Deformable 3D-2D registration for guiding K-wire placement in pelvic trauma surgery

J. Goerres, M. Jacobson, A. Uneri, T. De Silva, M. Ketcha, S. Reaungamornrat, S. Vogt, G. Kleinszig, J. P. Wolinsky, G. Osgood, J. H. Siewerdsen

Research output: Chapter in Book/Report/Conference proceedingConference contribution

2 Scopus citations


Pelvic Kirschner wire (K-wire) insertion is a challenging surgical task requiring interpretation of complex 3D anatomical shape from 2D projections (fluoroscopy) and delivery of device trajectories within fairly narrow bone corridors in proximity to adjacent nerves and vessels. Over long trajectories (∼10-25 cm), K-wires tend to curve (deform), making conventional rigid navigation inaccurate at the tip location. A system is presented that provides accurate 3D localization and guidance of rigid or deformable surgical devices ("components" - e.g., K-wires) based on 3D-2D registration. The patient is registered to a preoperative CT image by virtually projecting digitally reconstructed radiographs (DRRs) and matching to two or more intraoperative x-ray projections. The K-wire is localized using an analogous procedure matching DRRs of a deformably parametrized model for the device component (deformable known-component registration, or dKC-Reg). A cadaver study was performed in which a K-wire trajectory was delivered in the pelvis. The system demonstrated target registration error (TRE) of 2.1 ± 0.3 mm in location of the K-wire tip (median ± interquartile range, IQR) and 0.8 ± 1.4± in orientation at the tip (median ± IQR), providing functionality analogous to surgical tracking/navigation using imaging systems already in the surgical arsenal without reliance on a surgical tracker. The method offers quantitative 3D guidance using images (e.g., inlet/outlet views) already acquired in the standard of care, potentially extending the advantages of navigation to broader utilization in trauma surgery to improve surgical precision and safety.

Original languageEnglish (US)
Title of host publicationMedical Imaging 2017
Subtitle of host publicationImage-Guided Procedures, Robotic Interventions, and Modeling
EditorsRobert J. Webster, Baowei Fei
ISBN (Electronic)9781510607156
StatePublished - 2017
EventMedical Imaging 2017: Image-Guided Procedures, Robotic Interventions, and Modeling - Orlando, United States
Duration: Feb 14 2017Feb 16 2017

Publication series

NameProgress in Biomedical Optics and Imaging - Proceedings of SPIE
ISSN (Print)1605-7422


OtherMedical Imaging 2017: Image-Guided Procedures, Robotic Interventions, and Modeling
Country/TerritoryUnited States


  • 3D/2D registration
  • Deformable registration
  • Image guidance
  • Surgical navigation
  • Trauma surgery

ASJC Scopus subject areas

  • Electronic, Optical and Magnetic Materials
  • Atomic and Molecular Physics, and Optics
  • Radiology Nuclear Medicine and imaging
  • Biomaterials


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