The KIPS Transactions:PartB (정보처리학회논문지B)

Korea Information Processing Society (한국정보처리학회)
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Design and Implementation of A Medical Image Guided System for Vertebroplasty

척추성형술을 위한 의료 영상 시스템의 설계 및 개발

  • Published : 2003.08.01
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Abstract

Since surgical treatment of the spine should overcome neurological compromises, the operative procedures need to be carefully planned and carried out with high degree of precision. Percutaneous vertebroplasty is a surgical procedure that was introduced for the treatment of compression fracture of the vertebrae. This procedure includes puncturing vertebrae and filling with polymethylmethacrylate (PMMA). Recent studies have shown that the procedure could provide structural reinforcement for the osteoporotic vertebrae while being minimally invasive and safe with immediate relief of pain. However, failures of treatment due to excessive PMMA volume injection have been reported as one of complications in vertebroplasty. It is believed that the control of PMMA volume is one of the most critical factors that can reduce the incidence of complications. Therefore, clinical success of vertebroplasty can be dependent on the volume of PMMA injection for a given patient. In this study, the optimal volume of PMMA injection for vertebroplasty was predicted based on the image analysis of a given patient.

척추에 대한 외과수술은 신경조직을 손상하지 않아야 하기 때문에 수술 절차가 신중하게 계획되고 고도의 정밀을 요구한다. 척추성형술(verte-broplasty)은 골다공증으로 인한 척추의 골절을 치료하기 위해 제안된 비교적 새로운 외과적인 수술방법으로 최소침습적인 수술 기법으로 피부를 통하여 골절된 척추부위에 구멍을 내고 그곳에 PMMA(polymethylmethacrylate)라 불리는 골시멘트(bone cement)를 주입하여 치료하는 방법이다. 최근의 연구결과, 수술 후 즉각적인 고통의 경감을 가져오며, 골다공증으로 인한 골절부위에 강도가 강한 골시멘트를 주입하게 됨으로써 골다공증 척추체에 구조적인 안정성을 제공해 주는 것으로 알려져 있다. 수술 후 발생하는 합병증의 대부분은 과도한 골시멘트의 주입으로 인한 것으로 알려져 있으며, 따라서 척추성형술의 치료에 가장 중요한 요인은 주입한 골시멘트의 양을 조절하는 것이다. 이에 본 연구에서는 환자의 컴퓨터단층촬영(computer tomography)을 통하여 획득한 영상을 토대로 척추성형술 시술시 필요한 의료 영상 시스템을 설계 및 개발하고, 텍스처 분석을 통하여 개개인의 환자에게 필요한 골시멘트의 양을 계산하는 알고리즘을 개발하여 이를 실제 환자의 시술시에 적용해 보았다. 결과적으로 본 시스템은 척추성형술시에 최적의 골시멘트의 양을 예측할 수 있었으며, 정형외과의 다른 부위의 수술시에도 적용가능성을 확인할 수 있었다.

Keywords

References

  1. R. A. Robb, D. P. Hanson, J. J. Camp, 'Computer-aided surgery planning and rehearsal at Mayo clinic,' IEEE computer, 29, pp.39-47, 1996 https://doi.org/10.1109/2.481435
  2. C. A. Taylor, M. T. Draney, J. P. Ku, D. Parker, B. N. Steele, K. Wang, C. K. Zarins, 'Predictive medicine : computational techniques in therapeutic decision-making,' Comput. Aided Surg., Vol.4, pp.231-247, 1999 https://doi.org/10.1002/(SICI)1097-0150(1999)4:5<231::AID-IGS1>3.0.CO;2-Z
  3. R. W. Pho, S. Y. Lim, B. P. Pereira, 'Computer applications in orthopedics,' Ann. Acad. Med. Singapore, Vol.19, No.5, pp.691-698, 1990
  4. M. Viceconti, D. Testi, R. Gori, C. Zannoni, A. Capello, A. De Lollis, 'HIDE: a new hybrid environment for the design of custom-made hip prosthesis,' Comput. Methods Prog. Biomed, Vol.64, pp.137-144, 2001 https://doi.org/10.1016/S0169-2607(00)00097-3
  5. E. Y. Chao, F. H. Sim, 'Computer-aided preoperative planning in knee osteotomy,' Iowa Orthop. J., Vol.15, pp.4-18, 1995
  6. V. Zdravkovic, R. Bilic, 'Computer-assisted preoperative planning(CAPP) in orthopedic surgery,' Comput. Methods Prog. Biomed, Vol.32, No.2, pp.141-146, 1990 https://doi.org/10.1016/0169-2607(90)90094-P
  7. H. Deramond, C. Depriester, P. Galibert, D. Le Gars, 'Percutaneous vertebroplasty with polymethylmethacrylate technique, indications and results,' Radiol. Clinics of N. America, Vol.36, No.3, pp.533-546, 1998 https://doi.org/10.1016/S0033-8389(05)70042-7
  8. J. B. Martin, B. Jean, D. S. Ruiz, M. Piotin, K. Murphy, B. Rufenacht, M. Muster and D. A. Rufenacht, 'Vertebroplasty: clinical experience and follow-up results,' Bone, Vol.25, No.2, Supplement, pp.11S-15S, 1999 https://doi.org/10.1016/S8756-3282(99)00126-X
  9. J. D. Barr, M. S. Barr, T. J. Lemley and R. M. McCann, 'Percutaneous vertebroplasty for pain relief and spinal stabilization,' Spine, Vol.25, No.8, pp.923-928, 2000 https://doi.org/10.1097/00007632-200004150-00005
  10. IAP PrS Application Writer's Manual (Version 3.9), 1998
  11. A. H. Mir, M. Hanmandlu and S. N. Tandon, 'Texture analysis of CT images,' IEEE Eng. in Med. & Biol., pp.781-786, 1995 https://doi.org/10.1109/51.473275
  12. M. Ito, M. Ohki, K. Hayashi, M. Yamada, M. Uetani and T. Nakamura, 'Trabecular texture analysis of CT images in the relationship with spinal fracture,' Radiology, Vol.194, pp.55-59, 1995 https://doi.org/10.1148/radiology.194.1.7997582
  13. G. R. Tack, H. G. Choi, K. C. Shin, S. J. Lee, 'Relationship between trabecular texture features of CT images and an amount of bone cement volume injection in percutaneous vertebroplasty,' SPIE Medical Imaging 2001, Image perception and performance Conference, pp.4324-32, 2001 https://doi.org/10.1117/12.431193
  14. G. R. Tack, H. G. Choi, 'Semi-automatic segmentation tool for 3D visualization of medical images,' Proceedings of China-Japan-Korea Joint Symp. Med. Informatics, pp.70-71, 2000
  15. R. Krejci, M. Martos, J. Dvorak, J. Nedoma, J. Stehlik, '2D and 3D finite element pre- and post-processing in orthopaedy,' Int. J. Med. Informatics, Vol.45, pp.83-89, 1997 https://doi.org/10.1016/S1386-5056(97)00038-5
  16. M. Viceconti, C. Zannoni, D. Testi, A. Cappello, 'CT data sets surface extraction for biomechanical modeling of long bones,' Comput. Method. Prog. Biomed., Vol.59, pp.159-166, 1999 https://doi.org/10.1016/S0169-2607(98)00107-2
  17. J. H. Keyak, J. M. Meagher, H. B. Skinner, C. D. Mote Jr., 'Automated three dimensional finite element modeling of bone:a new method,' J.Biomed.Eng., Vol.12, No.5, pp.389-397, 1990 https://doi.org/10.1016/0141-5425(90)90022-F
  18. H. Keyak, M. G. Fourkas, J. M. Meagher, H. B. Skinner, 'Validation of an automated method of three dimensional finite element modeling of bone,' J.Biomed.Eng., Vol.15, No.6, pp.505-509, 1993 https://doi.org/10.1016/0141-5425(93)90066-8
  19. D. R. Carter, W. C. Hayes, 'The compressive behavior of bone as a two-phase porous structure,' J. Bone Joint Surg., 59A, pp.954-962, 1977
  20. D. H. Lim, S. J. Lee, K. C. Shin, B. J. Jun, G. R. Tack, S. S. Kim, J. W. Shin, 'Effect of polymethymethacrylate(PMMA) injection in vertebroplasty for the treatment of the osteoporotic vertebra,' Proceedings of world biomaterials congress, Hawaii, USA, pp.15-20, May, 2000