A-mode ultrasound-based intra-femoral bone cement detection and 3D reconstruction in RTHR.

Due to the difficulty of determining the 3D boundary of the cement-bone interface in Revision Total Hip Replacement (RTHR), the removal of the distal intra-femoral bone cement can be a time-consuming and risky operation. Within the framework of computer- and robot-assisted cement removal, the principles and first results of an automatic detection and 3D surface reconstruction of the cement-bone boundary using A-mode ultrasound are described. Sound propagation time and attenuation of cement were determined considering different techniques for the preparation of bone cement, such as the use of a vacuum system (Optivac, Biomet). A laboratory setup using a rotating, standard 5-MHz transducer was developed. The prototype enables scanning of bisected cement-prepared femur samples in a 90 degrees rotation range along their rotation axis. For system evaluation ex vivo, the distal femur of a human cadaver was prepared with bone cement and drilled (Ø 10 mm) to simulate the prosthesis cavity in a first approximation. The sample was cut in half and CT scanned (0.24 mm resolution; 0.5 mm distance; 0.5 mm thickness), and 3D voxel models of the manually segmented bone cement were reconstructed, providing the ground truth. Afterwards, 90 degrees segments of each ex-vivo sample were scanned by the A-mode ultrasound system. To obtain better ultrasound penetration, we used coded signal excitation and pulse compression filtering. A-mode ultrasound signal detection, filtering and segmentation were accomplished fully automatically. Subsequently, 3D voxel models of each sample were calculated. Accuracy evaluation of the measured ultrasound data was performed by ICP matching of each ultrasound dataset ( approximately 8000 points) to the corresponding CT dataset and calculation of the residual median distance error between the corresponding datasets. Prior to each ICP matching, an initial pre-registration was calculated using prominent landmarks in the corresponding datasets. This method yielded a median distance error in the region of 0.25 mm for the cement-bone interface in both femur halves.