. 2022 Jun 18;22(12):4615.
doi: 10.3390/s22124615.
Affiliations
Affiliations
- 1 Department of Spine Surgery, University Hospital of Strasbourg, 67200 Strasbourg, France.
- 2 Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France.
- 3 Department of Image Guided Therapy Systems, Philips Healthcare, 5684 PC Best, The Netherlands.
- 4 Department of Image Formation and Medical Image Acquisition, Philips Research, 22335 Hamburg, Germany.
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Yann Philippe Charles et al.
Sensors (Basel).
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. 2022 Jun 18;22(12):4615.
doi: 10.3390/s22124615.
Affiliations
- 1 Department of Spine Surgery, University Hospital of Strasbourg, 67200 Strasbourg, France.
- 2 Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France.
- 3 Department of Image Guided Therapy Systems, Philips Healthcare, 5684 PC Best, The Netherlands.
- 4 Department of Image Formation and Medical Image Acquisition, Philips Research, 22335 Hamburg, Germany.
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Abstract
Metal artifact reduction (MAR) algorithms are used with cone beam computed tomography (CBCT) during augmented reality surgical navigation for minimally invasive pedicle screw instrumentation. The aim of this study was to assess intra- and inter-observer reliability of pedicle screw placement and to compare the perception of baseline image quality (NoMAR) with optimized image quality (MAR). CBCT images of 24 patients operated on for degenerative spondylolisthesis using minimally invasive lumbar fusion were analyzed retrospectively. Images were treated using NoMAR and MAR by an engineer, thus creating 48 randomized files, which were then independently analyzed by 3 spine surgeons and 3 radiologists. The Gertzbein and Robins classification was used for screw accuracy rating, and an image quality scale rated the clarity of pedicle screw and bony landmark depiction. Intra-class correlation coefficients (ICC) were calculated. NoMAR and MAR led to similarly good intra-observer (ICC > 0.6) and excellent inter-observer (ICC > 0.8) assessment reliability of pedicle screw placement accuracy. The image quality scale showed more variability in individual image perception between spine surgeons and radiologists (ICC range 0.51-0.91). This study indicates that intraoperative screw positioning can be reliably assessed on CBCT for augmented reality surgical navigation when using optimized image quality. Subjective image quality was rated slightly superior for MAR compared to NoMAR.
Keywords:
augmented reality; cone beam computed tomography; image quality; metal artifact reduction algorithm; screw accuracy; surgical navigation.