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Register a new userPatch-Based Image Similarity for Intraoperative 2D/3D Pelvis Registration During Periacetabular Osteotomy
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Periacetabular osteotomy is a challenging surgical procedure for treating developmental hip dysplasia, providing greater coverage of the femoral head via relocation of a patients acetabulum. Since fluoroscopic imaging is frequently used in the surgical workflow, computer-assisted X-Ray navigation of osteotomes and the relocated acetabular fragment should be feasible. We use intensity-based 2D/3D registration to estimate the pelvis pose with respect to fluoroscopic images, recover relative poses of multiple views, and triangulate landmarks which may be used for navigation. Existing similarity metrics are unable to consistently account for the inherent mismatch between the preoperative intact pelvis, and the intraoperative reality of a fractured pelvis. To mitigate the effect of this mismatch, we continuously estimate the relevance of each pixel to solving the registration and use these values as weightings in a patch-based similarity metric. Limiting computation to randomly selected subsets of patches results in faster runtimes than existing patch-based methods. A simulation study was conducted with random fragment shapes, relocations, and fluoroscopic views, and the proposed method achieved a 1.7 mm mean triangulation error over all landmarks, compared to mean errors of 3 mm and 2.8 mm for the non-patched and image-intensity-variance-weighted patch similarity metrics, respectively.
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Augmented reality has the potential to improve operating room workflow by allowing physicians to see inside a patient through the projection of imaging directly onto the surgical field. For this to be useful the acquired imaging must be quickly and accurately registered with patient and the registration must be maintained. Here we describe a method for projecting a CT scan with Microsoft Hololens and then aligning that projection to a set of fiduciary markers. Radio-opaque stickers with unique QR-codes are placed on an object prior to acquiring a CT scan. The location of the markers in the CT scan are extracted and the CT scan is converted into a 3D surface object. The 3D object is then projected using the Hololens onto a table on which the same markers are placed. We designed an algorithm that aligns the markers on the 3D object with the markers on the table. To extract the markers and convert the CT into a 3D object took less than 5 seconds. To align three markers, it took $0.9 pm 0.2$ seconds to achieve an accuracy of $5 pm 2$ mm. These findings show that it is feasible to use a combined radio-opaque optical marker, placed on a patient prior to a CT scan, to subsequently align the acquired CT scan with the patient.
Accurate and consistent mental interpretation of fluoroscopy to determine the position and orientation of acetabular bone fragments in 3D space is difficult. We propose a computer assisted approach that uses a single fluoroscopic view and quickly reports the pose of an acetabular fragment without any user input or initialization. Intraoperatively, but prior to any osteotomies, two constellations of metallic ball-bearings (BBs) are injected into the wing of a patients ilium and lateral superior pubic ramus. One constellation is located on the expected acetabular fragment, and the other is located on the remaining, larger, pelvis fragment. The 3D locations of each BB are reconstructed using three fluoroscopic views and 2D/3D registrations to a preoperative CT scan of the pelvis. The relative pose of the fragment is established by estimating the movement of the two BB constellations using a single fluoroscopic view taken after osteotomy and fragment relocation. BB detection and inter-view correspondences are automatically computed throughout the processing pipeline. The proposed method was evaluated on a multitude of fluoroscopic images collected from six cadaveric surgeries performed bilaterally on three specimens. Mean fragment rotation error was 2.4 +/- 1.0 degrees, mean translation error was 2.1 +/- 0.6 mm, and mean 3D lateral center edge angle error was 1.0 +/- 0.5 degrees. The average runtime of the single-view pose estimation was 0.7 +/- 0.2 seconds. The proposed method demonstrates accuracy similar to other state of the art systems which require optical tracking systems or multiple-view 2D/3D registrations with manual input. The errors reported on fragment poses and lateral center edge angles are within the margins required for accurate intraoperative evaluation of femoral head coverage.
Fluoroscopy is the standard imaging modality used to guide hip surgery and is therefore a natural sensor for computer-assisted navigation. In order to efficiently solve the complex registration problems presented during navigation, human-assisted annotations of the intraoperative image are typically required. This manual initialization interferes with the surgical workflow and diminishes any advantages gained from navigation. We propose a method for fully automatic registration using annotations produced by a neural network. Neural networks are trained to simultaneously segment anatomy and identify landmarks in fluoroscopy. Training data is obtained using an intraoperatively incompatible 2D/3D registration of hip anatomy. Ground truth 2D labels are established using projected 3D annotations. Intraoperative registration couples an intensity-based strategy with annotations inferred by the network and requires no human assistance. Ground truth labels were obtained in 366 fluoroscopic images across 6 cadaveric specimens. In a leave-one-subject-out experiment, networks obtained mean dice coefficients for left and right hemipelves, left and right femurs of 0.86, 0.87, 0.90, and 0.84. The mean 2D landmark error was 5.0 mm. The pelvis was registered within 1 degree for 86% of the images when using the proposed intraoperative approach with an average runtime of 7 seconds. In comparison, an intensity-only approach without manual initialization, registered the pelvis to 1 degree in 18% of images. We have created the first accurately annotated, non-synthetic, dataset of hip fluoroscopy. By using these annotations as training data for neural networks, state of the art performance in fluoroscopic segmentation and landmark localization was achieved. Integrating these annotations allows for a robust, fully automatic, and efficient intraoperative registration during fluoroscopic navigation of the hip.
3D image registration is one of the most fundamental and computationally expensive operations in medical image analysis. Here, we present a mixed-precision, Gauss--Newton--Krylov solver for diffeomorphic registration of two images. Our work extends the publicly available CLAIRE library to GPU architectures. Despite the importance of image registration, only a few implementations of large deformation diffeomorphic registration packages support GPUs. Our contributions are new algorithms to significantly reduce the run time of the two main computational kernels in CLAIRE: calculation of derivatives and scattered-data interpolation. We deploy (i) highly-optimized, mixed-precision GPU-kernels for the evaluation of scattered-data interpolation, (ii) replace Fast-Fourier-Transform (FFT)-based first-order derivatives with optimized 8th-order finite differences, and (iii) compare with state-of-the-art CPU and GPU implementations. As a highlight, we demonstrate that we can register $256^3$ clinical images in less than 6 seconds on a single NVIDIA Tesla V100. This amounts to over 20$times$ speed-up over the current version of CLAIRE and over 30$times$ speed-up over existing GPU implementations.
We introduce a learning strategy for contrast-invariant image registration without requiring imaging data. While classical registration methods accurately estimate the spatial correspondence between images, they solve a costly optimization problem for every image pair. Learning-based techniques are fast at test time, but can only register images with image contrast and geometric content that are similar to those available during training. We focus on removing this image-data dependency of learning methods. Our approach leverages a generative model for diverse label maps and images that exposes networks to a wide range of variability during training, forcing them to learn features invariant to image type (contrast). This strategy results in powerful networks trained to generalize to a broad array of real input images. We present extensive experiments, with a focus on 3D neuroimaging, showing that this strategy enables robust registration of arbitrary image contrasts without the need to retrain for new modalities. We demonstrate registration accuracy that most often surpasses the state of the art both within and across modalities, using a single model. Critically, we show that input labels from which we synthesize images need not be of actual anatomy: training on randomly generated geometric shapes also results in competitive registration performance, albeit slightly less accurate, while alleviating the dependency on real data of any kind. Our code is available at: http://voxelmorph.csail.mit.edu
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