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Patient-Specific Three-Dimensional Composite Bone Models for Teaching and Operation Planning

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Abstract

Background: Orthopedic trauma care relies on two-dimensional radiograms both before and during the operation. Understanding the three-dimensional nature of complex fractures on plain radiograms is challenging. Modern fluoroscopes can acquire three-dimensional volume datasets even during an operation, but the device limitations constrain the acquired volume to a cube of only 12-cm edge. However, viewing the surrounding intact structures is important to comprehend the fracture in its context. We suggest merging a fluoroscope’s volume scan into a generic bone model to form a composite full-length 3D bone model. Methods: Materials consisted of one cadaver bone and 20 three-dimensional surface models of human femora. Radiograms and computed tomography scans were taken before and after applying a controlled fracture to the bone. A 3D scan of the fracture was acquired using a mobile fluoroscope (Siemens Siremobil). The fracture was fitted into the generic bone models by rigid registration using a modified least-squares algorithm. Registration precision was determined and a clinical appraisal of the composite models obtained. Results: Twenty composite bone models were generated. Average registration precision was 2.0 mm (range 1.6 to 2.6). Average processing time on a laptop computer was 35 s (range 20 to 55). Comparing synthesized radiograms with the actual radiograms of the fractured bone yielded clinically satisfactory results. Conclusion: A three-dimensional full-length representation of a fractured bone can reliably be synthesized from a short scan of the patient’s fracture and a generic bone model. This patient-specific model can subsequently be used for teaching, surgical operation planning, and intraoperative visualization purposes.

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Acknowledgments

The authors thank the following for contributing to this study: Department of Pathology, University Hospital of Basel/Switzerland (Prof. M.J. Mihatsch and Ralf Schoch) for supplying the bone specimen. Department of Radiology, University Hospital, Basel/Switzerland (Ms Severin Dziergwa) for performing repeated computed tomography scans. The AO Research Institute, Davos/Switzerland (Dr. Karsten Schwieger and Mr. Boyko Gueorguiev) for assisting in creating a controlled bone fracture. The AO Development Institute, Davos/Switzerland (Dr. Hanspeter Noser) for granting access to the AO bone database. The AO bone database is available to partner institutes for dedicated research projects. This study was co-funded by the Robert Mathys Foundation, Bettlach/Switzerland (Grant E06-0001) and a donation from Mrs M. Täsch Furger, Stäfa/Switzerland.

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Authors and Affiliations

  1. Brigham and Women’s Hospital, Surgical Planning Laboratory, Harvard Medical School, 75 Francis Street, Room L1-050, Boston, MA, 02115, USA

    Felix Matthews

  2. Center for Clinical Morphology and Biomedical Engineering, University of Basel, Computer Assisted Radiology and Computer Assisted Surgery (CARCAS), Basel, Switzerland

    Felix Matthews, Peter Messmer, Vladislav Raikov, Guido A. Wanner, Augustinus L. Jacob, Pietro Regazzoni & Adrian Egli

  3. Division of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland

    Vladislav Raikov & Guido A. Wanner

  4. Department of Radiology, University Hospital Basel, Basel, Switzerland

    Augustinus L. Jacob

  5. Department of Trauma Surgery, University Hospital Basel, Basel, Switzerland

    Pietro Regazzoni

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  1. Felix Matthews
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  2. Peter Messmer
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  3. Vladislav Raikov
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  4. Guido A. Wanner
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  5. Augustinus L. Jacob
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  7. Adrian Egli
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Correspondence to Felix Matthews.

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Matthews, F., Messmer, P., Raikov, V. et al. Patient-Specific Three-Dimensional Composite Bone Models for Teaching and Operation Planning. J Digit Imaging 22, 473–482 (2009). https://doi.org/10.1007/s10278-007-9078-8

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  • DOI: https://doi.org/10.1007/s10278-007-9078-8

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