A new experimental measurement and planning tool for sonographic-assisted navigation

In this study, we present a new 2.5-dimensional ultrasonic navigation system for measuring axes, lengths, and torsions preoperatively, intraoperatively, and postoperatively. The system comprises an ultrasound unit with a 5-MHz linear probe (TELEMED Echoblaster 128; Telemed, Vilnius, Lithuania) and a navigation system (OrthoPilot; B. Braun Aesculap, Tuttlingen, Germany) with a Polaris camera (Northern Digital, Waterloo, Canada). Specialized software developed for this application allows for selecting any body region on a virtual 3D skeleton. With a virtual ultrasound probe, planes needed for measurements can be defined. For each section, the respective surface contour of the bone, which is also shown in the ultrasound image, is displayed. Alternatively, the clinician can use established standard sections. Finally, the required length, axes, and torsions are defined. The accuracy and precision of the system were tested using a plastic model. The measurements of length, torsion, and axis values were accurate to -0.1 +/- 0.3 mm (95% CI), 0.1 degree +/- 0.2 degree (95% CI), and 0.0 degree +/- 0.006 degree (95% CI), respectively. The precision variances for length, torsion, and axis were 1.17 mm (standard deviation) and 0.94 degree and 0.66 degree. These results suggest that the new sonographic method is more accurate than conventional radiographic techniques.