Evaluation of Software-Based Metal Artifact Reduction in Intraoperative 3D Imaging of the Spine Using a Mobile Cone Beam
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ORIGINAL PAPER
Evaluation of Software-Based Metal Artifact Reduction in Intraoperative 3D Imaging of the Spine Using a Mobile Cone Beam CT Maxim Privalov 1 & Marcus Mohr 1 & Benedict Swartman 1 & Nils Beisemann 1 & Holger Keil 1 & Jochen Franke 1 & Paul Alfred Grützner 1 & Sven Yves Vetter 1
# Society for Imaging Informatics in Medicine 2020
Abstract The aim of our study was to evaluate whether software-based artifact reduction can achieve an improved image quality, using intraoperative 3D imaging in spinal surgery. A total of 49 intraoperative 3D image datasets of patients, who underwent surgery with pedicle screw placement, were retrospectively evaluated. The visibility of anatomical structures and the diameter of the pedicle screws were examined, with and without the application of the artifact reduction software. All software prototypes can improve the visibility of anatomical structures (P < 0.01), except MAR (metal artifact reduction) combined with IRIS (iterative reconstruction in image space) (P = 0.04). The algorithms MAR and MAR-2 can reduce the blooming artifacts significantly (P < 0.01), but SL (Shepp & Logan) cannot (P = 0.08–0.988). In summary, software-based artifact reduction for intraoperative 3D datasets can improve the current image quality. Additional information regarding the implant placement and the fracture reduction is therefore generated for the surgeon. Keywords Intraoperative 3D imaging . Cone-beam CT . Artifact reduction . Spinal surgery . Pedicle screw
Introduction The incidence of spinal fractures in western countries is around 64 per 100,000 inhabitants [1]. Elderly patients ≥ 65 years are increasingly affected [2]. In about 20% of all cases, the cervical spine is affected; the remaining 80% are related to injuries of the thoracic and lumbar spine [3]. The dorsal instrumentation of the spine using pedicle screws is the gold standard at present, especially not only in the stabilization of fractures but also in many congenital (e.g., scoliosis—spinal deformity in which a sideways curvature of the spine is caused by a defect present at birth) and degenerative diseases (e.g., spondylosis–osteoarthritic degeneration of the vertebral column) of the spine [4]. The pedicles are located in the immediate, topographic vicinity of the spinal cord, and the nerve roots. This determines the vulnerability
* Sven Yves Vetter [email protected] 1
Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
of these structures due to incorrectly placed screws. Despite this critical anatomical constellation, neurological complications with 0.19% per screw are comparatively rare. However, transitory neurapraxia, which is defined as temporary loss of motor and sensory function due to blockage of nerve conduction lasting an average of 6 to 8 weeks, is observed more frequently than a permanent neurological deficit [5]. Also, depending on the height, the viscera of th
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