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Assisted Surgery for Estimation of 3D Anatomy
from Sparse Data
Dr. Kumar Rajamani
M.E. Mueller Research Center,
Institute for Surgical Technology and Biomechanics,
University of Berne
Statistical Deformable Bone Models
October 16, 2008 2
Statistical Deformable Bone Models
Motivation of Computer Assisted
Orthopaedic Surgery (CAOS)
> Enhancing surgical accuracy
— Implant stability
— Quality of surgical treatment
> Standardizing surgical quality
> Enhancing anatomical orientation
— Minimally invasive surgeries
October 16, 2008 3
Statistical Deformable Bone Models
Navigation – basic principle
CT
Tool
October 16, 2008 4
Statistical Deformable Bone Models
Components of CAOS System (1)
> Navigator
— Precisely locates
– Surgical instruments
– Surgical target (bone)
— Usually:
– Optoelectronic camera
October 16, 2008 5
Statistical Deformable Bone Models
Navigation technologies
> Endoscope trackers
> Magnetic trackers
> Optoelectronic trackers
> Range scanner
October 16, 2008 6
Statistical Deformable Bone Models
Components of CAOS System (2)
> Image of the operated
anatomical region
— Enables preoperative
planning
— Provides “indirect sight”
during operation
— Preoperative
– CT
— Intraoperative
– 2D fluoroscopy
– 3D fluoroscopy
– Surgeondefined
October 16, 2008 7
Statistical Deformable Bone Models
Thesis Motivation
> Orthopaedic surgery (Hip Arthroplasty, Knee)
— No CT/MRI > No 3D models
— Visualization is not intuitive
> Problem Definition
— Point Cloud to 3D shape (Statistics – Solution)
Courtesy: Fleute
October 16, 2008 8
Statistical Deformable Bone Models
Related Work – Fleute, Lavallée, Troccaz
(1998 2002)
> Euclidean distance minimization
> Solved as multidimensional registration
— Initialized by Iterative Closest Point (ICP)
— Sim. Annealing/Simplex Downhill optimization
> Commercial ACL and TKA modules
— Modeled knee
> Large input point set O(102)
> Constrained
October 16, 2008 9
Statistical Deformable Bone Models
Related Work – Chan, Hawkes et al.
(2002~)
> Similar to Fleute et al.
— Iterate between alignment and deformation
— Parallel direct search optimization
> Modeled entire femur
> Input points extracted from ultrasound
— Bone surface points manually extracted
— Large input point set O(103)
> Limited amount of variability
October 16, 2008 10
Statistical Deformable Bone Models
Statistical Deformable Models:
(Steps & Methods)
> Model Building
— Correspondence Establishment
— PCA based model construction
> Deformation Schemes
— Removal of variability of known points from PCA
— Mahalanobis weighted leastsquares fit
— Nonlinear deformation framework using TPS
> Validation Schemes
— Leaveoneout experiments
— Plastic bone trials (Pointer & US)
— Dry cadaver bone experiments
October 16, 2008 11
Statistical Deformable Bone Models
Step One Correspondence Establishment
(Correspondence Evlauation)
> Styner, Rajamani, Szekely, Zsemlye, et al.
— IPMI 2003
> Femoral head / Lateral ventricle structures
> 4 methods:
— Landmark + subdivision (MSS) Zsemlye
— 1st order ellipsoid (SPHARM) Brehbühler
— Minimum Description Length Davies
— Determinant of Covariance Kotcheff
> Comparison to manual landmarks
> Correspondence quality
measurements
October 16, 2008 12
Statistical Deformable Bone Models
Our Results Correspondence Evaluation
> Compactness: Minimal set of parameters.
> Generalization: Description of shapes outside training set.
> Specificity: Representation of only valid instances
> MDL ( & DetCov Kotcheff) had best performance
October 16, 2008 13
Statistical Deformable Bone Models
Step Two : Model Construction
> Set of objects
— Population of proximal femur surface models
— Correspondence established
Mean
October 16, 2008 14
Statistical Deformable Bone Models
PCA – Capturing Major Directions of
Shape Variability
λ2
λ1
λ3
October 16, 2008 15
Statistical Deformable Bone Models
PCA – First Two Modes of Variation
October 16, 2008 16
Statistical Deformable Bone Models
PCA – Eigenmodes
> Any training object is expressed as linear combination
— Average shape + weighted eigenmodes
21.5
* 15.8
*
> An object is represented by a series of numbers
— e.g. [21.5, 15.8, 45.5, ...]
October 16, 2008 17
Statistical Deformable Bone Models
Shape Deformation Scheme – Removal of
Variability
> Rajamani, Hug, Styner, Based on J. Hug Dissertation
— SPIE Medical Imaging 2004
> Removal of variability of known points from PCA
— 3 vectors for displacement of each points
— Removal in training population and recomputation of
PCA
— Full set of PCA modes
— Leaveoneout 6 points: Mean error 3.1 4.2 mm Removing variability from PCA
> Downsides
↓ Unstable for large number of points
↓ Cannot incorporate more points than PCA modes/3
Modes of variation –
Before / After variability reduction
October 16, 2008 18
Statistical Deformable Bone Models
Shape Deformation Scheme –
Mahalanobis Weighted Fit
α1
* α2
*
> Solve for shape parameters αi, that satisfy some constraints
— Minimize distance term
— Valid shape
> Simple Linear Equation Solution
October 16, 2008 19
Statistical Deformable Bone Models
Euclidean Distance With Mahalanobis
Shape Regularization
Input points
Mean shape + PCA modes
Mahalanobis distance
Euclidean distance
October 16, 2008 20
Statistical Deformable Bone Models
Results – Leave one out experiments
Median/Mean error (6 points)
2.7mm → 1.2mm
3.4mm → 1.5mm
> Works well with small and large sets of
points
0 1 2 3 4 5 6 7
> Stable incorporation of full set of PCA
modes
> ISBI Paper 2004, Rajamani, Joshi,
Styner
0 5 10 15 20 25
30
October 16, 2008 21
Statistical Deformable Bone Models
Enhanced Deformation Algorithm
> ´p´ parameter relaxes the
regularization term as additional
points are digitized.
> Better estimation result due to ´p´
parameter
> MICCAI 2004 paper, Rajamani,
Nolte, Styner
October 16, 2008 22
Statistical Deformable Bone Models
Outlier Resistance
Mestimator
Weights
> Mestimators try to reduce the effect of
outliers
> Creates an inverted valley function and
smooth handling of outliers
> SPIE Paper 2005, Rajamani, Gonzalez
Ballester, Nolte, Styner
October 16, 2008 23
Statistical Deformable Bone Models
Schemes for Points Digitization
> Navigated 2D Bmode ultrasound
> Navigated digitizing pointer
October 16, 2008 24
Statistical Deformable Bone Models
Ultrasound Navigation [Kowal et.al]
> Rapid and accurate calibration
> Automatic segmentation yields bone contours
> Point cloud formed of bone contours provides bone surface
points for deformable model
October 16, 2008 25
Statistical Deformable Bone Models
Experimental Setup
> Two cast proximal femur bones in water bath
> Inhouse Research Platform
— Navigation (<0.1 mm tracking error)
— Registration of cast bones’ CT surface models (~0.2 mm error)
> Two users performed tests
— 5 trials per bone to assess repeatability
— 2426 surface points for deformation (US points sampled)
> Error computation using Mesh [Aspert et al.]
October 16, 2008 26
Statistical Deformable Bone Models
Ultrasound Experiment
October 16, 2008 27
Statistical Deformable Bone Models
Results – Average Mean Surface Error
Bone 1 Bone 2
October 16, 2008 28
Statistical Deformable Bone Models
Results – Pointer
7.0
5.0
3.0
1.0
0.0
October 16, 2008 29
Statistical Deformable Bone Models
Results – Ultrasound
> Bone 1
— 3.08 mm error for 1 trial
> Bone 2
— 3.0 ± 0.5 mm error for 4 trials
Gold reference Predicted shape
October 16, 2008 30
Statistical Deformable Bone Models
Validation Studies on Cadaver Femur
Bones
> 9 cadaver bones were used
— Two models to study the effect of
training size on morphing
> Estimation in CT coordinates
> EMBC 2005, Kumar, Haydar, Gonzalez
Ballester Statistics Cumulated from 9 Cadaver Bones
1.6 1.8 2.0 2.2 2.4 2.6
7.0
5.0
3.0
1.0
0.0
5 10 15 20 25 30 35 40 45 50
October 16, 2008 31
Statistical Deformable Bone Models
A Threestage Process – [Zheng et al.]
> Dense point distribution model (DPDM)
> Registration using ICP
— Removes dependence on initial landmarks
> Linear deformation
— Euclidean distance with Mahalanobis shape
regularization
> Nonlinear deformation using TPS
— Reduces dependence on training population
October 16, 2008 32
Statistical Deformable Bone Models
Results – Cadaver Femurs
October 16, 2008 33
Statistical Deformable Bone Models
October 16, 2008 34
Statistical Deformable Bone Models
Summary
> Accurate and stable shape estimation technique from incomplete and
sparse data.
> Conference & Journal Articles (September 2002 – Aug 2005)
— Conferences – 11 articles
– IPMI, ISBI, MICCAI, EMBC (2), SPIE (3), CAOS(3)
– CAOS 2005 Best Technical Podium Presentation
— Journal articles – 3 articles
– CAS 2005
– Talib, Rajamani, Kowal, Styner, Gonzalez Ballester.
A Comparison Study Assessing the Feasibility of UltrasoundInitialized
Deformable Bone Model
– MEDIA (Submitted)
– Rajamani, Styner, Talib, Nolte, Gonzalez Ballester
Statistical Deformable bone models for robust 3D surface extrapolation from
sparse data
– IEEE TBE (Submitted)
– Zheng, Rajamani, Dong, Zhang, Gonzalez Ballester, Styner, Nolte
Accurate and Robust Reconstruction of Proximal Femur from Sparse
Intraoperative Data and Dense PDM for Surgical Navigation
October 16, 2008 35
Statistical Deformable Bone Models
October 16, 2008 36