Automatic Multi-View X-Ray/CT Registration Using Bone Substructure Contours

TL;DR

This paper introduces a fully automatic multi-view X-ray/CT registration method based on bone substructure contours, achieving sub-millimeter accuracy for intraoperative orthopedic navigation with minimal manual effort.

Contribution

It proposes a novel contour-based ICP registration approach focusing on bone substructures, improving robustness and accuracy over existing methods.

Findings

Achieves mean reprojection error of 0.67mm, outperforming manual methods at 5.35mm.

Requires only two X-ray images, enabling fully automatic registration.

Provides a new dataset of cadaveric X-ray and CT images for research.

Abstract

Purpose: Accurate intraoperative X-ray/CT registration is essential for surgical navigation in orthopedic procedures. However, existing methods struggle with consistently achieving sub-millimeter accuracy, robustness under broad initial pose estimates or need manual key-point annotations. This work aims to address these challenges by proposing a novel multi-view X-ray/CT registration method for intraoperative bone registration. Methods: The proposed registration method consists of a multi-view, contour-based iterative closest point (ICP) optimization. Unlike previous methods, which attempt to match bone contours across the entire silhouette in both imaging modalities, we focus on matching specific subcategories of contours corresponding to bone substructures. This leads to reduced ambiguity in the ICP matches, resulting in a more robust and accurate registration solution. This approach requires only two X-ray images and operates fully automatically. Additionally, we contribute a dataset of 5 cadaveric specimens, including real X-ray images, X-ray image poses and the corresponding CT scans. Results: The proposed registration method is evaluated on real X-ray images using mean reprojection error (mRPD). The method consistently achieves sub-millimeter accuracy with a mRPD 0.67mm compared to 5.35mm by a commercial solution requiring manual intervention. Furthermore, the method offers improved practical applicability, being fully automatic. Conclusion: Our method offers a practical, accurate, and efficient solution for multi-view X-ray/CT registration in orthopedic surgeries, which can be easily combined with tracking systems. By improving registration accuracy and minimizing manual intervention, it enhances intraoperative navigation, contributing to more accurate and effective surgical outcomes in computer-assisted surgery (CAS).