title: Intraoperative detection and localization of cylindrical implants in cone-beam CT image data.
abstract: OBJECTIVE
  Orthopedic fractures are often fixed using metal implants. The correct positioning of cylindrical implants such as surgical screws, rods and guide wires is highly important. Intraoperative 3D imaging is often used to ensure proper implant placement. However, 3D image interaction is time-consuming and requires experience. We developed an automatic method that simplifies and accelerates location assessment of cylindrical implants in 3D images.
  
  
  METHODS
  Our approach is composed of three major steps. At first, cylindrical characteristics are detected by analyzing image gradients in small image regions. Next, these characteristics are grouped in a cluster analysis. The clusters represent cylindrical implants and are used to initialize a cylinder-to-image registration. Finally, the two end points are optimized regarding image contrast along the cylinder axis.
  
  
  RESULTS
  A total of 67 images containing 420 cylindrical implants were used for testing. Different anatomical regions (calcaneus, spine) and various image sources (two mobile devices, three reconstruction methods) were investigated. Depending on the evaluation set, the detection performance was between 91.7 and 96.1% true- positive rate with a false-positive rate between 2.0 and 3.2%. The end point distance errors ranged from [Formula: see text] to [Formula: see text] mm and the orientation errors from [Formula: see text] to [Formula: see text] degrees. The average computation time was less than 5 seconds.
  
  
  CONCLUSIONS
  An automatic method was developed and tested that obviates the need for 3D image interaction during intraoperative assessment of cylindrical orthopedic implants. The required time for working with the viewing software of cone-beam CT device is drastically reduced and leads to a shorter time under anesthesia for the patient.
authors.affiliation: Division of Medical and Biological Informatics (E130), German Cancer Research Center, Im Neuenheimer Feld 280, 69120 , Heidelberg, Germany. j.goerres@dkfz-heidelberg.de.
authors.forename: Joseph
authors.initials: J
authors.lastname: Görres
authors.affiliation: Division of Medical and Biological Informatics (E130), German Cancer Research Center, Im Neuenheimer Feld 280, 69120 , Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Brehler
authors.affiliation: BG Trauma Center, Ludwig-Guttmann-Straße 13, 67071 , Ludwigshafen am Rhein, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Franke
authors.affiliation: Siemens AG, Healthcare Sector, Henkestr. 127, 91052 , Erlangen, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Barth
authors.affiliation: BG Trauma Center, Ludwig-Guttmann-Straße 13, 67071 , Ludwigshafen am Rhein, Germany.
authors.forename: Sven Y
authors.initials: SY
authors.lastname: Vetter
authors.affiliation: Clínica Alemana de Santiago, Avenida Vitacura 5951, Santiago de Chile, Chile.
authors.forename: Andrés
authors.initials: A
authors.lastname: Córdova
authors.affiliation: BG Trauma Center, Ludwig-Guttmann-Straße 13, 67071 , Ludwigshafen am Rhein, Germany.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Grützner
authors.affiliation: Division of Medical and Biological Informatics (E130), German Cancer Research Center, Im Neuenheimer Feld 280, 69120 , Heidelberg, Germany.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Meinzer
authors.affiliation: Mannheim University of Applied Sciences, Paul-Wittsack-Str. 10, 68163 , Mannheim, Germany.
authors.forename: Ivo
authors.initials: I
authors.lastname: Wolf
authors.affiliation: Division of Medical and Biological Informatics (E130), German Cancer Research Center, Im Neuenheimer Feld 280, 69120 , Heidelberg, Germany.
authors.forename: Diana
authors.initials: D
authors.lastname: Nabers
mesh_terms: D002111:Calcaneus / Q000000981:diagnostic imaging / Q000601:surgery*; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D016343:Monitoring, Intraoperative; D019637:Orthopedic Procedures / Q000379:methods*; D019736:Prostheses and Implants; D012984:Software; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Calcaneus; Clustering; Cylinder detection; Internal fixation; Intraoperative Imaging; PCA; RANSAC; Segmentation; Spine
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