整合MR影像與CT影像方位校準及C-arm影像輔助脊椎手術的路徑規劃與導引

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題名:	整合MR影像與CT影像方位校準及C-arm影像輔助脊椎手術的路徑規劃與導引
作者:	陳宏融;Chen, Hung-Jung
貢獻者:	機械工程學系
關鍵詞:	內視鏡手術;脊椎手術;內視鏡夾持器;影像註冊;CT;MRI;C-arm;3D endoscopic surgery;spine surgery;endoscope holder;image registration;surgical guide;CT;MRI;C-arm
日期:	2021-07-29
上傳時間:	2021-12-07 13:24:55 (UTC+8)
出版者:	國立中央大學
摘要:	脊椎減壓、固定、融合術邁向微創手術方式後，其需反覆拍攝 X-ray 影像以確認手術器械位置與需醫師豐富臨床經驗等的缺點使手術導航系統因此而發展。眾多導航系統中，基於 2D C-arm 影像的導航系統設備成本較低，但提供路徑規劃的 2D C-arm 影像資訊較不足；而基於 3D C-arm 或 O-arm 影像的導航系統提供 3D 影像資訊但設備成本較高。這些單純使用術中 C-arm 影像的導航系統並未整合含有大量軟組織資訊可供醫師用於診斷與精細規劃手術路徑的 MR 影像。本研究將 2D C-arm 影像導航系統與 CT 影像結合，達成了設備成本低又保有三維影像路徑規劃的優點。而 MR 與 CT 影像的註冊，可使醫師在術前規劃比純以 CT 影像規劃更精細的內視鏡減壓手術的路徑與固定/融合手術的螺釘路徑，減少手術時間與不預期的失誤。本研究使用曲面對應法作為 MR 與 CT 影像的主要方位校準方法。應用演算法在 MR 影像中搜尋脊髓區域並建立其三維模型，並尋找棘突與椎孔上緣輪廓點作為與 CT 影像重建的骨頭輪廓曲面註冊用。影像註冊採用疊代最近點法配合初始特徵點對應，使曲面對應有效收斂。術中 CT 與 C-arm 影像的對位是依據醫師正常拍攝 C-arm 影像的方式由 CT 影像產生與 C-arm 影像相似的 DRR 影像，並提供輔助線比對校準，以將在 CT 影像上規劃之手術路徑輕易的對應至 C-arm 影像上。本研究另開發可於減壓手術中使用的內視鏡夾持器，其具備讓內視鏡輕易地繞空間中固定點旋轉角度、以及固定內視鏡的功能，使醫師不須持續以手握持內視鏡。以附有標記物的假體進行 MR 與 CT 影像註冊的準確度驗證實驗。實驗結果顯示若初對正之位移誤差在±4mm 以內或旋轉誤差 ±1 度以內，都可讓疊代最近點法收斂，而對位的收斂結果皆達臨床使用要求的 2mm 以內。又 CT 影像產生的 DRR 影像與 C-arm 影像比對部份，十字輔助線能在拍攝 C-arm 時提供有效的對照用以協助醫師調整 X-ray 投影位置與角度，使術前規劃之手術路徑能對應到 C-arm 影像上並由導航系統進行導引定位用。;The procedures of spinal decompression, fixation, and fusion are moving towards minimally invasive surgery. The need to repeatedly take X-ray images to confirm the positions of surgical instruments and the need for surgeons rich clinical experience has led to the development of surgical navigation systems. Among many navigation systems, the equipment cost of the navigation system based on 2D C-arm image is lower, but the 2D C-arm image information to provide path planning is insufficient. The navigation system based on 3D C-arm or O-arm image provides 3D image information, but the equipment costs higher. These navigation systems that only use intraoperative C-arm images do not integrate MR images that contain a large amount of soft tissue information for physicians to use for diagnosis and precise surgical path planning. This research integrates the 2D C-arm image navigation system with CT images to achieve the advantages of low cost of equipment and 3D image path planning. In addition, the registration of MR and CT images enables the surgeon to plan more precise endoscopic path for spinal decompression and screw insertion path for spinal fusion than that provided only by CT images, so that it will reduce the operation time and unexpected trouble or mistakes during the operation. In this study, the curved surface mapping method is used as the main registration method for MR and CT images. Use algorithm to search for spinal cord area in MR images and generate its three-dimensional model, and to find the contour points of the spinous process and the upper edge of the vertebral foramina as the registration points for the registration of the bone contour surface reconstructed from the CT images. The registration between MRI and CT images uses the iterative closest point method with initial feature points registration to speed up the convergence effectively. Intraoperative alignment of CT and C-arm images is based on the way surgeons normally take C-arm images. The DRR images similar to C-arm images are generated from CT images, and auxiliary line for comparison and calibration is also provided for surgeons to plan on CT images. The surgical path on the DRR (Digitally Reconstructed Radiography) is therefore easily mapped to the C-arm image. In addition, an endoscope holder for decompression surgery has also been developed. It is easy to adjust the angular direction of the endoscope about a fixed point in space and hold the endoscope, so that the surgeon does not need to hold the endoscope manually. The accuracy of MR and CT image registration was evaluated experimentally using marker-attached prostheses. The experimental results show that if the displacement or angular errors of initial alignment are within ±4mm or within ±1 degree respectively, the registration using iterative closest point method will converge with an error within 2mm, which satisfies the clinic need of spine surgery. In addition, the DRR image generated by the CT image is compared with the C-arm image. The cross auxiliary line can provide an effective comparison to help the surgeon adjust the X-ray projection position and angle, so as to the planned path prior to the operation can be mapped to the C-arm image and used by the navigation system for guidance and positioning.
顯示於類別:	[機械工程研究所] 博碩士論文

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