Automatic registration with continuous pose updates for marker-less surgical navigation in spine surgery.

Established surgical navigation systems for pedicle screw placement have been proven to be accurate, but still reveal limitations in registration or surgical guidance. Registration of preoperative data to the intraoperative anatomy remains a time-consuming, error-prone task that includes exposure to harmful radiation. Surgical guidance through conventional displays has well-known drawbacks, as information cannot be presented in-situ and from the surgeon's perspective. Consequently, radiation-free and more automatic registration methods with subsequent surgeon-centric navigation feedback are desirable. In this work, we present a marker-less approach that automatically solves the registration problem for lumbar spinal fusion surgery in a radiation-free manner. A deep neural network was trained to segment the lumbar spine and simultaneously predict its orientation, yielding an initial pose for preoperative models, which then is refined for each vertebra individually and updated in real-time with GPU acceleration while handling surgeon occlusions. An intuitive surgical guidance is provided thanks to the integration into an augmented reality based navigation system. The registration method was verified on a public dataset with a median of 100% successful registrations, a median target registration error of 2.7 mm, a median screw trajectory error of 1.6°and a median screw entry point error of 2.3 mm. Additionally, the whole pipeline was validated in an ex-vivo surgery, yielding a 100% screw accuracy and a median target registration error of 1.0 mm. Our results meet clinical demands and emphasize the potential of RGB-D data for fully automatic registration approaches in combination with augmented reality guidance.

Classification of airborne 3D point clouds regarding separation of vegetation in complex environments.

Classification of outdoor point clouds is an intensely studied topic, particularly with respect to the separation of vegetation from the terrain and manmade structures. In the presence of many overhanging and vertical structures, the (relative) height is no longer a reliable criterion for such a separation. An alternative would be to apply supervised classification; however, thousands of examples are typically required for appropriate training. In this paper, an unsupervised and rotation-invariant method is presented and evaluated for three datasets with very different characteristics. The method allows us to detect planar patches by filtering and clustering so-called superpoints, whereby the well-known but suitably modified random sampling and consensus (RANSAC) approach plays a key role for plane estimation in outlier-rich data. The performance of our method is compared to that produced by supervised classifiers common for remote sensing settings: random forest as learner and feature sets for point cloud processing, like covariance-based features or point descriptors. It is shown that for point clouds resulting from airborne laser scans, the detection accuracy of the proposed method is over 96% and, as such, higher than that of standard supervised classification approaches. Because of artifacts caused by interpolation during 3D stereo matching, the overall accuracy was lower for photogrammetric point clouds (74-77%). However, using additional salient features, such as the normalized green-red difference index, the results became more accurate and less dependent on the data source.

SpineDepth: A Multi-Modal Data Collection Approach for Automatic Labelling and Intraoperative Spinal Shape Reconstruction Based on RGB-D Data.

Computer aided orthopedic surgery suffers from low clinical adoption, despite increased accuracy and patient safety. This can partly be attributed to cumbersome and often radiation intensive registration methods. Emerging RGB-D sensors combined with artificial intelligence data-driven methods have the potential to streamline these procedures. However, developing such methods requires vast amount of data. To this end, a multi-modal approach that enables acquisition of large clinical data, tailored to pedicle screw placement, using RGB-D sensors and a co-calibrated high-end optical tracking system was developed. The resulting dataset comprises RGB-D recordings of pedicle screw placement along with individually tracked ground truth poses and shapes of spine levels L1-L5 from ten cadaveric specimens. Besides a detailed description of our setup, quantitative and qualitative outcome measures are provided. We found a mean target registration error of 1.5 mm. The median deviation between measured and ground truth bone surface was 2.4 mm. In addition, a surgeon rated the overall alignment based on 10% random samples as 5.8 on a scale from 1 to 6. Generation of labeled RGB-D data for orthopedic interventions with satisfactory accuracy is feasible, and its publication shall promote future development of data-driven artificial intelligence methods for fast and reliable intraoperative registration.