title: Automated fiducial marker detection for patient registration in image-guided neurosurgery.
abstract: OBJECTIVE
  The registration of applied fiducial markers within the preoperative data is often left to the surgeon, who has to identify and tag the center of each marker. This is both time-consuming and a potential source of error. For this reason, the development of an automated procedure was desirable. In this study, we have investigated the accuracy of a software algorithm for detecting fiducial markers within the navigation data set. The influence of adjustable values for accuracy and threshold on the sensitivity and specificity of the detection process, as well as the time gain, was investigated.
  
  
  METHODS
  One hundred MP-RAGE MRI data sets of patients with different pathologies who were scheduled for image-guided surgery were used in this study. A total of 591 applied fiducial markers were to be detected using the algorithm of the software VVPlanning 1.3 (BrainLAB, Heimstetten, Germany) on a Pentium II standard PC. The size value of a marker in the y-direction is called "accuracy" and depends on the slice thickness. "Threshold" describes the gray level above which the algorithm starts searching for pixel clusters. The threshold value was changed stepwise on the basis of a constant "accuracy" value. The "accuracy" value was changed on the basis of that threshold value at which all markers were detected correctly.
  
  
  RESULTS
  The time needed for automatic detection varied between 12 s and 25 s. An optimum value for adjustable marker size was found to be 1.1 mm, with 8 undetected markers (1.35%) and 7 additionally detected structures (1.18%) out of 591. The mean gray level (Threshold) for all data sets above which marker detection was correct was 248.9. The automatic detection of markers was good for higher gray levels, with 11 missed markers (1.86%). Starting the algorithm at lower gray levels led to a decreased incidence of missed markers (0.17%), but increased the incidence of additionally detected structures to 27.92%.
  
  
  CONCLUSIONS
  The automatic marker-detection algorithm is a robust, fast and objective instrument for reliable fiducial marker registration when used with optimum settings for both threshold and accuracy.
authors.affiliation: Department of Neurosurgery, Neurocenter, Johann Wolfgang Goethe University, Frankfurt am Main, Germany. R.Krishnan@em.uni-frankfurt.de
authors.forename: René
authors.initials: R
authors.lastname: Krishnan
authors.forename: Elvis
authors.initials: E
authors.lastname: Hermann
authors.forename: Robert
authors.initials: R
authors.lastname: Wolff
authors.forename: Michael
authors.initials: M
authors.lastname: Zimmermann
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
authors.forename: Andreas
authors.initials: A
authors.lastname: Raabe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001921:Brain / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation; D012189:Retrospective Studies