Goerres J, Jacobson M, Uneri A, De Silva T, Ketcha M, Reaungamornrat S, Vogt S, Kleinszig G, Wolinsky J-P, Osgood G, Siewerdsen J H
Johns Hopkins University, Biomedical Engineering, Baltimore, United States.
Siemens, Healthcare XP, Erlangen, Germany.
Proc SPIE Int Soc Opt Eng. 2017 Mar;10135. doi: 10.1117/12.2255952.
Pelvic Kirschner wire (K-wire) insertion is a challenging surgical task requiring interpretation of complex 3D anatomical shape from 2D projections (fluoroscopy) and delivery of device trajectories within fairly narrow bone corridors in proximity to adjacent nerves and vessels. Over long trajectories (~10-25 cm), K-wires tend to curve (deform), making conventional rigid navigation inaccurate at the tip location. A system is presented that provides accurate 3D localization and guidance of rigid or deformable surgical devices ("components" - e.g., K-wires) based on 3D-2D registration. The patient is registered to a preoperative CT image by virtually projecting digitally reconstructed radiographs (DRRs) and matching to two or more intraoperative x-ray projections. The K-wire is localized using an analogous procedure matching DRRs of a deformably parametrized model for the device component (deformable known-component registration, or dKC-Reg). A cadaver study was performed in which a K-wire trajectory was delivered in the pelvis. The system demonstrated target registration error (TRE) of 2.1 ± 0.3 mm in location of the K-wire tip (median ± interquartile range, IQR) and 0.8 ± 1.4° in orientation at the tip (median ± IQR), providing functionality analogous to surgical tracking/navigation using imaging systems already in the surgical arsenal without reliance on a surgical tracker. The method offers quantitative 3D guidance using images (e.g., inlet/outlet views) already acquired in the standard of care, potentially extending the advantages of navigation to broader utilization in trauma surgery to improve surgical precision and safety.
骨盆克氏针插入是一项具有挑战性的外科手术任务，需要从二维投影（荧光透视）解读复杂的三维解剖形状，并在靠近相邻神经和血管的相当狭窄的骨通道内输送器械轨迹。在较长轨迹（约10 - 25厘米）上，克氏针容易弯曲（变形），使得传统的刚性导航在针尖位置不准确。本文介绍了一种基于三维 - 二维配准提供刚性或可变形外科器械（“组件”——例如克氏针）精确三维定位和引导的系统。通过虚拟投射数字重建射线照片（DRR）并与两张或更多术中X光投影匹配，将患者与术前CT图像进行配准。使用类似的程序，通过匹配器械组件的可变形参数化模型的DRR来定位克氏针（可变形已知组件配准，或dKC - Reg）。进行了一项尸体研究，在骨盆中输送克氏针轨迹。该系统在克氏针尖位置的目标配准误差（TRE）为2.1±0.3毫米（中位数±四分位间距，IQR），在针尖方向上为0.8±1.4°（中位数±IQR），提供了类似于使用手术器械库中现有成像系统进行手术跟踪/导航的功能，而无需依赖手术跟踪器。该方法使用在标准治疗中已经获取的图像（例如入口/出口视图）提供定量三维引导，有可能将导航的优势扩展到创伤手术中更广泛的应用，以提高手术精度和安全性。
