TY - JOUR
T1 - Hybrid registration of the fibula for electromagnetically navigated osteotomies in mandibular reconstructive surgery
T2 - a phantom study
AU - Aukema, L.M.N.
AU - de Geer, A.F.
AU - van Alphen, M.J.A.
AU - Schreuder, W.H.
AU - van Veen, R.L.P.
AU - Ruers, T.J.M.
AU - Siepel, F.J.
AU - Karakullukcu, M.B.
N1 - Publisher Copyright:
© CARS 2024.
PY - 2025/2
Y1 - 2025/2
N2 - Purpose: In mandibular reconstructive surgery with free fibula flap, 3D-printed patient-specific cutting guides are the current state of the art. Although these guides enable accurate transfer of the virtual surgical plan to the operating room, disadvantages include long waiting times until surgery and the inability to change the virtual plan intraoperatively in case of tumor growth. Alternatively, (electromagnetic) surgical navigation combined with a non-patient-specific cutting guide could be used, requiring accurate image-to-patient registration. In this phantom study, we evaluated the accuracy of a hybrid registration method for the fibula and the additional error that is caused by navigating with a prototype of a novel non-patient-specific cutting guide to virtually planned osteotomy planes.Methods: The accuracy of hybrid registration and navigation was assessed in terms of target registration error (TRE), angular difference, and length difference of the intended fibula segments using three 3D-printed fibular phantoms with assessment points on osteotomy planes. Using electromagnetic tracking, hybrid registration was performed with point registration followed by surface registration on the lateral fibular surface. The fibula was fixated in the non-patient-specific cutting guide to navigate to planned osteotomy planes after which the accuracy was assessed.Results: Registration was achieved with a mean TRE, angular difference, and segment length difference of 2.3 ± 0.9 mm, 2.1 ± 1.4°, and 0.3 ± 0.3 mm respectively after hybrid registration. Navigation with the novel cutting guide increased the length difference (0.7 ± 0.6 mm), but decreased the angular difference (1.8 ± 1.3°).Conclusion: Hybrid registration showed to be a feasible and noninvasive method to register the fibula in phantom setup and could be used for electromagnetically navigated osteotomies with a novel non-patient-specific cutting guide. Future studies should focus on testing this registration method in clinical setting.
AB - Purpose: In mandibular reconstructive surgery with free fibula flap, 3D-printed patient-specific cutting guides are the current state of the art. Although these guides enable accurate transfer of the virtual surgical plan to the operating room, disadvantages include long waiting times until surgery and the inability to change the virtual plan intraoperatively in case of tumor growth. Alternatively, (electromagnetic) surgical navigation combined with a non-patient-specific cutting guide could be used, requiring accurate image-to-patient registration. In this phantom study, we evaluated the accuracy of a hybrid registration method for the fibula and the additional error that is caused by navigating with a prototype of a novel non-patient-specific cutting guide to virtually planned osteotomy planes.Methods: The accuracy of hybrid registration and navigation was assessed in terms of target registration error (TRE), angular difference, and length difference of the intended fibula segments using three 3D-printed fibular phantoms with assessment points on osteotomy planes. Using electromagnetic tracking, hybrid registration was performed with point registration followed by surface registration on the lateral fibular surface. The fibula was fixated in the non-patient-specific cutting guide to navigate to planned osteotomy planes after which the accuracy was assessed.Results: Registration was achieved with a mean TRE, angular difference, and segment length difference of 2.3 ± 0.9 mm, 2.1 ± 1.4°, and 0.3 ± 0.3 mm respectively after hybrid registration. Navigation with the novel cutting guide increased the length difference (0.7 ± 0.6 mm), but decreased the angular difference (1.8 ± 1.3°).Conclusion: Hybrid registration showed to be a feasible and noninvasive method to register the fibula in phantom setup and could be used for electromagnetically navigated osteotomies with a novel non-patient-specific cutting guide. Future studies should focus on testing this registration method in clinical setting.
KW - UT-Hybrid-D
KW - 2025 OA procedure
KW - Mandibular reconstruction
KW - Osteocutaneous fibula free flap
KW - Registration
KW - Surgical navigation
KW - Virtual surgical planning
KW - Electromagnetic navigation
KW - Electromagnetic tracking
UR - http://www.scopus.com/inward/record.url?scp=85210178012&partnerID=8YFLogxK
U2 - 10.1007/s11548-024-03282-0
DO - 10.1007/s11548-024-03282-0
M3 - Article
AN - SCOPUS:85210178012
SN - 1861-6410
VL - 20
SP - 369
EP - 377
JO - International journal of computer assisted radiology and surgery
JF - International journal of computer assisted radiology and surgery
IS - 2
ER -