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Radiation-free methods for navigated screw placement in slipped capital femoral epiphysis surgery

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

For orthopedic procedures, surgeons utilize intra-operative medical images such as fluoroscopy to plan screw placement and accurately position the guide wire with the intended trajectory. The number of fluoroscopic images needed depends on the complexity of the case and skill of the surgeon. Since more fluoroscopic images lead to more exposure and higher radiation dose for both surgeon and patient, a solution that decreases the number of fluoroscopic images would be an improvement in clinical care.

Methods

This article describes and compares three different novel navigation methods and techniques for screw placement using an attachable Inertial Measurement Unit device or a robotic arm. These methods provide projection and visualization of the surgical tool trajectory during the slipped capital femoral epiphysis procedure.

Results

These techniques resulted in faster and more efficient preoperative calibration and set up times compared to other intra-operative navigation systems in our phantom study. We conducted an experiment using 120 model bones to measure the accuracy of the methods.

Conclusion

As conclusion, these approaches have the potential to improve accuracy of surgical tool navigation and decrease the number of required X-ray images without any change in the clinical workflow. The results also show 65% decrease in total error compared to the conventional manual approach.

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Notes

  1. KUKA Robotics GMBH, Germany.

  2. Northern Digital Inc., Waterloo, Canada.

  3. X-IO Technologies, Bristol, UK.

  4. Epiphany Systems Inc., Palo Alto, CA.

  5. Model # 1161, Sawbones Worldwide, Vashon Island, WA.

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Funding

This research was internally funded by the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National Health System.

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Author notes

  1. Kevin Cleary and Nassir Navab contributed equally to the project organization and execution and should be co-last authors.

Authors and Affiliations

  1. Chair for Computer Aided Medical Procedures and Augmented Reality, Department of Informatics, Technical University of Munich (TUM), Munich, Germany

    Bamshad Azizi Koutenaei & Nassir Navab

  2. Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington, DC, USA

    Bamshad Azizi Koutenaei, Mathew Oetgen & Kevin Cleary

  3. Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA

    Javad Fotouhi, Farshid Alambeigi & Nassir Navab

  4. E-Kare Inc, Fairfax, VA, USA

    Emmanuel Wilson & Ozgur Guler

Authors
  1. Bamshad Azizi Koutenaei
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  2. Javad Fotouhi
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  3. Farshid Alambeigi
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  4. Emmanuel Wilson
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  5. Ozgur Guler
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  6. Mathew Oetgen
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  7. Kevin Cleary
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  8. Nassir Navab
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Corresponding author

Correspondence to Bamshad Azizi Koutenaei.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Cite this article

Azizi Koutenaei, B., Fotouhi, J., Alambeigi, F. et al. Radiation-free methods for navigated screw placement in slipped capital femoral epiphysis surgery. Int J CARS 14, 2199–2210 (2019). https://doi.org/10.1007/s11548-019-02026-9

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  • DOI: https://doi.org/10.1007/s11548-019-02026-9

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