Fast and automatic bone segmentation and registration of 3D ultrasound to CT for the full pelvic anatomy: a...

Ultrasound (US) is a safer alternative to X-rays for bone imaging, and its popularity for orthopedic surgical navigation is growing. Routine use of intraoperative US for navigation requires fast, accurate and automatic alignment of tracked US to preoperative computed tomography (CT) patient models. Our group previously investigated image segmentation and registration to align untracked US to CT of only the partial pelvic anatomy. In this paper, we extend this to study the performance of these previously published techniques over the full pelvis in a tracked framework, to characterize their suitability in more realistic scenarios, along with an additional simplified segmentation method and similarity metric for registration.

We evaluated phase symmetry segmentation, and Gaussian mixture model (GMM) and coherent point drift (CPD) registration methods on a pelvic phantom augmented with human soft tissue images. Additionally, we proposed and evaluated a simplified 3D bone segmentation algorithm we call Shadow-Peak (SP), which uses acoustic shadowing and peak intensities to detect bone surfaces. We paired this with a registration pipeline that optimizes the normalized cross-correlation (NCC) between distance maps of the segmented US-CT images.

SP segmentation combined with the proposed NCC registration successfully aligned tracked US volumes to the preoperative CT model in all trials, in contrast to the other techniques. SP with NCC achieved a median target registration error (TRE) of 2.44 mm (maximum 4.06 mm), when imaging all three anterior pelvic structures, and a mean runtime of 27.3 s. SP segmentation with CPD registration was the next most accurate combination: median TRE of 3.19 mm (maximum 6.07 mm), though a much faster runtime of 4.2 s.

We demonstrate an accurate, automatic image processing pipeline for intraoperative alignment of US-CT over the full pelvis and compare its performance with the state-of-the-art methods. The proposed methods are amenable to clinical implementation due to their high accuracy on realistic data and acceptably low runtimes.