Digital Medical Research Center of Shanghai Medical College, Fudan University, Shanghai, and Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Shanghai, China.
Int J Med Robot. 2014 Mar;10(1):55-64. doi: 10.1002/rcs.1509. Epub 2013 Jun 3.
Accurate patient to image registration is the core for successful image-guided neurosurgery. While skin adhesive markers (SMs) are widely used in point-matching registration, a proper implementation of anatomical landmarks (ALs) may overcome the inconvenience brought by the use of SMs.
Using nine ALs, a set of three configurations of different combinations of them is proposed. These configurations are defined according to the required positioning of the patient's head during surgery and the resulting distribution of the expected target registration error (TRE). These configurations were first evaluated by simulation experiment using the data of 20 patients from two hospitals, and then testing the applicability of them in eight real clinical surgeries of neuronavigation.
The results of the simulation experiment showed that, by incorporating a fiducial registration error (FRE) of 3.5 mm measured in the clinical setting, the expected TRE in the whole skull was less than 2.5 mm, and the expected TRE in the whole brain was less than 1.75 mm when using all the nine ALs. A small TRE could also be achieved in the corresponding surgical field by using the other three configurations with less ALs. In the clinical experiment, the FLE ranges in the image and the patient space were 1.4-3.6 mm and 1.6-5.5 mm, respectively. The measured TRE and FRE were 3.1 ± 0.75 mm and 3.5 ± 0.17 mm, respectively.
The AL configurations proposed in this investigation provide sufficient registration accuracy and can help to avoid the disadvantages of SMs if used clinically.
准确的患者与图像配准是成功实施影像引导神经外科手术的核心。虽然皮肤粘贴标记物（SMs）广泛用于点匹配配准，但适当实施解剖学标志（ALs）可以克服使用 SMs 带来的不便。
使用九个 ALs，提出了一组三种不同组合的配置。这些配置是根据手术中患者头部的所需定位以及预期目标配准误差（TRE）的分布来定义的。这些配置首先通过来自两家医院的 20 名患者的数据进行模拟实验评估，然后在 8 例神经导航的实际临床手术中测试其适用性。
模拟实验的结果表明，通过纳入临床环境中测量的 3.5mm 的基准注册误差（FRE），整个颅骨的预期 TRE 小于 2.5mm，当使用所有九个 ALs 时，整个大脑的预期 TRE 小于 1.75mm。当使用更少的 ALs 时，通过使用其他三种配置也可以在相应的手术区域实现较小的 TRE。在临床实验中，图像空间和患者空间中的 FLE 范围分别为 1.4-3.6mm 和 1.6-5.5mm。测量的 TRE 和 FRE 分别为 3.1±0.75mm 和 3.5±0.17mm。
本研究中提出的 AL 配置提供了足够的配准精度，如果在临床上使用，可以帮助避免 SMs 的缺点。
