基於C-arm影像的手術導引定位

The Framework of C-arm Based Surgical Navigation

吳吉春(Chi-Chun Wu)

指導教授 ： 曾清秀

國立中央大學/工學院/機械工程學系/碩士(2012年)

摘要

C-arm X光攝影機因為機動性高、取像速度快、及造影成本低等特性，是骨科手術常用的工具，但為了有效確認刀具的方位，須頻繁地拍攝以更新影像，致使病患在手術過程中承受高劑量的輻射，對醫療人員而言，長期累積的放射線劑量亦嚴重威脅身體健康，因此，如何有效減低C-arm的操作時間或使用量，並維持甚或提高手術精度，對於病患或醫療人員都是重要的考量。本研究目的在發展以C-arm影像作為手術導引與定位依據的技術，可在拍攝兩張影像的情況下，在術前由影像中相對應的成像位置計算目標點空間座標，以量測病灶的幾何尺寸，作為規劃手術的依據。手術進行過程中，可將刀具軸向即時地投影在經過畸變校正的C-arm影像上，讓醫師確認刀具與病灶的相對方位關係，達到導引定位之目的。應用此一技術建構之電腦輔助系統已於前十字韌帶重建手術中驗證其可行性與實用性。

關鍵字

前十字韌帶重建 ； 手術導引系統 ； 手術導引 ； C-arm

並列摘要

Due to high mobility, fast imaging, and low manipulation cost, C-arm fluoroscopy is frequently used for orthopedic surgery. However, mass use of C-arm fluoroscopy for confirmation of operation results is harmful to the health of the patient and medicine persons because of accumulated dosage of radiation. In this research, we have developed image-guided stereotactic technology. Only two images are needed to determine spatial positions and orientations of the targets. A prototype of surgical navigation system has been built. The system provides the functions of preoperative planning by selecting the surgical path on the two C-arm images and intraoperative guidance by watching the difference of the preplanned and real surgical paths. This system has been also applied to preliminary clinical test of anterior cruciate ligament reconstruction (ACL Reconstruction) to verify its clinic feasibility and practicability.

並列關鍵字

C-arm ； Surgical Navigation System ； ACL Reconstruction ； Surgical Navigation

參考文獻

[2] Barry, T.P., “Radiation exposure to an orthopedic surgeon,” Clin. Orthop., pp.182:160-163, 1993.

[4] Cerveri, P., Forlani, C., Borghese, N.A., et. al., “Distortion correction for x-ray image intensifiers: local unwarping polynomials and RBF neural networks,” Medical Physics, Vol. 29, Issue 8, pp. 1759-1771, 2002.

[5] Coltman, J.W., “Fluoroscopic image brightening by electronic means,” Radiology; Vol. 51, pp. 359-367, 1948.

[6] Fahrig, R., Moreau, M. and Holdsworth, D. W., “Three-dimensional computed tomographic reconstruction using a C-arm mounted XRII: correction of image intensifier distortion,” Medical Physics, Vol. 24, No. 7, pp. 1097-1106, 1997.

[8] Gronenschild, E., Roos, J., and Mulkens, G., “The accuracy and reproducibility of an algorithm to correct for geometric image distortion in quantitative coronary angiography,” IEEE Conference Proceedings, Computers in Cardiology, pp. 105-108, 1996.