KR101547608B1 - Method for automatically generating surgery plan based on template image - Google Patents

Abstract

The present disclosure relates to a method for automatically generating a template image based surgical plan, comprising: obtaining an preoperative image of an object; A step of registering a template image and a preoperative image as a basis for selection of operation plan information, the operation plan information including operation methods to be performed on an object based on a template image, A template image and a pre-operative image are registered, the template image including position or direction information of a surgical tool with respect to a subject; And a step of automatically adding the selected operation plan information to the matched preoperative images so as to generate the operation plan image, and a method of automatically generating the template image based operation plan.

Description

METHOD FOR AUTOMATICALLY GENERATING SURGERY PLAN BASED ON TEMPLATE IMAGE [0002]

Disclosure relates generally to a method for automatically generating a template-based surgical plan, and more particularly, to a template-based surgical plan for automatically generating a surgical plan on a surgical object image using a template image as a basis for selecting a procedure method And an automatic generation method.

Herein, the background art relating to the present disclosure is provided, and these are not necessarily meant to be known arts.

Spinal fusion surgery is an operation to prevent abnormal movements between the vertebral segments by inserting the guide wire into the affected vertebrae and inserting the pedicle screw into the vertebrae. Spinal fusion surgery is performed mainly in patients with severe symptoms that can not be treated by non-surgical treatment. It is considered effective for surgery of spinal diseases such as herniated disc, vertebral fracture, lumbar stenosis and spinal dystrophy.

Only a small margin of error is allowed in spinal fusion surgery, since important vessels and nerves pass through the vertebrae. Therefore, the doctor should be extremely careful and proceed with the procedure.

In spinal fusion surgery, percutaneous screws are inserted into the vertebrae without skin incision. For the procedure, the insertion point of the screw and the insertion route should be planned in advance. At this time, the procedure is also planned for a guide wire (Kirschner wire; K-wire) guiding the insertion point of the screw and the insertion path. In spine fusion procedures, dozens of screws are used at most, and procedures should be planned for multiple guide wires.

However, if multiple screws and guidewires are planned, performed, and verified as planned, it will take a long time and a lot of cost, and the patient will suffer a lot of pain. Also, there is a problem that the possibility of a mistake increases because the process requiring extreme care is repeated a lot.

Korean Patent Registration No. 1264198 discloses an automatic surgery planning system using a three-dimensional model and a surgical planning method using the same. The process of calculating the surgical suitability for the insertion path candidate group and the calculation of the safety margin, which is a measure of the degree of interference between the object to be inserted and the screw, requires a large number of inputs from the user , There is a problem that a complicated calculation process must be repeated every time a screw operation plan is made. There is also no disclosure of how the surgical plan is used in the treatment field to aid in the operation of the actual surgical subject.

This will be described later in the Specification for Implementation of the Invention.

SUMMARY OF THE INVENTION Herein, a general summary of the present disclosure is provided, which should not be construed as limiting the scope of the present disclosure. of its features).

According to one aspect of the present disclosure, there is provided a method of automatically generating a template-based surgical plan, comprising: obtaining a preoperative image of an object; A step of registering a template image and a preoperative image as a basis for selection of operation plan information, the operation plan information including operation methods to be performed on an object based on a template image, A template image and a pre-operative image are registered, the template image including position or direction information of a surgical tool with respect to a subject; And automatically adding the selected operation plan information to the matched preoperative images to generate a surgical plan image.

This will be described later in the Specification for Implementation of the Invention.

1 is a diagram illustrating an example of a method for automatically generating a template image based surgical plan according to the present disclosure;
FIG. 2 is a view for explaining an example of a pre-operative spinal image,
FIG. 3 is a view for explaining an example of a method of dividing a spinal image into segments according to vertebrae;
4 is a view for explaining an example of a standard model of a vertebra,
5 is a view for explaining an example of a template image provided for each vertebrae segment,
6 is a view for explaining an example of surgical procedures set on a template image,
FIG. 7 is a view for explaining an example of a method of determining the insertion path of the screw,
8 is a view for explaining an example of a surgery plan image in which surgery plan information is visualized in three dimensions,
9 is a view for explaining an example of a method of modifying a surgical plan in a surgical planning image,
10 is a view for explaining an example of a method in which a current image of a vertebra is acquired in a procedure field,
11 is a view for explaining an example of a current image of a vertebra obtained in a procedure field,
12 is a view for explaining an example of a method in which a surgery plan image and a current image are matched;

The present disclosure will now be described in detail with reference to the accompanying drawings.

1 is a diagram illustrating an example of a method for automatically generating a template image-based surgical plan according to the present disclosure.

In the automatic generation method of the template image-based surgical plan, the preoperative image of the subject is acquired (S110, S120). The template image and the pre-operation image, which serve as a basis for selection of the operation plan information, are registered (S130). Thereafter, the selected operation plan information is automatically added to the matched preoperative images to generate the operation plan image (S140). If necessary, the surgical plan is modified by the user (S150).

The surgical planning information is set based on the template image and may include surgical procedures to be performed on the subject. Procedural methods may include position and orientation information on the object of the surgical tool (e.g., screw or guide wire).

Automatic generation of template-based surgical plans can be applied to both humans and animals. The automatic generation method of the template image based surgical plan can be applied particularly to planning the operation on the bones, and can be applied to other parts than the bones. Hereinafter, a method of automatically generating a template-based surgical plan around the vertebrae will be described.

1 will not be described below.

2 is a view for explaining an example of a pre-procedure vertebral image.

First, a three-dimensional bone image is acquired before the operation. Fig. 2 (a) illustrates a spinal image. A spinal image of a patient requiring surgery is obtained using a medical imaging apparatus such as a computed tomography (CT) or a magnetic resonance imaging (MRI) (S110 in FIG. 1).

A surgical plan for the spine, for example, a screw or guide wire surgical plan, can be performed on each vertebrae node. The spine of an adult person consists of seven neckbones, twelve spines, and five backbones. The nodes of the vertebrae mean each of these bones.

The obtained spinal image is segmented according to the segment of the vertebrae (S120). For example, as shown in Fig. 2 (b), the vertebrae 10 to be treated can be extracted by division. Partial volume effect among bones has a great difficulty in dividing the vertebrae into segments. In particular, it is difficult to distinguish between simple thresholding and connected component analysis because of the presence of bone nodes.

FIG. 3 is a view for explaining an example of a method of dividing a vertebra by using a vertebral image.

For example, from the spinal image acquired by the Bi-plane C-arm or CT, it is detected for each vertebrae segment. The structure of the spinal nodes is analyzed through the process of distinguishing the positions of the body, the pedicle, and the like of the vertebrae.

For example, a thresholding technique may be applied to a spinal image acquired by CT (Computed Tomography) to be divided into segments of the vertebrae (S120 in FIG. 1). Removal of the voxel 5 with discontinuity using local Laplacian can detect the part of the vertebrae where the vertebrae meet. For example, voxels are removed where iterative orientation (negative gradient) mapping discontinuity occurs for boundary voxels. If there are many interfacial points, the spinal nodes can be segmented using surface fitting. Alternatively, a pedicle portion may be detected using a standard spine model to be described later.

FIG. 4 is a view for explaining an example of a standard model of a vertebra, and FIG. 5 is a view for explaining an example of a template image provided for each vertebrae.

After the spinal image is acquired before the procedure, the template image of the spinal column and the pre-operation spinal image are registered for each node of the vertebrae (S130 in FIG. 1).

For example, as shown in FIG. 4, a standard model of the vertebra is prepared, and a template image is prepared for each vertebrae as shown in FIG. The template image is an average shape or map of the spine, and a CT based spinal template image is prepared.

For example, a template image may be generated by automatically or semi-automatically extracting a segment of a vertebra from a CT image to generate a segment image of the vertebra, and a 3D image generation algorithm (for example, marching cubes (3-D) model image of the vertebrae using the Marching Cubes algorithm), and a landmark required for the operation of the vertebral column. Can be made by the process.

In this way, the template image of the prepared vertebrae node and the image of the vertebral node extracted from the preoperative vertebral image are matched. For example, rigid registration and deformable registration can be used.

Reference numeral 21 is described later.

6 is a view for explaining an example of surgical procedures set on a template image. Fig. 7 is a view for explaining an example of a method of determining the insertion path of the screw. 8 is a view for explaining an example of a surgery plan image in which the surgery plan information is visualized three-dimensionally.

Surgical plan information including the insertion point of the screw and the insertion route can be defined for each vertebrae based on the template image.

(A, B, C) in which a screw insertion point and an insertion path are set using a template image are illustrated as shown in Fig. In each procedure, the upper image shows the coronal (coronal) view (from the inside of the body), the middle view shows the transverse view 31). For example, the surgical procedures (A, B, C) may be a surgical procedure in which the insertion and insertion paths of the screws are preset in order to obtain optimal results based on accumulated clinical data and template images.

Procedural methods (A, B, C) can be determined using a template image corresponding to a vertebral segment (e.g., 10 in Fig. 2) requiring surgery. For example, when the procedure (C) is selected in Fig. 6, the insertion point and insertion path of the screw with respect to the vertebra are determined. These insertion points and insertion paths can be selected as optimal positions in the template image of the vertebrae segment based on accumulated clinical data and expert experience as described above. 7, the central axis 101 of the screw and the central axis 105 of the screw in the transverse section are determined in the sagittal plane. Thus, the center axis 109 is determined in the three-dimensional space of the screw.

As such, when the insertion point of the screw and the insertion route are determined, the operation plan can be determined for the position and direction of the guide wire guiding the screw (e.g., 21 in Fig. 5). The guide wire (45 in Fig. 8) can be positioned over the nodes of the plurality of vertebrae. Once the procedure is determined for each of the plurality of vertebral segments, the position and orientation of the guide wire may be determined.

Using the matching information between the vertebral image and the template image before the operation, the surgical planning information is automatically added to the matched preoperative images (S140 in FIG. 1). Surgical planning information is applied to the nodes of the vertebrae extracted from the pre-operative spinal image through registration of each vertebrae node.

For example, when the operation method C is clicked on with a mouse, the insertion point of the screw (41 in Fig. 8), the insertion path and the position of the guide wire (45 in Fig. 8) predetermined by the operation method It is automatically visualized in the whole image. This procedure is selected for several vertebral nodes and can be automatically visualized three-dimensionally in the pre-operative spinal image, as shown in FIG.

For example, it is visualized by the nodes of the vertebrae. The insertion point of the skin and bone and the guide wire (K-wire) are visualized together. The guide wire can visualize a line in the bone.

9 is a view for explaining an example of a method of modifying a surgical plan in a surgical plan image.

As described above, the procedure selected by the user interface (e.g., a mouse) is automatically visualized in the pre-procedure spine image. Surgical planning information may be modified in a surgical plan image or in a template image by a doctor or a user to create an optimal patient-specific surgical plan (S150 in FIG. 1).

For example, the insertion point and insertion path of the screw 41 in the surgical planning image can be modified by the mouse, and the surgical plan of the guide wire 45 can be modified accordingly. The modified surgical planning information is visualized in real time in the surgical planning image.

Fig. 9 (a) shows the preoperative spinal image visualized in the surgical planning information. FIG. 9 (b) shows two-dimensional images perpendicular to each other of the pre-operative spinal image visualizing the surgical planning information. Two-dimensional preoperative vertebral images can be extracted from three-dimensional surgery plan images in the same way as the virtual C-arm. FIG. 9 (c) shows an example of correcting the insertion point and direction of the incorrectly designed screw 41.

Modification of such a surgical plan can be accomplished by simple manipulation of the operation plan image with a mouse without complicated calculation procedures or procedures.

Thus, according to the method of automatically generating a template image-based surgical plan according to the present disclosure, a plurality of screws and guide wires can be automatically visualized three-dimensionally by visualization or vertebral segment by simply selecting the procedure. Therefore, it is possible to plan the operation of a large number of screws and guide wires, to reduce the burden on the patient, to save time and money, and to reduce the risk of mistakes.

FIG. 10 is a view for explaining an example of a method of acquiring a current image of a vertebra in a procedure field, and FIG. 11 is a view for explaining an example of a current image of a vertebra obtained in a procedure field.

The patient having the surgery plan image is placed in the treatment field, and the current image of the spine is acquired (S160 in FIG. 1). For example, two vertebrae two-dimensional current images (see Figs. 11 (a) and 11 (b)) perpendicular to each other are obtained by photographing the spine using the Bi-plane C-arm in the procedure field. The Bi-plane C-arm is a device in which two C-arms (X-ray) are mounted orthogonally. Alternatively, the C-arm may be used to photograph the vertebra twice, preferably in the direction orthogonal to the vertebra, or may be photographed using CBCT. It is not necessary to take a photograph in the direction orthogonal to the photographing, and it is sufficient to take a photograph so that a difference of 10 degrees or more is obtained.

Current images may or may not include guide wires. The acquired images are AP X-ray image and Lateral X-ray image, respectively. As described hereinabove, the lateral X-ray image does not necessarily have to be perpendicular to the AP X-ray image.

12 is a view for explaining an example of a method in which a surgery plan image and a current image are matched.

The operation plan image and the current image are registered using the shape of the node of the vertebrae (S170 in FIG. 1).

For example, a two-dimensional surgical planning image is extracted from a three-dimensional surgical planning image using a virtual C-arm method. The two-dimensional surgical planning image is extracted according to the condition (eg, angle) when the medical imaging device such as Bi-plane C-arm, C-arm, or CBCT captures the current image. Or, it is only necessary to be able to know the information for matching, such as the angle difference between the two-dimensional operation plan image and the current image.

Thereafter, bi-plane boundaries 11 and 15 of the vertebrae included in the current image corresponding to the vertebrae 10 to be treated can be found. The two-dimensional plan image of the spinal node 10 and the current image can be matched. The shapes (11, 15) of the vertebrae are obtained by extracting the three-dimensional vertebrae 10 from a certain angle, and thus can be matched on the basis of the shape.

Thereafter, the matched current image is compared with the surgical plan information to guide the procedure.

For example, it is judged whether or not the guide wire matches the operation plan (S180 in Fig. 1). If there is a discrepancy, the position of the guide wire is modified (S190 in FIG. 1) and the spinal image is again captured using the C-arm or CBCT to acquire the current image again. The obtained current image is compared with the surgical plan again.

The final confirmed surgical planning information may be transmitted to the robot or navigation device.

For example, an insertion point and / or an insertion path of a plurality of guide wires may be transmitted to a robot or a navigation device by using a TCP / IP or a dedicated communication protocol so as to be helpful in the procedure (S200 of FIG. 1) .

Various embodiments of the present disclosure will be described below.

(1) The surgical planning information includes the surgical procedures to be performed on the object based on the template image, and the surgical methods include the position or orientation information of the surgical tool on the object. Way.

(2) The step of obtaining the pre-operative image includes: a process of acquiring a three-dimensional spine image; And a process of segmenting the vertebrae by a segment of the vertebrae, wherein the step of aligning comprises: a step of registration of a template image of the vertebrae and a vertebral image of the vertebrae; Automatic generation method of template - based surgery plan.

(3) Template images of the vertebrae: The process of extracting the vertebral segments from the medical images of the vertebrae automatically or semiautomatically; A process of generating a three-dimensional model image of a vertebral segment using a 3D image generation algorithm for a vertebral segment image; And a procedure in which surgical planning information including a landmark necessary for the operation of the vertebral column is set in a three-dimensional model image of the vertebrae segment. .

(4) The operation plan information includes the position and orientation information of the guide wire guiding the insertion of the screw or the screw to be inserted into the vertebrae based on the template image of each vertebrae. Way.

(5) The step of generating the operation plan image includes: a step of selecting the operation plan information by the user interface; And automatically visualizing the selected surgical planning information on the matched preoperative images. ≪ Desc / Clms Page number 19 >

(6) modifying the insertion point and insertion path of the screw in the surgical planning image by the user interface; and automatically generating the template image-based surgical plan.

(7) The method of automatically generating a template image-based surgical plan according to claim 1, wherein the position and direction of the guide wire to be performed on the plurality of vertebrae are automatically determined by the surgical planning information added to each vertebrae node.

(8) a current image of the vertebra is obtained; The operation plan image and the current image are registered using the shape of the nodule of the vertebrae; And comparing the matched current image with a surgical plan image to guide the surgical operation.

(9) the current image of the vertebrae is acquired; A step of acquiring a current shape as a two-dimensional image by photographing a vertebra in a procedure field; and a step of registering a planar image and a current image, the step of: extracting a two-dimensional planar image from the planar image; And a process of matching the current image and the two-dimensional surgical planning image based on the shape of the vertebrae.

According to the automatic generation method of the template image-based surgical plan according to the present disclosure, the operation method can be automatically visualized in the three-dimensional image to be treated by simply selecting the operation method set in the template image, do.

In addition, the surgical planning for multiple screws or guidewires is done together to reduce patient burden and save time and money.

Also, the risk of mistakes is reduced in procedures that require a small margin of procedure, such as the spine, and require extreme caution.

In addition, insertion points and / or insertion paths of a plurality of guide wires can be transferred to a robot or a navigation device to help the procedure.

Claims (10)

A method for automatically generating a template-based surgical plan,
Obtaining a preoperative image of an object;
A step of registering a template image and a preoperative image as a basis for selection of operation plan information, the operation plan information including operation methods to be performed on an object based on a template image, A template image and a pre-operative image are registered, the template image including position or direction information of a surgical tool with respect to a subject; And
Wherein the selected operation plan information is automatically added to the matched preoperative images to generate a surgical plan image. delete The method according to claim 1,
The step of acquiring preoperative images comprises:
A process in which a three-dimensional spine image is acquired; And
A segmentation process of each vertebrae segment,
The matched steps are:
A method for automatically generating a template image-based surgical plan, the method comprising: registering a template image of the vertebrae and a vertebral image for each vertebrae of the vertebrae. The method of claim 3,
Template images of the vertebrae are:
The process of extracting the nodes of the vertebrae automatically or semiautomatically from the medical images of the vertebrae to generate the nodal images of the vertebrae;
A process of generating a three-dimensional model image of a vertebral segment using a 3D image generation algorithm for a vertebral segment image; And
Wherein the operation plan information including a landmark necessary for the operation of the vertebrae of the vertebra is set in a three-dimensional model image of the vertebrae segment. The method of claim 3,
Wherein the surgical planning information includes position and direction information of a guide wire for guiding the insertion of a screw or a screw to be inserted into a vertebra based on a template image of each vertebrae. The method of claim 3,
The step of generating a surgical plan image comprises:
A process in which the operation plan information is selected by the user interface; And
And automatically displaying the selected operation plan information on the matched pre-operation image. The method of claim 6,
And modifying the insertion point and insertion path of the screw in the surgical planning image by the user interface. The method of claim 6,
Wherein the position and orientation of the guide wire to be performed on the plurality of vertebrae are automatically determined by the surgical planning information added to the nodes of each vertebrae. The method of claim 3,
Obtaining a current image of the vertebra;
The operation plan image and the current image are registered using the shape of the nodule of the vertebrae; And
And comparing the matched current image with a surgical plan image to guide the surgical operation. The method of claim 9,
The steps of obtaining a current image of the vertebrae are:
And a step of photographing the vertebrae in the treatment field and acquiring a current shape as a two-dimensional image,
The step of registering the plan image and the current image is:
A process in which a two-dimensional surgical planning image is extracted from an operation plan image; And
Wherein the current image and the two-dimensional surgical planning image are matched on the basis of the shape of the vertebrae of the vertebrae.

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