C形臂X线投影图像3D建模及其应用

C形臂X线投影图像3D建模是指以C形臂获取的X线2D投影图像为基础,实现骨骼3D模型的术中重建。与单纯的2D切片图像或投影图像相比,3D重建模型不仅含有更为丰富的骨骼外部形状等解剖结构信息,而且还可包含骨密度及强度等骨骼内部多元有用信息。该技术在骨组织活检、椎弓根螺钉植入、髓内钉固定、及手足骨折修复等手术方面具有广阔的应用前景。对C形臂X线投影图像3D建模技术的研究意义、现状及现存问题进行介绍。在此基础上,分析了该技术所涉及的主要研究内容,提出了可分别沿两条主线研究基于普通C形臂2D投影图像的人体骨骼3D解剖模型构建:一、以C形臂按指定角度间隔获取的密集2D投影图像为基础,采用有限角锥束X射线投影合成方法进行3D重建;二、以C形臂在正位、侧位等姿态下获取的少量2D投影图像为基础,采用基于统计可变模型的非刚性配准方法进行3D重建。对每条主线都提出了对应的解决方案。     

一种基于2D/3D配准的脊柱术中校正方法

背景：脊柱术前三维影像有助于诊断和治疗,术中患者体位变化将引起脊柱形态改变,致使术前影像不能反映术中实际情况,无法确保手术的顺利实施。 目的：利用脊髓手术中影像校正术前脊柱模型形态。 方法：实验提出了一种基于2D/3D配准的脊柱术中校正方法,借助数字影像重建技术完成术前X射线图像与CT体数据的2D/3D配准,进一步完成术中、术前X射线图像中独立椎段的特征匹配,利用上述配准结果实现术前脊柱CT模型的术中快速校正。 结果与结论：采用附有标记的颈椎标本进行实验,校正后可基本消除术前脊柱模型与术中形态的偏差,其误差可控制在1 mm以内,能够满足医学临床要求。     

基于深度学习的2D/3D医学图像配准研究

2D/3D配准在临床诊断和手术导航规划中有着广泛的应用,可解决医学图像领域中不同维度图像存在信息缺失的问题,能辅助医生在术中精准定位患者的病灶。常规的2D/3D配准方法主要依赖于图像的灰度进行配准,但非常耗时,不利于临床实时性的需求,并且配准过程中容易陷入局部最优值。提出用深度学习的方法来解决2D/3D医学图像配准问题。采用一个基于深度学习的卷积神经网络,通过网络对数字影像重建技术(DRR)进行训练并自动学习图像特征,预测X光图像所对应的参数,从而实现配准。以人体骨盆的模型骨为实验对象,根据骨盆的CT数据生成36000张DRR图像作为训练集,同时通过C臂采集模型骨的50张X光图像作为验证。结果显示,深度学习算法在相关系数、归一化互信息、欧式距离3个精度评价指标上的测试值分别为0.82±0.07、0.32±0.03、61.56±10.91,而常规2D/3D算法对应的测试值分别为0.79±0.07、0.29±0.03、37.92±7.24,说明深度学习算法的配准精度优于常规2D/3D算法的配准精度,且不存在陷入局部最优值的问题。同时,深度学习的配准时间约为0.03s,远低于常规2D/3D配准的时间,可满足临床对于实时配准的需求,未来将进一步开展临床数据的2D/3D配准研究。     

基于C型臂超短扫描路径锥束投影的图像合成

背景：CT成像质量的优劣不仅取决于仪器的精密性和先进性,在很大程度上也取决于重建算法,由二维扇束扫描向三维锥束扫描是CT技术的发展方向,因此,寻找一种合适的锥束重建算法具有无法忽略的意义。 目的：探讨基于C型臂超短扫描路径锥束投影的图像合成,为实现基于C型臂2D投影图像的3D模型重建提供算法支持。 方法：由第一作者于2012年3至5月检索PubMed数据库、CNKI系列数据库及万方数据库1990年至2011年文献。检索词为“C型臂,超短扫描路径,FDK算法,有限角锥形束三维重建,超短扫描扇束重建算法”,检索文章的语言种类为中文和英文。计算机初检得到58篇文献,其中19篇符合纳入标准被保留。 结果与结论：基于C型臂2D投影图像的3D模型重建必须进行三维模型的重建,目前应用最为广泛的的三维图像重建方法仍然是FDK。但是FDK算法适用于全路径,对超短路径而言不能直接采用,而通过将二维扇束重建算法推广到三维空间中而获得的短扫描轨迹的FDK类型锥束重建算法可对采集到的锥束投影数据进行感兴趣区域重建。未来的研究可针对减少噪声等干扰数据对重建质量造成的影响进行探讨。     

2D/3D刚性图像配准在肿瘤放疗计划中的应用

目的:在肿瘤放疗中,2D/3D刚性图像配准技术是精确定位病人重要保证。方法:数字重建放射影像技术是2D/3D配准中最为关键的部分,一定程度上影响着配准效率。在对数字重建放射影像进行重点研究的基础上,实现了一种基于Bresenham方法的快速数字影像重建算法,并利用腹部CT体数据进行了2D/3D配准实验。实验以互信息、模式强度和梯度差分为相似性测度并采用了Powell-Brent优化算法。结果:在数字重建放射图像算法实验中,Bresemham方法相比于另外两种光线跟踪算法,时间仅需0.467 s。在2D/3D配准实验中,对三种相似性测度的实验结果进行了比较,互信息和梯度差分有较好的配准结果,模式强度仍存在不少问题。结论:实验结果表明,利用Bresenham方法产生的数字重建影像能使得配准具有较高精度,但配准时间仍然较长。     

利用数字几何技术重建个性化骨骼模型

背景:由于医学CT体数据存在各向异性的特点,导致CT序列图像重建网格模型时产生阶梯表面,从而影响后续的医学诊断。目的:利用数字几何处理技术重建个性化骨骼模型。方法:首先基于互信息的图像配准算法对骨骼CT序列图像进行配准,接着使用图像分割提取骨骼轮廓集并转化为三维点云,然后使用高斯加权的主成分分析方法估算点云法向量并对点云进行三边滤波去噪,最后对点云进行自适应圆球覆盖及网格化处理,完成个性化骨骼模型重建。结果与结论:文章所提的方法可以生成光顺的个性化骨骼表面网格模型,所形成的三角网格形状规则且自适应分布,可以为计算机辅助制造、有限元分析及3D打印提供准确的三维模型。     

基于2D/3D配准技术的正常膝关节运动还原在体稳定性参数研究

目的应用2D/3D图像配准技术进行运动还原以获得正常膝关节韧带的在体稳定性参数。方法在生理负重下利用两台C型臂X线机采集8名志愿者健、膝关节屈曲0°、15°、30°、60°和90°时的两幅相互垂直的X线影像(2D),与由CT重建的三维图像在虚拟X线投射系统进行2D/3D图像配准,还原膝关节不同角度时的股骨和胫骨相对3D位置关系,并通过韧带止点还原的方法对ACL、PCL、MCL、LCL进行韧带长度分析。结果随屈曲角度的增大,ACL长度逐渐缩短,从0(°27.73±1.34)mm至90(°23.34±1.48)mm;PCL长度逐渐增加,从0(°26.5±1.65)mm至90(°33.80±1.97)mm;MCL长度逐渐减小,从0°(38.17±1.40)mm至90°时(35.98±1.50)mm。LCL长度同样逐渐减小,从0°(52.56±1.64)mm至90°(50.22±1.41)mm。差异均有统计学意义(P0.05)。结论基于2D/3D图像配准技术可获得正常膝关节生理屈曲过程中韧带长度的变化规律。     

基于单幅X线图像和CT数据的2D/3D配准系统

目的建立基于统一计算架构(CUDA)下以单幅X线图像及CT扫描数据为数据源的2D/3D配准系统,并应用于膝关节在体运动及植入假体稳定性研究。方法首先应用张正友标定法对采集X线图像设备进行标定;其次基于CUDA构架利用光线跟踪算法生成数字影像重建图像,以相关性函数为相似性测度计算2D/3D配准参数;最后以三维激光扫描仪所获得的点云数据进行3D/3D配准,以验证2D/3D配准结果。结果以标本整体位置变换进行配准实验,6自由度平均误差中,位移小于1mm,旋转小于1°。结论此2D/3D配准系统达到了运动检测精度的要求,可以作为研究膝关节运动情况和假体在体稳定性研究的计算平台。     

基于2D-3D配准的术中腓骨旋转不良检测方法

目的通常检测腓骨旋转不良的方法是对术中踝关节2D X射线影像做目视评估,但主观判断往往导致结果误差较大;目前公认的准确检测腓骨旋转不良的方法需借助术后3D CT数据,但会为患者引入较大的辐射量。为此,本文提出了一种基于2D-3D配准技术准确识别术中腓骨旋转不良的低剂量、低成本的精准复位腓骨的可行方法,以此验证所提方法的可行性。方法研究对象为单一腓骨CT数据,初始位置定义为参考位,然后借助Mimics软件对其做不同程度的旋转变换,生成12组腓骨旋转畸形测试位的CT数据,模拟术中腓骨的不同姿态,包括6组腓骨内旋和6组腓骨外旋。测试位腓骨术中C臂图像由投影仿真程序生成。通过将术中C臂图像和参考位CT数据做2D-3D配准来识别这12组测试位相对于参考位的旋转不良程度。得到的结果和金标准比对,从而评估2D-3D配准的准确性;其中,金标准为参考位和12组测试位的3D-3D配准结果。另外,因为与投影轴平行方向检测位移不敏感,故本文用两幅正交位投影的配准结果做补偿。结果 10次测试12组数据配准结果在绕x轴、y轴和z轴旋转的平均角度(及沿3个方向的平均位移)误差分别为1. 19°(0. 56 mm)、0. 72°(0. 84 mm)和0. 81°(0. 65 mm);标准差依次为0. 43°(0. 38 mm)、0. 51°(0. 47 mm)和0. 58°(0. 5 mm);最大误差分别是2. 13°(1. 76 mm)、2. 74°(1. 90 mm)和2. 10°(2. 16 mm)。结论 2D-3D配准方法可为临床腓骨复位提供精度更高的监控工具,其误差远小于目前10°旋转的目测误差。相比于术前CT做手术规划、术后CT做手术评估,本文方法借助术前CT和术中C臂图像不仅可达到准确评估的目的,而且可实现术中动态评估,故其辐射剂量更低,患者医疗成本更低,治疗更及时、更有效。     

基于3D Shepp-Logan头部模型的三维医学图像重建仿真

Shepp-Logan头部模型是计算机断层图像重建(CT)领域仿真计算普遍采用的经典模型。我们提出一种新思路—以3D Shepp-Logan头部模型作为三维医学图像重建领域进行仿真实验和算法性能评测的基本参考模型。首先介绍了3D Shepp-Logan头部模型的设计与实现以及仿真投影数据的计算,进而描述了所设计的三维医学图像重建仿真计算过程。数值实验部分给出了基于3D Shepp-Logan头部模型的三维医学图像重建仿真实验。实验结果表明了新思路的可行性和模型计算的准确性。     

Direct navigation on 3D rotational x-ray data acquired with a mobile propeller C-arm: accuracy and application in functional endoscopic sinus surgery

Recently, three-dimensional (3D) rotational x-ray imaging has been combined with navigation technology, enabling direct 3D navigation for minimally invasive image guided interventions. In this study, phantom experiments are used to determine the accuracy of such a navigation set-up for a mobile C-arm with propeller motion. After calibration of the C-arm system, the accuracy is evaluated by pinpointing divots on a special-purpose phantom with known geometry. This evaluation is performed both with and without C-arm motion in between calibration and registration for navigation. The variation caused by each of the individual transformations in the calibration and registration process is also studied. The feasibility of direct navigation on 3D rotational x-ray images for functional endoscopic sinus surgery has been evaluated in a cadaver navigation experiment. Navigation accuracy was approximately 1.0 mm, which is sufficient for functional endoscopic sinus surgery. C-arm motion in between calibration and registration slightly degraded the registration accuracy by approximately 0.3 mm. Standard deviations of each of the transformations were in the range 0.15-0.31 mm. In the cadaver experiment, the navigation images were considered in good correspondence with the endoscopic images by an experienced ENT surgeon. Availability of 3D localization information provided by the navigation system was considered valuable by the ENT surgeon.     

移动式C型臂X射线机图像拼接在骨科手术中的应用

背景：在脊柱和长骨骨折等骨科手术治疗中,获取骨折部位的完整骨结构图像对于监控和评价骨科术中效果具有十分重要的临床意义。 目的：探讨移动式C型臂X射线机图像拼接技术在临床骨科手术中的应用效果。 方法：对骨科手术部位的脊柱和长骨进行C型臂X射线机透视并采集2-4幅图像,经过图像拼接软件将图像多区域重叠,进行图像拼接技术处理后得到脊柱和长骨骨折内固定手术部位的1张全景图像。 结果与结论：移动式C型臂X射线机图像拼接技术处理后能在1张照片上获得脊柱和长骨骨折内固定手术部位全景图像,能较清晰、完整地显示脊柱和长骨的全景,并有助于术者在术中及时地了解和评估骨折部位的对位、对线情况,且能进行长度和角度测量,为进一步提高手术质量提供强有力的支持。     

Modality-integrated magnetic catheter tracking for x-ray vascular interventions

A novel setup for the integration of a magnetic tracking system (MTS) into a catheter laboratory environment by attaching the field generator of the MTS to the C-arm of the x-ray system was investigated. The metal interference of the x-ray system with the MTS then becomes static and can be calibrated. The registration of a tracked catheter to 2D live x-ray images with high and well-defined accuracy is thus possible for arbitrary C-arm positions. Interference with imaging by blocking the field of view is avoided. Real-time registration methods to maintain the registration of the catheter also to static 2D or 3D images (roadmaps), regardless of the C-arm rotation during catheter tracking, were investigated. Residual registration errors of the tracked catheter with respect to the static roadmaps (2D and 3D) were reduced by using the vessel geometry and shape information. The algorithms potentially allow for motion correction (e.g. due to respiration). Using the shape-based correction algorithms the average registration accuracies to static roadmaps for different C-arm angulations and catheter positions were determined to be 3.3-4.2 mm. The magnetic registration of the C-arm was furthermore allowed to compute the imaging geometry (position of the C-arm) and to produce virtual angiographic preview images before contrast injection and x-ray dose application. Thus, optimal projection geometries and collimator settings for the target region can be chosen in an 'off line' fashion. The proposed MTS-supported navigation setup on both 3D (static) and 2D (live and static) roadmaps merges the high resolution and real-time feedback of 2D x-ray images with the navigation support from 3D static images.     

个体股骨头坏死三维有限元模型的建立与应用

同时基于个体股骨头坏死患者的X-ray、CT和MRI图像,采用图像配准和融合技术对包含坏死股骨头的髋关节进行三维重建,获取具有高度几何相似性的三维有限元网格模型。选择1例中年女性股骨头坏死患者,分别获取X-ray、CT和MRI三套图像,采用Mimics 13.1和Pro/E 5.1软件分别基于这三套数据建立相关三维实体模型,经图像投影转换后,确定图像之间的匹配点,进行二维图像配准,配准后对成功融合的图像进行三维有限元网格模型显示。建立了具有良好几何相似性的髋关节三维有限元网格模型,包括正常皮质骨、松质骨、关节软骨和股骨头坏死区、断裂骨小梁等六部份,较真实地反映了包含坏死股骨头的髋关节的形态特征及毗邻关系,为进一步的生物力学分析和手术模拟提供了较理想的研究平台。     

Targeted 2D/3D registration using ray normalization and a hybrid optimizer

X-ray images are often used to guide minimally invasive procedures in interventional radiology. The use of a preoperatively obtained 3D volume can enhance the visualization needed for guiding catheters and other surgical devices. However, for intraoperative usefulness, the 3D dataset needs to be registered to the 2D x-ray images of the patient. We investigated the effect of targeting subvolumes of interest in the 3D datasets and registering the projections with C-arm x-ray images. We developed an intensity-based 2D/3D rigid-body registration using a Monte Carlo-based hybrid algorithm as the optimizer, using a single view for registration. Pattern intensity (PI) and mutual information (MI) were two metrics tested. We used normalization of the rays to address the problems due to truncation in 3D necessary for targeting. We tested the algorithm on a C-arm x-ray image of a pig's head and a 3D dataset reconstructed from multiple views of the C-arm. PI and MI were comparable in performance. For two subvolumes starting with a set of initial poses from +/-15 mm in x, from +/-3 mm (random), in y and z and +/-4 deg in the three angles, the robustness was 94% for PI and 91% for MI, with accuracy of 2.4 mm (PI) and 2.6 mm (MI), using the hybrid algorithm. The hybrid optimizer, when compared with a standard Powell's direction set method, increased the robustness from 59% (Powell) to 94% (hybrid). Another set of 50 random initial conditions from [+/-20] mm in x,y,z and [+/-10] deg in the three angles, yielded robustness of 84% (hybrid) versus 38% (Powell) using PI as metric, with accuracies 2.1 mm (hybrid) versus 2.0 mm (Powell).     

Volume-of-change cone-beam CT for image-guided surgery

C-arm cone-beam CT (CBCT) can provide intraoperative 3D imaging capability for surgical guidance, but workflow and radiation dose are the significant barriers to broad utilization. One main reason is that each 3D image acquisition requires a complete scan with a full radiation dose to present a completely new 3D image every time. In this paper, we propose to utilize patient-specific CT or CBCT as prior knowledge to accurately reconstruct the aspects of the region that have changed by the surgical procedure from only a sparse set of x-rays. The proposed methods consist of a 3D-2D registration between the prior volume and a sparse set of intraoperative x-rays, creating digitally reconstructed radiographs (DRRs) from the registered prior volume, computing difference images by subtracting DRRs from the intraoperative x-rays, a penalized likelihood reconstruction of the volume of change (VOC) from the difference images, and finally a fusion of VOC reconstruction with the prior volume to visualize the entire surgical field. When the surgical changes are local and relatively small, the VOC reconstruction involves only a small volume size and a small number of projections, allowing less computation and lower radiation dose than is needed to reconstruct the entire surgical field. We applied this approach to sacroplasty phantom data obtained from a CBCT test bench and vertebroplasty data with a fresh cadaver acquired from a C-arm CBCT system with a flat-panel detector. The VOCs were reconstructed from a varying number of images (10-66 images) and compared to the CBCT ground truth using four different metrics (mean squared error, correlation coefficient, structural similarity index and perceptual difference model). The results show promising reconstruction quality with structural similarity to the ground truth close to 1 even when only 15-20 images were used, allowing dose reduction by the factor of 10-20.     

虚拟中国人女性一号松质骨图像数据的配准与三维重建

目的：研究从虚拟人体数据集中松质骨连续切片图像的分割、配准、及三维重建的技术方法。方法：利用现有的虚拟中国人女性一号数据集中腰椎和股骨部分解剖连续切片数据集，用基于外置标记点和分割—计数法两种方法进行参数计算，依参数对图像进行刚体变换完成配准，将配准后的切片图像输入二维图像处理软件进行分割，提取感兴趣区域后输入三维重建软件进行三维重建。结果：重建后的松质骨三维立体图像呈均匀、致密的立体网状结构，骨小梁连接清晰可见。结论：利用现有软件及技术可重建虚拟人体的精细结构。     

基于3D打印个性化手术导航模板辅助下的人工全膝关节置换

背景：膝关节的解剖形态个体差异显著,而传统膝关节置换手术定位力线方法复杂,不能准确预测术中患者的力线位置、假体大小及截骨量。 目的：探讨基于医学图像三维重建、计算机辅助设计技术以及3D打印制造的个性化手术导航模板辅助下全膝关节置换的临床效果。 方法：采用CT或者磁共振扫描设备对患者进行扫描,获取患者医学图像数据;采用二维医学图像处理技术进行骨骼的三维重构;利用计算机辅助设计技术进行导航模板的设计;采用3D打印技术制造个性化手术导航模板,并进行临床全膝关节置换;置换后采用影像学评估术后效果。 结果与结论：Arigin 3D Pro(昕健医疗技术有限公司)能够准确重构出患者下肢骨骼三维模型,自主研发的三维设计软件Arigin Surgical Templating(昕健医疗)能够精确定位包括下肢力线、股骨旋转轴等在内的下肢相关轴线及截骨参考点。该组研究设计和制作的个性化膝关节手术导航模板,术中和股骨髁与胫骨平台骨性解剖结构贴合紧密,无明显移动;全膝关节置换后患者下肢力线偏差小于3°。 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程