{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T02:31:00Z","timestamp":1790389860724,"version":"4.1.0"},"reference-count":45,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T00:00:00Z","timestamp":1658707200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Spinal deformation during surgical intervention (caused by patient positioning and\/or the correction of malalignment) confounds conventional navigation due to the assumptions of rigid transformation. Moreover, the ability to accurately quantify spinal alignment in the operating room would provide an assessment of the surgical product via metrics that correlate with clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>A method for deformable 3D\u20132D registration of preoperative CT to intraoperative long\u2010length tomosynthesis images is reported for an accurate 3D evaluation of device placement in the presence of spinal deformation and automated evaluation of global spinal alignment (GSA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Long\u2010length tomosynthesis (\u201cLong Film,\u201d LF) images were acquired using an O\u2010arm imaging system (Medtronic, Minneapolis USA). A deformable 3D\u20132D patient registration was developed using multi\u2010scale masking (proceeding from the full\u2010length image to local subvolumes about each vertebra) to transform vertebral labels and planning information from preoperative CT to the LF images. Automatic measurement of GSA (main thoracic kyphosis [MThK] and lumbar lordosis [LL]) was obtained using a spline fit to registered labels. The \u201cKnown\u2010Component Registration\u201d method for device registration was adapted to the multi\u2010scale process for 3D device localization from orthogonal LF images. The multi\u2010scale framework was evaluated using a deformable spine phantom in which pedicle screws were inserted, and deformations were induced over a range in LL \u223c25\u00b0\u201380\u00b0. Further validation was carried out in a cadaver study with implanted pedicle screws and a similar range of spinal deformation. The accuracy of patient and device registration was evaluated in terms of 3D translational error and target registration error, respectively, and the accuracies of automatic GSA measurements were compared to manual annotation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Phantom studies demonstrated accurate registration via the multi\u2010scale framework for all vertebral levels in both the neutral and deformed spine: median (interquartile range, IQR) patient registration error was 1.1\u00a0mm (0.7\u20131.9\u00a0mm IQR). Automatic measures of MThK and LL agreed with manual delineation within \u22121.1\u00b0\u00a0\u00b1\u00a02.2\u00b0 and 0.7\u00b0\u00a0\u00b1\u00a02.0\u00b0 (mean and standard deviation), respectively. Device registration error was 0.7\u00a0mm (0.4\u20131.0\u00a0mm IQR) at the screw tip and 0.9\u00b0 (1.0\u00b0\u20131.5\u00b0) about the screw trajectory. Deformable 3D\u20132D registration significantly outperformed conventional rigid registration (<jats:italic>p\u00a0<\/jats:italic>&lt;\u00a00.05), which exhibited device registration errors of 2.1\u00a0mm (0.8\u20134.1\u00a0mm) and 4.1\u00b0 (1.2\u00b0\u20139.5\u00b0). Cadaver studies verified performance under realistic conditions, demonstrating patient registration error of 1.6\u00a0mm (0.9\u20132.1\u00a0mm); MThK within \u22124.2\u00b0\u00a0\u00b1\u00a06.8\u00b0 and LL within 1.7\u00b0\u00a0\u00b1\u00a03.5\u00b0; and device registration error of 0.8\u00a0mm (0.5\u20131.9\u00a0mm) and 0.7\u00b0 (0.4\u00b0\u20131.2\u00b0) for the multi\u2010scale deformable method, compared to 2.5\u00a0mm (1.0\u20137.9\u00a0mm) and 2.3\u00b0 (1.6\u00b0\u20138.1\u00b0) for rigid registration (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The deformable 3D\u20132D registration framework leverages long\u2010length intraoperative imaging to achieve accurate patient and device registration over the extended lengths of the spine (up to 64\u00a0cm) even with strong anatomical deformation. The method offers a new means for the quantitative validation of spinal correction (intraoperative GSA measurement) and the 3D verification of device placement in comparison to preoperative images and planning data.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.15819","type":"journal-article","created":{"date-parts":[[2022,6,28]],"date-time":"2022-06-28T06:03:32Z","timestamp":1656396212000},"page":"5715-5727","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Deformable 3D\u20132D image registration and analysis of global spinal alignment in long\u2010length intraoperative spine imaging"],"prefix":"10.1002","volume":"49","author":[{"given":"Xiaoxuan","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Uneri","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yixuan","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig K.","family":"Jones","sequence":"additional","affiliation":[{"name":"The Malone Center for Engineering in Healthcare Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy F.","family":"Witham","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick A.","family":"Helm","sequence":"additional","affiliation":[{"name":"Medtronic Inc.  Littleton Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey H.","family":"Siewerdsen","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering Johns Hopkins University  Baltimore Maryland USA"},{"name":"The Malone Center for Engineering in Healthcare Johns Hopkins University  Baltimore Maryland USA"},{"name":"Department of Neurosurgery Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,7,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60658-3"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0000000000000938"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.BRS.0000092484.31316.32"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)31125-0"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12178-016-9372-5"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.3171\/2017.3.SPINE161011"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-012-2499-1"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2019.05.021"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/abde96"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2021.03.078"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.3171\/2021.3.SPINE201856"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm8111826"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.14245\/ns.1938426.213"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-87141-x"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1117\/1.JMI.7.3.035001"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1117\/1.JMI.7.3.031502"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/igs.10034"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1006\/cviu.1997.0608"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10851-005-0483-7"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.1915012"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.media.2010.07.008"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1120\/jacmp.v8i4.2432"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.2975230"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/aa4f6d"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/52\/19\/003"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/60\/20\/8007"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/58\/22\/7979"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/aada66"},{"key":"e_1_2_8_30_1","first-page":"117","article-title":"Non\u2010rigid craniofacial 2D\u20103D registration using CNN\u2010based regression","author":"Pei Y","year":"2017","journal-title":"Int Work Deep Learn Med Image Anal"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1109\/TMI.2018.2878316"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1109\/TMI.2016.2521800"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11548-018-1776-9"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/aa6b3e"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11263-012-0601-0"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1162\/106365601750190398"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2014.11.043"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/ac07c7"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.3171\/2018.1.SPINE17808"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2013.07.464"},{"issue":"1","key":"e_1_2_8_41_1","article-title":"BRAINSFit: mutual information rigid registrations of whole\u2010brain 3D images, using the insight toolkit","volume":"57","author":"Johnson H","year":"2007","journal-title":"Insight J"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/59\/18\/5329"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200102150-00010"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.media.2009.02.004"},{"key":"e_1_2_8_45_1","first-page":"122","article-title":"Spine detection and labeling using a parts\u2010based graphical model","author":"Schmidt S","year":"2007","journal-title":"Bienn Int Conf Inf Process Med Imaging"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1109\/TMI.2019.2927289"}],"container-title":["Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mp.15819","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/mp.15819","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mp.15819","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T16:10:52Z","timestamp":1697731852000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1002\/mp.15819"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,25]]},"references-count":45,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2022,9]]}},"alternative-id":["10.1002\/mp.15819"],"URL":"https:\/\/doi.org\/10.1002\/mp.15819","archive":["Portico"],"relation":{},"ISSN":["0094-2405","2473-4209"],"issn-type":[{"value":"0094-2405","type":"print"},{"value":"2473-4209","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,25]]},"assertion":[{"value":"2022-02-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-06-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-07-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}