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Arumugam S, Ranganathan R, Narayanasamy VK. Virtual registration of comminuted bone fracture and preoperative assessment of reconstructed bone model using the Procrustes algorithm based on CT dataset. Proc Inst Mech Eng H 2024; 238:219-236. [PMID: 38239062 DOI: 10.1177/09544119231221192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
A research work was undergone in a virtual bone reduction process for reconstruction of the comminuted pelvic bone fracture using a CT scan dataset of patients. This includes segmentation, 3D model optimization and bone registration technique. The accuracy of the reconstructed bone model was validated using Finite Element Method. Analysed and applied various segmentation techniques to segregate the injured bone structure. The ICP (Iterative Closest Point), Procrustes algorithm and Canny edge detection algorithm were applied to understand the bone registration process for surgery in detail. The average RMS error, mean absolute distance, mean absolute deviation, and mean signed distance of the reconstructed bone model using proposed algorithms involving 10 patient datasets in a group were found to be 1.77, 1.48, 1.51 and -0.31 mm respectively. The calculated RMS error value proved minimal error in semi-automatic registration than other existing automatic registration techniques. Therefore, the proposed approach is suitable for virtual bone reduction for comminuted pelvic bone fracture. This method could also be implemented for various other bone fracture reconstruction requirements.
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Affiliation(s)
- Senthilmurugan Arumugam
- Department of Mechanical Engineering, Coimbatore Institute of Technology, Coimbatore, Tamil Nadu, India
| | - Rajesh Ranganathan
- Department of Mechanical Engineering, Coimbatore Institute of Technology, Coimbatore, Tamil Nadu, India
| | - Venkatesh Kumar Narayanasamy
- Department of Orthopaedics & Trauma, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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Lu S, Yang Y, Li S, Zhang L, Shi B, Zhang D, Li B, Hu Y. Preoperative Virtual Reduction Planning Algorithm of Fractured Pelvis Based on Adaptive Templates. IEEE Trans Biomed Eng 2023; 70:2943-2954. [PMID: 37126611 DOI: 10.1109/tbme.2023.3272007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE The minimally invasive treatment of pelvic fractures is one of the most challenging trauma orthopedics surgeries, where preoperative planning is crucial for the performance and outcome of the surgery. However, planning the ideal position of fragments currently relies heavily on the experience of the surgeon. METHODS A pelvic fracture virtual reduction algorithm for target position is provided based on statistical shape models (SSM). First, according to sexual dimorphism, pelvic SSM based on point cloud curvature down-sampling are constructed as adaptive templates. Then, an optimization algorithm is designed to iteratively adjust the target pose of the fragments and the adaptive matching of the templates. Finally, the feasibility of the method is verified by simulating fractures and clinical data. RESULTS The pelvis has complex shape characteristics, which can be analyzed by SSM to clearly understand the pattern of change. Experiments showed that the SSM-based pelvic fracture reduction method had translation and rotation errors of 2.20±1.09 mm and 3.16±1.26° in simulated cases, and 2.78±0.95 mm and 3.10±0.53° in clinical cases, which has higher accuracy than methods based on mean shape models, and wider applicability than methods based on pelvic symmetry. CONCLUSION The pelvic digital model created by SSM has good generalization properties, and the SSM-based virtual reduction algorithm can effectively reconstruct the target position of the fractured pelvis in preoperative planning. SIGNIFICANCE The proposed reduction method has the characteristics of high precision and wide application range, which provides a powerful tool for the surgeon's virtual preoperative planning.
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Chen J, Zheng Y, Zhou W, Qian S, Chen Y, Cheng Y, Wang G, Cai X, Liu X. Three-Dimensional Printed Plate Template Versus Hemipelvis Model in Patient-Specific Plate Preparation for Posterior Wall Acetabular Fractures. Orthop Surg 2023; 15:2383-2392. [PMID: 37525356 PMCID: PMC10475674 DOI: 10.1111/os.13838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 06/24/2023] [Accepted: 06/30/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE The application of three-dimensional (3D) printing technology in the management of posterior wall acetabular fractures can greatly reduce surgical invasiveness and operative time and simplify the procedure of reconstruction plate contouring, but the cost and time of patient-specific plate preparation on the basis of traditional 3D-printed pelvis model should not be neglected. We described a new method for patient-specific plate preparation by using 3D-printed plate template. The study aimed to assess the effectiveness and feasibility of the 3D-printed plate template in patient-specific plate preparation for posterior wall acetabular fractures. METHODS A total of 65 cases of posterior wall acetabular fractures with surgical treatment from December 2012 to December 2020 were chosen. According to the different plate contouring methods, the 65 cases were divided into three groups, which were group A (21 cases), group B (20 cases), and group C (24 cases). In group A, the 3D-printed plate template was used to contour the patient-specific reconstruction plate before surgery, whereas the 3D-printed hemipelvis model was adopted for group B. In group C, the reconstruction plate was contoured intraoperatively. Among the three groups, the instrumentation time, surgical time, blood loss, patient-specific plate preparation time, complications, reduction quality, and hip function were compared. The Kruskal-Wallis test was used to analyze the reduction quality and hip function among three groups. RESULTS In comparison with group C, patients in groups A and B were featured by obviously shorter instrumentation time (-22, -23 min), shorter surgical time (-46, -44 min), and less intraoperative blood loss (-110, -122 mL). Compared to the hemipelvis model in group B (2.29 ± 0.56 vs. 12.70 ± 3.79 days), the 3D printing time for plate templates in group A was significantly shorter. The reduction quality and hip function had no obvious statistical difference among the three groups. The complication rate within group A (3/21) and group B (3/20) were both slightly lower than group C (5/24), with no obvious difference. CONCLUSIONS Both the patient-specific pre-contoured plate fixation methods based on the 3D-printed hemipelvis model and plate template can achieve satisfactory clinical efficacy, with the advantage of shorter instrumentation and surgical time, and less intraoperative blood loss. However, 3D printing of plate template is easier and less time-consuming, considering the shorter time and less cost for 3D printing of physical model.
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Affiliation(s)
- Jianan Chen
- Department of Orthopeadics SurgeryGeneral Hospital of Central Theater CommandWuhanChina
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
| | - Yifan Zheng
- Department of Orthopeadics SurgeryGeneral Hospital of Central Theater CommandWuhanChina
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
| | - Wei Zhou
- Department of Orthopeadics SurgeryGeneral Hospital of Central Theater CommandWuhanChina
| | - Shenglong Qian
- Department of Orthopeadics SurgeryGeneral Hospital of Central Theater CommandWuhanChina
| | - Yu Chen
- Department of Orthopeadics SurgeryGeneral Hospital of Central Theater CommandWuhanChina
| | - Yipeng Cheng
- Department of Orthopeadics SurgeryGeneral Hospital of Central Theater CommandWuhanChina
| | - Guodong Wang
- Department of Orthopeadics SurgeryGeneral Hospital of Central Theater CommandWuhanChina
| | - Xianhua Cai
- Department of Orthopeadics SurgeryGeneral Hospital of Central Theater CommandWuhanChina
| | - Ximing Liu
- Department of Orthopeadics SurgeryGeneral Hospital of Central Theater CommandWuhanChina
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Moolenaar JZ, Tümer N, Checa S. Computer-assisted preoperative planning of bone fracture fixation surgery: A state-of-the-art review. Front Bioeng Biotechnol 2022; 10:1037048. [PMID: 36312550 PMCID: PMC9613932 DOI: 10.3389/fbioe.2022.1037048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Bone fracture fixation surgery is one of the most commonly performed surgical procedures in the orthopedic field. However, fracture healing complications occur frequently, and the choice of the most optimal surgical approach often remains challenging. In the last years, computational tools have been developed with the aim to assist preoperative planning procedures of bone fracture fixation surgery. Objectives: The aims of this review are 1) to provide a comprehensive overview of the state-of-the-art in computer-assisted preoperative planning of bone fracture fixation surgery, 2) to assess the clinical feasibility of the existing virtual planning approaches, and 3) to assess their clinical efficacy in terms of clinical outcomes as compared to conventional planning methods. Methods: A literature search was performed in the MEDLINE-PubMed, Ovid-EMBASE, Ovid-EMCARE, Web of Science, and Cochrane libraries to identify articles reporting on the clinical use of computer-assisted preoperative planning of bone fracture fixation. Results: 79 articles were included to provide an overview of the state-of-the art in virtual planning. While patient-specific geometrical model construction, virtual bone fracture reduction, and virtual fixation planning are routinely applied in virtual planning, biomechanical analysis is rarely included in the planning framework. 21 of the included studies were used to assess the feasibility and efficacy of computer-assisted planning methods. The reported total mean planning duration ranged from 22 to 258 min in different studies. Computer-assisted planning resulted in reduced operation time (Standardized Mean Difference (SMD): -2.19; 95% Confidence Interval (CI): -2.87, -1.50), less blood loss (SMD: -1.99; 95% CI: -2.75, -1.24), decreased frequency of fluoroscopy (SMD: -2.18; 95% CI: -2.74, -1.61), shortened fracture healing times (SMD: -0.51; 95% CI: -0.97, -0.05) and less postoperative complications (Risk Ratio (RR): 0.64, 95% CI: 0.46, 0.90). No significant differences were found in hospitalization duration. Some studies reported improvements in reduction quality and functional outcomes but these results were not pooled for meta-analysis, since the reported outcome measures were too heterogeneous. Conclusion: Current computer-assisted planning approaches are feasible to be used in clinical practice and have been shown to improve clinical outcomes. Including biomechanical analysis into the framework has the potential to further improve clinical outcome.
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Affiliation(s)
- Jet Zoë Moolenaar
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Delft, Netherlands
| | - Nazli Tümer
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Delft, Netherlands
- *Correspondence: Nazli Tümer, ; Sara Checa,
| | - Sara Checa
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
- *Correspondence: Nazli Tümer, ; Sara Checa,
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Chen J, Zheng Y, Fang Z, Zhou W, Xu D, Wang G, Cai X, Liu X. One-stop computerized virtual planning system for the surgical management of posterior wall acetabular fractures. J Orthop Surg Res 2022; 17:439. [PMID: 36195909 PMCID: PMC9531475 DOI: 10.1186/s13018-022-03333-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background Posterior wall acetabular fractures remain one of the most difficult fracture injuries to treat. Accurate assessment of fracture characteristics and appropriate preoperative surgical strategies are essential for excellent reduction. This paper evaluates the feasibility and effectiveness of a one-stop computerized virtual planning system for the surgical management of posterior wall acetabular fractures.
Methods 52 cases of posterior wall acetabular fractures treated surgically were selected in our department between January 2015 and December 2020 for retrospective analysis. 52 cases were classified into group A (25 patients) and group B (27 patients) according to whether computerized virtual planning procedures were performed preoperatively. In group A, virtual surgical simulation was conducted using a one-stop computerized planning system preoperatively. In group B, traditional surgery was employed. Reduction quality, surgical time, blood loss, hip function, complications, and instrumentation time were compared between the two groups. Results The actual surgery for all patients in group A was essentially the same as the virtual surgery before the operation. Compared to group B, patients in group A had markedly shorter surgical time (−43 min), shorter instrumentation time (−20 min), and less intraoperative blood loss (−130 ml). However, no significant statistical difference was observed in reduction quality and hip function. The complication rate was slightly lower in group A (4/25) than in group B (7/27), without a significant difference. Conclusion The one-stop computerized virtual planning system is a highly effective, user-friendly and educational tool for allowing the cost-efficient surgical simulation of posterior wall acetabular fractures and providing a more individualized therapeutic schedule. The one-stop computerized planning system is feasible to treat posterior wall acetabular fractures, which is an effective method than the conventional treatment of posterior wall acetabular fractures. Trial registration: retrospective registration.
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Affiliation(s)
- Jianan Chen
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Yifan Zheng
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Zhixun Fang
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Wei Zhou
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China
| | - Dan Xu
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China
| | - Guodong Wang
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China
| | - Xianhua Cai
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China
| | - Ximing Liu
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China.
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Efficient lower-limb segmentation for large-scale volumetric CT by using projection view and voxel group attention. Med Biol Eng Comput 2022; 60:2201-2216. [DOI: 10.1007/s11517-022-02598-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
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Malfroy Camine L, Varlet V, Campana L, Grabherr S, Moghaddam N. The big puzzle: A critical review of virtual re-association methods for fragmented human remains in a DVI context'. Forensic Sci Int 2021; 330:111033. [PMID: 34883302 DOI: 10.1016/j.forsciint.2021.111033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 12/15/2022]
Abstract
During a Disaster Victims Identification (DVI) mission, international protocols rely on interdisciplinary work, especially between specialists from forensic imaging and anthropology. In case of air crashes or explosions, DVI units may face thousands of fragmented human remains (FHRs). The physical re-association of FHRs and the identification process is very complex and challenging, and relies upon expensive and destructive DNA analysis. A virtual re-association (VRA) of these fragments, using Multidetector Computed Tomography (MDCT), could be a helpful tool in forensic anthropology analysis, as it could assist in reducing the number of DNA samples. However, there is no standardized protocol for including such an approach into a DVI procedure. The aim of this study was to summarize and analyze existing techniques through a systematic review and to develop a protocol for virtual re-association of FHRs, adapted to the DVI context. A keyword-based literature search was conducted, focusing on the VRA methods using MDCT imaging and 3D surface scan methodology. Reviews and primary articles, published between 2005 and 2020 in the fields of forensic anthropology, paleoanthropology, archeology, and fracture reduction surgery were sorted out. A total of 45 publications were selected and analyzed based on their content and relevance. The results show that research on the re-association of FHRs increased significantly during the last five years. Seven steps regarding the MDCT-based method for the virtual re-association of FHRs could be identified: acquisition of 3D-images, segmentation of the MDCT-data, post-processing and surface generation, identification of intact and fracture surfaces, identification and registration of matching fragments, and validation of the re-association. The literature is surprisingly sparse regarding the FHRs re-association as a forensic tool, and mainly consists in case reports, whereas validated methods were presented in archeology and surgery publications. However, we were able to adapt the MDCT-based approach for the virtual re-association of the FHRs and propose an innovative protocol for DVI missions. This protocol includes the needed details, from the acquisition of MDCT imaging to the virtual re-association of 3D models and its validation. Each step has to be fully tested, adapted and validated in future studies.
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Affiliation(s)
- Lise Malfroy Camine
- Swiss Human Institute of Forensic Taphonomy, University Centre of Legal Medicine Lausanne Geneva, Switzerland; Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Vincent Varlet
- Swiss Human Institute of Forensic Taphonomy, University Centre of Legal Medicine Lausanne Geneva, Switzerland; Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Lorenzo Campana
- Forensic Imaging and Anthropology Unit, University Centre of Legal Medicine Lausanne Geneva, Switzerland; Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Silke Grabherr
- Swiss Human Institute of Forensic Taphonomy, University Centre of Legal Medicine Lausanne Geneva, Switzerland; Forensic Imaging and Anthropology Unit, University Centre of Legal Medicine Lausanne Geneva, Switzerland; Geneva University Hospital and University of Geneva, Geneva, Switzerland; Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Negahnaz Moghaddam
- Swiss Human Institute of Forensic Taphonomy, University Centre of Legal Medicine Lausanne Geneva, Switzerland; Forensic Imaging and Anthropology Unit, University Centre of Legal Medicine Lausanne Geneva, Switzerland; Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Li DX, Ead MS, Duke KK, Jaremko JL, Westover L. Quantitative analysis of regional specific pelvic symmetry. Med Biol Eng Comput 2021; 59:369-381. [PMID: 33452611 DOI: 10.1007/s11517-020-02296-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 12/14/2020] [Indexed: 11/29/2022]
Abstract
Understanding bilateral pelvic symmetry can be useful for analyzing complex pelvis anatomy and simplifying difficult procedures for pelvic fractures. This paper aims to quantify the degree of regional pelvic symmetry using computer-based methods. CT scans of 30 intact pelvises were digitized into 3D models and regions were defined: the ilium, acetabulum, pubis, and ischium. The right hemipelvis was aligned with the left, and deviations between the two models were quantified using method 1 (global registration) and method 2 (local registration). Symmetry was evaluated using the root mean square (RMS) of the deviations and the percentage of points within preset thresholds of ± 2 mm and ± 1 mm. The results showed that > 86% of points are within the ± 2 mm deviation threshold and average RMS are < 1.33 mm. For all regions, method 2 showed lower deviations than method 1. The pubis and ischium regions showed a large difference in symmetry between the two methods indicating high local symmetry, but a degree of global asymmetry. Conversely, the acetabular and iliac regions showed similar levels of symmetry with the two methods. When evaluated locally, the pelvic regions can be considered highly symmetric; the acetabulum is highly symmetric globally as well. These findings can be used in future studies to assess the feasibility of patient-specific implants using the mirrored contralateral hemipelvis as a template for unilateral pelvic fracture fixation. The left image shows the "cut planes" used to define four pelvic regions: the ilium, acetabulum, pubis, and ischium. The right image shows a deviation color map (DCM) used to quantify bilateral pelvic symmetry. The scale and color illustrate the degree of deviation of the left hemipelvis with the right hemipelvis with the units in millimeters (mm).
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Affiliation(s)
- David Xinzheyang Li
- Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, T6G 2R3, Canada.
| | - Maha S Ead
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Kajsa K Duke
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Jacob L Jaremko
- Department of Radiology & Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Lindsey Westover
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, T6G 2R3, Canada
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Wake N, Rosenkrantz AB, Sodickson DK, Chandarana H, Wysock JS. MRI guided procedure planning and 3D simulation for partial gland cryoablation of the prostate: a pilot study. 3D Print Med 2020; 6:33. [PMID: 33141272 PMCID: PMC7607830 DOI: 10.1186/s41205-020-00085-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 10/25/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This study reports on the development of a novel 3D procedure planning technique to provide pre-ablation treatment planning for partial gland prostate cryoablation (cPGA). METHODS Twenty men scheduled for partial gland cryoablation (cPGA) underwent pre-operative image segmentation and 3D modeling of the prostatic capsule, index lesion, urethra, rectum, and neurovascular bundles based upon multi-parametric MRI data. Pre-treatment 3D planning models were designed including virtual 3D cryotherapy probes to predict and plan cryotherapy probe configuration needed to achieve confluent treatment volume. Treatment efficacy was measured with 6 month post-operative MRI, serum prostate specific antigen (PSA) at 3 and 6 months, and treatment zone biopsy results at 6 months. Outcomes from 3D planning were compared to outcomes from a series of 20 patients undergoing cPGA using traditional 2D planning techniques. RESULTS Forty men underwent cPGA. The median age of the cohort undergoing 3D treatment planning was 64.8 years with a median pretreatment PSA of 6.97 ng/mL. The Gleason grade group (GGG) of treated index lesions in this cohort included 1 (5%) GGG1, 11 (55%) GGG2, 7 (35%) GGG3, and 1 (5%) GGG4. Two (10%) of these treatments were post-radiation salvage therapies. The 2D treatment cohort included 20 men with a median age of 68.5 yrs., median pretreatment PSA of 6.76 ng/mL. The Gleason grade group (GGG) of treated index lesions in this cohort included 3 (15%) GGG1, 8 (40%) GGG2, 8 (40%) GGG3, 1 (5%) GGG4. Two (10%) of these treatments were post-radiation salvage therapies. 3D planning predicted the same number of cryoprobes for each group, however a greater number of cryoprobes was used in the procedure for the prospective 3D group as compared to that with 2D planning (4.10 ± 1.37 and 3.25 ± 0.44 respectively, p = 0.01). At 6 months post cPGA, the median PSA was 1.68 ng/mL and 2.38 ng/mL in the 3D and 2D cohorts respectively, with a larger decrease noted in the 3D cohort (75.9% reduction noted in 3D cohort and 64.8% reduction 2D cohort, p 0.48). In-field disease detection was 1/14 (7.1%) on surveillance biopsy in the 3D cohort and 3/14 (21.4%) in the 2D cohort, p = 0.056) In the 3D cohort, 6 month biopsy was not performed in 4 patients (20%) due to undetectable PSA, negative MRI, and negative MRI Axumin PET. For the group with traditional 2D planning, treatment zone biopsy was positive in 3/14 (21.4%) of the patients, p = 0.056. CONCLUSIONS 3D prostate cancer models derived from mpMRI data provide novel guidance for planning confluent treatment volumes for cPGA and predicted a greater number of treatment probes than traditional 2D planning methods. This study prompts further investigation into the use of 3D treatment planning techniques as the increase of partial gland ablation treatment protocols develop.
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Affiliation(s)
- Nicole Wake
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA. .,Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA.
| | - Andrew B Rosenkrantz
- Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Daniel K Sodickson
- Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Hersh Chandarana
- Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - James S Wysock
- Division of Urologic Oncology, Department of Urology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
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Virtual reconstruction of unilateral pelvic fractures by using pelvic symmetry. Int J Comput Assist Radiol Surg 2020; 15:1267-1277. [PMID: 32249403 DOI: 10.1007/s11548-020-02140-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/25/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE Pelvic fractures are known to be one of the most difficult injuries to treat. The objective of this study is to introduce a novel technique for virtual unilateral pelvic fracture reconstruction. Since the pelvis exhibits remarkable left-right symmetry, the contralateral hemipelvis can be used as a template for rebuilding the fractured hemipelvis. METHODS CT scan data of the pelvic region of eight subjects with acute unilateral pelvic fractures were involved in this study. Computer-aided design software was used to create 3D models of these pelvises. The contralateral hemipelvis of each subject was then reflected across the sagittal plane, and the fractured hemipelvis was rebuilt by aligning the bone fragments with their equivalent location on the reflected side. To evaluate the quality of this reduction process, a 3D deviation analysis was conducted to calculate the differences between the reflected intact hemipelvis and the reconstructed hemipelvis. RESULTS Results showed that the average root mean square (RMS) of deviations and average percentage of points within a ± 2 mm predefined threshold was 1.32 ± 0.22 mm and 88.4 ± 3.78%, respectively. The deviation color maps obtained indicated that the largest differences were along the fracture lines and on the non-articular surfaces of the pelvises. CONCLUSION These results allowed us to conclude the validity of this procedure, since the average RMS difference was below 2 mm and the average percentage of points within ± 2 mm was high. The proposed technique will allow surgeons to provide their patients with more accurate reconstruction procedures which can potentially improve surgical outcomes.
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Xu J, Zhang G, He Z, Zhong S, Chen Y, Wei C, Zheng Y, Lin H, Li W, Huang W. Anatomical reduction and precise internal fixation of intra-articular fractures of the distal radius with virtual X-ray and 3D printing. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 43:10.1007/s13246-019-00795-w. [PMID: 31641940 PMCID: PMC7026237 DOI: 10.1007/s13246-019-00795-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 08/10/2019] [Accepted: 08/29/2019] [Indexed: 12/29/2022]
Abstract
To evaluate and precisely internal fix intra-articular distal radial fracture (IDRF) using the virtual X-ray and three-dimensional (3D) printing technologies. Twenty-one patients with IDRF were recruited, and the data from digital design group (DDG) and real surgery group (RSG) were collected and analyzed. In DDG, the data from thin-slice computed tomography scan, virtual X-ray measurement parameters, including volar tilt, palmar tilt, radius length (D1), ulnar variation (D2), locking plate position parameter (D3) and distance between key nail and joint surface (D4) were collected. The bone was virtually fixed with the locking plate, and the final model of radius with the screw was obtained by 3D printing. In RSG, the locking plate was precisely pre-bended and used in surgery. During the surgery, the key K-wire was accurately placed and the locking plate was adjusted with the aid of the U-shaped navigation arm. The C-arm was used to observe the positions of key K-wires and the locking plate, and the same above-mentioned parameters were measured intra- and post-operatively. The data from RSG and DDG were compared statistically by t test. This approach proved to be successful in all 21 patients, and none of the screws pierced through the wrist joint surface. All the measured parameters, including the volar tilt, palmar tilt, D1-4, in RSG were not significantly different from preoperative DDG data. Virtual X-ray measurement of anatomical reduction parameters and 3D printing can help the anatomical reduction and precise internal fixation by providing quantitative references, preoperatively, intraoperatively and postoperatively.
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Affiliation(s)
- Jing Xu
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, No. 1838 Guangzhou Road North, Guangzhou, 510515 Guangdong China
| | - Guodong Zhang
- Department of Orthopedics, Affiliated Hospital of Putian University, No. 999 East Shenzhen Road, Licheng District, Putian City, 510080 Fujian China
| | - Zaopeng He
- Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Shizhen Zhong
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, No. 1838 Guangzhou Road North, Guangzhou, 510515 Guangdong China
| | - Yongshao Chen
- Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Chunrong Wei
- Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Yudong Zheng
- Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Haibin Lin
- Department of Orthopedics, Affiliated Hospital of Putian University, No. 999 East Shenzhen Road, Licheng District, Putian City, 510080 Fujian China
| | - Wei Li
- Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Wenhua Huang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, No. 1838 Guangzhou Road North, Guangzhou, 510515 Guangdong China
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Xia S, Fu B, Wang B, Wu J, Cui Y, Wang X. Computed Tomography Imaging-Based Preoperative Virtual Simulation for Calcaneal Fractures Reduction. J Foot Ankle Surg 2019; 58:248-252. [PMID: 30850096 DOI: 10.1053/j.jfas.2018.08.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Indexed: 02/03/2023]
Abstract
Reduction of calcaneal fractures via a small incision approach at the sinus tarsi is technically difficult. This study was undertaken to determine if preoperative virtual simulation based on computed tomographic data improves reduction and reduces complications. Fifty-five patients with calcaneal fractures were treated via the sinus tarsi approach with minimally invasive plates between February 2013 and December 2015. DICOM files obtained from computed tomographic imaging preoperatively were imported into Superimage software, and virtual surgery was performed. Preoperative planning time, operative time, and complications were recorded. Clinical function was analyzed with radiology and with the American Orthopaedic Foot and Ankle Society and visual analogue scale scores. As a result, preoperative planning time was 30.7 ± 4.1 minutes, which increased with the severity of the fracture (Sanders III vs Sanders II: 34.2 ± 2.5 minutes vs 27.8 ± 2.7 minutes), which was in line with the real surgery, with a mean operative time of 86.7 ± 4.5 minutes (Sanders III vs Sanders II: 89.5 ± 2.7 minutes vs 84.3 ± 4.4 minutes). Radiologic results indicated that the calcaneal width, length, height, Böhler angle, and Gissane angle were significantly corrected from preoperatively to postoperatively. After a mean follow-up of 21.5 ± 6.1 months, no complications were observed. The mean American Orthopaedic Foot and Ankle Society score was 88.7 ± 4.0, with an excellent/good rate of 94.5% (52 of 55). The mean visual analogue scale score was 0.8 ± 0.9. In conclusion, preoperative virtual simulation may be efficient to promote accomplishment of sinus tarsi surgery, and this step may help improve outcomes for calcaneal fractures.
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Affiliation(s)
- Shengli Xia
- Chief Physician, Department of Orthopedics, Shanghai Pudong New Area Zhoupu Hospital, Shanghai, China.
| | - Beigang Fu
- Associate Chief Physician, Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Bin Wang
- Resident Physician, Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Jiajun Wu
- Resident Physician, Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yin Cui
- Associate Chief Physician, Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Xiuhui Wang
- Chief Physician, Department of Orthopedics, Shanghai Pudong New Area Zhoupu Hospital, Shanghai, China
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Intelligent HMI in Orthopedic Navigation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1093:207-224. [DOI: 10.1007/978-981-13-1396-7_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Boudissa M, Courvoisier A, Chabanas M, Tonetti J. Computer assisted surgery in preoperative planning of acetabular fracture surgery: state of the art. Expert Rev Med Devices 2017; 15:81-89. [PMID: 29206497 DOI: 10.1080/17434440.2017.1413347] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The development of imaging modalities and computer technology provides a new approach in acetabular surgery. AREAS COVERED This review describes the role of computer-assisted surgery (CAS) in understanding of the fracture patterns, in the virtual preoperative planning of the surgery and in the use of custom-made plates in acetabular fractures with or without 3D printing technologies. A Pubmed internet research of the English literature of the last 20 years was carried out about studies concerning computer-assisted surgery in acetabular fractures. The several steps for CAS in acetabular fracture surgery are presented and commented by the main author regarding to his personal experience. EXPERT COMMENTARY Computer-assisted surgery in acetabular fractures is still initial experiences with promising results. Patient-specific biomechanical models considering soft tissues should be developed to allow a more realistic planning.
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Affiliation(s)
- Mehdi Boudissa
- b Grenoble Alpes University , Grenoble , France.,c TIMC-IMAG Lab , Univ. Grenoble Alpes, CNRS UMR , Grenoble , France.,d Orthopedic and Traumatology Surgery Department , Grenoble University Hospitals, Northern Hospital, Joseph Fourier University , Grenoble , France
| | - Aurélien Courvoisier
- a Pediatric Orthopedics , Grenoble University Hospitals, Northern Hospital, Joseph Fourier University , Grenoble , France.,b Grenoble Alpes University , Grenoble , France.,c TIMC-IMAG Lab , Univ. Grenoble Alpes, CNRS UMR , Grenoble , France
| | - Matthieu Chabanas
- b Grenoble Alpes University , Grenoble , France.,c TIMC-IMAG Lab , Univ. Grenoble Alpes, CNRS UMR , Grenoble , France.,d Orthopedic and Traumatology Surgery Department , Grenoble University Hospitals, Northern Hospital, Joseph Fourier University , Grenoble , France
| | - Jérôme Tonetti
- b Grenoble Alpes University , Grenoble , France.,c TIMC-IMAG Lab , Univ. Grenoble Alpes, CNRS UMR , Grenoble , France.,d Orthopedic and Traumatology Surgery Department , Grenoble University Hospitals, Northern Hospital, Joseph Fourier University , Grenoble , France
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