Evaluating soft tissue simulation in maxillofacial surgery using pre and post-operative CT scan
Matthieu Chabanas, Christophe Marecaux, Franz Chouly, Franck Boutault, Yohan Payan
发表信息：
Proceedings of the 18th International Conference on Computer Assisted Radiology and Surgery, CARS 2004. International Congress Series, Vol. 1268 Elsevier (Ed.) (2004) 419-424
One of the most important issue in soft tissue modeling is to assess the quality of the simulations. A validation protocol is presented based on two CT scans of the patient acquired before and after cranio-maxillofacial surgery. The actual bones repositioning realized during the intervention are accurately measured and reproduced. A evaluation of the soft tissue deformation is then computed using a finite element model of the face. The simulations are therefore compared, qualitatively and quantitatively, with the actual outcome of the surgery. This protocol enable to rigorously evaluate different modeling methods, and to assess the clinical relevance of soft tissue simulation in maxillofacial surgery.
A Finite Element model of the face soft tissue is proposed to simulate the morphological outcomes of maxillofacial surgery. Three modelling options are implemented: a linear elastic model with small and large deformation hypothesis, and an hyperelastic Mooney-Rivlin model. An evaluation procedure based on a qualitative and quantitative comparison of the simulations with a post-operative CT scan is detailed. It is then applied to one clinical case to evaluate the differences between the three models, and with the actual patient morphology. First results shows in particular that for a "simple" c…
This paper introduces a multimodal elastic registration algorithm applied to match a generic Finite Element model of the face to several patients morphologies. The method is automatic and appears to be accurate and robust. The computing time is compatible with clinical practice constraints.
This paper presents the biomechanical finite element models that have been developed in the framework of the computer-assisted maxillofacial surgery. After a brief overview of the continuous elastic modelling method, two models are introduced and their use for computer-assisted applications discussed. The first model deals with orthognathic surgery and aims at predicting the facial consequences of maxillary and mandibular osteotomies. For this, a generic three-dimensional model of the face is automatically adapted to the morphology of the patient by the mean of elastic registration. Qualitativ…
An optimal planning procedure has been proposed to define the target position of the zygomatic bone following a fracture of the mid-face skeleton. The protocol has been successfully tested on healthy subjects, and ensures the global symmetry of the face could be obtained after the reconstruction surgery. Now that the planning procedure is available, the next step of this project will be to develop an intra-operative guiding system to help the surgeon to follow the planning. This procedure will mainly rely on the intra-operative registration of the zygomatic bone fragment, and the design of spe…
This paper addresses an important issue raised for the clinical relevance of Computer-Assisted Surgical applications, namely the methodology used to automatically build patient-specific Finite Element (FE) models of anatomical structures. From this perspective, a method is proposed, based on a technique called the Mesh-Matching method, followed by a process that corrects mesh irregularities. The Mesh-Matching algorithm generates patient-specific volume meshes from an existing generic model. The mesh regularization process is based on the Jacobian matrix transform related to the FE reference el…
We describe an arrangement for simultaneous recording of speech and geometry of vocal tract in patients undergoing surgery involving this area. Experimental design is considered from an articulatory phonetic point of view. The speech and noise signals are recorded with an acoustic-electrical arrangement. The vocal tract is simultaneously imaged with MRI. A MATLAB-based system controls the timing of speech recording and MR image acquisition. The speech signals are cleaned from acoustic MRI noise by a non-linear signal processing algorithm. Finally, a vowel data set from pilot experiments is com…
Two aspects required to establish a planning in orthognatic surgery are addressed in this paper. First, a 3D cephalometric analysis, which is clini-cally essential for the therapeutic decision. Then, an original method to build a biomechanical model of patient face soft tissue, which provides evaluation of the aesthetic outcomes of an intervention. Both points are developed within a clinical application context for computer aided maxillofacial surgery.
A computer aided maxillofacial sequence is presented, applied to orthognatic surgery. It consists of 5 main stages: data acquisition and integration, surgical planning, surgical simulation, and per operative assistance. The planning and simulation steps are then addressed in a way that is clinically relevant. First concepts toward a 3D cephalometry are presented for a morphological analysis, surgical planning, and bone and soft tissue simulation. The aesthetic surgical outcomes of bone repositioning are studied with a biomechanical Finite Element soft tissue model.
Proptosis is characterized by a protrusion of the eyeball due to an increase of the orbital tissue volume. To recover a normal eyeball positioning, the most frequent surgical technique (BROD technique) consists in the osteotomy of orbital walls combined with a loading on the eyeball to initiate tissue decompression. This paper proposed an experimental method to quantify the intra-operative clinical gesture in proptosis reduction, and the pilot study concerned one clinical case. The eyeball's backward displacement was measured by an optical 3D localizer and the load applied by the surgeon was s…
The study is looking into the potential of using computational fluid dynamics (CFD) as a tool for predicting the outcome of surgery for alleviation of obstructive sleep apnea syndrome (OSAS). From pre- and post-operative computed tomography (CT) of an OSAS patient, the pre- and post-operative geometries of the patient's upper airways were generated. CFD simulations of laminar flow in the patient's upper airway show that after nasal surgery the mass flow is more evenly distributed between the two nasal cavities and the pressure drop over the nasal cavity has increased. The pressure change is co…
Imperial College London（伦敦帝国理工学院）；Shanghai Jiao Tong University（上海交通大学）
Artificial Intelligence (AI) is gradually changing the practice of surgery with the advanced technological development of imaging, navigation and robotic intervention. In this article, the recent successful and influential applications of AI in surgery are reviewed from pre-operative planning and intra-operative guidance to the integration of surgical robots. We end with summarizing the current state, emerging trends and major challenges in the future development of AI in surgery.
In the 80's, biomechanicians were asked to work on Computer Aided Surgery applications since orthopaedic surgeons were looking for numerical tools able to predict risks of fractures. More recently, biomechanicians started to address soft tissues arguing that most of the human body is made of such tissues that can move as well as deform during surgical gestures [1]. An intra-operative use of a continuous Finite Element (FE) Model of a given tissue mainly faces two problems: (1) the numerical simulations have to be "interactive", i.e. sufficiently fast to provide results during surgery (which ca…
Proptosis is characterized by a protrusion of the eyeball due to an increase of the orbital tissue volume. To recover a normal eyeball positioning, the most frequent surgical technique (BROD technique) consists in the osteotomy of orbital walls combined with a loading on the eyeball to initiate tissue decompression. In this paper, a stiffness sensor device is proposed to (1) provide to the surgeon pre, intra and post-operative data concerning the stiffness of the intra-orbital soft tissues, and (2) provide constitutive parameters to the Finite Element model of the intra-orbital tissues already…
A stable shape for corneas experiencing refractive surgery has to be sustained so as to elude post-refractive surgery de-compensation. This de-compensation leads to visual complications and unsatisfactory procedure recovery. Variation in corneal lamellae and collagen fibres is induced by recent LASER refractive surgical procedures utilizing LASER ablation and disruption techniques. Conserving a steady response of central apex flattening and peripheral steepening in an elastic cornea pre- and post- procedure is the ultimate purpose of successful refractive surgery. Early diagnosis of ectatic co…
In this study, finite element analysis is used to simulate the surgical deployment procedure of a bifurcated stent-graft on a real patient's arterial geometry. The stent-graft is modeled using realistic constitutive properties for both the stent and most importantly for the graft. The arterial geometry is obtained from pre-operative imaging exam. The obtained results are in good agreement with the post-operative imaging data. As the whole computational time was reduced to less than 2 hours, this study constitutes an essential step towards predictive planning simulations of aneurysmal endovascu…
Breast-conserving surgery is the most acceptable operation for breast cancer removal from an invasive and psychological point of view. Before the surgical procedure, a preoperative MRI is performed in the prone configuration, while the surgery is achieved in the supine position. This leads to a considerable movement of the breast, including the tumor, between the two poses, complicating the surgeon's task. In this work, a simulation pipeline allowing the computation of patient-specific geometry and the prediction of personalized breast material properties was put forward. Through image segment…
Imaging modalities provide clinicians with real-time visualization of anatomical regions of interest (ROI) for the purpose of minimally invasive surgery. During the procedure, low-resolution image data are acquired and registered with high-resolution preoperative 3D reconstruction to guide the execution of surgical preplan. Unfortunately, due to the potential large strain and nonlinearities in the deformation of soft biological tissues, significant mismatch may be observed between ROI shapes during pre- and intra-operative imaging stages, making the surgical preplan prone to failure. In an eff…
