Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Preclinical evaluation of a prototype freehand drill video guidance system for orthopedic surgery

Preclinical evaluation of a prototype freehand drill video guidance system for orthopedic surgery Abstract.Purpose: Internal fixation of pelvic fractures is a challenging task requiring the placement of instrumentation within complex three-dimensional bone corridors, typically guided by fluoroscopy. We report a system for two- and three-dimensional guidance using a drill-mounted video camera and fiducial markers with evaluation in first preclinical studies.Approach: The system uses a camera affixed to a surgical drill and multimodality (optical and radio-opaque) markers for real-time trajectory visualization in fluoroscopy and/or CT. Improvements to a previously reported prototype include hardware components (mount, camera, and fiducials) and software (including a system for detecting marker perturbation) to address practical requirements necessary for translation to clinical studies. Phantom and cadaver experiments were performed to quantify the accuracy of video-fluoroscopy and video-CT registration, the ability to detect marker perturbation, and the conformance in placing guidewires along realistic pelvic trajectories. The performance was evaluated in terms of geometric accuracy and conformance within bone corridors.Results: The studies demonstrated successful guidewire delivery in a cadaver, with a median entry point error of 1.00 mm (1.56 mm IQR) and median angular error of 1.94 deg (1.23 deg IQR). Such accuracy was sufficient to guide K-wire placement through five of the six trajectories investigated with a strong level of conformance within bone corridors. The sixth case demonstrated a cortical breach due to extrema in the registration error. The system was able to detect marker perturbations and alert the user to potential registration issues. Feasible workflows were identified for orthopedic-trauma scenarios involving emergent cases (with no preoperative imaging) or cases with preoperative CT.Conclusions: A prototype system for guidewire placement was developed providing guidance that is potentially compatible with orthopedic-trauma workflow. First preclinical (cadaver) studies demonstrated accurate guidance of K-wire placement in pelvic bone corridors and the ability to automatically detect perturbations that degrade registration accuracy. The preclinical prototype demonstrated performance and utility supporting translation to clinical studies. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Medical Imaging SPIE

Preclinical evaluation of a prototype freehand drill video guidance system for orthopedic surgery

Download PDF
20 pages

Loading next page...
 
/lp/spie/preclinical-evaluation-of-a-prototype-freehand-drill-video-guidance-erv0ZGunz1
Publisher
SPIE
Copyright
© 2022 Society of Photo-Optical Instrumentation Engineers (SPIE)
ISSN
2329-4302
eISSN
2329-4310
DOI
10.1117/1.jmi.9.4.045004
Publisher site
See Article on Publisher Site

Abstract

Abstract.Purpose: Internal fixation of pelvic fractures is a challenging task requiring the placement of instrumentation within complex three-dimensional bone corridors, typically guided by fluoroscopy. We report a system for two- and three-dimensional guidance using a drill-mounted video camera and fiducial markers with evaluation in first preclinical studies.Approach: The system uses a camera affixed to a surgical drill and multimodality (optical and radio-opaque) markers for real-time trajectory visualization in fluoroscopy and/or CT. Improvements to a previously reported prototype include hardware components (mount, camera, and fiducials) and software (including a system for detecting marker perturbation) to address practical requirements necessary for translation to clinical studies. Phantom and cadaver experiments were performed to quantify the accuracy of video-fluoroscopy and video-CT registration, the ability to detect marker perturbation, and the conformance in placing guidewires along realistic pelvic trajectories. The performance was evaluated in terms of geometric accuracy and conformance within bone corridors.Results: The studies demonstrated successful guidewire delivery in a cadaver, with a median entry point error of 1.00 mm (1.56 mm IQR) and median angular error of 1.94 deg (1.23 deg IQR). Such accuracy was sufficient to guide K-wire placement through five of the six trajectories investigated with a strong level of conformance within bone corridors. The sixth case demonstrated a cortical breach due to extrema in the registration error. The system was able to detect marker perturbations and alert the user to potential registration issues. Feasible workflows were identified for orthopedic-trauma scenarios involving emergent cases (with no preoperative imaging) or cases with preoperative CT.Conclusions: A prototype system for guidewire placement was developed providing guidance that is potentially compatible with orthopedic-trauma workflow. First preclinical (cadaver) studies demonstrated accurate guidance of K-wire placement in pelvic bone corridors and the ability to automatically detect perturbations that degrade registration accuracy. The preclinical prototype demonstrated performance and utility supporting translation to clinical studies.

Journal

Journal of Medical Imaging – SPIE

Published: Jul 1, 2022

Keywords: surgical navigation; image-guided surgery; guidewire insertion; internal fixation; pelvic trauma

References

  • A nationwide analysis of pelvic ring fractures
    Buller, L. T.; Best, M. J.; Quinnan, S. M.
  • The epidemiology of pelvic ring fractures: a population-based study
    Balogh, Z.
  • 2D-fluoroscopic navigated percutaneous screw fixation of pelvic ring injuries - a case series
    Gras, F.
  • Clinical outcomes of unstable pelvic fractures in skeletally immature patients
    Smith, W.
  • Treatment and outcomes of pelvic malunions and nonunions: a systematic review
    Kanakaris, N. K.
  • Intraoperative fluoroscopic evaluation of screw placement during pelvic and acetabular surgery
    Yi, C.; Burns, S.; Hak, D. J.
  • Minimally invasive fluoro-navigation screw fixation for the treatment of pelvic ring injuries
    Gao, H.
  • 2D versus 3D fluoroscopy-based navigation in posterior pelvic fixation: review of the literature on current technology
    Thakkar, S. C.
  • Pelvic ring disruptions: effective classification system and treatment protocols
    Burgess, A. R.
  • Functional outcome of internal fixation for pelvic ring fractures
    Van Den Bosch, E. W.
  • Virtual fluoroscopy for intraoperative C-arm positioning and radiation dose reduction
    De Silva, T.
  • Minimally invasive screw fixation of unstable pelvic fractures using the “Blunt End” Kirschner wire technique assisted by 3D printed external template
    Chen, K.
  • Spinal navigation and imaging: history, trends, and future
    Helm, P. A.
  • Worldwide survey on the use of navigation in spine surgery
    Härtl, R.
  • Computer-assisted periacetabular screw placement: comparison of different fluoroscopy-based navigation procedures with conventional technique
    Ochs, B. G.
  • First generation computerized fluoroscopic navigation in percutaneous pelvic surgery
    Mosheiff, R.
  • Image guidance in pelvic and acetabular surgery-expectations, success and limitations
    Stöckle, U.; Schaser, K.; König, B.
  • Development of a fluoroscopically guided robotic assistant for instrument placement in pelvic trauma surgery
    Vijayan, R. C.
  • Image-guided robotic k-wire placement for orthopaedic trauma surgery
    Vijayan, R. C.
  • An electromagnetic “tracker-in-Table” configuration for x-ray fluoroscopy and cone-beam CT-guided surgery
    Yoo, J.
  • Camera augmented mobile C-arm (CAMC): calibration, accuracy study, and clinical applications
    Navab, N.; Heining, S. M.; Traub, J.
  • An on-board surgical tracking and video augmentation system for C-arm image guidance
    Reaungamornrat, S.
  • Design and evaluation of a portable intra-operative unified-planning-and-guidance framework applied to distal radius fracture surgery
    Magaraggia, J.
  • Drill-mounted video guidance for orthopaedic trauma surgery
    Vagdargi, P.
  • Calibration and registration of a freehand video-guided surgical drill for orthopaedic trauma
    Vagdargi, P.
  • Pre-clinical evaluation of a video-based drill guidance system for orthopaedic trauma surgery
    Sheth, N. M.
  • Automatic generation and detection of highly reliable fiducial markers under occlusion
    Garrido-Jurado, S.
  • Generation of fiducial marker dictionaries using mixed integer linear programming
    Garrido-Jurado, S.
  • Atlas-based automatic planning and 3D-2D fluoroscopic guidance in pelvic trauma surgery
    Han, R.
  • TREK: an integrated system architecture for intraoperative cone-beam CT-guided surgery
    Uneri, A.
  • 3D–2D registration for surgical guidance: effect of projection view angles on registration accuracy
    Uneri, A.
  • Multi-body 3D-2D registration for image-guided reduction of pelvic dislocation in orthopaedic trauma surgery
    Han, R.
  • Planning, guidance, and quality assurance of pelvic screw placement using deformable image registration
    Goerres, J.
  • Predicting error in rigid-body point-based registration
    Michael Fitzpatrick, J.; West, J. B.; Maurer, C. R.
  • Fiducial registration error and target registration error are uncorrelated
    Fitzpatrick, J. M.
  • Are fiducial registration error and target registration error correlated? SciKit-SurgeryFRED for teaching and research
    Thompson, S. A.
  • Fast, intuitive, vision-based: performance metrics for visual registration, instrument guidance, and image fusion
    Basafa, E.; Hoßbach, M.; Stolka, P. J.
  • Implementation, calibration and accuracy testing of an image-enhanced endoscopy system
    Shahidi, R.
  • Stereotactic biopsies guided by an optical navigation system: technique and clinical experience
    Grunert, P.
  • What are the optimal targeting visualizations for performing surgical navigation of iliosacral screws? A user study
    Pandey, P. U.
  • Visualization task performance with 2D, 3D, and combination displays
    Tory, M.
  • Ensuring navigation integrity using robotics in spine surgery
    Crawford, N.; Johnson, N.; Theodore, N.
  • Comparison of 3 optical navigation systems for computer-aided maxillofacial surgery
    Strong, E. B.
  • Comparison of two electromagnetic navigation systems for CT-guided punctures: a phantom study Elektromagnetische Navigationssysteme im Vergleich: CT-gezielte Punktionen an einem Phantom
    Putzer, D.
  • Early experience of placing image-guided minimally invasive pedicle screws without K-wires or bone-anchored trackers
    Malham, G. M.; Parker, R. M.
  • The prevention of wound contamination by skin organisms by the pre-operative application of an iodophor impregnated plastic adhesive drape
    Fairclough, J. A.; Johnson, D.; Mackie, I.
  • Known-component 3D–2D registration for quality assurance of spine surgery pedicle screw placement
    Uneri, A.
  • Separation of concerns
    Glaser, J. D.; O’Hanley, R.
  • Platform-based design and software design methodology for embedded systems
    Sangiovanni-Vincentelli, A.; Martin, G.
  • 3D slicer
    Pieper, S.; Halle, M.; Kikinis, R.
  • OpenIGTLink: an open network protocol for image-guided therapy environment
    Tokuda, J.