Intra-Operative Fiducial-Based CT/Fluoroscope Image Registration Framework for Image-Guided Robot-Assisted Joint Fracture Surgery
Author(s)
Type
Journal Article
Abstract
Purpose Joint fractures must be accurately reduced minimising
soft tissue damages to avoid negative surgical outcomes.
To this regard, we have developed the RAFS surgical
system, which allows the percutaneous reduction of intraarticular
fractures and provides intra-operative real-time 3D
image guidance to the surgeon. Earlier experiments showed
the effectiveness of the RAFS system on phantoms, but also
key issues which precluded its use in a clinical application.
This work proposes a redesign of the RAFS’s navigation system
overcoming the earlier version’s issues, aiming to move
the RAFS system into a surgical environment.
Methods The navigation system is improved through an
image registration framework allowing the intra-operative
registration between pre-operative CT images and intraoperative
fluoroscopic images of a fractured bone using a
custom-made fiducial marker. The objective of the registration
is to estimate the relative pose between a bone fragment
and an orthopaedic manipulation pin inserted into it intraoperatively.
The actual pose of the bone fragment can be
updated in real time using an optical tracker, enabling the
image guidance.
Results Experiments on phantom and cadavers demonstrated
the accuracy and reliability of the registration framework,
showing a reduction accuracy (sTRE) of about 0.88 ±
0.2 mm (phantom) and 1.15±0.8 mm (cadavers). Four distal
femur fractures were successfully reduced in cadaveric specimens using the improved navigation system and the RAFS
system following the new clinical workflow (reduction error
1.2 ± 0.3 mm, 2 ± 1◦).
Conclusion Experiments showed the feasibility of the image
registration framework. It was successfully integrated into
the navigation system, allowing the use of the RAFS system
in a realistic surgical application.
soft tissue damages to avoid negative surgical outcomes.
To this regard, we have developed the RAFS surgical
system, which allows the percutaneous reduction of intraarticular
fractures and provides intra-operative real-time 3D
image guidance to the surgeon. Earlier experiments showed
the effectiveness of the RAFS system on phantoms, but also
key issues which precluded its use in a clinical application.
This work proposes a redesign of the RAFS’s navigation system
overcoming the earlier version’s issues, aiming to move
the RAFS system into a surgical environment.
Methods The navigation system is improved through an
image registration framework allowing the intra-operative
registration between pre-operative CT images and intraoperative
fluoroscopic images of a fractured bone using a
custom-made fiducial marker. The objective of the registration
is to estimate the relative pose between a bone fragment
and an orthopaedic manipulation pin inserted into it intraoperatively.
The actual pose of the bone fragment can be
updated in real time using an optical tracker, enabling the
image guidance.
Results Experiments on phantom and cadavers demonstrated
the accuracy and reliability of the registration framework,
showing a reduction accuracy (sTRE) of about 0.88 ±
0.2 mm (phantom) and 1.15±0.8 mm (cadavers). Four distal
femur fractures were successfully reduced in cadaveric specimens using the improved navigation system and the RAFS
system following the new clinical workflow (reduction error
1.2 ± 0.3 mm, 2 ± 1◦).
Conclusion Experiments showed the feasibility of the image
registration framework. It was successfully integrated into
the navigation system, allowing the use of the RAFS system
in a realistic surgical application.
Date Issued
2017-05-04
Date Acceptance
2017-04-25
Citation
International Journal of Computer Assisted Radiology and Surgery, 2017, 12, pp.1383-1397
ISSN
1861-6429
Publisher
Springer Verlag
Start Page
1383
End Page
1397
Journal / Book Title
International Journal of Computer Assisted Radiology and Surgery
Volume
12
Copyright Statement
© The Author(s) 2017. This article is an open access publication
License URL
Subjects
Science & Technology
Technology
Life Sciences & Biomedicine
Engineering, Biomedical
Radiology, Nuclear Medicine & Medical Imaging
Surgery
Engineering
Intra-operative registration
Image-guided surgery
Minimally invasive fracture surgery
Robot-assisted surgery
CT/fluoroscopy data
INTENSIFIER DISTORTION CORRECTION
X-RAY
RIGID REGISTRATION
REDUCTION
SYSTEM
FLUOROSCOPY
EXPERIENCE
NEED
CT
1103 Clinical Sciences
Nuclear Medicine & Medical Imaging
Publication Status
Published