PurposeMobile C-arm systems represent the standard imaging devices within the field of spine surgery. In addition to 2D imaging, they allow for 3D scans while preserving unrestricted patient access. For viewing, the acquired volumes are adjusted such that their anatomical standard planes align with the axes of the viewing modality. This difficult and time-consuming step is currently performed manually by the leading surgeon. This process is automatized within this work to improve the usability of C-arm systems. Thereby, the spinal region consisting of multiple vertebrae and the standard planes of all vertebrae being of interest to the surgeon need to be taken into account.ApproachAn object detection algorithm based on the you only look once version 3 architecture, adapted to 3D inputs, is compared with a segmentation-based approach employing a 3D U-Net. Both algorithms are trained on a dataset of 440 and tested on 218 spinal volumes.ResultsAlthough the detection-based algorithm is slightly inferior concerning the detection (91% versus 97% accuracy), localization (1.26 mm versus 0.74 mm error) and alignment accuracy (5.00 deg versus 4.73 deg error), it outperforms the segmentation-based one in terms of speed (5 s versus 38 s).ConclusionsBoth algorithms show similar good results. However, the speed gain of the detection-based algorithm, resulting in a run time of 5 s, makes it more suitable for usage in an intra-operative scenario.
Purpose: To assess the result in orthopedic trauma surgery, usually three-dimensional volume data of the treated region is acquired. With mobile C-arm systems, these acquisitions can be performed intraoperatively, reducing the number of required revision surgeries. However, the acquired volumes are typically not aligned to the anatomical regions. Thus, the multiplanar reconstructed (MPR) planes need to be adjusted manually during the review of the volume. To speed up and ease the workflow, an automatic parameterization of these planes is needed.
Approach: We present a detailed study of multitask learning (MTL) regression networks to estimate the parameters of the MPR planes. First, various mathematical descriptions for rotation, including Euler angle, quaternion, and matrix representation, are revised. Then, two different MTL network architectures based on the PoseNet are compared with a single task learning network.
Results: Using a matrix description rather than the Euler angle description, the accuracy of the regressed normals improves from 7.7 deg to 7.3 deg in the mean value for single anatomies. The multihead approach improves the regression of the plane position from 7.4 to 6.1 mm, whereas the orientation does not benefit from this approach. Thus, the achieved accuracy meets the reported interrater variance in similarly complex body regions of up to 6.3 deg for the normals and up to 9.3 mm for the plane position.
Conclusions: The use of a multihead approach with shared features leads to more accurate plane regression compared with the use of individual networks for each task. It also improves the angle estimation for the ankle region. The reported results are in the same range as manual plane adjustments. The use of a combined network with shared parameters requires less memory, which is a great benefit for the implementation of an application for the surgical environment.
Purpose: The choice of input normalization has effects on the generalization and performance of deep neural networks. While this topic is explored for 2D imaging applications, the influence of different normalization techniques on medical imaging modalities, e.g. cone-beam CT (CBCT), differs due to a different value range and distribution. In this paper a good normalization technique for intra-operatively acquired surgical CBCT volumes is presented. Methods: A set of normalization strategies, namely histogram equalization, min-max scaling, z-score normalization, linear look up table (LUT) with clipping and sigmoid function with clipping is compared on a CBCT volume classification task. Results: The results show that a combination of parameterized LUTs and clipping with the range [-710, 1640] HU independent of the underlying intensity histogram provides the best performance for the task at hand. Conclusions: The clipping based normalization technique helps to compress the feature space to the relevant range. By this approach, most of the information about the intensity values of soft tissue and bone is retained. The clipping range presented in this paper is valid for surgical CBCTs.
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