Abstract
Purpose
Derotation varisation osteotomy of the proximal femur in pediatric patients usually relies on 2-dimensional X-ray imaging, as CT and MRI still are disadvantageous when applied in small children either due to a high radiation exposure or the need of anesthesia. This work presents a radiation-free non-invasive tool to 3D-reconstruct the femur surface and measure relevant angles for orthopedic diagnosis and surgery planning from 3D ultrasound scans instead.
Methods
Multiple tracked ultrasound recordings are segmented, registered and reconstructed to a 3D femur model allowing for manual measurements of caput-collum-diaphyseal (CCD) and femoral anteversion (FA) angles. Novel contributions include the design of a dedicated phantom model to mimic the application ex vivo, an iterative registration scheme to overcome movements of a relative tracker only attached to the skin, and a technique to obtain the angle measurements.
Results
We obtained sub-millimetric surface reconstruction accuracy from 3D ultrasound on a custom 3D-printed phantom model. On a pre-clinical pediatric patient cohort, angular measurement errors were \(3.0^{\circ }\pm 2.0^{\circ }\) and eventually \(4.7^{\circ }\pm 2.7^{\circ }\) for CCD and FA angles, respectively, both within the clinically acceptable range. To obtain these results, multiple refinements of the acquisition protocol were necessary, ultimately reaching success rates of up to 67% for achieving sufficient surface coverage and femur reconstructions that allow for geometric measurements.
Conclusion
Given sufficient surface coverage of the femur, clinically acceptable characterization of femoral anatomy is feasible from non-invasive 3D ultrasound. The acquisition protocol requires leg repositioning, which can be overcome using the presented algorithm. In the future, improvements of the image processing pipeline and more extensive surface reconstruction error assessments could enable more personalized orthopedic surgery planning using cutting templates.
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Acknowledgements
We thank Florian Fischer for his support in obtaining imaging data, and Vincent Frimberger for facilitating early 3D US experiments.
Funding
This study was partially supported by the German Ministry for Education and Research (BMBF), grant number 13GW0293B, “FOMIPU”. Parts of the equipment used at the Musculoskeletal University Center Munich was funded by the Bavarian Ministry of “Bildung und Kultus, Wissenschaft und Kunst”.
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Patients and their legal guardian were informed about the diagnostics and the purpose of the study and agreed to participate in the study via written informed consent.
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The study was approved by the local ethics committee of the Ludwig-Maximilians-University (Ethics No.: 20-317) and conducted according to the guidelines of the Declaration of Helsinki.
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Gebhardt, C., Göttling, L., Buchberger, L. et al. Femur reconstruction in 3D ultrasound for orthopedic surgery planning. Int J CARS 18, 1001–1008 (2023). https://doi.org/10.1007/s11548-023-02868-4
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DOI: https://doi.org/10.1007/s11548-023-02868-4