Abstract
Purpose
An accurate and reliable benchmark of registration accuracy and intervertebral motion compensation is important for spinal image guidance. In this study, we evaluated the utility of intraoperative CT (iCT) in place of bone-implanted screws as the ground-truth registration and illustrated its use to benchmark the performance of intraoperative stereovision (iSV).
Methods
A template-based, multi-body registration scheme was developed to individually segment and pair corresponding vertebrae between preoperative CT and iCT of the spine. Intervertebral motion was determined from the resulting vertebral pair-wise registrations. The accuracy of the image-driven registration was evaluated using surface-to-surface distance error (SDE) based on segmented bony features and was independently verified using point-to-point target registration error (TRE) computed from bone-implanted mini-screws. Both SDE and TRE were used to assess the compensation accuracy using iSV.
Results
The iCT-based technique was evaluated on four explanted porcine spines (20 vertebral pairs) with artificially induced motion. We report a registration accuracy of 0.57 \(\pm \) 0.32 mm (range 0.34–1.14 mm) and 0.29 \(\pm \) 0.15 mm (range 0.14–0.78 mm) in SDE and TRE, respectively, for all vertebrae pooled, with an average intervertebral rotation of \(4.9^{\circ } \pm 1.2^{\circ }\) (range 1.5\(^{\circ }\)–7.9\(^{\circ }\)). The iSV-based compensation accuracy for one sample (four vertebrae) was 1.32 \(\pm \) 0.19 mm and 1.72 \(\pm \) 0.55 mm in SDE and TRE, respectively, exceeding the recommended accuracy of 2 mm.
Conclusion
This study demonstrates the effectiveness of iCT in place of invasive fiducials as a registration ground truth. These findings are important for future development of on-demand spinal image guidance using radiation-free images such as stereovision and ultrasound on human subjects.
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Acknowledgments
This work was supported, in part, by the NIH R21 NS078607, The Dartmouth Clinical and Translational Science Institute under Award Number KL2TR001088 from the National Center for Advancing Translational Sciences (NCATS) of the NIH (SJ), and the Dow-Crichlow Award (SSL). The content is solely the responsibility of the author(s) and does not necessarily represent the official views of Dartmouth SYNERGY or the NIH. The authors are grateful to Dr. Timothy Schaewe for technical assistance on SteathLink\(^\circledR \) and help from the Medtronic Navigation (Louisville, CO, USA).
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K.D. Paulsen and D.W. Roberts receive research support from Medtronic Inc. and Carl Zeiss Inc. D.W. Roberts serves on the scientific advisory board for Medtronic Inc., Carl Zeiss Inc., and IMRIS Inc. Other authors declare that they have no conflict of interest.
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Ji, S., Fan, X., Paulsen, K.D. et al. Intraoperative CT as a registration benchmark for intervertebral motion compensation in image-guided open spinal surgery. Int J CARS 10, 2009–2020 (2015). https://doi.org/10.1007/s11548-015-1255-5
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DOI: https://doi.org/10.1007/s11548-015-1255-5