertise and experience to perform a cognitive registration of the two image sets. Considering only radiation safety and cost, ultrasound is the best choice, but ultrasound imaging is difficult to interpret unless performed by very experienced professionals. It is difficult to identify the target location in the images due to freehand nature of the manipulation and noise levels which are substantially higher than CT/MRI. When fluoroscopy or a C-Arm are used for real time imaging, the images are clearer and it is easier to find lesions than with ultrasound, but radiation exposure of both patient and surgeon during surgical procedures is a serious problem. Our proposal is real-time 2D ultrasound imaging registered to static 3D MRI imaging for minimally invasive spine surgery while still ensuring real-time high quality imaging visualization. The main idea is to actively guide an ultrasound probe to scan the target lesion and register it at spots shown in the MRI and then perform feature detection/tracking on ultrasound images for detailed and higher degree registration using various deep learning methods. Commercial registration hardware/software is available, but nothing that provides radiation-free and minimally invasive solutions. Minimally invasive surgery will help patients to recover faster while operation costs will be lowered by eliminating C-arm use during surgery, but the greatest benefits derived from the radiation-free nature of the process. The research outcome will promote the use of ultrasound imaging in spine surgery, providing a safer environment for both patient and surgeon.