A level-wise spine registration framework to account for large pose changes

Cai, Yunliang; Wu, Shaoju; Fan, Xiaoyao; Olson, Jonathan D.; Evans, Linton T.; Lollis, S. Scott; Mirza, Sohail K.; Paulsen, Keith D.; Ji, Songbai

doi:10.1007/s11548-021-02395-0

Cited by 5 publications

(11 citation statements)

References 36 publications

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“…It has also been demonstrated that this iSV system can drive the creation of an updated CT that accounts for the pre-operative-to-intraoperative shift of the spine pose (7)(8)(9)(10). To date, we have published studies investigating the effects of performing this updating on pre-operative imaging to match the pose of the spine from intraoperative patient positioning (7)(8)(9)(10)(11)(12). These studies account for any pre-operative to intraoperative motion that might occur; however, investigations into accounting for any motion that could occur as the surgery continues to proceed have not been conducted.…”

Section: A Methods For Image Updatingmentioning

confidence: 99%

Towards accounting for intraoperative spine motion: a simulation study of registration between stereovision surfaces

Warner

Fan

Duke

et al. 2023

Medical Imaging 2023: Image-Guided Procedures, Robotic Interventions, and Modeling

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Registration of preoperative or intraoperative imaging is necessary to facilitate surgical navigation in spine surgery. After image acquisition, intervertebral motion and spine pose changes can occur during surgery from instrumentation, decompression, physician manipulation or correction. This causes deviations from the reference imaging reducing the navigation accuracy. To evaluate the ability to use the registration between stereovision surfaces in order to account for this intraoperative spine motion through a simulation study. Co-registered CT and stereovision surface data were obtained of a swine cadaver’s exposed lumbar spine in the prone position. Data was segmented and labeled by vertebral level. A simulation of biomechanically bounded motion was applied to each vertebral level to move the prone spine to a new position. A reduced surface data set was then registered level-wise back to the prone spines original position. The average surface to surface distance was recorded between simulated and prone positions. Localized targets on these surfaces were used for a calculation of target registration error. Target registration error increases with distance between surfaces. Movement exceeding 2.43 cm between stereovision acquisitions exceeds registration accuracy of 2mm. Lateral bending of the spine contributes most to this effect compared to axial rotation and flexion-extension. In conclusion, the viability of using stereovision-to-stereovision registration to account for interoperative motion of the spine is shown through this simulation. It is suggested the distance of spine movement between corresponding points does not surpass 2.43 cm between stereovision acquisitions.

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Section: A Methods For Image Updatingmentioning

confidence: 99%

Towards accounting for intraoperative spine motion: a simulation study of registration between stereovision surfaces

Warner

Fan

Duke

et al. 2023

Medical Imaging 2023: Image-Guided Procedures, Robotic Interventions, and Modeling

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“…Preoperative CT was registered with iSV surfaces using a deformable registration (illustrated in Fig. 3 , technical details published elsewhere 10 , 11 ). An updated CT (uCT) image volume was generated by deforming the pCT, and uploaded to the StealthStation.…”

Section: Methodsmentioning

confidence: 99%

“…We developed a novel method of compensating for spinal motion between preoperative scans and intraoperative positioning, and registering the surgical field automatically on the basis of intraoperative photographs acquired with a handheld camera system rather than more expensive structured light equipment or repeated CT scans with ionizing radiation 10 , 11 . This optically tracked, radiation-free, handheld intraoperative stereovision (iSV) device acquires depth-of-field data of exposed vertebral surfaces 12 .…”

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confidence: 99%

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Accuracy of Stereovision-Updated Versus Preoperative CT-Based Image Guidance in Multilevel Lumbar Pedicle Screw Placement

Fan

Mirza

et al. 2022

JBJS Open Access

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Background: Change in vertebral position between preoperative imaging and the surgical procedure reduces the accuracy of image-guided spinal surgery, requiring repeated imaging and surgical field registration, a process that takes time and exposes patients to additional radiation. We developed a handheld, camera-based, deformable registration system (intraoperative stereovision, iSV) to register the surgical field automatically and compensate for spinal motion during surgery without further radiation exposure.Methods: We measured motion-induced errors in image-guided lumbar pedicle screw placement in 6 whole-pig cadavers using state-of-the-art commercial spine navigation (StealthStation; Medtronic) and iSV registration that compensates for intraoperative vertebral motion. We induced spinal motion by using preoperative computed tomography (pCT) of the lumbar spine performed in the supine position with accentuated lordosis and performing surgery with the animal in the prone position. StealthStation registration of pCT occurred using metallic fiducial markers implanted in each vertebra, and iSV data were acquired to perform a deformable registration between pCT and the surgical field. Sixty-eight pedicle screws were placed in 6 whole-pig cadavers using iSV and StealthStation registrations in random order of vertebral level, relying only on image guidance without invoking the surgeon's judgment. The position of each pedicle screw was assessed with post-procedure CT and confirmed via anatomical dissection. Registration errors were assessed on the basis of implanted fiducials. Results:The frequency and severity of pedicle screw perforation were lower for iSV registration compared with StealthStation (97% versus 68% with Grade 0 medial perforation for iSV and StealthStation, respectively). Severe perforation occurred only with StealthStation (18% versus 0% for iSV). The overall time required for iSV registration (computational efficiency) was ;10 to 15 minutes and was comparable with StealthStation registration (;10 min). The mean target registration error was smaller for iSV relative to StealthStation (2.81 ± 0.91 versus 8.37 ± 1.76 mm).Conclusions: Pedicle screw placement was more accurate with iSV registration compared with state-of-the-art commercial navigation based on preoperative CT when alignment of the spine changed during surgery.Clinical Relevance: The iSV system compensated for intervertebral motion, which obviated the need for repeated vertebral registration while providing efficient, accurate, radiation-free navigation during open spinal surgery.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSOA/A365).

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“…An average registration accuracy of 1.43 ± 0.35 mm was achieved. Cai et al (2021) used a parameterized moving-frame based method to generate topologically encoded depth projection 2D images to establish a point-to-pixel correspondence. The patient-to-intraoperative CT registration can be achieved in real-time with a registration accuracy about 2 mm.…”

Section: Image Registration and Tool Calibrationmentioning

confidence: 99%

A review of advances in image-guided orthopedic surgery

Fan¹,

Zhu²,

Tu³

et al. 2023

Phys. Med. Biol.

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Orthopedic surgery remains technically demanding due to the complex anatomical structures and cumbersome surgical procedures. The introduction of image-guided orthopedic surgery (IGOS) has significantly decreased the surgical risk and improved the operation results. This review focuses on the application of recent advances in Artificial Intelligence (AI), Deep Learning (DL), Augmented Reality (AR) and Robotics in image-guided spine surgery, joint arthroplasty, fracture reduction and bone tumor resection. For the pre-operative stage, key technologies of AI and deep learning based medical image segmentation, 3D reconstruction and surgical planning procedures are systematically reviewed. For the intra-operative stage, the development of novel image registration, surgical tool calibration and real-time navigation are reviewed. Furthermore, the combination of the surgical navigation system with augmented reality (AR) and robotic technology is also discussed. Finally, the current issues and prospects of the IGOS system are discussed, with the goal of establishing a reference and providing guidance for surgeons, engineers, and researchers involved in the research and development of this area.

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A level-wise spine registration framework to account for large pose changes

Cited by 5 publications

References 36 publications

Towards accounting for intraoperative spine motion: a simulation study of registration between stereovision surfaces

Towards accounting for intraoperative spine motion: a simulation study of registration between stereovision surfaces

Accuracy of Stereovision-Updated Versus Preoperative CT-Based Image Guidance in Multilevel Lumbar Pedicle Screw Placement

A review of advances in image-guided orthopedic surgery

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