9.4.2008
DICOM International Conference & Seminar
Work Item Implants – Current State and Outlook
Michael [email protected]
Thomas Trommer, Armin Löpfe, Oliver Burgert
2Outline
Implant Templates and Implantation Planning
Motivation
Features
Information Models
Examples
3Implant Templates & Implantation Planning
The pre-operative selection of the most suitable implant and the determination of the optimal position and fixation of an implant in the patient’s body is called implantation planning.
Planning is done with radiological images and graphical representations of implants, called implant templates.
4Implant Templates & Implantation Planning
5Motivation
PACS Server
Vendor Template Repository
Planning Workstation
Patient Images
Implant Templates
Planning Report
Required Templates
Intraoperative SystemPatient Images
HISEHR Data
At present: No standardized semantics and syntax for implant
templates No standardized format for planning results No integration of information flow into PACS
6Motivation
Patient Images
Implant Templates
Planning Report
Required Templates
Intraoperative SystemPatient Images
HISEHR Data
Planning Report
Required Templates
PACS Serverincl. Temp. Rep.
Planning Workstation
Our goal: Implant templates standardized in DICOM Implantation plans standardizes in DICOM All data stored in PACS server Whole data is exchanged via PACS
7Required Concepts
Patient‘s Morphology X-Rays, CTs, 3D Ultrasound Segmentation and Classification
Implant Geometry 2D 3D
Result Simulation Biomechanical properties Tissue deformation
Transfer into the OR Network technology & Displays Transfer protocols and formats
8DICOM Sup. 131 and 134
Bone MountedImplants
ImplantsImplantsImplantsImplants
Stents, Valves, … Many more
HipHip ShoulderShoulder DentalDentalSpineSpine Middle EarMiddle Ear
Implant Repository:Implant Repository:Bone Mounted Implant Template Storage
SOP Class
Patient Specific Plan / Report:Patient Specific Plan / Report:Implantation Plan Document SOP Class
General SurfaceMesh Module
EncapsulatedHPGL 2
Based on SR
9Workshops
In workshops with representatives from the implant industry and implantation planning software industry. Leipzig, December 13, 2007 San Francisco, March 3, 2008
A set of features and attributes was elaborated.
Working Group 24 is working on the translation of the workshop results into DICOM Supplements.
In parallel, ICCAS works on a test implementation of the new DICOM SOP Classes.
10Features
Implant Templates contain 2D and/or 3D representation, contain (anatomical) landmarks for
registration with patient images, contain information about indication, and can consist of several components,
Component assembly is described:compatibility,geometric constraints, and degrees of freedom.
11Information Model - Implant Templates
Implant
Component
1
1-n
Surface ModelFiducial
Manufacturer
Frame of Reference
11-n
11-n
1
0-n
Contact
0-n 1-naccepts
has has has
spatially defines
produces
consistsof
1
0-n
1
0-1
2D Template
has
1
0-n
12Example
Component 1“Hip Joint Head”“Material: Porcelain”Contact 1
CoordinatesAxesLink: Comp. 2, CP 1
Component 2“Hip Joint Shaft”“Material: Titan”Contact 1
CoordinatesAxesLink: Comp. 1, CP 1
Fiducial 1Femur Axis
13Implant Types
Implants for different purposes differ very much in the Attributes and landmarks that describe them.
We propose an encoding mechanism that leaves room for a lot of flexibility.
Only the Attributes that are applicable to the type of implant that is described in one Instance need to be present.
General Implant Attributes Hip Joint
Assembly
Dental Implant
14Implantation Plan SR Document: Features
Registration
Templates (Implant Components)
Patient Image VisualizationAnatomical
Fiducials
Implantation Plan Assembly
description
Planning Information
Derived Fiducials
Images: ENDOTEC
15Information Model - Implantation Plan SR Document
Implant IOD
Surface ModelFiducials
Implantation Plan SR
contains
references
Registration IOD
Image IOD
Surface Seg. IOD
Spatial Fiducials IOD
refers to
spatiallyaligns
2D Templates
9.4.2008
Acknowledgements
The Innovation Center Computer Assisted Surgery (ICCAS) at the Faculty of Medicine at the University of Leipzig is funded by the German Federal Ministry for Education and Research (BMBF) and the Saxon Ministry of Science and the Fine Arts (SMWK) in the scope of the initiative “Unternehmen Region” with the grant numbers 03 ZIK 031 and 03 ZIK 032.
Gefördert im Rahmen der Technologieförderung mit Mitteln des Europäischen Fonds für regionale Entwicklung (EFRE) und mit Mitteln des Freistaates Sachsen.
Thank you very much for your attention!