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The minimally invasive surgery in spinal surgery has become increasingly popular in recent years as it reduces the chances of complications during post-operation. However, the procedure of spinal surgery is complicated and the surgical vision of minimally invasive surgery is limited. In order to increase the quality of percutaneous pedicle screw placement, the O-arm that is a mobile intraoperative imaging system is used to assist surgery. The robot navigation system combined with O-arm is also i
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Content from this work may be used under the terms of the Creative Commons Attribution 3.0 licence. Any further distribution
of this work must maintain attribution to the author(s) and the title of the work, journal citation and DOI.
Published under licence by IOP Publishing Ltd
1234567890 ‘’“”
ICMCE IOP Publishing
IOP Conf. Series: Journal of Physics: Conf. Series 1016 (2018) 012006 doi :10.1088/1742-6596/1016/1/012006
A spatial registration method for navigation system
combining O-arm with spinal surgery robot
H Bai
1,2
, G L Song
1
Y W Zhao
1
X Z Liu
1,2
and Y X Jiang
1
1
Shenyang Institute of Automation, Chinese Academy of Sciences, China.
2
Northeastern University, China.
Email: songgl@sia.cn
Abstract. The minimally invasive surgery in spinal surgery has become increasingly popular
in recent years as it reduces the chances of complications during post-operation. However, the
procedure of spinal surgery is complicated and the surgical vision of minimally invasive
surgery is limited. In order to increase the quality of percutaneous pedicle screw placement, the
O-arm that is a mobile intraoperative imaging system is used to assist surgery. The robot
navigation system combined with O-arm is also increasing, with the extensive use of O-arm.
One of the major problems in the surgical navigation system is to associate the patient space
with the intra-operation image space. This study proposes a spatial registration method of
spinal surgical robot navigation system, which uses the O-arm to scan a calibration phantom
with metal calibration spheres. First, the metal artifacts were reduced in the CT slices and then
the circles in the images based on the moments invariant could be identified. Further, the
position of the calibration sphere in the image space was obtained. Moreover, the registration
matrix is obtained based on the ICP algorithm. Finally, the position error is calculated to verify
the feasibility and accuracy of the registration method.
1. Introduction
In the past two decades, minimally invasive spine surgery (MISS) has been increasingly applied and
drawn much attention in the treatment of spinal disorders[1]. The development of image technology
has led to a more significant development of minimally invasive spinal surgery. Not only can MISS
minimize injury to paraspinal back muscles, connective tissues, and joints but it can also decrease the
amount of bleeding, infection, hospital stay, and postoperative pain[2].It decreases the incidence of
complications and approach-related morbidity and mortality associated with conventional open
surgery. The traditional open spine surgery has gradually been replaced with MISS. According to the
reports[1], the number of MISS conducted in 2010 accounted for 1/6 of the total number of all spine
surgeries in the United States and 1/3 in 2016, which is anticipated to be more than 1/2 in 2020.
Although MISS has the above advantages, it still faces to the following problems: (1) Surgeon's
surgical vision is limited. (2) With the increasing number of surgery, the surgeon's intra-operative
radiation exposure will accumulate. (3) The lack of surgical instrument's real-time position, reduces
the safety of surgical procedures.
In order to solve the above problems, some scholars have proposed that the robot navigation
technology could assist surgeons. A study assessed the feasibility and clinical value of robot assisted
navigation drilling for pedicle screw placement and the results confirmed that robot assisted surgery
could increase the quality of percutaneous pedicle screw placement[3]. The accuracy of guidance
systems in screw insertion procedures is particularly notable in anatomically difficult cases, such as
2
1234567890 ‘’“”
ICMCE IOP Publishing
IOP Conf. Series: Journal of Physics: Conf. Series 1016 (2018) 012006 doi :10.1088/1742-6596/1016/1/012006
scoliosis correction surgeries, with a reported 6-fold reduction in perforation rates and mean insertion
angle errors compared with conventional methods[4]. In the meta-comparison of navigation-assisted
versus conventional screw placement covering 28 clinical, 14 cadaveric, and 1 model-based study,
Tian [5], reported a higher overall accuracy of screw position in navigation-assisted procedures.
The Rosa spine robot[6], which has been used clinically, combines robots and navigation systems
to obtain the pose of surgical instruments and patients through two IR cameras. Under the assistance
of intra-operative images, the surgical robot is guided to the surgical position and finally assists
surgeons place pedicle screws. The navigation system of Rosa spine robot is through the optical
imaging system to achieve spatial positioning and such systems are vulnerable to the effect of intra-
operative objects' shelter, the surrounding light and metallic objects mirror reflection. What' s more,
the Renaissance guidance system[7], uses operating forceps or Hover-T to fix a miniature parallel
robot on the patient's spine. The C-arm takes anterior–posterior and lateral intra-operative fluoroscopic
images of the patient and transfers them to the workstation system for automatic image registration.
But the specially designed jig with three marker holes need to be fixed to the patient's body, causing
additional trauma to the patient.
In order to solve the above problems, this paper proposes a robotic navigation system based on O-
arm. One of the major problems of this system is to registration of patient space and intra-operation
image space. This study mainly introduces the registration method of the system.
2. Material and method
2.1. Material
This study designed a calibration phantom to assist spatial registration and error calculations. Taking
the registration into account, the main criterion given for the phantom was the need to provide
multiple surfaces for placement the calibration sphere[8]. The solution for this criterion was to design
a 70mm × 70mm × 80mm cube calibration phantom. The four faces of which are accurately placed
with calibration holes, each with 16 calibration holes on each plane to provide sufficient test volume.
Figure 1 illustrates the used calibration phantom. The calibration holes were machined 15mm apart,
and the position error for the distance horizontally and vertically was within ± 0.02 mm. The diameter
and depth of the calibration hole is 2.5 mm, which ensures that the calibration sphere is exactly filled
in the hole.
The use of O-arm has been increasing in recent years, because the medical staff can leave the
operating theatre to decrease their exposure to radiation, during an O-arm 3D image acquisition[9].
The O-arm is a mobile intra-operative computed tomography imaging system optimized for bony
structures in spinal and orthopedic surgery [10]. Pixel size is 0.424 × 0.424 mm within a slice
thickness of 0.625 mm. Figure 2 illustrates the calibration phantom and the spinal phantom with the O-
arm.
Figure 1. The present calibration phantom. Figure 2. The two phantom with O-arm.
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