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Intra-operative fiducial-based CT/fluoroscope image registration framework for image-guided robot-assisted joint fracture surgery

Dagnino, Giulio; Georgilas, Ioannis; Morad, Samir; Gibbons, Peter; Tarassoli, Payam; Atkins, Roger; Dogramadzi, Sanja

Intra-operative fiducial-based CT/fluoroscope image registration framework for image-guided robot-assisted joint fracture surgery Thumbnail


Authors

Giulio Dagnino

Ioannis Georgilas

Samir Morad

Peter Gibbons

Payam Tarassoli

Roger Atkins



Abstract

© 2017, The Author(s). 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 intra-articular 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 intra-operative 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 intra-operatively. 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±0.2mm (phantom) and 1.15±0.8mm (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±0.3mm, 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.

Citation

Dagnino, G., Georgilas, I., Morad, S., Gibbons, P., Tarassoli, P., Atkins, R., & Dogramadzi, S. (2017). Intra-operative fiducial-based CT/fluoroscope image registration framework for image-guided robot-assisted joint fracture surgery. International Journal of Computer Assisted Radiology and Surgery, 12(8), 1383-1397. https://doi.org/10.1007/s11548-017-1602-9

Journal Article Type Article
Acceptance Date Apr 25, 2017
Online Publication Date May 4, 2017
Publication Date Aug 1, 2017
Deposit Date May 10, 2017
Publicly Available Date Mar 28, 2024
Journal International Journal of Computer Assisted Radiology and Surgery
Print ISSN 1861-6410
Electronic ISSN 1861-6429
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 12
Issue 8
Pages 1383-1397
DOI https://doi.org/10.1007/s11548-017-1602-9
Keywords intra-operative registration, image-guided surgery, minimally invasive fracture surgery, robot-assisted surgery, CT/fluoroscopy data
Public URL https://uwe-repository.worktribe.com/output/882372
Publisher URL http://dx.doi.org/10.1007/s11548-017-1602-9
Additional Information Additional Information : The final publication is available at Springer via http://dx.doi.org/10.1007/s11548-017-1602-9

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