End-to-end 2D/3D registration from pre-operative MRI to intra-operative fluoroscopy for orthopedic procedures.
Authors
Affiliations (5)
Affiliations (5)
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, 21218, USA. [email protected].
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, 21218, USA.
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, 21224, USA.
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
- Institute for Integrative and Innovative Research, University of Arkansas, Fayetteville, AR, 72701, USA.
Abstract
Soft tissue pathologies and bone defects are not easily visible in intra-operative fluoroscopic images; therefore, we develop an end-to-end MRI-to-fluoroscopic image registration framework, aiming to enhance intra-operative visualization for surgeons during orthopedic procedures. The proposed framework utilizes deep learning to segment MRI scans and generate synthetic CT (sCT) volumes. These sCT volumes are then used to produce digitally reconstructed radiographs (DRRs), enabling 2D/3D registration with intra-operative fluoroscopic images. The framework's performance was validated through simulation and cadaver studies for core decompression (CD) surgery, focusing on the registration accuracy of femur and pelvic regions. The framework achieved a mean translational registration accuracy of 2.4 ± 1.0 mm and rotational accuracy of 1.6 ± <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><mn>0</mn> <mo>.</mo> <msup><mn>8</mn> <mo>∘</mo></msup> </mrow> </math> for the femoral region in cadaver studies. The method successfully enabled intra-operative visualization of necrotic lesions that were not visible on conventional fluoroscopic images, marking a significant advancement in image guidance for femur and pelvic surgeries. The MRI-to-fluoroscopic registration framework offers a novel approach to image guidance in orthopedic surgeries, exclusively using MRI without the need for CT scans. This approach enhances the visualization of soft tissues and bone defects, reduces radiation exposure, and provides a safer, more effective alternative for intra-operative surgical guidance.