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Med. Biol."],"published-print":{"date-parts":[[2017,12,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Percutaneous pelvic screw placement is challenging due to narrow bone corridors surrounded by vulnerable structures and difficult visual interpretation of complex anatomical shapes in 2D x-ray projection images. To address these challenges, a system for planning, guidance, and quality assurance (QA) is presented, providing functionality analogous to surgical navigation, but based on robust 3D\u20132D image registration techniques using fluoroscopy images already acquired in routine workflow. Two novel aspects of the system are investigated: automatic planning of pelvic screw trajectories and the ability to account for deformation of surgical devices (K-wire deflection).<\/jats:p>\n                  <jats:p>Atlas-based registration is used to calculate a patient-specific plan of screw trajectories in preoperative CT. 3D\u20132D registration aligns the patient to CT within the projective geometry of intraoperative fluoroscopy. Deformable known-component registration (dKC-Reg) localizes the surgical device, and the combination of plan and device location is used to provide guidance and QA. A leave-one-out analysis evaluated the accuracy of automatic planning, and a cadaver experiment compared the accuracy of dKC-Reg to rigid approaches (e.g. optical tracking).<\/jats:p>\n                  <jats:p>Surgical plans conformed within the bone cortex by 3\u20134\u2009mm for the narrowest corridor (superior pubic ramus) and\u2009\u2009&gt;5\u2009mm for the widest corridor (tear drop). The dKC-Reg algorithm localized the K-wire tip within 1.1\u2009mm and 1.4\u00b0 and was consistently more accurate than rigid-body tracking (errors up to 9\u2009mm).<\/jats:p>\n                  <jats:p>The system was shown to automatically compute reliable screw trajectories and accurately localize deformed surgical devices (K-wires). Such capability could improve guidance and QA in orthopaedic surgery, where workflow is impeded by manual planning, conventional tool trackers add complexity and cost, rigid tool assumptions are often inaccurate, and qualitative interpretation of complex anatomy from 2D projections is prone to trial-and-error with extended fluoroscopy time.<\/jats:p>","DOI":"10.1088\/1361-6560\/aa954f","type":"journal-article","created":{"date-parts":[[2017,10,23]],"date-time":"2017-10-23T18:14:37Z","timestamp":1508782477000},"page":"9018-9038","update-policy":"https:\/\/doi.org\/10.1088\/crossmark-policy","source":"Crossref","is-referenced-by-count":19,"title":["Planning, guidance, and quality assurance of pelvic screw placement using deformable image registration"],"prefix":"10.1088","volume":"62","author":[{"given":"J","family":"Goerres","sequence":"first","affiliation":[{"name":"Johns Hopkins University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3419-1805","authenticated-orcid":false,"given":"A","family":"Uneri","sequence":"additional","affiliation":[{"name":"Johns Hopkins University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Jacobson","sequence":"additional","affiliation":[{"name":"Johns Hopkins University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Ramsay","sequence":"additional","affiliation":[{"name":"Johns Hopkins University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T","family":"De Silva","sequence":"additional","affiliation":[{"name":"Johns Hopkins University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Ketcha","sequence":"additional","affiliation":[{"name":"Johns Hopkins University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Han","sequence":"additional","affiliation":[{"name":"Johns Hopkins University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Manbachi","sequence":"additional","affiliation":[{"name":"Johns Hopkins University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Vogt","sequence":"additional","affiliation":[{"name":"Siemens Healthineers"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Kleinszig","sequence":"additional","affiliation":[{"name":"Siemens Healthineers"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J-P","family":"Wolinsky","sequence":"additional","affiliation":[{"name":"The Johns Hopkins Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Osgood","sequence":"additional","affiliation":[{"name":"The Johns Hopkins Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J H","family":"Siewerdsen","sequence":"additional","affiliation":[{"name":"Johns Hopkins University"},{"name":"The Johns Hopkins Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"266","published-online":{"date-parts":[[2017,11,13]]},"reference":[{"key":"pmbaa954fbib001","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1016\/j.neuroimage.2009.02.018","type":"journal-article","article-title":"Multi-atlas based segmentation of brain images: atlas selection and its effect on accuracy","volume":"46","author":"Aljabar","year":"2009","journal-title":"Neuroimage"},{"key":"pmbaa954fbib002","doi-asserted-by":"publisher","first-page":"1520","DOI":"10.1302\/0301-620X.87B11.16614","type":"journal-article","article-title":"The use of a virtual three-dimensional model to evaluate the intraosseous space available for percutaneous screw fixation of acetabular fractures","volume":"87","author":"Attias","year":"2005","journal-title":"Bone Joint J."},{"key":"pmbaa954fbib003","doi-asserted-by":"publisher","first-page":"80","DOI":"10.3113\/JSOA.2016.0080","type":"journal-article","article-title":"Computed tomography-based software safely guides anterograde percutaneous anterior and posterior column acetabular screws","volume":"25","author":"Banerjee","year":"2016","journal-title":"J. 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