Periacetabular osteotomy through the pararectus approach: technical feasibility and control of fragment mobility by a validated surgical navigation system in a cadaver experiment.

Purpose: The pararectus approach has been validated for managing acetabular fractures. We hypothesised it might be an alternative approach for performing periacetabular osteotomy (PAO).

Methods: Using four cadaver specimens, we randomly performed PAO through either the pararectus or a modified Smith-Petersen (SP) approach.

Hierarchical segmentation-assisted multimodal registration for MR brain images.

Information theory-based metric such as mutual information (MI) is widely used as similarity measurement for multimodal registration. Nevertheless, this metric may lead to matching ambiguity for non-rigid registration. Moreover, maximization of MI alone does not necessarily produce an optimal solution.

3D face reconstruction from 2D pictures: first results of a web-based computer aided system for aesthetic procedures.

The human face is a vital component of our identity and many people undergo medical aesthetics procedures in order to achieve an ideal or desired look. However, communication between physician and patient is fundamental to understand the patient's wishes and to achieve the desired results. To date, most plastic surgeons rely on either "free hand" 2D drawings on picture printouts or computerized picture morphing.

Comparative evaluation of pelvic allograft selection methods.

This paper presents a firsthand comparative evaluation of three different existing methods for selecting a suitable allograft from a bone storage bank. The three examined methods are manual selection, automatic volume-based registration, and automatic surface-based registration. Although the methods were originally published for different bones, they were adapted to be systematically applied on the same data set of hemi-pelvises.

Population-based design of mandibular plates based on bone quality and morphology.

In this paper we present a new population-based implant design methodology, which advances the state-of-the-art approaches by combining shape and bone quality information into the design strategy. The method enhances the mechanical stability of the fixation and reduces the intra-operative in-plane bending which might impede the functionality of the locking mechanism. The method is presented for the case of mandibular locking fixation plates, where the mandibular angle and the bone quality at screw locations are taken into account.

Population-based design of mandibular fixation plates with bone quality and morphology considerations.

In this paper we present a new population-based implant design methodology, which advances the state-of-the-art approaches by combining shape and bone quality information into the design strategy. The method may enhance the mechanical stability of the fixation and reduces the intra-operative in-plane bending which might impede the functionality of the locking mechanism. The computational method is presented for the case of mandibular locking fixation plates, where the mandibular angle and the bone quality at screw locations are taken into account.

Statistical model based shape prediction from a combination of direct observations and various surrogates: application to orthopaedic research.

In computer-assisted orthopaedic surgery, recovering three-dimensional patient-specific anatomy from incomplete information has been focus of interest due to several factors such as less invasive surgical procedures, reduced radiation doses, and rapid intra-operative updates of the anatomy. The aim of this paper is to report results obtained combining statistical shape modeling and multivariate regression techniques for predicting bone shape from clinically and surgically relevant predictors, including sparse observations of the bone surface but also morphometric and anthropometric information. Different state of the art methods such as partial least square regression, principal component regression, canonical correlation analysis, and non-parametric kernel-based regression are compared.

ECM versus ICP for point registration.

Iterative Closest Point (ICP) is a widely exploited method for point registration that is based on binary point-to-point assignments, whereas the Expectation Conditional Maximization (ECM) algorithm tries to solve the problem of point registration within the framework of maximum likelihood with point-to-cluster matching. In this paper, by fulfilling the implementation of both algorithms as well as conducting experiments in a scenario where dozens of model points must be registered with thousands of observation points on a pelvis model, we investigated and compared the performance (e.g.

Minimization of intra-operative shaping of orthopaedic fixation plates: a population-based design.

In this paper we present a new population-based method for the design of bone fixation plates. Standard pre-contoured plates are designed based on the mean shape of a certain population. We propose a computational process to design implants while reducing the amount of required intra-operative shaping, thus reducing the mechanical stresses applied to the plate.

A navigation system for percutaneous needle interventions based on PET/CT images: design, workflow and error analysis of soft tissue and bone punctures.

Percutaneous needle intervention based on PET/CT images is effective, but exposes the patient to unnecessary radiation due to the increased number of CT scans required. Computer assisted intervention can reduce the number of scans, but requires handling, matching and visualization of two different datasets. While one dataset is used for target definition according to metabolism, the other is used for instrument guidance according to anatomical structures.

Allograft selection for transepiphyseal tumor resection around the knee using three-dimensional surface registration.

Transepiphyseal tumor resection is a common surgical procedure in patients with malignant bone tumors. The aim of this study is to develop and validate a computer-assisted method for selecting the most appropriate allograft from a cadaver bone bank. Fifty tibiae and femora were 3D reconstructed from computed tomography (CT) images.

Automated detection of fiducial screws from CT/DVT volume data for image-guided ENT surgery.

This paper presents an automated solution for precise detection of fiducial screws from three-dimensional (3D) Computerized Tomography (CT)/Digital Volume Tomography (DVT) data for image-guided ENT surgery. Unlike previously published solutions, we regard the detection of the fiducial screws from the CT/DVT volume data as a pose estimation problem. We thus developed a model-based solution.

Computer aided surgery for percutaneous nephrolithotomy: Clinical requirement analysis and system design.

Percutaneous nephrolithotomy (PCNL) for the treatment of renal stones and other related renal diseases has proved its efficacy and has stood the test of time compared with open surgical methods and extracorporeal shock wave lithotripsy. However, access to the collecting system of the kidney is not easy because the available intra-operative image modalities only provide a two dimensional view of the surgical scenario. With this lack of visual information, several punctures are often necessary which, increases the risk of renal bleeding, splanchnic, vascular or pulmonary injury, or damage to the collecting system which sometimes makes the continuation of the procedure impossible.

Multimodal target correction by local bone registration: a PET/CT evaluation.

PET/CT guidance for percutaneous interventions allows biopsy of suspicious metabolically active bone lesions even when no morphological correlation is delineable in the CT images. Clinical use of PET/CT guidance with conventional step-by-step technique is time consuming and complicated especially in cases in which the target lesion is not shown in the CT image. Our recently developed multimodal instrument guidance system (IGS) for PET/CT improved this situation.

2D/3D reconstruction of a scaled lumbar vertebral model from a single fluoroscopic image.

Accurate three-dimensional (3D) models of lumbar vertebrae can enable image-based 3D kinematic analysis. The common approach to derive 3D models is by direct segmentation of CT or MRI datasets. However, these have the disadvantages that they are expensive, time-consuming and/or induce high-radiation doses to the patient.

Integrating optical fiber force sensors into microforceps for ORL microsurgery.

The delicate anatomy of the ear require surgeons to use great care when operating on its internal structures. One example for such an intervention is the stapedectomy, where a small crook shaped piston is placed in the oval window of the cochlea and connected to the incus through crimping thus bypassing the diseased stapes. Performing the crimp process with the correct force is necessary since loose crimps poorly transmit sound whereas tight crimps will eventually result in necrosis of the incus.

A new soft-tissue simulation strategy for cranio-maxillofacial surgery using facial muscle template model.

We propose a computationally efficient, bio-mechanically relevant soft-tissue simulation method for cranio-maxillofacial (CMF) surgery. Special emphasis is given to comply with the current clinical workflow. A template-based facial muscle prediction was introduced to avoid laborious segmentation from medical images.

Anatomically-driven soft-tissue simulation strategy for cranio-maxillofacial surgery using facial muscle template model.

We propose a computationally efficient and bio-mechanically relevant soft-tissue simulation method for cranio-maxillofacial (CMF) surgery. A template-based facial muscle reconstruction was introduced to minimize the efforts on preparing a patient-specific model. A transversely isotropic mass-tensor model (MTM) was adopted to realize the effect of directional property of facial muscles in reasonable computation time.

Calibration of X-ray radiographs and its feasible application for 2D/3D reconstruction of the proximal femur.

In the past ten years, a variety of computer-assisted surgical technologies have been introduced for total hip replacement (THR). Despite the different approaches, orthopedic surgeons routinely still acquire 2D X-ray radiographs for preoperative diagnostic and templating purposes. Such images provide detailed information in high resolution about the underlying anatomy.

A feasibility study of computer-assisted bone graft implantation for tissue-engineered replacement of the human ankle joint.

Objective: Computer-assisted graft implantation may contribute to achieving biological joint replacement in the future. The purpose of this experimental study was to evaluate the feasibility and accuracy of a series of computer-assisted graft implantations into human cadaver ankle joints.

Methods: Three-dimensional graft models of virtually planned corresponding tibial and talar defects were created from bovine cancellous bone.

Augmented reality endoscopic system (ARES): preliminary results.

Objectives: During endoscopic surgery, it is difficult to ascertain the anatomical landmarks once the anatomy is fiddled with or if the operating area is filled with blood. An augmented reality system will enhance the endoscopic view and further enable surgeons to view hidden critical structures or the results of preoperative planning.

Method: The skull and endoscope are fixed with optical markers that are used as dynamic reference bases for tracking.

A robust and accurate two-stage approach for automatic recovery of distal locking holes in computer-assisted intramedullary nailing of femoral shaft fractures.

It has been recognized that one of the most difficult steps in intramedullary nailing of femoral shaft fractures is the distal locking - the insertion of distal transverse interlocking screws, for which it is necessary to know the positions and orientations of the distal locking holes (DLHs) of the intramedullary nail (IMN). This paper presents a robust and accurate approach for solving this problem based on two calibrated and registered fluoroscopic images. The problem is formulated as a two-stage model-based optimal fitting process.

Accurate and robust reconstruction of a surface model of the proximal femur from sparse-point data and a dense-point distribution model for surgical navigation.

Constructing a 3-D surface model from sparse-point data is a nontrivial task. Here, we report an accurate and robust approach for reconstructing a surface model of the proximal femur from sparse-point data and a dense-point distribution model (DPDM). The problem is formulated as a three-stage optimal estimation process.

Virtual 3D planning of acetabular fracture reduction.

Displaced acetabular fractures are best treated with open reduction to achieve anatomic reduction and maximize the chance of a good functional outcome. Because of the anatomic complexity and often limited visualization, fracture reduction can be difficult. Virtual planning software can allow the surgeon to understand the fracture morphology and to rehearse reduction maneuvers.

Automated detection and segmentation of cylindrical fragments from calibrated C-arm images for long bone fracture reduction.

Long bone fracture belongs to one of the most common injuries encountered in clinical routine trauma surgery. Automated identification, pose and size estimation, and contour extraction of diaphyseal bone fragments can greatly improve the usability of a computer-assisted, fluoroscopy-based navigation system for long bone fracture reduction. In this paper, a two-step solution is proposed.