A fluoroscopy-based planning and guidance software tool for minimally invasive hip refixation by cement injection.

DF Malan, SJ van der Walt, Renata Raidou, B van den Berg, BC Stoel, CP Botha, RG Nelissen, ER Valstar
A fluoroscopy-based planning and guidance software tool for minimally invasive hip refixation by cement injection.
International journal of computer assisted radiology and surgery,, 11(2):281-296, 2016.

Information

Abstract

PURPOSE: In orthopaedics, minimally invasive injection of bone cement is an established technique. We present HipRFX, a software tool for planning and guiding a cement injection procedure for stabilizing a loosening hip prosthesis. HipRFX works by analysing a pre-operative CT and intraoperative C-arm fluoroscopic images. METHODS: HipRFX simulates the intraoperative fluoroscopic views that a surgeon would see on a display panel. Structures are rendered by modelling their X-ray attenuation. These are then compared to actual fluoroscopic images which allow cement volumes to be estimated. Five human cadaver legs were used to validate the software in conjunction with real percutaneous cement injection into artificially created periprothetic lesions. RESULTS: Based on intraoperatively obtained fluoroscopic images, our software was able to estimate the cement volume that reached the pre-operatively planned targets. The actual median target lesion volume was 3.58 ml (range 3.17-4.64 ml). The median error in computed cement filling, as a percentage of target volume, was 5.3% (range 2.2-14.8%). Cement filling was between 17.6 and 55.4% (median 51.8%). CONCLUSIONS: As a proof of concept, HipRFX was capable of simulating intraoperative fluoroscopic C-arm images. Furthermore, it provided estimates of the fraction of injected cement deposited at its intended target location, as opposed to cement that leaked away. This level of knowledge is usually unavailable to the surgeon viewing a fluoroscopic image and may aid in evaluating the success of a percutaneous cement injection intervention.

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BibTeX

@article{malan_fluoro,
  title =      "A fluoroscopy-based planning and guidance software tool for
               minimally invasive hip refixation by cement injection.",
  author =     "DF Malan and SJ van der Walt and Renata Raidou and B van den
               Berg and BC Stoel and CP Botha and RG Nelissen and ER
               Valstar",
  year =       "2016",
  abstract =   "PURPOSE: In orthopaedics, minimally invasive injection of
               bone cement is an established technique. We present HipRFX,
               a software tool for planning and guiding a cement injection
               procedure for stabilizing a loosening hip prosthesis. HipRFX
               works by analysing a pre-operative CT and intraoperative
               C-arm fluoroscopic images. METHODS: HipRFX simulates the
               intraoperative fluoroscopic views that a surgeon would see
               on a display panel. Structures are rendered by modelling
               their X-ray attenuation. These are then compared to actual
               fluoroscopic images which allow cement volumes to be
               estimated. Five human cadaver legs were used to validate the
               software in conjunction with real percutaneous cement
               injection into artificially created periprothetic lesions.
               RESULTS: Based on intraoperatively obtained fluoroscopic
               images, our software was able to estimate the cement volume
               that reached the pre-operatively planned targets. The actual
               median target lesion volume was 3.58 ml (range 3.17-4.64
               ml). The median error in computed cement filling, as a
               percentage of target volume, was 5.3% (range 2.2-14.8%).
               Cement filling was between 17.6 and 55.4% (median 51.8%).
               CONCLUSIONS: As a proof of concept, HipRFX was capable of
               simulating intraoperative fluoroscopic C-arm images.
               Furthermore, it provided estimates of the fraction of
               injected cement deposited at its intended target location,
               as opposed to cement that leaked away. This level of
               knowledge is usually unavailable to the surgeon viewing a
               fluoroscopic image and may aid in evaluating the success of
               a percutaneous cement injection intervention.",
  journal =    "International journal of computer assisted radiology and
               surgery,",
  number =     "2",
  volume =     "11",
  pages =      "281--296",
  URL =        "https://www.cg.tuwien.ac.at/research/publications/2016/malan_fluoro/",
}