Pre-operative Dynamic Interactive Exploration of Complex Articular Fractures Using a Novel 3D Navigation Tool

M. Marschollek; M. Teistler; O. J. Bott; K. M. Stuermer; D. P. Pretschner; K. Dresing

doi:10.1055/s-0038-1634092

Methods of Information in Medicine, Table of Contents

Methods Inf Med 2006; 45(04): 384-388
DOI: 10.1055/s-0038-1634092

Original Article

Schattauer GmbH

Pre-operative Dynamic Interactive Exploration of Complex Articular Fractures Using a Novel 3D Navigation Tool

M. Marschollek

¹Institute for Medical Informatics, Technical University Carolo-Wilhelmina, Braunschweig, Germany

,

M. Teistler

²Biomedical Imaging Lab, Biomedical Sciences Institutes, Technology & Research (ASTAR), Singapore

,

O. J. Bott

¹Institute for Medical Informatics, Technical University Carolo-Wilhelmina, Braunschweig, Germany

,

K. M. Stuermer

³Department of Trauma and Casualty, Plastic and Reconstructive Surgery, University Hospital, Georg-August-University, Goettingen, Germany

,

D. P. Pretschner

¹Institute for Medical Informatics, Technical University Carolo-Wilhelmina, Braunschweig, Germany

,

K. Dresing

³Department of Trauma and Casualty, Plastic and Reconstructive Surgery, University Hospital, Georg-August-University, Goettingen, Germany

› Author Affiliations

Abstract

Summary

Objectives: Trauma surgeons possess specific anticipative pathoanatomical and procedural domain knowledge that can be used for information extraction from original CT image data. This knowledge so far remains unused in clinical workflow and surgeons do not take an active part in the process of image generation and processing. The objectives of our work are to propose and employ a strategy to directly involve surgeons in a dynamic image exploration process and to exemplarily assess the clinical use of this appoach for pre-operative diagnosis of complex articular fractures.

Methods: We used an interactive 3D navigation tool with a novel human-computer interface for the exploration of articular fractures of two selected anatomical structures. The system offers dynamic interaction with a virtual 3D reconstruction model and the possibility to create on-the-fly oblique multiplanar reformations by tracking hand movements. Three expert surgeons performed exemplary explorations and rated the use of the method for preoperative diagnosis in informal interviews.

Results: The approach and the system were well received by the three surgeons. The dynamic interaction was rated to be helpful in understanding fracture morphology. Two examples – a radius and a calcaneal fracture – are presented.

Conclusions: Surgeons with their specific domain knowledge should be involved in the process of image processing. The benefit of using oblique multiplanar reformations for pre-operative planning in articular fractures appears to be substantial and they should therefore be included in radiological and surgical textbooks. Further evaluation is necessary to assess the use of interactive exploration systems in routine diagnosis.

Keywords

Diagnostic imaging - human-computer interface - articular fractures - visualization - pre-operative planning

Full Text

References

References
1 Tamm EP. et al Impact of multislice CT on PACS resources. J Digit Imaging 2002; 15 Suppl 1 96-101.
2 Borrelli , Jr. J. et al Assessment of articular fragment displacement in acetabular fractures: a comparison of computerized tomography and plain radiographs. J Orthop Trauma 2002; 16 (007) 449-56. discussion 456-7
3 Franca C. et al Use of three-dimensional spiral computed tomography imaging for staging and surgical planning of head and neck cancer. J Digit Imaging 2000; 13 (2, Suppl 1) 24-32.
4 Nogueira-Barbosa MH, Defino HL. Multiplanar reconstructions of helical computed tomography in planning of atlanto-axial transarticular fixation. Eur Spine J 2005; 14 (005) 493-500.
5 Handels H, Ehrhardt J, Ploetz W, Poeppl SJ. Simulation of hip operations and design of custommade endoprostheses using virtual reality techniques. Methods Inf Med 2001; 40 (002) 74-7.
6 Rieger M. et al CT virtual reality in the preoperative workup of malunited distal radius fractures: preliminary results. Eur Radiol 2005; 15 (004) 792-7.
7 Hsieh MS. et al Virtual reality simulator for osteotomy and fusion involving the musculoskeletal system. Comput Med Imaging Graph 2002; 26 (002) 91-101.
8 Dahlen C, Zwipp H. Computer-assisted surgical planning. Unfallchirurg 2001; 104 (006) 466-79. (Article in German.)
9 Lehmann TM. et al Advances in biomedical image analysis - past, present and future challenges. Methods Inf Med 2004; 43 (004) 308-14.
10 Lehmann TM, Bredno J, Spitzer K. On the design of active contours for medical image segmentation. A Scheme for Classification and construction. Methods Inf Med 2003; 42 (001) 89-98.
11 Teistler M. et al Virtual Tomography. A New Approach for Efficient Human-Computer Interaction for Medical Imaging. In Galloway Jr RL. editor. Proc of SPIE; 2003; San Diego 2003; pp 512-9.
12 Rueedi TP, Murphy WM. editors AO Principles of Fracture Management. Stuttgart: Thieme 2001
13 Dahlen HC. et al Incorrect classification of extraarticular distal radius fractures by conventional x-rays. Comparison between biplanar radiologic diagnostics and CT assessment of fracture morphology. Unfallchirurg 2004; 107 (006) 491-8. (Article in German.)
14 Freund M. et al Optimized preoperative planning of calcaneal fractures using spiral computed tomography. Eur Radiol 1999; 9 (005) 901-6.
15 Linsenmaier U. et al Classification of calcaneal fractures by spiral computed tomography: implications for surgical treatment. Eur Radiol 2003; 13 (010) 2315-22.
16 Horsch A. et al Establishing an International Reference Image Database for Research and Development in Medical Image Processing. Methods Inf Med 2004; 43: 409-12.