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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. Wed . "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 = {Wed Jun 15 00:00:00 EDT 2016},
month = {Wed Jun 15 00:00:00 EDT 2016}
}