Fiducial-Free 2D/3D Registration For Robot-Assisted Femoroplasty

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Abstract

Femoroplasty is a proposed alternative therapeutic method for preventing osteoporotic hip fractures in the elderly. Previously developed navigation system for femoroplasty required the attachment of an external X-ray fiducial to the femur. We propose a fiducial-free 2D/3D registration pipeline using fluoroscopic images for robot-assisted femoroplasty. Intraoperative fluoroscopic images are taken from multiple views to perform registration of the femur and drilling/injection device. The proposed method was tested through comprehensive simulation and cadaveric studies. Performance was evaluated on the registration error of the femur and the drilling/injection device. In simulations, the proposed approach achieved a mean accuracy of 1.26±0.74 mm for the relative planned injection entry point; 0.63±0.21° and 0.17±0.19° for the femur injection path direction and device guide direction, respectively. In the cadaver studies, a mean error of 2.64 ± 1.10 mm was achieved between the planned entry point and the device guide tip. The biomechanical analysis showed that even with a 4 mm translational deviation from the optimal injection path, the yield load prior to fracture increased by 40.7%. This result suggests that the fiducial-less 2D/3D registration is sufficiently accurate to guide robot assisted femoroplasty.

Keywords: 2D/3D Registration; Femur Registration; Robot-Assisted Femoroplasty; X-ray Navigation.

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Figures

Fig. 1:

Fig. 1:

Top left: An example augmentation…

Fig. 1:

Top left: An example augmentation scheme of the optimized injection pattern (green), practical…

Fig. 1: Top left: An example augmentation scheme of the optimized injection pattern (green), practical injection volume (blue) and line of injection (red) [8]. Bottom left: Components of robot-assisted femoroplasty system. Right: Illustration of the intensity-based 2D/3D registration for the femur and D/I device in the C-arm coordinate frame. The red cross arrows are the coordinate frames of each component; the blue arrows illustrate the transformations; the pink dotted line shows the planned trajectory for femoroplasty.
Fig. 2:

Fig. 2:

Illustration of registration pipeline. Left:…

Fig. 2:

Illustration of registration pipeline. Left: 3D pelvis anatomical landmark locations and an example…

Fig. 2: Illustration of registration pipeline. Left: 3D pelvis anatomical landmark locations and an example of CNN-based 2D landmark detection and bone segmentation. Stages 1-3 show three multi-view intensity-based registrations. The pink arrows correspond to the initialization procedures. The transformations are described in Section III-B.
Fig. 3:

Fig. 3:

Top: Illustrations of the multi-view…

Fig. 3:

Top: Illustrations of the multi-view C-arms, anatomy, patient bed and robot setup. The…

Fig. 3: Top: Illustrations of the multi-view C-arms, anatomy, patient bed and robot setup. The top blue arrows show the C-arm rotations. The first view C-arm frame is shown in RGB cross arrows at the source position. Bottom: An example set of simulated fluoroscopic images. The first row in orange is used for pelvis and femur registration. The second row in blue is used for device registration.
Fig. 4:

Fig. 4:

Registration workflow.

Fig. 4:

Registration workflow.

Fig. 4: Registration workflow.
Fig. 5:

Fig. 5:

Biomechanical analysis workflow: An FE…

Fig. 5:

Biomechanical analysis workflow: An FE model (top right) is created from segmented CT…

Fig. 5: Biomechanical analysis workflow: An FE model (top right) is created from segmented CT scans of the specimen. 3 Step Pre-operative planning (bottom left) was performed on the specimen and evaluated in both optimal drilling path (solid blue) and a path 4mm inferior of the optimal (dotted blue)
Fig. 6:

Fig. 6:

Upper: Overlay example of registration…

Fig. 6:

Upper: Overlay example of registration convergence stage. 2D overlay of multiple input simulation…

Fig. 6: Upper: Overlay example of registration convergence stage. 2D overlay of multiple input simulation X-rays (background) and DRR-derived edges in green. Lower: Coordinate frames and path direction vectors used to report the registration error are marked with RGB cross arrows. Coordinate frames include: PC - Pelvis volume center; FH - Femoral head center; ID - Injection device guide center. Path direction vectors include pfem and pinj, which are described in Section IV-A.
Fig. 7:

Fig. 7:

Left: Cadaver study setup with…

Fig. 7:

Left: Cadaver study setup with injection device, specimen and C-arm. Middle: Two example…

Fig. 7: Left: Cadaver study setup with injection device, specimen and C-arm. Middle: Two example AP view intraoperative fluoroscopic images corresponding to images➀➁ in Fig. 3. Right top: The injected BBs are zoomed. One example BB location is marked with orange circle. Right bottom: Picture of BBs glued on the surface of the injection device for groundtruth injection pose calculation. One example BB is marked with blue circle.
Fig. 8:

Fig. 8:

(a)-(e): Normalized 2D histograms of…

Fig. 8:

(a)-(e): Normalized 2D histograms of pelvis pose ( δT pel ), femur pose…

Fig. 8: (a)-(e): Normalized 2D histograms of pelvis pose (δTpel), femur pose (δTfem), injection device pose (δTinj), C-arm view2 (δTC1C2), C-arm view3 (δTC1C3) error for the simulation studies. (f)-(h): Normalized histogram of l2 distance error in mm of femur entry point (δxC1EP), injection device guide tip (δxC1TIP) and their relative error ( (δxEPTIP)). (i)-(j): Normalized histogram of direction error in degree of femur path vector (δθC1fem) and the injection guide direction vector (δθC1inj).
Fig. 9:

Fig. 9:

Left: Scatter plot of correlation…

Fig. 9:

Left: Scatter plot of correlation matrix between femoral head center translation error and…

Fig. 9: Left: Scatter plot of correlation matrix between femoral head center translation error and pelvis translation error reported in femoral head center. Right: Scatter plot of correlation matrix between femur entry point error and pelvis translation error reported in femoral head center. Correlation coefficients are marked on the right bottom of each plot.
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References

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  • R01 EB023939/EB/NIBIB NIH HHS/United States
  • R21 EB020113/EB/NIBIB NIH HHS/United States

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