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Title: WE-AB-BRA-09: Registration of Preoperative MRI to Intraoperative Radiographs for Automatic Vertebral Target Localization

Abstract

Purpose: Accurate localization of target vertebrae is essential to safe, effective spine surgery, but wrong-level surgery occurs with surprisingly high frequency. Recent research yielded the “LevelCheck” method for 3D-2D registration of preoperative CT to intraoperative radiographs, providing decision support for level localization. We report a new method (MR-LevelCheck) to perform 3D-2D registration based on preoperative MRI, presenting a solution for the increasingly common scenario in which MRI (not CT) is used for preoperative planning. Methods: Direct extension of LevelCheck is confounded by large mismatch in image intensity between MRI and radiographs. The proposed method overcomes such challenges with a simple vertebrae segmentation. Using seed points at centroids, vertebrae are segmented using continuous max-flow method and dilated by 1.8 mm to include surrounding cortical bone (inconspicuous in T2w-MRI). MRI projections are computed (analogous to DRR) using segmentation and registered to intraoperative radiographs. The method was tested in a retrospective IRB-approved study involving 11 patients undergoing cervical, thoracic, or lumbar spine surgery following preoperative MRI. Registration accuracy was evaluated in terms of projection-distance-error (PDE) between the true and estimated location of vertebrae in each radiograph. Results: The method successfully registered each preoperative MRI to intraoperative radiographs and maintained desirable properties of robustnessmore » against image content mismatch, and large capture range. Segmentation achieved Dice coefficient = 89.2 ± 2.3 and mean-absolute-distance (MAD) = 1.5 ± 0.3 mm. Registration demonstrated robust performance under realistic patient variations, with PDE = 4.0 ± 1.9 mm (median ± iqr) and converged with run-time = 23.3 ± 1.7 s. Conclusion: The MR-LevelCheck algorithm provides an important extension to a previously validated decision support tool in spine surgery by extending its utility to preoperative MRI. With initial studies demonstrating PDE <5 mm and 0% failure rate, the method is now in translation to larger scale prospective clinical studies. S. Vogt and G. Kleinszig are employees of Siemens Healthcare.« less

Authors:
; ; ; ;  [1]; ;  [2];  [3];
  1. Johns Hopkins University, Baltimore, MD (United States)
  2. Siemens Healthcare, Erlangen (Germany)
  3. The Johns Hopkins Hospital, Baltimore, MD (United States)
Publication Date:
OSTI Identifier:
22654099
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; IMAGES; MATHEMATICAL SOLUTIONS; NMR IMAGING; SURGERY; VERTEBRAE

Citation Formats

De Silva, T, Uneri, A, Ketcha, M, Reaungamornrat, S, Goerres, J, Vogt, S, Kleinszig, G, Wolinsky, J, and Siewerdsen, JH. WE-AB-BRA-09: Registration of Preoperative MRI to Intraoperative Radiographs for Automatic Vertebral Target Localization. United States: N. p., 2016. Web. doi:10.1118/1.4957738.
De Silva, T, Uneri, A, Ketcha, M, Reaungamornrat, S, Goerres, J, Vogt, S, Kleinszig, G, Wolinsky, J, & Siewerdsen, JH. WE-AB-BRA-09: Registration of Preoperative MRI to Intraoperative Radiographs for Automatic Vertebral Target Localization. United States. doi:10.1118/1.4957738.
De Silva, T, Uneri, A, Ketcha, M, Reaungamornrat, S, Goerres, J, Vogt, S, Kleinszig, G, Wolinsky, J, and Siewerdsen, JH. 2016. "WE-AB-BRA-09: Registration of Preoperative MRI to Intraoperative Radiographs for Automatic Vertebral Target Localization". United States. doi:10.1118/1.4957738.
@article{osti_22654099,
title = {WE-AB-BRA-09: Registration of Preoperative MRI to Intraoperative Radiographs for Automatic Vertebral Target Localization},
author = {De Silva, T and Uneri, A and Ketcha, M and Reaungamornrat, S and Goerres, J and Vogt, S and Kleinszig, G and Wolinsky, J and Siewerdsen, JH},
abstractNote = {Purpose: Accurate localization of target vertebrae is essential to safe, effective spine surgery, but wrong-level surgery occurs with surprisingly high frequency. Recent research yielded the “LevelCheck” method for 3D-2D registration of preoperative CT to intraoperative radiographs, providing decision support for level localization. We report a new method (MR-LevelCheck) to perform 3D-2D registration based on preoperative MRI, presenting a solution for the increasingly common scenario in which MRI (not CT) is used for preoperative planning. Methods: Direct extension of LevelCheck is confounded by large mismatch in image intensity between MRI and radiographs. The proposed method overcomes such challenges with a simple vertebrae segmentation. Using seed points at centroids, vertebrae are segmented using continuous max-flow method and dilated by 1.8 mm to include surrounding cortical bone (inconspicuous in T2w-MRI). MRI projections are computed (analogous to DRR) using segmentation and registered to intraoperative radiographs. The method was tested in a retrospective IRB-approved study involving 11 patients undergoing cervical, thoracic, or lumbar spine surgery following preoperative MRI. Registration accuracy was evaluated in terms of projection-distance-error (PDE) between the true and estimated location of vertebrae in each radiograph. Results: The method successfully registered each preoperative MRI to intraoperative radiographs and maintained desirable properties of robustness against image content mismatch, and large capture range. Segmentation achieved Dice coefficient = 89.2 ± 2.3 and mean-absolute-distance (MAD) = 1.5 ± 0.3 mm. Registration demonstrated robust performance under realistic patient variations, with PDE = 4.0 ± 1.9 mm (median ± iqr) and converged with run-time = 23.3 ± 1.7 s. Conclusion: The MR-LevelCheck algorithm provides an important extension to a previously validated decision support tool in spine surgery by extending its utility to preoperative MRI. With initial studies demonstrating PDE <5 mm and 0% failure rate, the method is now in translation to larger scale prospective clinical studies. S. Vogt and G. Kleinszig are employees of Siemens Healthcare.},
doi = {10.1118/1.4957738},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: This study introduces a probabilistic nonrigid registration method for use in image-guided prostate brachytherapy. Intraoperative imaging for prostate procedures, usually transrectal ultrasound (TRUS), is typically inferior to diagnostic-quality imaging of the pelvis such as endorectal magnetic resonance imaging (MRI). MR images contain superior detail of the prostate boundaries and provide substructure features not otherwise visible. Previous efforts to register diagnostic prostate images with the intraoperative coordinate system have been deterministic and did not offer a measure of the registration uncertainty. The authors developed a Bayesian registration method to estimate the posterior distribution on deformations and provide a case-specific measuremore » of the associated registration uncertainty. Methods: The authors adapted a biomechanical-based probabilistic nonrigid method to register diagnostic to intraoperative images by aligning a physician's segmentations of the prostate in the two images. The posterior distribution was characterized with a Markov Chain Monte Carlo method; the maximum a posteriori deformation and the associated uncertainty were estimated from the collection of deformation samples drawn from the posterior distribution. The authors validated the registration method using a dataset created from ten patients with MRI-guided prostate biopsies who had both diagnostic and intraprocedural 3 Tesla MRI scans. The accuracy and precision of the estimated posterior distribution on deformations were evaluated from two predictive distance distributions: between the deformed central zone-peripheral zone (CZ-PZ) interface and the physician-labeled interface, and based on physician-defined landmarks. Geometric margins on the registration of the prostate's peripheral zone were determined from the posterior predictive distance to the CZ-PZ interface separately for the base, mid-gland, and apical regions of the prostate. Results: The authors observed variation in the shape and volume of the segmented prostate in diagnostic and intraprocedural images. The probabilistic method allowed us to convey registration results in terms of posterior distributions, with the dispersion providing a patient-specific estimate of the registration uncertainty. The median of the predictive distance distribution between the deformed prostate boundary and the segmented boundary was Less-Than-Or-Slanted-Equal-To 3 mm (95th percentiles within {+-}4 mm) for all ten patients. The accuracy and precision of the internal deformation was evaluated by comparing the posterior predictive distance distribution for the CZ-PZ interface for each patient, with the median distance ranging from -0.6 to 2.4 mm. Posterior predictive distances between naturally occurring landmarks showed registration errors of Less-Than-Or-Slanted-Equal-To 5 mm in any direction. The uncertainty was not a global measure, but instead was local and varied throughout the registration region. Registration uncertainties were largest in the apical region of the prostate. Conclusions: Using a Bayesian nonrigid registration method, the authors determined the posterior distribution on deformations between diagnostic and intraprocedural MR images and quantified the uncertainty in the registration results. The feasibility of this approach was tested and results were positive. The probabilistic framework allows us to evaluate both patient-specific and location-specific estimates of the uncertainty in the registration result. Although the framework was tested on MR-guided procedures, the preliminary results suggest that it may be applied to TRUS-guided procedures as well, where the addition of diagnostic MR information may have a larger impact on target definition and clinical guidance.« less
  • Purpose: To evaluate localization accuracy resulting from rigid registration of locally-advanced lung cancer targets using fully automatic and semi-automatic protocols for image-guided radiation therapy. Methods: Seventeen lung cancer patients, fourteen also presenting with involved lymph nodes, received computed tomography (CT) scans once per week throughout treatment under active breathing control. A physician contoured both lung and lymph node targets for all weekly scans. Various automatic and semi-automatic rigid registration techniques were then performed for both individual and simultaneous alignments of the primary gross tumor volume (GTV{sub P}) and involved lymph nodes (GTV{sub LN}) to simulate the localization process in image-guidedmore » radiation therapy. Techniques included ''standard'' (direct registration of weekly images to a planning CT), ''seeded'' (manual prealignment of targets to guide standard registration), ''transitive-based'' (alignment of pretreatment and planning CTs through one or more intermediate images), and ''rereferenced'' (designation of a new reference image for registration). Localization error (LE) was assessed as the residual centroid and border distances between targets from planning and weekly CTs after registration. Results: Initial bony alignment resulted in centroid LE of 7.3 {+-} 5.4 mm and 5.4 {+-} 3.4 mm for the GTV{sub P} and GTV{sub LN}, respectively. Compared to bony alignment, transitive-based and seeded registrations significantly reduced GTV{sub P} centroid LE to 4.7 {+-} 3.7 mm (p = 0.011) and 4.3 {+-} 2.5 mm (p < 1 x 10{sup -3}), respectively, but the smallest GTV{sub P} LE of 2.4 {+-} 2.1 mm was provided by rereferenced registration (p < 1 x 10{sup -6}). Standard registration significantly reduced GTV{sub LN} centroid LE to 3.2 {+-} 2.5 mm (p < 1 x 10{sup -3}) compared to bony alignment, with little additional gain offered by the other registration techniques. For simultaneous target alignment, centroid LE as low as 3.9 {+-} 2.7 mm and 3.8 {+-} 2.3 mm were achieved for the GTV{sub P} and GTV{sub LN}, respectively, using rereferenced registration. Conclusions: Target shape, volume, and configuration changes during radiation therapy limited the accuracy of standard rigid registration for image-guided localization in locally-advanced lung cancer. Significant error reductions were possible using other rigid registration techniques, with LE approaching the lower limit imposed by interfraction target variability throughout treatment.« less
  • Purpose: To improve the quality of mega-voltage orthogonal scout images (MV topograms) for a fast and low-dose alternative technique for patient localization on the TomoTherapy HiART system. Methods: Digitally reconstructed radiographs (DRR) of anthropomorphic head and pelvis phantoms were synthesized from kVCT under TomoTherapy geometry (kV-DRR). Lateral (LAT) and anterior-posterior (AP) aligned topograms were acquired with couch speeds of 1cm/s, 2cm/s, and 3cm/s. The phantoms were rigidly translated in all spatial directions with known offsets in increments of 5mm, 10mm, and 15mm to simulate daily positioning errors. The contrast of the MV topograms was automatically adjusted based on the imagemore » intensity characteristics. A low-pass fast Fourier transform filter removed high-frequency noise and a Weiner filter reduced stochastic noise caused by scattered radiation to the detector array. An intensity-based image registration algorithm was used to register the MV topograms to a corresponding kV-DRR by minimizing the mean square error between corresponding pixel intensities. The registration accuracy was assessed by comparing the normalized cross correlation coefficients (NCC) between the registered topograms and the kV-DRR. The applied phantom offsets were determined by registering the MV topograms with the kV-DRR and recovering the spatial translation of the MV topograms. Results: The automatic registration technique provided millimeter accuracy and was robust for the deformed MV topograms for three tested couch speeds. The lowest average NCC for all AP and LAT MV topograms was 0.96 for the head phantom and 0.93 for the pelvis phantom. The offsets were recovered to within 1.6mm and 6.5mm for the processed and the original MV topograms respectively. Conclusion: Automatic registration of the processed MV topograms to a corresponding kV-DRR recovered simulated daily positioning errors that were accurate to the order of a millimeter. These results suggest the clinical use of MV topograms as a promising alternative to MVCT patient alignment.« less
  • Purpose: To determine the 6 degree of freedom systematic deviations between 2D/3D and CBCT image registration with various imaging setups and fusion algorithms on the Varian Edge Linac. Methods: An anthropomorphic head phantom with radio opaque targets embedded was scanned with CT slice thicknesses of 0.8, 1, 2, and 3mm. The 6 DOF systematic errors were assessed by comparing 2D/3D (kV/MV with CT) with 3D/3D (CBCT with CT) image registrations with different offset positions, similarity measures, image filters, and CBCT slice thicknesses (1 and 2 mm). The 2D/3D registration accuracy of 51 fractions for 26 cranial SRS patients was alsomore » evaluated by analyzing 2D/3D pre-treatment verification taken after 3D/3D image registrations. Results: The systematic deviations of 2D/3D image registration using kV- kV, MV-kV and MV-MV image pairs were within ±0.3mm and ±0.3° for translations and rotations with 95% confidence interval (CI) for a reference CT with 0.8 mm slice thickness. No significant difference (P>0.05) on target localization was observed between 0.8mm, 1mm, and 2mm CT slice thicknesses with CBCT slice thicknesses of 1mm and 2mm. With 3mm CT slice thickness, both 2D/3D and 3D/3D registrations performed less accurately in longitudinal direction than thinner CT slice thickness (0.60±0.12mm and 0.63±0.07mm off, respectively). Using content filter and using similarity measure of pattern intensity instead of mutual information, improved the 2D/3D registration accuracy significantly (P=0.02 and P=0.01, respectively). For the patient study, means and standard deviations of residual errors were 0.09±0.32mm, −0.22±0.51mm and −0.07±0.32mm in VRT, LNG and LAT directions, respectively, and 0.12°±0.46°, −0.12°±0.39° and 0.06°±0.28° in RTN, PITCH, and ROLL directions, respectively. 95% CI of translational and rotational deviations were comparable to those in phantom study. Conclusion: 2D/3D image registration provided on the Varian Edge radiosurgery, 6 DOF-based system provides accurate target positioning for frameless image-guided cranial stereotactic radiosurgery.« less
  • Purpose: In image-guided spine surgery, mapping 3D preoperative images to 2D intraoperative images via 3D-2D registration can provide valuable assistance in target localization. However, the presence of surgical instrumentation, hardware implants, and soft-tissue resection/displacement causes mismatches in image content, confounding existing registration methods. Manual/semi-automatic methods to mask such extraneous content is time consuming, user-dependent, error prone, and disruptive to clinical workflow. We developed and evaluated 2 novel similarity metrics within a robust registration framework to overcome such challenges in target localization. Methods: An IRB-approved retrospective study in 19 spine surgery patients included 19 preoperative 3D CT images and 50 intraoperativemore » mobile radiographs in cervical, thoracic, and lumbar spine regions. A neuroradiologist provided truth definition of vertebral positions in CT and radiography. 3D-2D registration was performed using the CMA-ES optimizer with 4 gradient-based image similarity metrics: (1) gradient information (GI); (2) gradient correlation (GC); (3) a novel variant referred to as gradient orientation (GO); and (4) a second variant referred to as truncated gradient correlation (TGC). Registration accuracy was evaluated in terms of the projection distance error (PDE) of the vertebral levels. Results: Conventional similarity metrics were susceptible to gross registration error and failure modes associated with the presence of surgical instrumentation: for GI, the median PDE and interquartile range was 33.0±43.6 mm; similarly for GC, PDE = 23.0±92.6 mm respectively. The robust metrics GO and TGC, on the other hand, demonstrated major improvement in PDE (7.6 ±9.4 mm and 8.1± 18.1 mm, respectively) and elimination of gross failure modes. Conclusion: The proposed GO and TGC similarity measures improve registration accuracy and robustness to gross failure in the presence of strong image content mismatch. Such registration capability could offer valuable assistance in target localization without disruption of clinical workflow. G. Kleinszig and S. Vogt are employees of Siemens Healthcare.« less