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Marinetto E, Uneri A, De Silva T, Reaungamornrat S, Zbijewski W, Sisniega A, Vogt S, Kleinszig G, Pascau J, Siewerdsen JH. Integration of free-hand 3D ultrasound and mobile C-arm cone-beam CT: Feasibility and characterization for real-time guidance of needle insertion. Comput Med Imaging Graph 2017; 58:13-22. [PMID: 28414927 DOI: 10.1016/j.compmedimag.2017.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 12/16/2016] [Accepted: 03/28/2017] [Indexed: 12/27/2022]
Abstract
This work presents development of an integrated ultrasound (US)-cone-beam CT (CBCT) system for image-guided needle interventions, combining a low-cost ultrasound system (Interson VC 7.5MHz, Pleasanton, CA) with a mobile C-arm for fluoroscopy and CBCT via use of a surgical tracker. Imaging performance of the ultrasound system was characterized in terms of depth-dependent contrast-to-noise ratio (CNR) and spatial resolution. US-CBCT system was evaluated in phantom studies simulating three needle-based procedures: drug delivery, tumor ablation, and lumbar puncture. Low-cost ultrasound provided flexibility but exhibited modest CNR and spatial resolution that is likely limited to fairly superficial applications within a ∼10cm depth of view. Needle tip localization demonstrated target registration error 2.1-3.0mm using fiducial-based registration.
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Goerres J, Uneri A, De Silva T, Ketcha M, Reaungamornrat S, Jacobson M, Vogt S, Kleinszig G, Osgood G, Wolinsky JP, Siewerdsen JH. Spinal pedicle screw planning using deformable atlas registration. Phys Med Biol 2017; 62:2871-2891. [PMID: 28177300 DOI: 10.1088/1361-6560/aa5f42] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Jacobson MW, Ketcha M, Uneri A, Goerres J, De Silva T, Reaungamornrat S, Vogt S, Kleinszig G, Siewerdsen JH. Geometric Calibration Using Line Fiducials for Cone-Beam CT with General, Non-Circular Source-Detector Trajectories. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2017; 10132. [PMID: 28989218 DOI: 10.1117/12.2255724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
PURPOSE Traditional BB-based geometric calibration methods for cone-beam CT (CBCT) rely strongly on foreknowledge of the scan trajectory shape. This is a hindrance to the implementation of variable trajectory CBCT systems, normally requiring a dedicated calibration phantom or software algorithm for every scan orbit of interest. A more flexible method of calibration is proposed here that accommodates multiple orbit types - including strongly noncircular trajectories - with a single phantom and software routine. METHODS The proposed method uses a calibration phantom consisting of multiple line-shaped wire segments. Geometric models relating the 3D line equations of the wires to the 2D line equations of their projections are used as the basis for system geometry estimation. This method was tested using a mobile C-arm CT system and comparisons were made to standard BB-based calibrations. Simulation studies were also conducted using a sinusoid-on-sphere orbit. Calibration performance was quantified in terms of Point Spread Function (PSF) width and back projection error. Visual image quality was assessed with respect to spatial resolution in trabecular bone in an anthropomorphic head phantom. RESULTS The wire-based calibration method performed equal to or better than BB-based calibrations in all evaluated metrics. For the sinusoidal scans, the method provided reliable calibration, validating its application to non-circular trajectories. Furthermore, the ability to improve image quality using non-circular orbits in conjunction with this calibration method was demonstrated. CONCLUSION The proposed method has been shown feasible for conventional circular CBCT scans and offers a promising tool for non-circular scan orbits that can improve image quality, reduce dose, and extend field of view.
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Ketcha MD, de Silva T, Han R, Uneri A, Goerres J, Jacobson M, Vogt S, Kleinszig G, Siewerdsen JH. Fundamental limits of image registration performance: Effects of image noise and resolution in CT-guided interventions. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2017; 10135. [PMID: 28572693 DOI: 10.1117/12.2256025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE In image-guided procedures, image acquisition is often performed primarily for the task of geometrically registering information from another image dataset, rather than detection / visualization of a particular feature. While the ability to detect a particular feature in an image has been studied extensively with respect to image quality characteristics (noise, resolution) and is an ongoing, active area of research, comparatively little has been accomplished to relate such image quality characteristics to registration performance. METHODS To establish such a framework, we derived Cramer-Rao lower bounds (CRLB) for registration accuracy, revealing the underlying dependencies on image variance and gradient strength. The CRLB was analyzed as a function of image quality factors (in particular, dose) for various similarity metrics and compared to registration accuracy using CT images of an anthropomorphic head phantom at various simulated dose levels. Performance was evaluated in terms of root mean square error (RMSE) of the registration parameters. RESULTS Analysis of the CRLB shows two primary dependencies: 1) noise variance (related to dose); and 2) sum of squared image gradients (related to spatial resolution and image content). Comparison of the measured RMSE to the CRLB showed that the best registration method, RMSE achieved the CRLB to within an efficiency factor of 0.21, and optimal estimators followed the predicted inverse proportionality between registration performance and radiation dose. CONCLUSIONS Analysis of the CRLB for image registration is an important step toward understanding and evaluating an intraoperative imaging system with respect to a registration task. While the CRLB is optimistic in absolute performance, it reveals a basis for relating the performance of registration estimators as a function of noise content and may be used to guide acquisition parameter selection (e.g., dose) for purposes of intraoperative registration.
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Goerres J, Jacobson M, Uneri A, De Silva T, Ketcha M, Reaungamornrat S, Vogt S, Kleinszig G, Wolinsky JP, Osgood G, Siewerdsen J. Deformable 3D-2D Registration for Guiding K-Wire Placement in Pelvic Trauma Surgery. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2017; 10135:101350A. [PMID: 28989221 PMCID: PMC5627511 DOI: 10.1117/12.2255952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Pelvic Kirschner wire (K-wire) insertion is a challenging surgical task requiring interpretation of complex 3D anatomical shape from 2D projections (fluoroscopy) and delivery of device trajectories within fairly narrow bone corridors in proximity to adjacent nerves and vessels. Over long trajectories (~10-25 cm), K-wires tend to curve (deform), making conventional rigid navigation inaccurate at the tip location. A system is presented that provides accurate 3D localization and guidance of rigid or deformable surgical devices ("components" - e.g., K-wires) based on 3D-2D registration. The patient is registered to a preoperative CT image by virtually projecting digitally reconstructed radiographs (DRRs) and matching to two or more intraoperative x-ray projections. The K-wire is localized using an analogous procedure matching DRRs of a deformably parametrized model for the device component (deformable known-component registration, or dKC-Reg). A cadaver study was performed in which a K-wire trajectory was delivered in the pelvis. The system demonstrated target registration error (TRE) of 2.1 ± 0.3 mm in location of the K-wire tip (median ± interquartile range, IQR) and 0.8 ± 1.4° in orientation at the tip (median ± IQR), providing functionality analogous to surgical tracking/navigation using imaging systems already in the surgical arsenal without reliance on a surgical tracker. The method offers quantitative 3D guidance using images (e.g., inlet/outlet views) already acquired in the standard of care, potentially extending the advantages of navigation to broader utilization in trauma surgery to improve surgical precision and safety.
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Uneri A, De Silva T, Goerres J, Jacobson MW, Ketcha MD, Reaungamornrat S, Kleinszig G, Vogt S, Khanna AJ, Osgood GM, Wolinsky JP, Siewerdsen JH. Intraoperative evaluation of device placement in spine surgery using known-component 3D-2D image registration. Phys Med Biol 2017; 62:3330-3351. [PMID: 28233760 DOI: 10.1088/1361-6560/aa62c5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Intraoperative x-ray radiography/fluoroscopy is commonly used to assess the placement of surgical devices in the operating room (e.g. spine pedicle screws), but qualitative interpretation can fail to reliably detect suboptimal delivery and/or breach of adjacent critical structures. We present a 3D-2D image registration method wherein intraoperative radiographs are leveraged in combination with prior knowledge of the patient and surgical components for quantitative assessment of device placement and more rigorous quality assurance (QA) of the surgical product. The algorithm is based on known-component registration (KC-Reg) in which patient-specific preoperative CT and parametric component models are used. The registration performs optimization of gradient similarity, removes the need for offline geometric calibration of the C-arm, and simultaneously solves for multiple component bodies, thereby allowing QA in a single step (e.g. spinal construct with 4-20 screws). Performance was tested in a spine phantom, and first clinical results are reported for QA of transpedicle screws delivered in a patient undergoing thoracolumbar spine surgery. Simultaneous registration of ten pedicle screws (five contralateral pairs) demonstrated mean target registration error (TRE) of 1.1 ± 0.1 mm at the screw tip and 0.7 ± 0.4° in angulation when a prior geometric calibration was used. The calibration-free formulation, with the aid of component collision constraints, achieved TRE of 1.4 ± 0.6 mm. In all cases, a statistically significant improvement (p < 0.05) was observed for the simultaneous solutions in comparison to previously reported sequential solution of individual components. Initial application in clinical data in spine surgery demonstrated TRE of 2.7 ± 2.6 mm and 1.5 ± 0.8°. The KC-Reg algorithm offers an independent check and quantitative QA of the surgical product using radiographic/fluoroscopic views acquired within standard OR workflow. Such intraoperative assessment could improve quality and safety, provide the opportunity to revise suboptimal constructs in the OR, and reduce the frequency of revision surgery.
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De Silva T, Punnoose J, Uneri A, Goerres J, Jacobson M, Ketcha MD, Manbachi A, Vogt S, Kleinszig G, Khanna AJ, Wolinksy JP, Osgood G, Siewerdsen JH. C-arm Positioning Using Virtual Fluoroscopy for Image-Guided Surgery. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2017; 10135:101352K. [PMID: 28572694 PMCID: PMC5449120 DOI: 10.1117/12.2256028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Fluoroscopically guided procedures often involve repeated acquisitions for C-arm positioning at the cost of radiation exposure and time in the operating room. A virtual fluoroscopy system is reported with the potential of reducing dose and time spent in C-arm positioning, utilizing three key advances: robust 3D-2D registration to a preoperative CT; real-time forward projection on GPU; and a motorized mobile C-arm with encoder feedback on C-arm orientation. METHOD Geometric calibration of the C-arm was performed offline in two rotational directions (orbit α, orbit β). Patient registration was performed using image-based 3D-2D registration with an initially acquired radiograph of the patient. This approach for patient registration eliminated the requirement for external tracking devices inside the operating room, allowing virtual fluoroscopy using commonly available systems in fluoroscopically guided procedures within standard surgical workflow. Geometric accuracy was evaluated in terms of projection distance error (PDE) in anatomical fiducials. A pilot study was conducted to evaluate the utility of virtual fluoroscopy to aid C-arm positioning in image guided surgery, assessing potential improvements in time, dose, and agreement between the virtual and desired view. RESULTS The overall geometric accuracy of DRRs in comparison to the actual radiographs at various C-arm positions was PDE (mean ± std) = 1.6 ± 1.1 mm. The conventional approach required on average 8.0 ± 4.5 radiographs spent "fluoro hunting" to obtain the desired view. Positioning accuracy improved from 2.6° ± 2.3° (in α) and 4.1° ± 5.1° (in β) in the conventional approach to 1.5° ± 1.3° and 1.8° ± 1.7°, respectively, with the virtual fluoroscopy approach. CONCLUSION Virtual fluoroscopy could improve accuracy of C-arm positioning and save time and radiation dose in the operating room. Such a system could be valuable to training of fluoroscopy technicians as well as intraoperative use in fluoroscopically guided procedures.
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Vogt S, Ramzan R, Irqsusi M, Mirow N, Moosdorf R. Mitochondrial Pharmaco-Bioenergetics in Heart Surgical Patients: Do We Harm When We Treat? Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Irqsusi M, Mirow N, Schenk T, Vogt S, Moosdorf R. Cranial Computed Tomography Imaging for Postoperative Neurological Damage after Coronary Artery Bypass Surgery: What is it Good for? Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stock S, Finney L, Telser A, Maxey E, Vogt S, Okasinski J. Cementum structure in Beluga whale teeth. Acta Biomater 2017; 48:289-299. [PMID: 27836805 DOI: 10.1016/j.actbio.2016.11.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/02/2016] [Accepted: 11/03/2016] [Indexed: 01/22/2023]
Abstract
A large fraction of the volume of Beluga whale (Delphinapterus leucas) teeth consists of cementum, a mineralized tissue which grows throughout the life of the animal and to which the periodontal ligaments attach. Annular growth bands or growth layer groups (GLGs) form within Beluga cementum, and this study investigates GLG structure using X-ray fluorescence mapping and X-ray diffraction mapping with microbeams of synchrotron radiation. The Ca and Zn fluorescent intensities and carbonated hydroxyapatite (cAp) diffracted intensities rise and fall together and match the light-dark bands visible in transmitted light micrographs. Within the bands of maximum Ca and Zn intensity, the ratio of Zn to Ca is slightly higher than in the minima bands. Further, the GLG cAp, Ca and Zn modulation is preserved throughout the cementum for durations >25year. STATEMENT OF SIGNIFICANCE Cementum is an important tooth tissue to which the periodontal ligaments attach and consists primarily of carbonated apatite mineral and collagen. In optical microscopy of cementum thin sections, light/dark bands are formed annually, and age at death is determined by counting these bands. We employ synchrotron X-ray diffraction and X-ray fluorescence mapping to show the bands in Beluga whale cementum result from differences in mineral content and not from differences in collagen orientation as was concluded by others. Variation in Zn fluorescent intensity was found to be very sensitive indicator of changing biomineralization and suggest that Zn plays an important role this process.
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De Silva T, Uneri A, Ketcha MD, Reaungamornrat S, Goerres J, Jacobson MW, Vogt S, Kleinszig G, Khanna AJ, Wolinsky JP, Siewerdsen JH. Registration of MRI to intraoperative radiographs for target localization in spinal interventions. Phys Med Biol 2017; 62:684-701. [PMID: 28050972 DOI: 10.1088/1361-6560/62/2/684] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Decision support to assist in target vertebra localization could provide a useful aid to safe and effective spine surgery. Previous solutions have shown 3D-2D registration of preoperative CT to intraoperative radiographs to reliably annotate vertebral labels for assistance during level localization. We present an algorithm (referred to as MR-LevelCheck) to perform 3D-2D registration based on a preoperative MRI to accommodate the increasingly common clinical scenario in which MRI is used instead of CT for preoperative planning. Straightforward adaptation of gradient/intensity-based methods appropriate to CT-to-radiograph registration is confounded by large mismatch and noncorrespondence in image intensity between MRI and radiographs. The proposed method overcomes such challenges with a simple vertebrae segmentation step using vertebra centroids as seed points (automatically defined within existing workflow). Forwards projections are computed using segmented MRI and registered to radiographs via gradient orientation (GO) similarity and the CMA-ES (covariance-matrix-adaptation evolutionary-strategy) optimizer. The method was tested in an IRB-approved study involving 10 patients undergoing cervical, thoracic, or lumbar spine surgery following preoperative MRI. The method successfully registered each preoperative MRI to intraoperative radiographs and maintained desirable properties of robustness against image content mismatch and large capture range. Robust registration performance was achieved with projection distance error (PDE) (median ± IQR) = 4.3 ± 2.6 mm (median ± IQR) and 0% failure rate. Segmentation accuracy for the continuous max-flow method yielded dice coefficient = 88.1 ± 5.2, accuracy = 90.6 ± 5.7, RMSE = 1.8 ± 0.6 mm, and contour affinity ratio (CAR) = 0.82 ± 0.08. Registration performance was found to be robust for segmentation methods exhibiting RMSE <3 mm and CAR >0.50. The MR-LevelCheck method provides a potentially valuable extension to a previously developed decision support tool for spine surgery target localization by extending its utility to preoperative MRI while maintaining characteristics of accuracy and robustness.
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Wedding JL, Harris HH, Bader CA, Plush SE, Mak R, Massi M, Brooks DA, Lai B, Vogt S, Werrett MV, Simpson PV, Skelton BW, Stagni S. Intracellular distribution and stability of a luminescent rhenium(i) tricarbonyl tetrazolato complex using epifluorescence microscopy in conjunction with X-ray fluorescence imaging. Metallomics 2017; 9:382-390. [DOI: 10.1039/c6mt00243a] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Reaungamornrat S, De Silva T, Uneri A, Goerres J, Jacobson M, Ketcha M, Vogt S, Kleinszig G, Khanna AJ, Wolinsky JP, Prince JL, Siewerdsen JH. Performance evaluation of MIND demons deformable registration of MR and CT images in spinal interventions. Phys Med Biol 2016; 61:8276-8297. [PMID: 27811396 DOI: 10.1088/0031-9155/61/23/8276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Accurate intraoperative localization of target anatomy and adjacent nervous and vascular tissue is essential to safe, effective surgery, and multimodality deformable registration can be used to identify such anatomy by fusing preoperative CT or MR images with intraoperative images. A deformable image registration method has been developed to estimate viscoelastic diffeomorphisms between preoperative MR and intraoperative CT using modality-independent neighborhood descriptors (MIND) and a Huber metric for robust registration. The method, called MIND Demons, optimizes a constrained symmetric energy functional incorporating priors on smoothness, geodesics, and invertibility by alternating between Gauss-Newton optimization and Tikhonov regularization in a multiresolution scheme. Registration performance was evaluated for the MIND Demons method with a symmetric energy formulation in comparison to an asymmetric form, and sensitivity to anisotropic MR voxel-size was analyzed in phantom experiments emulating image-guided spine-surgery in comparison to a free-form deformation (FFD) method using local mutual information (LMI). Performance was validated in a clinical study involving 15 patients undergoing intervention of the cervical, thoracic, and lumbar spine. The target registration error (TRE) for the symmetric MIND Demons formulation (1.3 ± 0.8 mm (median ± interquartile)) outperformed the asymmetric form (3.6 ± 4.4 mm). The method demonstrated fairly minor sensitivity to anisotropic MR voxel size, with median TRE ranging 1.3-2.9 mm for MR slice thickness ranging 0.9-9.9 mm, compared to TRE = 3.2-4.1 mm for LMI FFD over the same range. Evaluation in clinical data demonstrated sub-voxel TRE (<2 mm) in all fifteen cases with realistic deformations that preserved topology with sub-voxel invertibility (0.001 mm) and positive-determinant spatial Jacobians. The approach therefore appears robust against realistic anisotropic resolution characteristics in MR and yields registration accuracy suitable to application in image-guided spine-surgery.
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Uneri A, Goerres J, De Silva T, Jacobson MW, Ketcha MD, Reaungamornrat S, Kleinszig G, Vogt S, Khanna AJ, Wolinsky JP, Siewerdsen JH. Deformable 3D-2D Registration of Known Components for Image Guidance in Spine Surgery. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2016; 9902:124-132. [PMID: 37195053 PMCID: PMC10183252 DOI: 10.1007/978-3-319-46726-9_15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
A 3D-2D image registration method is reported for guiding the placement of surgical devices (e.g., K-wires). The solution registers preoperative CT (and planning data therein) to intraoperative radiographs and computes the pose, shape, and deformation parameters of devices (termed "components") known to be in the radiographic scene. The deformable known-component registration (dKC-Reg) method was applied in experiments emulating spine surgery to register devices (K-wires and spinal fixation rods) undergoing realistic deformation. A two-stage registration process (i) resolves patient pose from individual radiographs and (ii) registers components represented as polygonal meshes based on a B-spline model. The registration result can be visualized as overlay of the component in CT analogous to surgical navigation but without conventional trackers or fiducials. Target registration error in the tip and orientation of deformable K-wires was (1.5±0.9)mm and 0.6∘±0.2∘, respectively. For spinal fixation rods, the registered components achieved Hausdorff distance of 3.4 mm. Future work includes testing in cadaver and clinical data and extension to more generalized deformation and component models.
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Vogt S, Wahl S, Kettunen J, Breitner S, Kastenmüller G, Gieger C, Suhre K, Waldenberger M, Kratzsch J, Perola M, Salomaa V, Blankenberg S, Zeller T, Soininen P, Kangas AJ, Peters A, Grallert H, Ala-Korpela M, Thorand B. Characterization of the metabolic profile associated with serum 25-hydroxyvitamin D: a cross-sectional analysis in population-based data. Int J Epidemiol 2016; 45:1469-1481. [PMID: 27605587 PMCID: PMC5100623 DOI: 10.1093/ije/dyw222] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Numerous observational studies have observed associations between vitamin D deficiency and cardiometabolic diseases, but these findings might be confounded by obesity. A characterization of the metabolic profile associated with serum 25-hydroxyvitamin D [25(OH)D] levels, in general and stratified by abdominal obesity, may help to untangle the relationship between vitamin D, obesity and cardiometabolic health. METHODS Serum metabolomics measurements were obtained from a nuclear magnetic resonance spectroscopy (NMR)- and a mass spectrometry (MS)-based platform. The discovery was conducted in 1726 participants of the population-based KORA-F4 study, in which the associations of the concentrations of 415 metabolites with 25(OH)D levels were assessed in linear models. The results were replicated in 6759 participants (NMR) and 609 (MS) participants, respectively, of the population-based FINRISK 1997 study. RESULTS Mean [standard deviation (SD)] 25(OH)D levels were 15.2 (7.5) ng/ml in KORA F4 and 13.8 (5.9) ng/ml in FINRISK 1997; 37 metabolites were associated with 25(OH)D in KORA F4 at P < 0.05/415. Of these, 30 associations were replicated in FINRISK 1997 at P < 0.05/37. Among these were constituents of (very) large very-low-density lipoprotein and small low-density lipoprotein subclasses and related measures like serum triglycerides as well as fatty acids and measures reflecting the degree of fatty acid saturation. The observed associations were independent of waist circumference and generally similar in abdominally obese and non-obese participants. CONCLUSIONS Independently of abdominal obesity, higher 25(OH)D levels were associated with a metabolite profile characterized by lower concentrations of atherogenic lipids and a higher degree of fatty acid polyunsaturation. These results indicate that the relationship between vitamin D deficiency and cardiometabolic diseases is unlikely to merely reflect obesity-related pathomechanisms.
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Eaves D, Behmer L, Vogt S. EEG and behavioural correlates of different forms of motor imagery during action observation in rhythmical actions. Brain Cogn 2016; 106:90-103. [DOI: 10.1016/j.bandc.2016.04.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/24/2016] [Accepted: 04/26/2016] [Indexed: 01/29/2023]
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Dressler D, Vogt S, Saberi F. Der Off-Label Use am Beispiel der Botulinumtoxin-Therapie. KLIN NEUROPHYSIOL 2016. [DOI: 10.1055/s-0041-111362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Reaungamornrat S, De Silva T, Uneri A, Wolinsky J, Khanna A, Kleinszig G, Vogt S, Prince J, Siewerdsen J. TH-CD-206-10: Clinical Application of the MIND Demons Algorithm for Symmetric Diffeomorphic Deformable MR-To-CT Image Registration in Spinal Interventions. Med Phys 2016. [DOI: 10.1118/1.4958191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Uneri A, De Silva T, Goerres J, Jacobson M, Ketcha M, Reaungamornrat S, Kleinszig G, Vogt S, Khanna A, Wolinsky J, Siewerdsen J. WE-AB-BRA-07: Operating Room Quality Assurance (ORQA) for Spine Surgery Using Known-Component 3D-2D Image Registration. Med Phys 2016. [DOI: 10.1118/1.4957736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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De Silva T, Uneri A, Ketcha M, Reaungamornrat S, Goerres J, Vogt S, Kleinszig G, Wolinsky J, Siewerdsen JH. WE-AB-BRA-09: Registration of Preoperative MRI to Intraoperative Radiographs for Automatic Vertebral Target Localization. Med Phys 2016. [DOI: 10.1118/1.4957738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Blanke F, Vogt S. Zellfreie Biomaterialien. ARTHROSKOPIE 2016. [DOI: 10.1007/s00142-016-0067-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lenz R, Kieb M, Diehl P, Grim C, Vogt S, Tischer T. [Muscle, tendon and joint injections : What is the evidence?]. DER ORTHOPADE 2016; 45:459-68. [PMID: 27147429 DOI: 10.1007/s00132-016-3262-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Injections at tendon insertions, in muscles and in joints are an important instrument in the conservative treatment of musculoskeletal diseases, for acute injuries as well as for chronic degenerative diseases. Local anesthetic agents and glucocorticoids are well-established medications; however, severe side effects, such as chondrolysis have sometimes been reported, particularly for local anesthetic agents. In addition platelet rich plasma (PRP) and hyaluronic acid are also widely used; however, the clinical effectiveness has not always been proven. This article gives an overview on the most commonly used medications for injections and the mechanisms of action. The indications for treatment and the evidence for the clinical adminstration of muscle, tendon and joint injections are described based on the currently available literature.
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Origlia S, Schiller S, Pramod MS, Smith L, Singh Y, He W, Viswam S, Świerad D, Hughes J, Bongs K, Sterr U, Lisdat C, Vogt S, Bize S, Lodewyck J, Le Targat R, Holleville D, Venon B, Gill P, Barwood G, Hill IR, Ovchinnikov Y, Kulosa A, Ertmer W, Rasel EM, Stuhler J, Kaenders W. Development of a strontium optical lattice clock for the SOC mission on the ISS. ACTA ACUST UNITED AC 2016. [DOI: 10.1117/12.2229473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Kraus TM, Imhoff FB, Reinert J, Wexel G, Wolf A, Hirsch D, Hofmann A, Stöckle U, Buchmann S, Tischer T, Imhoff AB, Milz S, Anton M, Vogt S. Stem cells and bFGF in tendon healing: Effects of lentiviral gene transfer and long-term follow-up in a rat Achilles tendon defect model. BMC Musculoskelet Disord 2016; 17:148. [PMID: 27048602 PMCID: PMC4822291 DOI: 10.1186/s12891-016-0999-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 03/25/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The influence of stem cells and lentiviral expression of basic fibroblastic growth factor (bFGF) on tendon healing and remodelling was investigated in an in-vivo long-term (12 weeks) rat Achilles tendon defect model. METHODS In sixty male Lewis rats, complete tendon defects (2.4 mm) were created and either left untreated (PBS) or treated by injection of stem cells lentivirally expressing the enhanced green fluorescence marker gene eGFP (MSC-LV-eGFP) or basic fibroblast growth factor bFGF (MSC-LV-bFGF). Tendons were harvested after 12 weeks and underwent biomechanical and (immuno)-histological analysis. RESULTS After 12 weeks the mean ultimate load to failure ratio (treated side to contralateral side) in biomechanical testing reached 97 % in the bFGF-group, 103 % in the eGFP-group and 112 % in the PBS-group. Also in the stiffness testing both MSC groups did not reach the results of the PBS group. Histologically, the MSC groups did not show better results than the control group. There were clusters of ossifications found in all groups. In immunohistology, only the staining collagen-type-I was strongly increased in both MSC groups in comparison to PBS control group. However, there were no significant differences in the (immuno)-histological results between both stem cell groups. CONCLUSION The biomechanical and (immuno)-histological results did not show positive effects of the MSC groups on tendon remodelling in a long-term follow-up. Interestingly, in later stages stem cells had hardly any effects on biomechanical results. This study inspires a critical and reflected use of stem cells in tendon healing.
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De Silva T, Uneri A, Ketcha MD, Reaungamornrat S, Kleinszig G, Vogt S, Aygun N, Lo SF, Wolinsky JP, Siewerdsen JH. 3D-2D image registration for target localization in spine surgery: investigation of similarity metrics providing robustness to content mismatch. Phys Med Biol 2016; 61:3009-25. [PMID: 26992245 DOI: 10.1088/0031-9155/61/8/3009] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In image-guided spine surgery, robust three-dimensional to two-dimensional (3D-2D) registration of preoperative computed tomography (CT) and intraoperative radiographs can be challenged by the image content mismatch associated with the presence of surgical instrumentation and implants as well as soft-tissue resection or deformation. This work investigates image similarity metrics in 3D-2D registration offering improved robustness against mismatch, thereby improving performance and reducing or eliminating the need for manual masking. The performance of four gradient-based image similarity metrics (gradient information (GI), gradient correlation (GC), gradient information with linear scaling (GS), and gradient orientation (GO)) with a multi-start optimization strategy was evaluated in an institutional review board-approved retrospective clinical study using 51 preoperative CT images and 115 intraoperative mobile radiographs. Registrations were tested with and without polygonal masks as a function of the number of multistarts employed during optimization. Registration accuracy was evaluated in terms of the projection distance error (PDE) and assessment of failure modes (PDE > 30 mm) that could impede reliable vertebral level localization. With manual polygonal masking and 200 multistarts, the GC and GO metrics exhibited robust performance with 0% gross failures and median PDE < 6.4 mm (±4.4 mm interquartile range (IQR)) and a median runtime of 84 s (plus upwards of 1-2 min for manual masking). Excluding manual polygonal masks and decreasing the number of multistarts to 50 caused the GC-based registration to fail at a rate of >14%; however, GO maintained robustness with a 0% gross failure rate. Overall, the GI, GC, and GS metrics were susceptible to registration errors associated with content mismatch, but GO provided robust registration (median PDE = 5.5 mm, 2.6 mm IQR) without manual masking and with an improved runtime (29.3 s). The GO metric improved the registration accuracy and robustness in the presence of strong image content mismatch. This capability could offer valuable assistance and decision support in spine level localization in a manner consistent with clinical workflow.
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