Machine learning for automated 3-dimensional segmentation of the spine and suggested placement of pedicle screws based on intraoperative cone-beam computer tomography

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  • 1 Department of Clinical Neuroscience, Karolinska Institutet;
  • 2 Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden;
  • 3 Digital Imaging, Philips Research, Hamburg, Germany;
  • 4 Image Guided Interventional Therapy, Philips Healthcare, Best, The Netherlands; and
  • 5 Interventional Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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OBJECTIVE

The goal of this study was to develop and validate a system for automatic segmentation of the spine, pedicle identification, and screw path suggestion for use with an intraoperative 3D surgical navigation system.

METHODS

Cone-beam CT (CBCT) images of the spines of 21 cadavers were obtained. An automated model-based approach was used for segmentation. Using machine learning methodology, the algorithm was trained and validated on the image data sets. For measuring accuracy, surface area errors of the automatic segmentation were compared to the manually outlined reference surface on CBCT. To further test both technical and clinical accuracy, the algorithm was applied to a set of 20 clinical cases. The authors evaluated the system’s accuracy in pedicle identification by measuring the distance between the user-defined midpoint of each pedicle and the automatically segmented midpoint. Finally, 2 independent surgeons performed a qualitative evaluation of the segmentation to judge whether it was adequate to guide surgical navigation and whether it would have resulted in a clinically acceptable pedicle screw placement.

RESULTS

The clinically relevant pedicle identification and automatic pedicle screw planning accuracy was 86.1%. By excluding patients with severe spinal deformities (i.e., Cobb angle > 75° and severe spinal degeneration) and previous surgeries, a success rate of 95.4% was achieved. The mean time (± SD) for automatic segmentation and screw planning in 5 vertebrae was 11 ± 4 seconds.

CONCLUSIONS

The technology investigated has the potential to aid surgeons in navigational planning and improve surgical navigation workflow while maintaining patient safety.

ABBREVIATIONS CBCT = cone-beam CT; IQR = interquartile range; MaxDist = maximum distance; OR = operating room; RMSDist = root-mean-squared distance.

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Contributor Notes

Correspondence Gustav Burström: Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. gustav.burstrom@ki.se.

INCLUDE WHEN CITING Published online March 22, 2019; DOI: 10.3171/2018.12.SPINE181397.

Disclosures C.B., J.H., R.N., C.L., D.B., R.H., and M.G. are employed by Philips Research and/or Philips Healthcare, which has a vested interest in the product in this manuscript. The authors report that Karolinska University Hospital and Philips Healthcare have a major collaboration agreement. Dr. Racadio reports that Cincinnati Children’s Hospital Medical Center Department of Radiology has a Master Research Agreement with Philips Medical.

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