Registration of a statistical model to intraoperative ultrasound for scaphoid screw fixation

Emran Mohammad Abu Anas, Alexander Seitel, Abtin Rasoulian, Paul St John, Tamas Ungi, Andras Lasso, Kathryn Darras, David Wilson, Victoria A. Lessoway, Gabor Fichtinger, Michelle Zec, David Pichora, Parvin Mousavi, Robert Rohling, Purang Abolmaesumi

Research output: Contribution to journalArticle

Abstract

Purpose: Volar percutaneous scaphoid fracture fixation is conventionally performed under fluoroscopy-based guidance, where surgeons need to mentally determine a trajectory for the insertion of the screw and its depth based on a series of 2D projection images. In addition to challenges associated with mapping 2D information to a 3D space, the process involves exposure to ionizing radiation. Three-dimensional ultrasound has been suggested as an alternative imaging tool for this procedure; however, it has not yet been integrated into clinical routine since ultrasound only provides a limited view of the scaphoid and its surrounding anatomy. Methods: We propose a registration of a statistical wrist shape + scale + pose model to a preoperative CT and intraoperative ultrasound to derive a patient-specific 3D model for guiding scaphoid fracture fixation. The registered model is then used to determine clinically important intervention parameters, including the screw length and the trajectory of screw insertion in the scaphoid bone. Results: Feasibility experiments are performed using 13 cadaver wrists. In 10 out of 13 cases, the trajectory of screw suggested by the registered model meets all clinically important intervention parameters. Overall, an average 94 % of maximum allowable screw length is obtained based on the measurements from gold standard CT. Also, we obtained an average 92 % successful volar accessibility, which indicates that the trajectory is not obstructed by the surrounding trapezium bone. Conclusions: These promising results indicate that determining clinically important screw insertion parameters for scaphoid fracture fixation is feasible using 3D ultrasound imaging. This suggests the potential of this technology in replacing fluoroscopic guidance for this procedure in future applications.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalInternational journal of computer assisted radiology and surgery
DOIs
StateAccepted/In press - Mar 16 2016
Externally publishedYes

Keywords

  • Drill path
  • Scaphoid fracture
  • Screw axis
  • Statistical wrist model
  • Ultrasound guidance
  • Volar percutaneous approach

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Health Informatics
  • Surgery

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  • Cite this

    Anas, E. M. A., Seitel, A., Rasoulian, A., John, P. S., Ungi, T., Lasso, A., Darras, K., Wilson, D., Lessoway, V. A., Fichtinger, G., Zec, M., Pichora, D., Mousavi, P., Rohling, R., & Abolmaesumi, P. (Accepted/In press). Registration of a statistical model to intraoperative ultrasound for scaphoid screw fixation. International journal of computer assisted radiology and surgery, 1-9. https://doi.org/10.1007/s11548-016-1370-y