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Augmented reality surgical navigation with ultrasound-assisted registration for pedicle screw placement: a pilot study

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

Abstract

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 \(2.74{^{\circ }}\), 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 \(4.51{^{\circ }}\), and US-assisted registration yielded better targeting results than skin markers-based registration (targeting errors: 2.41 vs. 5.18 mm, angle errors: \(3.13{^{\circ }}\) vs. \(5.89{^{\circ }})\).

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.

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Acknowledgements

This work is supported in part by National Natural Science Foundation of China (Grant Nos. 81427803, 61361160417, 81271735), Grant-in-Aid of Project 985, and Beijing Municipal Science & Technology Commission (Z151100003915079).

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Author notes

  1. Longfei Ma and Zhe Zhao have contributed equally to this work.

Authors and Affiliations

  1. Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China

    Longfei Ma, Fang Chen, Boyu Zhang & Hongen Liao

  2. Department of Orthopedics, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218, China

    Zhe Zhao & Ligong Fu

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  1. Longfei Ma
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  2. Zhe Zhao
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  3. Fang Chen
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Correspondence to Hongen Liao.

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Ma, L., Zhao, Z., Chen, F. et al. Augmented reality surgical navigation with ultrasound-assisted registration for pedicle screw placement: a pilot study. Int J CARS 12, 2205–2215 (2017). https://doi.org/10.1007/s11548-017-1652-z

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  • DOI: https://doi.org/10.1007/s11548-017-1652-z

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