Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China.
Department of Orthopedics, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218, China.
Int J Comput Assist Radiol Surg. 2017 Dec;12(12):2205-2215. doi: 10.1007/s11548-017-1652-z. Epub 2017 Aug 5.
PURPOSE: We present a novel augmented reality (AR) surgical navigation system based on ultrasound-assisted registration for pedicle screw placement. This system provides the clinically desired targeting accuracy and reduces radiation exposure. METHODS: Ultrasound (US) is used to perform registration between preoperative computed tomography (CT) images and patient, and the registration is performed by least-squares fitting of these two three-dimensional (3D) point sets of anatomical landmarks taken from US and CT images. An integral videography overlay device is calibrated to accurately display naked-eye 3D images for surgical navigation. We use a 3.0-mm Kirschner wire (K-wire) instead of a pedicle screw in this study, and the K-wire is calibrated to obtain its orientation and tip location. Based on the above registration and calibration, naked-eye 3D images of the planning path and the spine are superimposed onto patient in situ using our AR navigation system. Simultaneously, a 3D image of the K-wire is overlaid accurately on the real one to guide the insertion procedure. The targeting accuracy is evaluated postoperatively by performing a CT scan. RESULTS: An agar phantom experiment was performed. Eight K-wires were inserted successfully after US-assisted registration, and the mean targeting error and angle error were 3.35 mm and [Formula: see text], respectively. Furthermore, an additional sheep cadaver experiment was performed. Four K-wires were inserted successfully. The mean targeting error was 3.79 mm and the mean angle error was [Formula: see text], and US-assisted registration yielded better targeting results than skin markers-based registration (targeting errors: 2.41 vs. 5.18 mm, angle errors: [Formula: see text] vs. [Formula: see text]. CONCLUSION: Experimental outcomes demonstrate that the proposed navigation system has acceptable targeting accuracy. In particular, the proposed navigation method reduces repeated radiation exposure to the patient and surgeons. Therefore, it has promising prospects for clinical use.
目的：我们提出了一种基于超声辅助配准的新型增强现实（AR）手术导航系统，用于椎弓根螺钉放置。该系统提供了临床所需的定位精度，并降低了辐射暴露。
方法：使用超声（US）在术前计算机断层扫描（CT）图像和患者之间执行配准，并通过对来自 US 和 CT 图像的这两个解剖标志的三维（3D）点集进行最小二乘拟合来执行配准。一个集成的录像叠加设备经过校准，可以准确显示用于手术导航的肉眼 3D 图像。在这项研究中，我们使用 3.0 毫米的克氏针（K-wire）代替椎弓根螺钉，并用其校准来获得其方向和尖端位置。基于上述注册和校准，我们的 AR 导航系统将规划路径和脊柱的肉眼 3D 图像叠加到患者原位。同时，准确地将 K-wire 的 3D 图像叠加在真实的 K-wire 上，以指导插入过程。通过术后进行 CT 扫描评估定位准确性。
结果：进行了琼脂体模实验。在 US 辅助配准后成功插入了 8 根 K-wire，平均定位误差和角度误差分别为 3.35 毫米和 [Formula: see text]。此外，还进行了额外的绵羊尸体实验。成功插入了 4 根 K-wire。平均定位误差为 3.79 毫米，平均角度误差为 [Formula: see text]，US 辅助配准的定位结果优于皮肤标记物辅助配准（定位误差：2.41 毫米比 5.18 毫米，角度误差：[Formula: see text]比 [Formula: see text]）。
结论：实验结果表明，所提出的导航系统具有可接受的定位精度。特别是，所提出的导航方法减少了患者和外科医生的重复辐射暴露。因此，它具有广阔的临床应用前景。
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