The success of deep brain stimulation (DBS) is dependent on the accurate placement of electrodes in the operating room (OR). However, due to intraoperative brain shift, the accuracy of pre-operative scans and pre-surgical planning are often degraded. To compensate for brain shift, we created a finite element bio-mechanical brain model that updates preoperative images by assimilating intraoperative sparse data from the brain surface or deep brain targets. Additionally, we constructed an artificial neural network (ANN) that leveraged a large number of ventricle nodal displacements to estimate brain shift. The machine learning method showed potential in incorporating ventricle sparse data to accurately compute shift at the brain surface. Thus, in this paper, we propose using this machine learning model to estimate brain atrophy at deep brain targets such as the anterior commissure (AC) and the posterior commissure (PC). The ANN consists of an input layer with nine hand-engineered features, such as the distance between the deep brain target and the ventricle node, two hidden layers and an output layer. This model was trained using eight patient cases and tested on two patient cases.
In open cranial procedures, the accuracy of image guidance using preoperative MR (pMR) images can be degraded by intraoperative brain deformation. Intraoperative stereovision (iSV) has been used to acquire 3D surface profile of the exposed cortex at different surgical stages, and surface displacements can be extracted to drive a biomechanical model as sparse data to provide updated MR (uMR) images that match the surgical scene. In previous studies, we have employed an Optical Flow (OF) based registration technique to register iSV surfaces acquired from different surgical stages and estimate cortical surface shift throughout surgery. The technique was efficient and accurate but required manually selected Regions of Interest (ROI) in each image after resection began. In this study, we present a registration technique based on Scale Invariant Feature Transform (SIFT) algorithm and illustrate the methods using an example patient case. Stereovision images of the cortical surface were acquired and reconstructed at different time points during surgery. Both SIFT and OF based registration techniques were used to estimate cortical shift, and extracted displacements were compared against ground truth data. Results show that the overall errors of SIFT and OF based techniques were 0.65±0.53 mm and 2.18±1.35 mm in magnitude, respectively, on the intact cortical surface. The OF-based technique generated inaccurate sparse data near the resection cavity region, whereas SIFT-based technique only generated accurate sparse data. The computational efficiency was ⪅0.5 s and ⪆20 s for SIFT and OF based techniques, respectively. Thus, the SIFT-based registration technique shows promise for OR applications.
Registration of preoperative or intraoperative imaging is necessary to facilitate surgical navigation in spine surgery. After image acquisition, intervertebral motion and spine pose changes can occur during surgery from instrumentation, decompression, physician manipulation or correction. This causes deviations from the reference imaging reducing the navigation accuracy. To evaluate the ability to use the registration between stereovision surfaces in order to account for this intraoperative spine motion through a simulation study. Co-registered CT and stereovision surface data were obtained of a swine cadaver’s exposed lumbar spine in the prone position. Data was segmented and labeled by vertebral level. A simulation of biomechanically bounded motion was applied to each vertebral level to move the prone spine to a new position. A reduced surface data set was then registered level-wise back to the prone spines original position. The average surface to surface distance was recorded between simulated and prone positions. Localized targets on these surfaces were used for a calculation of target registration error. Target registration error increases with distance between surfaces. Movement exceeding 2.43 cm between stereovision acquisitions exceeds registration accuracy of 2mm. Lateral bending of the spine contributes most to this effect compared to axial rotation and flexion-extension. In conclusion, the viability of using stereovision-to-stereovision registration to account for interoperative motion of the spine is shown through this simulation. It is suggested the distance of spine movement between corresponding points does not surpass 2.43 cm between stereovision acquisitions.
The success of deep brain stimulation (DBS) depends upon the accurate surgical placement of electrodes in the OR. However, the accuracy of pre-operative scans is often degraded by intraoperative brain shift. To compensate for brain shift, we developed a biomechanical brain model that updates preoperative images by assimilating intraoperative sparse data from either the brain surface or deep brain structures. In addition to constraining the finite element model, surface sparse data estimates model boundary conditions such as the level of cerebrospinal fluid (CSF). As a potentially cost-effective and safe alternative to intraoperative imaging techniques, a machine learning method was proposed to estimate surface brain atrophy by leveraging a large number of ventricle nodal displacements. Specifically, we constructed an artificial neural network (ANN) that consisted of an input layer with 9 hand-engineered features such as the surface-to-ventricle nodal distance. The multilayer perceptron was trained using 132,000 nodal pairs from eleven patient cases and tested using 48,000 from four cases. Results showed that in a testing case, the ANN estimated an overall surface displacement of 8.79 ± 0.765 mm to the left and 8.26 ± .455 mm to the right compared to the ground truth (10.36 ± 1.33 mm left and 7.40 ± 1.40 mm right). The average prediction error of all four testing cases was less than 2 mm. With further development and evaluation, the proposed method has the potential of supplementing the biomechanical brain model with surface sparse data and estimating boundary parameters.
Brain shift is a confounder to the accuracy of electrode lead placement during deep brain stimulation (DBS) surgery. Model based image updating method can compensate for brain shift with high efficiency and accuracy. A key element to achieving clinically accepted accuracy using our biomechanical brain model is designating rigorous boundary conditions (BCs) that define general physics of the model. In this retrospective study, we searched for a set of six optimal BCs such as gravitational direction and level of CSF for our model to simulate accurate brain shift in DBS lead placement surgery. Specifically, we conducted 9072 trials of brain shift simulation with varying boundary conditions and deep brain sparse data for three training cases and applied these parameters to three testing cases for evaluation. The optimal set of parameters was determined based on lowest target registration error (TRE) evaluated at five deep brain landmarks near the subthalamus area. We show that simulations with optimal BCs compensated 61.28% and 50.06% of brain shift on average in two of the three testing cases where large brain deformation occurred and 26.5% in one testing case of small brain shift. In comparison, optimal BCs delivered consistent and accurate prediction of brain shift at all deep brain landmarks in both training and testing cases whereas default sets of BCs produced similar results at some landmarks but underperformed for the rest. With only deep brain sparse data and a set of optimal BCs, our biomechanical brain model can achieve significant brain shift compensation in DBS cases and Its clinical utility will be examined in surgical cases in future OR.
KEYWORDS: 3D image processing, Image segmentation, 3D modeling, Magnetic resonance imaging, Tissues, 3D scanning, Visualization, Matrices, Image registration, Reconstruction algorithms
Purpose: Detecting knee orientation automatically from scout scans with high speed and accuracy is essential to a successful workflow of MR knee imaging. Although traditional methods of image processing such as rigid image registration and object detection are potentially available solutions, they are sensitive to image noise such as missing features due to the metal implants and anatomical variability in knee size and tissue composition. Method: In this study, a segmentation-based approach was proposed to calculate a 3-D transformation matrix that defined 3-D knee orientation using low-res MR scout scans. Specifically, 3-D U-net was used to segment a plane that was parallel to the knee meniscus plane and reconstruct the plane norm as one of the vectors (v1) needed for a 3d transformation matrix. A separate model of 3-D U-net was then trained to segment another plane that was perpendicular to the meniscus and reconstruct the plane norm as v2. A linear 3-D transformation matrix was then obtained for each patient case in 14 testing subjects that were initially manually rotated in small (group S) and large (group L) degrees for training. Angle corrected images were also visually compared against their corresponding ground truth. Results: The average of v1 and v2 error in group S were 5.62° and 5.12° , respectively, whereas the error average of these two vectors were 6.65° and 8.25° , respectively for group L. The standard deviation for v1 and v2 in group S and L were 2.51° , 2.84° , 5.65° , and 7.65° , respectively. The Dice similarity coefficient (DSC) of reconstructed v1 and v2 planes were 0.78, 0.70, 0.71, and 0.65 for group S and L. The qualitative assessment further showed consistent knee representation after correction for knees with heavy distortion and fatty tissue. Conclusion: Initial results suggest that our approach has the potential to automatically correct for small knee rotations commonly seen in clinical setting and is robust even under stress test for knees with anatomical structures (e.g. fatty tissue) that were even absent in the training data set and that appear heavily distorted.
Accurate surgical placement of electrodes is essential to successful deep brain stimulation (DBS) for patients with neurodegenerative diseases such as Parkinson’s disease. However, the accuracy of pre-operative images used for surgical planning and guidance is often degraded by brain shift during surgery. To predict such intra-operative target deviation due to brain shift, we have developed a finite-element biomechanical model with the assimilation of intraoperative sparse data to compute a whole brain displacement field that updates preoperative images. Previously, modeling with the incorporation of surface sparse data achieved promising results at deep brain structures. However, access to surface data may be limited during a burr hole-based procedure where the size of exposed cortex is too small to acquire adequate intraoperative imaging data. In this paper, our biomechanical brain model was driven by deep brain sparse data that was extracted from lateral ventricles using a Demon’s algorithm and the simulation result was compared against the one resulted from modeling with surface data. Two patient cases were explored in this study where preoperative CT (preCT) and postoperative CT (postCT) were used for the simulation. In patient case one of large symmetrical brain shift, results show that model driven by deep brain sparse data reduced the target registration error(TRE) of preCT from 3.53 to 1.36 and from 1.79 to 1.17 mm at AC and PC, respectively, whereas results from modeling with surface data produced even lower TREs at 0.58 and 0.69mm correspondingly; However, in patient case two of large asymmetrical brain shift, modeling with deep brain sparse data yielded the lowest TRE of 0.68 from 1.73 mm. Results in this study suggest that both surface and deep brain sparse data are capable of reducing the TRE of preoperative images at deep brain landmarks. The success of modeling with the assimilation of deep brain sparse data alone shows the potential of implementing such method in the OR because sparse data at lateral ventricle can be acquired using ultrasound imaging.
In open spine surgery, the accuracy of image guidance is compromised by alignment change between supine preoperative CT images (pCT) and prone intraoperative positioning. We have developed a level-wise registration framework to compensate for the intervertebral motion by updating pCT to match with intraoperative stereovision (iSV) data of the exposed spine. In this study, we compared performance of the iSV image updating system in different lengths of exposure using retrospective data from one cadaver pig specimen. Specifically, L1 to L6 were exposed and 3 metallic mini-screws were implanted on each level as “ground truth” locations. The spine was positioned supine to acquire pCT, and then positioned prone to acquire iSV using a hand-held iSV device. One image pair of iSV was acquired from each exposed vertebra. Three exposure lengths were evaluated by selecting data from corresponding levels to compare performance: 6 levels, 4 levels, and 3 levels. Accuracy of iSV updating was assessed through point-to-point registration error (ppRE) using mini-screw locations, and the average accuracy was 1.26±0.77 mm, 1.54±0.62 mm, and 1.38±0.44 mm, for the three exposure lengths, respectively. The time cost was ~10-15 min and similar in all three exposure sizes. Results indicate that performance of iSV image updating was similar in different lengths of exposure, and the accuracy was within clinically acceptable range (2 mm).
Deep brain stimulation (DBS) electrode placement is a burr-hole procedure for the treatment of patients with neuro- degenerative disease such as Parkinson’s disease, essential tremor and dystonia. Accurate placement of electrodes is the key to optimal surgical outcome. However, the accuracy of pre-operative images used for surgical planning are often degraded by intraoperative brain shift. To compensate for intraoperative target deviation, we have developed a biomechanical model, driven by partially sampled displacements between pre- and postCT, to estimate a whole brain displacement field based on which updated CT (uCT) can be generated. The results of the finite element model depend on sparse data, as the model minimizes the difference between model estimates and sparse data. Existing approaches to extract sparse data from brain surface are typically geometry or feature-based. In this paper, we explore a geometry- based iterative closest point (ICP) algorithm and a feature-based image registration algorithm, and drive the model with 1) geometry-based sparse data only, 2) feature-based sparse data only, and 3) combined data from 1) and 2). We assess the model performance in terms of model-data misfit, as well as target registration errors (TREs) at the anterior commissure (AC) and posterior commissure (PC). Results show that the model driven by the geometry-based sparse data reduced the TREs of preCT from 1.65mm to 1.26 mm and 1.88 mm to 1.58 mm at AC and PC, respectively by compensating majorly along the direction of gravity and the longitudinal axis, whereas feature-based sparse data contributed to the compensation along the lateral direction at PC.
The accuracy of image guidance in spinal surgery can be compromised by intervertebral motion between preoperative supine CT images and intraoperative prone positioning. Patient registration and image updating approaches have been developed to register CT images with intraoperative spine and compensate for posture and alignment changes. We have developed a hand-held stereovision (HHS) system to acquire intraoperative profiles of the exposed spine and facilitate image registration and surgical navigation during open spinal surgery. First, we calibrated the stereo parameters using a checkerboard pattern, and the mean reprojection error was 0.33 pixel using 42 image pairs. Second, we attached an active tracker to the HHS device to track its location using a commercial navigation system. We performed spatial calibration to find the transformation between camera space and tracker space, and the error was 0.73 ± 0.39 mm. Finally, we evaluated the accuracy of the HHS using an ex-vivo porcine specimen. We used a tracked stylus to acquire locations of landmarks such as spinous and transverse processes, and calculated the distances between these points and the reconstructed stereovision surface. The resulting accuracy was 0.91 ± 0.58 mm, with an overall computational efficiency of ~ 5s for each image pair. Compared to our previous microscope-based stereovision system, the accuracy and efficiency of HHS are similar while HHS is more practical and functional, and would be more broadly applicable in spine procedures.
The success of deep brain stimulations (DBS) heavily relies on the accurate placement of electrodes in the operating room (OR). However, the pre-operative images such as MRI and CT for surgical targeting are degraded by brain shift, a combination of brain movement and deformation. One way to compensate for this intra-operative brain shift is to utilize a nonlinear biomechanical brain model to estimate the whole brain deformation based on which an updated MR can be generated. Due to the variability of deformation in both magnitude and direction among different cases, partially sampled intraoperative data (e.g., O-arm, CT) of tissue motion is critical to guide the model estimation. In this paper, we present a method to extract the sparse data by matching brain surface features from pre- and post-operative CTs, followed by the reconstruction of the full 3d-displacement field based on the original spatial information of these 2d points. Specifically, the size and the location of the sparse data were determined based on the pneumocephalus in the post-operative CT. The 2D CT-encoded texture maps from both pre-and post-operative CTs were then registered using Demons algorithm. The final 3d-displacement field in our one-patient-example shows an average lateral shift of 1.42mm, and a shift of 10.11mm in the direction of gravity. The results presented in this work have shown the potential of assimilating the sparse data from intra-operative images into the pipeline of model-based image guidance for DBS in the future.
KEYWORDS: Brain, Data modeling, Neuroimaging, Finite element methods, Ultrasonography, Magnetic resonance imaging, Surgery, Data acquisition, Image registration, Image segmentation
Intraoperative image guidance using preoperative MR images (pMR) is widely used in neurosurgery, but the accuracy can be compromised by brain deformation as soon as the dura is open. Biomechanical finite element models (FEM) have been developed to compensate for brain deformation that occurs at different surgical stages. Intraoperative sparse data extracted from the exposed cortical surface and/or from deeper brain is used to drive the FEM model to compute wholebrain deformation field and produce model-updated MR (uMR) that matches the surgical scene. In previous studies, we quantified the accuracy using model-data misfit (i.e., the root-mean-square error between model estimates and sparse data), as well as target registration errors (TRE) of surface features (such as vessel junctions), and showed that the accuracy on the cortical surface was ~1-2 mm. However, the accuracy in deeper brain has not been investigated, as it is challenging to obtain subsurface features during surgery for accuracy assessment. In this study, we used intraoperative stereovision (iSV) to extract sparse data, which was employed to drive the FEM model and produce uMR, and acquired co-registered intraoperative ultrasound images (iUS) at different surgical stages in 2 cases for cross validation. We quantify model-data misfit, and compare model updated MR with iUS for qualitative assessment of accuracy in deeper brain. The results show that the model-data misfit was 2.39 and 0.64 mm, respectively, for the 2 cases reported, and uMR aligned well with both iSV and iUS, indicating a good accuracy both on the surface and in deeper brain.
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