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A hybrid registration method using the mandibular bone surface for electromagnetic navigation in mandibular surgery

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

To utilize navigated mandibular (reconstructive) surgery, accurate registration of the preoperative CT scan with the actual patient in the operating room (OR) is required. In this phantom study, the feasibility of a noninvasive hybrid registration method is assessed. This method consists of a point registration with anatomic landmarks for initialization and a surface registration using the bare mandibular bone surface for optimization.

Methods

Three mandible phantoms with reference notches on two osteotomy planes were 3D printed. An electromagnetic tracking system in combination with 3D Slicer software was used for navigation. Different configurations, i.e., different surface point areas and number and configuration of surface points, were tested with a dentate phantom (A) in a metal-free environment. To simulate the intraoperative environment and different anatomies, the registration procedure was also performed with an OR bed using the dentate phantom and two (partially) edentulous phantoms with atypical anatomy (B and C). The accuracy of the registration was calculated using the notches on the osteotomy planes and was expressed as the target registration error (TRE). TRE values of less than 2.0 mm were considered as clinically acceptable.

Results

In all experiments, the mean TRE was less than 2.0 mm. No differences were found using different surface point areas or number or configurations of surface points. Registration accuracy in the simulated intraoperative setting was—mean (SD)—0.96 (0.22), 0.93 (0.26), and 1.50 (0.28) mm for phantom A, phantom B, and phantom C.

Conclusion

Hybrid registration is a noninvasive method that requires only a small area of the bare mandibular bone surface to obtain high accuracy in phantom setting. Future studies should test this method in clinical setting during actual surgery.

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Data availability

The authors are willing to share the data for further research purposes.

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Acknowledgements

The authors thank the clinical implementation team from the Netherlands Cancer Institute for using their equipment and for their help during the conceptualization of the experiments.

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Verwelius 3D Lab, Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands

    A. F. de Geer, M. J. A. van Alphen, C. L. Zuur, R. L. P. van Veen & M. B. Karakullukcu

  2. Educational Program Technical Medicine, Leiden University Medical Center, Delft University of Technology, Erasmus University Medical Center, Leiden, Delft, Rotterdam, The Netherlands

    A. F. de Geer

  3. Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands

    C. L. Zuur

  4. Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands

    A. J. Loeve

Authors
  1. A. F. de Geer
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  2. M. J. A. van Alphen
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  3. C. L. Zuur
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  4. A. J. Loeve
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Contributions

All authors contributed to conceptualization and methodology, AFG contributed to formal analysis and investigation, AFG contributed to writing—original draft, MJAA, CLZ, AJL, RLPV, MBK contributed to writing—review and editing, MJAA, CLZ, AJL, RLPV, MBK contributed to supervision.

Corresponding author

Correspondence to M. J. A. van Alphen.

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de Geer, A.F., van Alphen, M.J.A., Zuur, C.L. et al. A hybrid registration method using the mandibular bone surface for electromagnetic navigation in mandibular surgery. Int J CARS 17, 1343–1353 (2022). https://doi.org/10.1007/s11548-022-02610-6

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  • DOI: https://doi.org/10.1007/s11548-022-02610-6

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