X-ray-based machine vision system for distal locking of intramedullary nails (original) (raw)
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The International Journal of Medical Robotics and Computer Assisted Surgery, 2005
The insertion of distal locking screws is a difficult task in intra-medullary (IM) nailing operations of long bones and contributes a significant proportion to the overall operating time. The current technique to insert these screws uses numerous fluoroscopic images and depends on the skills and expertise of the surgeon. The Computer Assisted Orthopaedic Surgical System (CAOSS) was developed to assist orthopaedic surgeons in these operations. The laboratory based test results for insertion of distal locking screws in IM nailing procedures are presented and discussed in terms of accuracy and as part of the validation process to introduce new CAOS procedures into clinical use. This study shows that CAOSS in IM nailing is robust and reliable. Positional accuracy was shown to be within 0.3 mm and angular accuracy within 0.2˚with femoral IM nail. CAOSS was also shown to be very reliable and accurate at different angles of distal screws in fluoroscopic image space.
Radiation-Free Drill Guidance in Interlocking of Intramedullary Nails
Lecture Notes in Computer Science, 2012
Intramedullary nailing is a technically demanding procedure which involves an excessive amount of X-ray acquisitions; one study lists as many as 48 to successfully complete the procedure. In this work, a novel low cost radiation-free drilling guide is designed to assist surgeons in completing the distal locking procedure without any X-ray acquisitions. Using an augmented reality fluoroscope that coregisters optical and X-ray images, we exploit solely the optical images to detect the drilling guide in order to estimate the tip position in real-time in X-ray. We tested over 200 random drill guide poses showing a mean tip-estimation error of 1.72 ± 0.7 mm which is significantly robust and accurate for the interlocking. In a preclinical study on dry bone phantom, three expert surgeons successfully completed the interlocking 56 out of 60 trials with no X-ray acquisition for guidance and an average time of 2 min.
Precise robot-assisted guide positioning for distal locking of intramedullary nails
IEEE Transactions on Medical Imaging, 2005
This paper presents a novel image-guided robotbased system to assist orthopedic surgeons in performing distal locking of long bone intramedullary nails. The system consists of a bone-mounted miniature robot fitted with a drill guide that provides rigid mechanical guidance for hand-held drilling of the distal screws' pilot holes. The robot is automatically positioned so that the drill guide and nail distal locking axes coincide, using a single fluoroscopic X-ray image. Since the robot is rigidly attached to the intramedullary nail or bone, no leg immobilization or real-time tracking is required. We describe the system and protocol and present a method for accurate and robust drill guide and nail hole localization and registration. The in vitro system accuracy experiments for fronto-parallel viewing show a mean angular error of 1.3 (std = 0 4) between the computed drill guide axes and the actual locking holes axes, and a mean 3.0 mm error (std = 1 1 mm) in the entry and exit drill point, which is adequate for successfully locking the nail.
International Journal of Electrical and Computer Engineering (IJECE), 2019
Distal locking procedure is one of the most complex tasks in close intramedullary nailing operation which requires fluoroscopic image to interpret 2-D distal locking position on image related to 3-D distal locking position on the patient site. Hence the surgeon has to perform the distal locking process by using multiple fluoroscopic images which causes a lot of x-ray exposure to the patient and surgeon and is a time consuming task. This paper presents the system integration of a fluoroscopic image calibration using robot assisted surgical guidance. The system integration consists of three parts; distal locking recovery, fluoroscopic calibration and tracking, and robot assisted surgical guidance. The distal locking-hole recovery algorithm is based on characteristic information of the major and minor axes of distal locking hole. The fluoroscopic calibration and tracking is modeled as pin-hole projection model to estimate a projection equation based on optical tracking system. The robo...
Lecture Notes in Computer Science, 2004
We are developing an image-guided robot-based system to assist orthopaedic surgeons in performing distal locking of long bone intramedullary nails. The system consists of a bone-mounted miniature robot fitted with a drill guide that provides rigid mechanical guidance for hand-held drilling of the distal screws' pilot holes. The robot is automatically positioned so that the drill guide and nail distal locking axes coincide using a single fronto-parallel fluoroscopic X-ray. This paper describes new methods for accurate and robust drill guide and nail hole localization and registration and reports the results of our in-vitro system accuracy experiments. Tests of 17 runs show a mean angular error of 1.3 o (std = 0.4 o) between the computed drill guide axes and the actual locking holes axes, and a mean 3.0mm error (std = 1.1mm) in the entry and exit drill point, which is adequate for successfully locking the nail.
A robot-assisted system for long bone intramedullary distal locking: concept and preliminary results
International Congress Series, 2003
This paper presents a new robot-based system to assist orthopaedic surgeons in performing distal intramedullary locking in femoral and tibial fracture reduction. The system consists of a miniature bone-mounted robot fitted with a drill guide that provides mechanical guidance for manual drilling of the distal screws' pilot holes. The drill guide and the nail's distal locking holes axes are automatically aligned with a few X-ray fluoroscopic images. The goal is to eliminate the guesswork from drill positioning, thus reducing surgery time and surgeon's cumulative radiation exposure, and to ensure drill and hole's axis alignment during drilling, thus eliminating geometric errors and their complications. We describe the system's rationale and concept, its architecture and usage protocol, the image processing and registration algorithms, and preliminary experimental results. D
International Congress Series, 2004
The difficult part of the intramedullary (IM) nailing operation of long bone is to insert the distal locking screws. The current technique to insert these screws uses numerous fluoroscopic images and depends on skills and expertise of the surgeon. A Computer-Assisted Orthopaedic Surgical System (CAOSS) has been developed collaboratively by the University of Hull and the East Yorkshire Hospitals NHS Trust to assist the orthopaedic surgeons in these operations. The laboratory based test results for insertion of distal locking screws in intramedullary nailing procedure are presented and discussed in terms of accuracy and as part of the validation process to introduce new CAOS procedures into clinical use. This study shows that CAOSS in IM nails is robust and reliable. The positional accuracy in planning the trajectory for insertion of the distal locking screws was shown to be within 0.3 mm and angular accuracy within 0.2j. D
Computer-Assisted Image-Guided Intramedullary Nailing of Femoral Shaft Fractures
Techniques in Orthopaedics, 2003
Closed reduction and intramedullary nailing under x-ray fluoroscopy is the current treatment of choice for femoral shaft fractures. However, many images are required to successfully perform the procedure, especially for distal locking of the nail, resulting in cumulative radiation exposure to the surgeon. Recently, computer-based technologies have been developed for surgical navigation, enabling the surgeon to accurately track in real-time the instruments, implants, and patient anatomy during a procedure. This article reviews the principles and potential benefits of computer-aided image-guided surgery for femoral shaft fracture, its indications, and its pitfalls. The existing systems, commercially available and prototypes, and the early clinical experience using this technique are also briefly discussed.