System and method for displaying images

Abstract

A method and system for analyzing and evaluating image data of a subject is disclosed. The image data can be collected with an imaging system in a selected manner and / or motion. More than one projection can be combined to produce and create a selected view of the subject. The evaluation can be a position determination of a member positioned within the subject.

Description

[0001] Cross Reference to Related Applications

[0002] This application claims priority to U.S. Patent Application No. 16 / 375,327, filed April 4, 2019. The entire disclosure of the above application is incorporated herein by reference. TECHNICAL FIELD

[0003] The present disclosure relates to imaging a subject, and in particular to a system for accessing image data to produce a selected view of a subject. BACKGROUND

[0004] This section provides background information relating to the present disclosure and is not necessarily prior art.

[0005] A subject, such as a human patient, can undergo a procedure. The procedure can include a surgical procedure to correct or augment an anatomical structure of the subject. Augmentation of the anatomical structure can include various procedures, such as movement or augmentation of bone, insertion of an implant (i.e., an implantable device), or other appropriate procedures.

[0006] A surgeon can perform a procedure on a subject based on images of the subject that are projected based on the subject. The images can be produced with an imaging system, such as a magnetic resonance imaging (MRI) system, a computed tomography (CT) system, a fluoroscope (e.g., a C-arm imaging system), or other appropriate imaging system. SUMMARY

[0007] This section provides a general summary of the disclosure and is not a comprehensive disclosure of its full scope or all of its features.

[0008] According to various embodiments, a system to acquire image data of a subject with an imaging system can use x-rays. The subject can be a living patient (e.g., a human patient). The subject can also be an inanimate subject, such as a shell, a housing, or the like. Thus, it can be appreciated that appropriate subjects can be imaged. The imaging system can include a movable source and / or detector that is movable relative to the subject.

[0009] The imaging system can include a movable source and / or detector to produce or acquire one and / or multiple projections of the subject. The multiple projections can be acquired in a linear path of movement of the source and / or detector. The multiple projections can then be combined, such as by being stitched together, to produce or form a long view (also referred to as a long film). The long view can be a two-dimensional view of the subject.

[0010] In various embodiments, the imaging system can acquire multiple projections at different perspectives relative to the subject. Different perspectives can result due to the different x-ray paths from the single source to the detector through the subject. Parallax effects exist and can allow for different views of the same location of the subject. The parallax effects can be created due to the filter having multiple slits or slots through which x-rays pass and impinge on the detector. Thus, movement of the source and / or detector relative to the subject can allow for acquisition of multiple projections through the subject that contain parallax effects. The multiple projections can then be stitched to form multiple long views of the subject due to the movement of the source and / or detector.

[0011] Image data and / or images of the subject can also be acquired separately from the imaging system having the filter with slots. Further, images of the subject can be acquired at different time periods. The various images can also have different dimensions, such as three-dimensional (3D) or two-dimensional (2D). However, the different images can be registered to one another. In various embodiments, the registration can allow for positioning of a member within the subject and / or positioning of a member within a selected image.

[0012] Other areas of application will become apparent from the description provided herein. The description and specific examples in this summary are intended only to provide illustrative purposes and are not intended to limit the scope of the disclosure. BRIEF DESCRIPTION OF DRAWINGS

[0013] The diagrams described herein are for the purpose of illustrating selected embodiments only and are not intended to limit the scope of the present disclosure.

[0014] Figure 1 is an environmental view of an imaging system in an operating room;

[0015] Figure 2 is a top plan view of a slot filter body according to various embodiments;

[0016] Figure 3 is a view of a 3D image and a member;

[0017] Figure 4 is a view of a 2D image;

[0018] Figure 5 is a flowchart of a process for member / part registration;

[0019] Figure 6 is a flowchart of a process for subject image registration;

[0020] Figure 7 is a 2D view of a representation of a registered position of a member;

[0021] Figure 8It is a 3D view representing the registration position of the components; and

[0022] Figure 9 This is a flowchart of the process of defining the shape of a component based on the registration of the first component.

[0023] The corresponding reference numerals indicate the corresponding parts in several views throughout the accompanying drawing. Detailed Implementation

[0024] Example embodiments will now be described more fully with reference to the accompanying drawings.

[0025] refer to Figure 1 A schematic diagram of operating room 20 is shown. A user 24, such as a surgeon, can perform surgery on a subject, such as patient 28. The subject can be placed on a support, such as a table 32 for a selected portion of the surgery. The table 32 does not interfere with image data acquisition via imaging system 36. During the procedure, user 24 can use imaging system 36 to acquire image data of patient 28, allowing selected systems to generate or create images to aid in the procedure. In various embodiments, imaging system 36 can generate one or more projections of patient 28 as its image data.

[0026] Images generated using image data can include models (e.g., three-dimensional (3D) images), long views, single-projection views, etc., which can be generated using image data and displayed as image 40 on display device 44. Display device 44 may be part of and / or connected to processor system 48, which includes input device 52 (e.g., keyboard) and processor 56, which may include one or more processors or microprocessors combined with processor system 48, and a selected type of non-transitory and / or transient memory 58. A connection 62 may be provided between processor 56 and display device 44 for data communication to allow driving display device 44 to display or show image 40. Processor 56 may be any suitable type of processor, such as a general-purpose processor executing instructions contained in a program or a special-purpose processor, such as an application-specific integrated circuit.

[0027] Imaging system 36 may include components sold by Medtronic Navigation, Inc., which has a place of business in Louisville, Colorado, USA. Imaging system. Includes Imaging system 36 or other suitable imaging system may be used during the selected procedure, such as the imaging systems described in U.S. Patent Nos. 8,238,631; 9,411,057; and 9,807,860, all of which are incorporated herein by reference.

[0028] When, for example, including The imaging system 36, when, for example, including

[0029] The imaging system 36 can include an additional extra portion, for example, an imaging gantry 70 in which a source unit (also referred to as a source assembly) 74 and a detector unit (also referred to as a detector assembly) 78 are positioned. The gantry 70 is movably connected to the mobile cart 60. The gantry 70 can be O-shaped or ring-shaped, where the gantry 70 is substantially ring-shaped and includes walls that form a volume in which the source unit 74 and the detector 78 can move. The mobile cart 60 can also be mobile and can be moved from one operating room to another operating room and or another room. The gantry 70 can be moved relative to the cart 60, as discussed further herein. This allows the imaging system 36 to be mobile and movable relative to the subject 28, allowing it to be used in multiple locations and with multiple procedures without the capital expenditure or space dedicated to a fixed imaging system.

[0030] The processor 66 can be a general purpose processor or a special purpose processor. The memory system 68 can be a non-transitory memory, for example, rotating disks or solid state non-volatile memory. In various embodiments, the memory system can include instructions to be executed by the processor 66 to perform functions and determine results, as discussed herein.

[0031] In various embodiments, the imaging system 36 can include an imaging system that acquires images and / or image data by using emitted x-rays and detecting interactions and / or attenuation of the x-rays with the subject 28. The x-rays emitted from the source 74 can be within a spectrum and poly-energetic. Thus, x-ray imaging can be one imaging modality. It should be appreciated that other imaging modalities are also possible.

[0032] Thus, the imaging system 36 including the source unit 74 can be an x-ray emitter that can emit x-rays through the patient 28 to be detected by the detector 78. As understood by those skilled in the art, the x-rays emitted by the source 74 can be emitted in a cone 90 along a selected principal vector 94 and detected by the detector 78, as Figure 2The source 74 and detector 78 can also be referred to together as a source / detector unit 79, particularly where the source 74 is generally diametrically opposed (e.g., 180 degrees apart) from the detector 78 within the gantry 70. The source 74 and detector 78 can be mounted to a rotor and / or can move on an internal track or moving assembly 95.

[0033] The imaging system 36 can move in whole or in part relative to the subject 28. For example, the source 74 and detector 78 can be moved 360° around the patient 28. Movement of the source / detector unit 98 within the gantry 70 can allow the source 74 to remain approximately 180° opposed from the detector 78 (e.g., with a fixed internal gantry or rotor or moving system). Thus, unless otherwise disclosed, the detector 78 can be referred to as moving (e.g., in a circular or helical shape) around the subject 28, and it should be understood that the source 74 remains opposed to the subject.

[0034] Further, the gantry 70 can be moved equidistantly (also referred to as "swung" around an axis 102 generally in the direction of arrow 100 relative to the subject 28, e.g., by the cart 60, as shown. Figure 1 The gantry 34 can also be tilted relative to the long axis 106 of the patient 28, as shown by arrow 110. When tilted, the plane of the gantry 70 can be tilted or form a non-orthogonal angle with the axis 106 of the subject 28.

[0035] The gantry 70 can also be moved longitudinally relative to the subject 28 and / or cart 60 along line 106 in the direction of arrow 114. Further, the cart 60 can be moved to move the gantry 70. Further, the gantry 70 can be moved up and down relative to the cart 30 and / or subject 28 generally in the direction of arrow 118, generally transverse to the axis 106 and parallel to the axis 102.

[0036] The whole or partial movement of the imaging system 60 is to allow positioning of the source / detector unit (SDU) 79 relative to the subject 28. The imaging device 36 can be precisely controlled to move the SDU 79 relative to the subject 28 to produce precise image data of the subject 28. The imaging device 36 can be connected with the processor 56 via a connection 120, which can include a wired or wireless connection or physical media transfer from the imaging system 36 to the processor 56. Thus, image data collected using the imaging system 36 can be transferred to the processing system 56 for navigation, display, reconstruction, etc.

[0037] As discussed herein, the source 74 can include one or more x-ray sources for imaging the subject 28. In various embodiments, the source 74 can include a single source, which can be powered by more than one power source to generate and / or emit x-rays having different energy characteristics. Further, more than one x-ray source can be the source 74 that can be powered to emit x-rays having different energy characteristics at selected times.

[0038] According to various embodiments, the imaging system 36 can be used with a non- navigated or navigated procedure. In a navigated procedure, a localizer and / or digitizer, including either or both of the optical localizer 130 and / or the electromagnetic localizer 138, can be used to generate a field and / or receive and / or transmit signals within a navigation space relative to the subject 28. The navigation space relative to the subject 28 can be registered with the image 40. As understood in the art, the correlation allows for registration of the navigation space defined within the navigation space and the image space defined by the image 40. A patient tracker or dynamic reference frame (DRF) 140 can be attached to the subject 28 to allow for dynamic registration and maintenance of the registration of the subject 28 with the image 40. In various embodiments, the DRF 140 can be attached to and / or relative to a vertebra 141 within the spine of the subject 28.

[0039] The patient tracking device or dynamic registration device 140 and the instrument 144 can then be tracked relative to the subject 28 to allow for the navigated procedure. The instrument 144 can include a tracking device, such as the optical tracking device 148 and / or the electromagnetic tracking device 152, to allow for tracking of the instrument 144 with either or both of the optical localizer 130 or the electromagnetic localizer 138. Associated with the instrument 144 can be a second instrument (also referred to as an instrument), object, and / or member or implant 146. The implant 146 can also be tracked using the tracking system as the implant is attached to the instrument 144.

[0040] The navigation / probe interface device 158 can be in communication (e.g., wired or wireless) with the instrument 144 (e.g., via the communication line 156), with the electromagnetic localizer 138 (e.g., via the communication line 162), and / or the optical localizer 130 (e.g., via the communication line 166). The interface 158 can also be in communication with the processor 56 via the communication line 168 and can communicate information (e.g., signals) regarding the various items attached to the interface 158. It should be understood that any communication line can be wired, wireless, physical media transmission or mobile, or any other appropriate communication. However, an appropriate communication system can be equipped with a corresponding localizer to allow for tracking of the instrument 144 relative to the subject 28, allowing for illustration of the tracked position of the instrument 144 relative to the image 40 to perform the procedure.

[0041] Those skilled in the art will appreciate that instrument 144 and / or member 146 can be any appropriate instrument, such as a ventricular or vascular stent, a spinal implant, a neural stent or stimulator, an ablation device, etc. Instrument 144, 146 can be an interventional instrument, or can include or be an implantable device. Tracking instrument 144, 146 allows the use of registered image 40 to view the position of instrument 144, 146 relative to subject 28 (including x, y, z position and orientation) without the need to directly view instrument 144, 146 within subject 28. Moreover, unless explicitly indicated otherwise, the discussion herein of instrument 144 is understood to reference any tracked member, such as instrument 146.

[0042] Further, imaging system 36, such as gantry 70, can include an optical tracking device 174 and / or an electromagnetic tracking device 178 to be tracked with a corresponding optical localizer 130 and / or electromagnetic localizer 138. Thus, imaging device 36 can be tracked relative to subject 28, as can instrument 144, to allow for initial registration, automatic registration, or continued registration of subject 28 relative to image 40. Registration and navigation procedures are discussed in U.S. Patent No. 8,238,631, incorporated above, which is incorporated herein by reference. Upon registration and tracking of instrument 144, an icon 180 can be displayed relative to image 40, including overlaid on the image.

[0043] With continued reference to Figure 1 and additional reference to Figure 2 According to various embodiments, source 74 can include a single x-ray tube assembly 190. As described above, x-rays can be emitted from x-ray tube 190 generally in a cone 90 toward detector 78 and generally in a direction from x-ray tube 190 as indicated by arrow, beam arrow, beam, or vector 94. Vector 94 can be a central vector or ray within x-ray cone 90. The x-ray beam can be emitted as a cone 90 or other suitable geometry. Vector 94 can include a selected line or axis related to further interaction of the beam, such as interaction with a filter member, as discussed further herein.

[0044] Subject 28 can be positioned within x-ray cone 94 to allow for acquisition of image data of subject 28 based on emission of x-rays in the direction of vector 94 toward detector 78.

[0045] The x-ray tube 190 can be used to produce one or more two-dimensional (2D) x-ray projections of the subject 28, including a selected portion or any region, zone, or volume of interest of the subject 28, from x-rays impinging on or detected by a 2D or flat panel detector, such as the detector 78. Generally, more than one 2D x-ray projection can be reconstructed as discussed herein to produce and / or display a three-dimensional (3D) volume model of the subject 28, a selected portion of the subject 28, or any region, zone, or volume of interest. As discussed herein, the 2D x-ray projections can be image data acquired with the imaging system 36, while the 3D volume model can be produced or modeled from the image data.

[0046] For reconstructing or forming 3D volume images, suitable algebraic techniques include expectation maximization (EM), ordered subset EM (OS-EM), simultaneous algebraic reconstruction technique (SART), total variation minimization (TVM), filtered backprojection (FBP) (e.g., Feldkamp-Davis-Kress algorithm reconstruction), model-based iterative reconstruction, and others generally understood by those skilled in the art. Application of 3D volume reconstruction based on 2D projections allows for efficient and complete volume reconstruction.

[0047] In various embodiments, the algebraic techniques can include an iterative process of performing reconstruction of the subject 28 for display as the image 40. For example, pure or theoretical image data projections, such as those generated based on or from a “theoretical” patient atlas or stylized model, can be iteratively altered until the theoretical projection images match the acquired 2D projection image data of the subject 28. The stylized model can then be appropriately altered to a 3D volume reconstruction model of the selected subject 28 acquired 2D projection image data and can be used for surgical treatment, such as navigation, diagnosis, or planning. The theoretical model can be associated with the theoretical image data to construct the theoretical model. In this manner, the model or image data 40 can be constructed based on image data of the subject 28 acquired with the imaging device 36.

[0048] The source 74 can include various components or features that are movable relative to the x-ray tube 190. In various embodiments, for example, a collimator can be positioned relative to the x-ray tube 190 to help form and / or shape the cone 90 relative to the subject 28. The collimator can include various features, such as movable components that can help position one or more filters within the cone 90 of x-rays prior to reaching the subject 28. In various embodiments, the components can include filters, such as a slotted or three slotted filter 200. In various embodiments, as discussed herein, the x-ray beam 90 can be formed or split into multiple beams or split into one or more thin sectors or planes (e.g., 206, 210, 214) that reach and pass through the subject 28 and are detected by the detector 78. The collimator and / or filter portion including the imaging system 36 can include those disclosed in U.S. Patent Application Publication No. __ / _____(U.S. Patent Application No. 16 / 233,753; filed December 27, 2018), which is incorporated by reference herein.

[0049] The filter 200 can include a selected number of slots or passages, such as including three slots, including a first edge slot 220, a middle slot 224, and a second edge slot 228. Each of the three slots 220, 224, 228 can be formed through the filter 200 in an appropriate manner, such as electrical discharge machining or other appropriate tooling (e.g., a slotting machine or a punch). It should also be understood that the slots can be forged or otherwise cut into the filter 200.

[0050] In various embodiments, proximate to or at the first surface 230, each of the three slots 220, 224, 228 is formed by respective two corresponding sidewalls. The sidewalls of each of the slots 220, 224, 228 are generally equally spaced apart along the length of the respective slot and are substantially parallel. Further, the slot walls are generally straight and parallel with respect to each other. It can be appreciated, however, that certain tooling can result in portions of the slots having slightly different dimensions, such as the entry or exit cut into the cutout to initiate or end the slot. However, each of the slots 220, 224, 228 is generally formed to have a dimension between the sidewalls of about 0.001 inches to about 0.1 inches, including about 0.009 inches to about 0.03 inches, and further including about 0.025 inches to about 0.01 inches, and further including about 0.02 inches (about 0.5 mm). The dimension of the slots 220, 224, 228 can be substantially the same for each slot, generally the dimension between the inner surfaces of the respective opposing walls of the respective slot.

[0051] A central axis can be defined through each of the slots 220, 224, 228. The central axis of the middle slot 224 can be substantially perpendicular to the plane of the detector 78. However, the edge slots 220 and 228 can have respective central axes that are substantially parallel to the respective side walls and not perpendicular to the surface 230 and / or the detector extends. Thus, these slots split the beam 90 into three sectors 206, 210, and 214. The two outer or edge sectors will form an angle 240 relative to the central sector 210. The angle 240 can be about 5 degrees to about 10 degrees, and further about 6 degrees to about 8 degrees, and further about 7 degrees.

[0052] As Figure 2 Illustratively, these angles can help allow the x-rays to pass from the source 190 through the respective slots 220-228 without any or substantial distortion due to interaction with the respective side walls. As Figure 2 Illustrated and as discussed above, the x-rays can be emitted from the source tube 190 in a substantially conical shape. Thus, x-rays traveling substantially perpendicular to the surface 230 will pass through the central slot 224 along the central axis without substantial or any interaction with the side walls forming the slot 224. Also due to the respective angles, x-rays near the edges of the cone 90 can pass through the edge slots 220, 228 without substantial interaction with the respective side walls due to the respective angles of the slots.

[0053] Due to the respective slots 220-228, the slot filter member 200 can allow for the formation of three x-ray sectors or regions of x-rays, including a first sector 206, a second sector 210, and a third sector 210. In other words, the slot filter 200 filters the x-rays from the source 190 and allows the x-rays to pass through the slots 220-228 to form the sectors 206-214. In various embodiments, the slot filter assembly 200 is a selected distance from the source 190. The distance can be about 50 mm to about 100 mm, including about 60 mm to about 80 mm, further including about 68 mm to about 72 mm.

[0054] As further discussed herein, due to the imaging area on the detector 78, the three sectors 206-214 allow for the production of selected image projections. It is further to be understood that the numbering of the slots 220-228 and the respective sectors 206-214 is merely for clarity of the current discussion and is not intended to require any particular order. Moreover, it is to be understood that the filter member 200 can include a selected number of slots, such as less than three or more than three, and three are shown and discussed with respect to the current disclosure. However, it is to be understood that the three slots allow for the production of long views in an efficient and rapid manner, as further discussed herein. Including a different number of slots can allow for the production of a different number of intermediate images, as discussed herein, but this is not required.

[0055] The entire cone 90 from source 74 may have an area that will excite or impact the entire surface of detector 78. However, individual sectors 206-214 typically only impact a narrow band of pixel 250. It should be understood that the number of pixels excited can encompass the entire width 254 of detector 78, but is limited to a selected length 258 of the detector. For example, assuming no object or subject is within the path of the x-ray (e.g., air scan), the corresponding sectors 206-214 may impact approximately 10 to approximately 100 pixels. However, the number of pixels excited in dimension 258 of detector 78 can be enhanced or adjusted depending on the distance from detector 78 to filter assembly 200, the width of the slot (220-228), or other appropriate considerations. However, as Figure 2 As shown, each of the corresponding sectors 206-214 will strike the detector 78 at a substantially narrow location and excite a pixel that can extend along a length 258 of substantially the entire width 254 of the detector 78. As discussed herein, the width of the slots 220-228 that cause the length of the pixel 258 to be excited (e.g., to generate image data) limits or eliminates parallax distortion within the image portion collected by the imaging system using the slot filter 200.

[0056] In addition, such as Figure 2 As shown, the three sectors 206-214 can impact detector 78 substantially simultaneously from a single location of source tube 190 along the Z-axis, generally in the direction of double-headed arrow 106z. In various embodiments, the Z-axis can be aligned with or parallel to the long axis 106 of subject 28. Thus, detector 78 can output three distinct images or image data for three different X-ray positions at each single location of source tube 190. However, movement of source tube 190 of source 74 generally in the direction of double-headed arrow 114 can produce up to three views along the Z-axis, as further discussed herein. Each of sectors 206-214 can be separated by a selected distance, which can also be an angular distance 240.

[0057] Imaging system 36 can be used to generate images of subject 28 for various purposes. As described above, images of subject 28 can be generated to perform surgery on subject 28, such as spinal fusion and / or implants associated with or attached to spinal fusion. Thus, in various embodiments, user 24 can assess subject 28 by viewing and evaluating images of subject 28 to determine the placement of selected implants, such as pedicle screws. Therefore, imaging system 36 can be used to acquire images of subject 28. Imaging system 36 can be used to acquire one or more projections. As described above, detector 78 detects X-rays passing through or attenuated by subject 28. However, typically detector 78 detects a single projection at a time. Imaging system 36, including control system 64, alone or in combination with processor system 48, can generate a long film or long view of subject 28 by accumulating (e.g., stitching) multiple projections of subject 28. In various embodiments, imaging system 36 can therefore be operated to acquire multiple images.

[0058] In addition to acquiring images of subject 28 using imaging system 36, additional and / or alternative image data of subject 28 can be obtained and / or accessed. For example, subject 28 can be imaged using a selected imaging system that can acquire and / or reconstruct a three-dimensional (3D) image or model of subject 28. As further discussed herein, the images can be used for various purposes to assist in performing procedures on subject 28 and / or analyzing the procedures performed on subject 28.

[0059] In various embodiments, 3D image data of subject 28 can be acquired using a computed tomography (CT) imaging system, a magnetic resonance (MR) imaging system, or other suitable imaging system. Typically, the imaging system acquires image data of subject 28 to allow for the reconstruction of 3D images for analysis and / or visualization of subject 28. 3D images or models can be acquired and / or generated at a selected time, such as before a procedure. Therefore, 3D images can be stored in a selected memory, such as memory 58 or other suitable accessible memory.

[0060] 3D images can be generated in any suitable manner, such as through imaging techniques discussed above. (Reference) Figure 3, 3D image 300 can be displayed as image 40 on display device 44 or any suitable image display. Further, as further selected or discussed herein, image 300 can be stored in memory 58 for calling for various purposes, including registration with images acquired later. Image 300 can include image data of an entire subject (e.g., an entire spine of a patient) and / or a portion of the anatomy of subject 28, such as a region of interest (ROI) of the subject, including one or more vertebrae of subject 28. For example, image or image data 300 can include image data of first vertebra 304 and second vertebra 308. However, it should be understood that image 300 can include image data of all vertebrae of subject 28.

[0061] In various embodiments, subject 28 can have a selected or diagnosed feature, such as scoliosis. Thus, a portion of image 300 can include a diagnosed feature, such as scoliosis portion 312. However, it should be understood that all vertebrae related to a diagnosed issue can be imaged and included in image 300.

[0062] Image 300 can be a three-dimensional image of subject 28, including a spine of the subject. Thus, image 300 can include image data of a plurality of vertebrae, such as first and second vertebrae 304, 308, in at least three dimensions. It should be understood that a plurality of images can be acquired to show three-dimensional properties of the imaged portion over time. However, in the following discussion, it should be understood that image 300 can be a three-dimensional image for analysis and / or comparison with subsequently acquired images.

[0063] In various embodiments, for example, image 300 of subject 28 can be acquired for diagnosing subject 28. Further, image 300 can be used to plan a selected procedure related to subject 28. For example, performing a procedure on subject 28 can include positioning one or more screws, such as pedicle screw 320, into one or more vertebrae, such as second vertebra 308. Screw 320 can include a shank portion 322 and a head portion 324. Head portion 324 is movable relative to shank portion 322. Screw 320 can include a CD or spine or pedicle screw. In addition to screws, rods or fixation members 330 can also be used. Rod 330 can also be similar to a CD Rods or portions used with a spinal fixation system. Rods 330 can be positioned between and secured to the plurality of screws 320 positioned within subject 28 to maintain the respective vertebrae in selected positions relative to one another. Rods 330 can be locked in place within heads 324, for example, using locking or set screws in an appropriate manner.

[0064] At a selected time period, for example, prior to performing a surgical procedure on subject 28, image 300 can be acquired and analyzed by a selected user, for example, user 24. During the planning procedure, the positioning of one or more screws 320 within the vertebrae can be determined, for example, relative to vertebrae 304. In various embodiments, an icon or graphical representation of screw 320 can be displayed on image 300 as screw representation 320a. Accordingly, user 24 can plan a location for one or more screws 320 in subject, for example, on 3D model 300. User 24 can also plan a selected geometry of rod 330 to interconnect the plurality of screws. For example, rod 330 can comprise at least two portions, for example, a first elongated portion 334 and a second elongated or curved portion 338. A curved portion or bend 342 can interconnect the respective elongated portions 334, 338.

[0065] However, 3D image 300 of subject 28 can be acquired for various purposes, for example, planning a procedure related to subject 28. The acquired image 300 can then be saved in a selected memory, for example, memory 58, for recall at a selected time after the image 300 is acquired and stored. For example, as discussed further herein, image system 36 can acquire an image that can be compared to 3D image 300.

[0066] User 34 can then perform a procedure on subject 28. The procedure performed on the subject can be any appropriate procedure and can be based on a plan that can use image 300 and / or various alternatives thereof. Regardless, user 34 can perform a procedure on patient 28.

[0067] In various embodiments, the procedure can include positioning one or more screws 320 into subject 28. During the procedure, user 34 can position a selected number of screws into one or more vertebrae 304, 308 of subject 28. After a selected time period, for example, after positioning all of the screws identified in the plan, an image of subject 28 can be acquired. In various embodiments, imaging system 36 can be used to acquire one or more projections of subject 28. As discussed above, imaging system 36 can be used in any appropriate manner to produce the projections. In general, the projections of subject 28 can be acquired in a substantially two-dimensional manner and at different positions relative to subject 28.

[0068] With continued reference to Figure 1 and2 and additionally referring to Figure 4 As discussed above, imaging system 36 can acquire a plurality of projections by moving relative to subject 28, typically along the long axis 106 of the subject along the Z axis 106z. The acquired images can be any appropriate type of image, for example with or without a slotted filter 200. Various selected slotted projections (i.e., produced by a fan beam of x-rays) can be stitched together to form a selected long view, for example a first or projection long view 360, which can include images of a plurality of vertebrae, for example seven vertebrae in a projection including projected or stitched vertebrae 364i through 364vii. In various embodiments, for example using a filter including a single slot, a single projection or stitched projection can be viewed or produced. First view 360 can be a short view or partial long view that can be formed by stitching together a plurality of projections from one or more slots, for example slots 220 acquired as source 190 is moved relative to subject 28.

[0069] However, as discussed above, filter 200 can include a plurality of slots 220-228, thus allowing a plurality of projections to be produced along the Z axis 106z. Thus, a second or projection long view 368 can include a selected number of vertebrae, including overlapping vertebrae 364v, 364vi and 364vii. In addition, image projection 368 can include an additional plurality of vertebrae, including 372i through 372viii. Thus, second image projection 368 can include images of 11 vertebrae. Finally, a third or projection long view 374 can include a plurality of vertebrae projection images, including vertebrae 372vi, 372vii and 372viii. However, third projection 374 can further include additional vertebrae or portions of subject including vertebrae 376i and 376ii.

[0070] Each of the individual projection long views 360, 368, 374 can be formed, for example, by stitching together a plurality of projections produced by sectors 206-214 on detector 78, which are collected as source 190 is moved relative to subject 28, for example by movement of gantry 70. Thus, each of the individual projection long views 360, 368, 374 can be stitched together from selected and / or individual projections of subject 28.

[0071] In various embodiments, multiple individual or separate long spliced projection 360, 368, 374 can be spliced into a single very long or extended film or projection 390. Each of the individual projection long views 360, 368, 374 can also be referred to as a constituent view or constituent long view. In various embodiments, the long view 390 can be formed based on a weighted splicing of the shorter or individual long views 360, 368, 374 that occupies the most or best imaged portion of the subject in the individual long views 360, 368, 374 (e.g., more of the lower portion and more of the upper portion containing the subject 28).

[0072] In various images or image data containing spliced images 360, 368, 374 and extended film 390, the images of the subject 28 can generally be collected during or after a procedure, such as a portion of a procedure. For example, the subject containing the vertebrae 141 can be viewed in a visualization or view based on, for example, the extended long view 390. However, it should be understood that the discussion herein of the long view 390 is merely exemplary and any appropriate view as discussed herein can be used.

[0073] Regardless, the long view 390 of the subject 28 can be produced during a selected portion of a procedure and can contain a vertebra 141 that can be identified as the vertebra 141i. As discussed above, the vertebra 141i can be identified in the long view 390 through various mechanisms, such as anatomical reconstruction, image analysis, etc. Further, as discussed above, between various views or long films 360, 368, 374, portions in various anatomical portions or images that overlap can be identified. These overlaps can allow the various views to be spliced together. Further, more than one view of the subject 28 can be produced, such as two substantially orthogonal views. Thus, the vertebra 141 can be determined in three-dimensional space based on multiple long views.

[0074] Further, as discussed above, an implant 146 can be positioned within the subject, which can contain a screw 320. Since the long view 390 is acquired after a portion of the procedure is performed, an image of the screw 320i can also be identified. It should be understood that multiple screws, such as the first screw 320i and the second screw 320'i, can be contained in the long view 390. It should be understood that any appropriate number of screws can be viewed in the image 390 and the number in the image or long view 390 can be based on the number positioned in the subject 28.

[0075] Regardless of the number of screws in the subject 28 imaged in the long view 390, the screws, including their geometry and their three-dimensional position, can be identified in the image. As discussed further herein, the three-dimensional image 300 of the subject 28 of the subject 28 can be acquired prior to any procedure performed on the subject 28. Thus, the three-dimensional image 300 can not contain any objects therein, such as the screws 320. However, the three-dimensional image 300 can be of the same anatomical portion (e.g., ROI) or any appropriate portion of any appropriate subject as the long film 390. As discussed further herein, a registration can be made between the long film 390 and the three-dimensional image 300. Based on the registration of the long film 390 and the three-dimensional film 300, the position of the screws, such as the screws in the images 320i and 320'i, can be determined and then can be correlated with the three-dimensional image from the long view 390 to identify the actual placement of the screws in the subject 28 relative to the three-dimensional image 300 and / or a comparison to a planned position of the screws, such as the planned position 320a.

[0076] With continued reference to Figure 3 and Figure 4 and additional reference to Figure 5 , according to the process 400 of registering or determining screw positions in an image, such as the long view image 390, the images of the screws 320i and 320'i can be identified in the long image 390. The process 400 can include various processes, including a parametric process, where the parameters can include known components of the implant, such as the screws 320, to identify the screws in the image 390. The known components can be used to minimize or reduce metal artifacts in the final visualization of the long film 390. However, it should be understood that any appropriate determination of the screw images 320i and 320'i in the image 390, such as determining the position of the screws in the image long view 390, can be made and correlated using a registration to the 3D view 300.

[0077] The process or flowchart 400 illustrates a process for determining the position of a construct, also referred to as a component or an item, such as the screw image 320i in the image 390, that can be efficient and / or fast. In various embodiments, the process 400 can be used to remove artifacts from a visualization, but can also be used to determine the position of an item for various purposes. The process 400 allows for efficiently, including with lower computational time and / or necessary resources, determining the substantially accurate position of an item in an image and / or producing a visualization. In various embodiments, the access can include the long film 390.

[0078] Vertebral pedicle screw 320 can be formed of one or more selected materials (e.g., metal or metal alloy) that affect x-rays in a manner that causes distortion or artifacts relative to x-rays that produce image data of vertebra 141 when producing x-ray image data. Thus, when image 40 is produced for display with display device 44, process 400 can be used to remove or interpret artifacts in the image data. It is further understood that vertebral pedicle screw 320 or other selected items can be formed of or include a variety of materials.

[0079] With continued reference to Figure 5 Process 400 is understood to be an image analysis and / or reconstruction process 400 that can be performed individually and / or as part of a selected procedure, such as a surgical procedure that includes positioning vertebral pedicle screw 320 in vertebra 141. Thus, process 400 can also be or include an algorithm that can be executed by a selected processor or processor system, such as imaging processing unit 56 discussed above. However, it is understood that any suitable processing system can be used to execute process 400 to produce images for display on display device 44.

[0080] As discussed above, various procedures can be performed relative to subject 28. In various embodiments, vertebral pedicle screw 320 can be placed in subject 28. Thus, projections of subject 28 can be acquired using one or more vertebral pedicle screws implanted therein. As discussed above, the projections can be acquired and then accessed at a selected time in block 420.

[0081] However, any suitable selected number of projections can be acquired and accessed in process 400. For example, the projections shown can be included Figure 4 However, it is further understood that the stitched long view can also be accessed as a projection and can be stitched prior to process 400.

[0082] The projections in block 420 can include a first input to process 400. In block 424, additional inputs can include parameters, such as known component parameters or known components (KC). The parameters in block 424 can be parameters that are generally known or predetermined. The parameters can be used to define a component (as referred to above, also referred to as a member or item). The component or member can include screw 320. The item or member in subject 28 as a screw is merely exemplary and the discussion of screw 320 herein is not intended to limit the scope of the present disclosure or the appended claims.

[0083] The parameters can be predetermined parameters of a selected item such as pedicle screw 320. In various embodiments, for example, the parameters can include particular characteristics of the item such as pedicle screw 320. For example, screw 320 includes a shank 322 and a head 324. The parameters can further include material types of selected portions of pedicle screw 320, such as shank 322 formed of a stainless steel alloy and head 324 formed of the same stainless steel alloy. The parameters can further include selected dimensions, such as length, width, height, etc. The parameters in block 424 can also include a range of motion and / or degrees of freedom of motion (e.g., possible geometries) of shank 322 relative to head 324. These parameters can also take into account or be known about the imaging modality, such as a cone-beam x-ray or other characteristic.

[0084] Thus, in various embodiments, the parameters in block 424 can be a representation including the selected item of pedicle screw 320, such as a look-up table. Further, the known parameters in block 424 can include a selected specific model, such as a computer aided design (CAD) model of pedicle screw 320, including its known materials and known interactions of x-rays therewith. In various embodiments, pedicle screw 320 is a CD The implantable pedicle screw, and the parameters in block 424 can include a CAD model of the specific pedicle screw (including a specific model number and / or its geometry and dimensions) or a deformable spline model (such as a spline model of a cylindrical wire, needle, or rod) and known materials, known interactions of materials, etc. The known parameters in block 424 can then be accessed, such as called using processing unit 56, for use in further portions of process 400.

[0085] Using the accessed projections in block 420 and the accessed parameters in block 424, a registration or position determination can occur. As discussed herein, the registration can include various steps or processes. In various embodiments, a forward projection is generated in block 430 based on the known parameters in block 424. As further discussed herein, the forward projection in block 430 can then be compared to the projections in block 436. Based on the comparison in block 436, a similarity measure (which can include a gradient correlation (GC)) can be determined in block 442. The comparison in block 436 can then be optimized in block 450, resulting in the similarity measure in block 442.

[0086] In optimization determination block 450, if it is determined that the GC is not optimized by following "NO" path 456, a transformation can be generated that is applied again to the forward projection in block 430. Once it is determined that the GC will be optimized, "YES" path 460 can be followed to provide a registration or position output of the item in block 470.

[0087] When following the "yes" path 460, the optimized transformation can be a convergence where the difference between the forward projection in block 430 and the projection in block 420 is substantially smaller or has a selected similarity measure in block 450. In the selected transformation of the similarity measure, the transformation is determined to have converged or optimized to an optimized transformation and can be used to register and determine the position of an image, such as image 390. In various embodiments, the reconstruction of image 390 can also be performed using the registration parameters of the article.

[0088] The registration process 400 includes registering the parameters from block 424 with a selected number of projections, including less than or all of the acquired projections from block 420, which can be used for subsequent reconstruction and / or visualization. In particular, the registration is to determine the portion of the projections acquired from block 420 that match the parameters in block 424, which can include known component definitions of the article, such as screw 320. For example, one or more pixels in one or more projections are produced by the selected article imaged in subject 28 in projections 420, such as pedicle screw 320, and thus should match the forward projection determined in block 430 from the known components from block 424. For example, as discussed above, pedicle screw 320 can have precise or determined parameters, such as a predetermined parameter that defines the parameters in block 424.

[0089] The parameters, as represented by K, can be input. The forward projection can be determined as a digital radiograph reconstruction or digital reconstructed radiograph (DRR) The forward projection is formed in block 430 and can be defined by equation 1 (Eq. 1):

[0090]

[0091] In Eq. 1, the forward projection is a projection based on the parameters from block 424. In particular, Eq. 1 is formed from the input parameters K from block 424, which can include a mesh model of the selected article that is a line integral along the rays incident on the transformation parameters K. Thus, the forward projection is a digital reconstructed radiograph (also referred to herein as a mask) based on the parameters K from block 424, which can be compared to the acquired projections (also referred to herein as p). One or more selected transformation models (T) can be employed, such as a rigid homogeneous transformation or a deformable b-spline function. Typically, only one transformation model can be selected in any particular application, but various appropriate models or transformations (T) can be selected. Further, a selected set or limited parameters K can be included in the optimization process, such as modeling an unknown diameter of a tool having a cylindrical profile.

[0092] The forward projection determined in block 430 can be compared in block 436 to the accessed projection p from block 420. The comparison in block 436 allows an output or determination of a similarity measure, which in various embodiments is defined as the gradient correlation (GC) defined in equation 2 (Eq. 2) in block 442. While GC is a suitable similarity measure, it is understood that other similarity measures can be used as well. With respect to GC, Eq. 2 is:

[0093]

[0094] And the NCC is defined in equation 3 (Eq. 3):

[0095]

[0096] The GC generally looks for gradients (also referred to as high contrast regions or edges) between the forward projection in block 430 and the accessed projection in block 420. According to Eq. 2 and Eq. 3, the GC is defined as the sum of the normalized cross correlation (NCC) of the orthogonal image gradients. For example, the NCC defines the correlation of the normalized intensities of the image gradients a and b of p and respectively. Thus, as defined in equation 2, the GC is the sum of the gradients between the forward projection from block 430 and the accessed projection from block 420.

[0097] In block 450, it can be determined whether the GC is optimized. In making the determination, a maximum or convergence of the transformation has been found or achieved. In particular, the convergence is defined by equation 4 (Eq. 4):

[0098]

[0099] The equation can be solved iteratively between the forward projection in block 430 and the accessed projection from block 420. Eq. 4 is used to determine the maximum similarity between the forward projection in block 430 and the accessed projection in block 420. The iteration is performed by determining the GC in block 442 based on the comparison in block 436, and then determining in block 450 whether the GC is optimized. Thus, for example, the optimizer block 450 can determine whether the similarity measure in block 442 is the same or has been optimized and / or within a selected threshold of variation when the average change in T is less than about 0.01 millimeters (mm) to about 0.2 mm, inclusive of about 0.1 mm and about 0.01 degrees to about 0.2 degrees, inclusive of about 0.1 degrees. The threshold can also or instead include a specific value, such as when the change in the similarity measure GC is close to the machine precision used to represent floating point numbers (e.g., image processing unit 56).

[0100] If the optimizer in block 450 determines that the threshold has not been reached, a "no" path 456 can be followed to update the transform T in block 458, which can be applied in block 430 in determining the forward projection. The forward projection can then be changed, such as by changing (e.g., rotating or translating) the components or members in determining the forward projection. In other words, in block 430, a different perspective of the components defined by the known components can be used to form a new forward projection to compare to the projection obtained from block 436. If the optimizer block 450 determines that convergence has been achieved (e.g., the difference from the current GC is within a threshold relative to the previous GC), the converged or optimized transform The "yes" path 460 can be output using.

[0101] Suitable optimization techniques can be used in the optimizer block 450, such as optimization techniques that can be performed by the processing unit 56 or other suitable processing unit. In various embodiments, a covariance matrix adaptation evolution strategy can be used to achieve optimization in block 450. The selected strategy can include a derivative-free optimization method. However, it should be understood that other suitable optimization methods or techniques can be used in the optimizer block 450.

[0102] Once the "yes" path 460 is followed, the optimized transform As discussed herein, the optimized transform can also be referred to as a registration to allow for determining the location of the item (e.g., screw 320) in space. In various embodiments, even if the accessed projection is two-dimensional (2D), the optimized location can be used to determine a 3D location of the item.

[0103] With continued reference to Figure 5 and additional reference to Figure 6 The output member registration 470 can be performed according to Figure 6 The registration of the output member registration 470 with the three-dimensional image 300 can be performed according to the process 500 shown. The registration process or localization in three-dimensions can include evaluating the accessed projection in block 420 and evaluating the output registration in block 470. In various embodiments, the accessed projection in block 420 can be registered with the forward projection from the three-dimensional image 300. According to the process 500, the 3D image 300 can be accessed in block 510. After accessing the 3D image in block 510, a projection can be generated in block 520, such as a subject forward projection. Generating the forward projection 520 can be based on various calculations including equation 5 (Eq. 5):

[0104] ∫ r P(r)dr (Eq. 5)

[0105] Generating the forward projection can be based on any appropriate calculation, such as generally understood in the art. However, in various embodiments, the forward projection can be defined by an integral along a projection of a ray r through the patient image P. The patient image P can be the three-dimensional model 300 as discussed above. Once the forward projection is generated in block 520, the subject forward projection is compared to the accessed projection in block 526. As discussed above, the accessed projection can be the projection accessed in block 420, as discussed above. Thus, the accessed projection can be based on generating or collecting image data during a selected procedure, such as using the imaging system 36. The imaging system 36 can generate a plurality of projections of the subject 28, which can be substantially 2D projections of the subject. In various embodiments, the projections can include projections of the subject 28 collected from x-ray emissions collected on the detector 78 or other appropriate projections. As discussed further herein, the projections can include a plurality of fan projections or thin projections generated by the slotted filter 200 to generate various long films, such as the long film 390.

[0106] In various embodiments, the subject forward projection from block 520 can be compared to the accessed projection in block 526. A similarity measure can then be determined. In block 530, the similarity measure can include a gradient orientation (GO). In determining the similarity measure in block 530, appropriate techniques can include determining a similarity between the forward projection and the accessed projection in block 420. As discussed herein, the similarity measure GO can be similar to the similarity measure GC, and similar techniques can be used to determine a similarity between the subject forward projection generated in block 520 and the accessed projection in block 420.

[0107] Once the similarity measure is determined in block 530, a determination can be made in block 536 whether the similarity measure is optimized. As discussed above, the determination of optimization can include a calculation of a maximization of the similarity measure. In various embodiments, the optimization can be defined by equation 6 (Eq. 6):

[0108]

[0109] The optimization can include a summation or maximization of the similarity measure GO, including after rotating the image (e.g., 3D model 300) when generating the forward projection, and defined as a translation thereto. P θ is a projection accessed at an angle of θ, and is a projection of the previously defined 3D image of the subject 300.

[0110] If the similarity measure is not optimized or determined to be optimized in block 536, the "NO" path 450 can be followed. In following the "NO" path 540, a transformation can be generated in block 544. The generated transformation can contain an alternative or different rotation and / or translation of the image 300 when the forward projection is generated in block 520. Thus, the optimization process can be an integrated process of maximizing the similarity measure. In block 536, various techniques can be used to determine the optimization, such as a covariance matrix adaptation evolutionary strategy or process, to optimize the rotation to achieve the optimization.

[0111] Similar to the process discussed above, in various embodiments, the determination of the optimization can also contain determining the position of an item, such as the screw 320, in the three-dimensional view 300. According to Eq. 7:

[0112]

[0113] The optimization or registration of the screw in the 3D image can be based on the optimization of the pose or position parameters λ of the item, such as the screw 320. In Eq. 7, the similarity measure can contain a gradient correlation (GC) between the accessed projections, such as represented as VLF φ the projection taken through the slotted filter at an angle φ. P φ [κ(λ)] is the projection accessed at an angle φ using the parameters κ or position parameters λ at the selected pose. Thus, the output item member registration in block 470 can be incorporated as the last term into Eq. 7 to determine the registration of the 2D image containing the item, such as the screw 320, with the prior 3D image 300. The optimization process of Eq. 7 can contain various techniques, such as the covariance matrix adaptation evolutionary strategy discussed above, to optimize various parameters, such as the pose parameters or position parameters λ of the item. Thus, the position can be determined directly from the 2D projections and illustrated with respect to a 3D view of the subject, which can be previously acquired, such as prior to positioning the item, such as the screw 320, within the subject.

[0114] Regardless of the optimization technique or direct registration, once the similarity measure is optimized in block 536, the "YES" path 560 can be followed in block 570 to output the item registration or position in 3D. The output of the item registration can be used or contain determining the position of the item, such as the screw 320, in three-dimensional space. In other words, the position of the item, such as the screw 320, in the 2D image, such as the long view 390, can be correlated to the position in the 3D image, such as the 3D model 300. As further discussed herein, the determination of the item in three-dimensional space can be used for various purposes. Furthermore, the discussion herein of the illustration and determination of the screw 320 and / or portions thereof in three-dimensional space is merely exemplary and not intended to limit the disclosure or the appended claims herein.

[0115] In various embodiments, as discussed above, the optimization performed in block 536 can include or result in a 2D to 3D registration, including the registration of the accessed 3D image 300 with the accessed projections in block 420. Thus, following the "yes" path in block 580, a 2D to 3D registration can be initially performed or output. The 2D to 3D registration can include the registration as discussed above and can be output separately, such as initially from the "yes" block 560, to register a 2D image (e.g., a 2D image space) with a 3D image (e.g., a 3D image space). The object or member registration from block 470 can be applied to the output 2D to 3D registration in block 590. By applying the object or member registration from block 470 with the 2D accessed projection registration in block 420, the 2D to 3D registration from block 580 can allow the output of the object registration or position in 3D in block 570. Thus, according to the process 500, the registration or positioning of an object in three dimensions can be performed in an appropriate manner, including (i) registering a 2D projection (e.g., the accessed projection from block 420) after registering or positioning the object and / or (ii) determining a similarity or optimizing a similarity between a three-dimensional image and a forward projection of at least the object based on known components or parameters of the three-dimensional image.

[0116] Thus, for example, a long film or long view such as the long view 390 can include images of the screws 320i and 320' i, as the long view 390 is generated by stitching together multiple projections of the subject 28, such as fan projections or slot projections, after positioning the implant therein. As discussed above, the implant can be any appropriate object, such as the screw 320. Further, as discussed above, the projections generated by the slotted filter 200 can be angled relative to the source 190 and relative to other slots. Thus, the multiple projections taken using the slotted filter 200 can define a parallax between the different projections to allow for a determination of the position of an object (e.g., the screw 320) imaged in an image such as the long view 390.

[0117] In various embodiments, to perform the registration using equation 7, knowledge or a prior determination of the position of the respective projections taken with the individual slots can be used when performing the stitching of the various projections to form the long view 390. As discussed above, the long view 390 can be generated by stitching together the projections taken with the slotted filter 200. Thus, the knowledge or prior determination of the position of the respective projections taken with the individual slots can be used to determine the position of the respective projections taken with the individual slots in the stitching of the projections to form the long view 390. Figure 4 As shown, the long view 390 can be a combination of three shorter long views 360, 368, 374, which are formed due to a single slot of the slots of the slotted filter 200. Thus, various selected functions, such as a weighted function, can be used to generate the long view 390, where portions of the long view 390 are generated from the slot view or projection that is most relevant to the position of the long view 390. Thus, as shown, the long view 390 can be generated by stitching together the projections taken with the slotted filter 200, where the stitching is performed using the knowledge or prior determination of the position of the respective projections taken with the individual slots. Figure 4As shown, vertebra 364i can be generated from view 360 and long view 390 substantially based on view 360 rather than other long views 368, 374. Thus, generation of long view 390 can be generated with substantial reduction or minimization of parallax distortion due to the slots of the slotted filter 200, as disclosed in U.S. Publication No. __________ (U.S. Patent Application No. 16 / 233,753, filed December 27, 2018), which is incorporated herein by reference.

[0118] Regardless of the technique used for registration, including the techniques discussed above, the location of an item such as screw 320 can be shown and / or represented relative to the images or reconstruction as Figure 7 shown visualizations. The representations can include overlay or superimposed graphics and / or alterations to the image display. Display device 44 can display images 40, including multiple images 40, to represent the location in the 3D image or space.

[0119] Once the user 24 has completed registration of the system, the visualizations can include various features, such as showing one or more projections of the subject 28, such as fourth lumbar left visualization image 600 including the primary axis or main axis 610 of screw 320. The main axis 610 can be shown to the user 24 to understand the registered position of implant 320. Additional visualizations can also be provided, such as the right side of the first lumbar vertebra in image 614, including main axis 620. Additional and / or alternative visualizations can include overlaying or superimposing a graphical representation 626 of screw 320 on the image or visualization portion 630.

[0120] The user 24 can use the various representations including axis representations 610, 620 and / or graphical representation 626 to understand the registered (i.e., relevant) position of implant 320 relative to the subject 28 with one or more positions. As discussed above, the user 24 can use the 3D image 300 to plan the procedure, such as by placing a planned position image 320a. The images 40 including various visualizations 600, 614, 630 can be compared and / or overlaid with the planned position of image 300. Thus, as Figure 8 shown, in addition to or instead of images 40, display 44 can display the 3D image as a registered image display 650.

[0121] As Figure 8As shown, 3D image 300 can be displayed together with the planned location 320a and the registration location of screw 320 on image 650. Therefore, image 650 can contain 3D image 300 that can be acquired prior to the procedure. As discussed above, 3D image 300 can be based on or contain CT images, MR images, or other suitable 3D images. However, the registration location of screw 320 can be shown as an icon or graphical representation 656 superimposed on image 300 in registration location image 650. Each registration screw representation 656 can be superimposed on the 3D image or included in registration image 650 to help the user visualize or understand the position of the implanted screw relative to the planned location, and the final position of screw 320.

[0122] like Figure 8 As shown, the visualization of the screws can include a representation of each screw implanted in subject 28. For example, eight screws can be included within the registration image 650, representing the eight screws located in patient 28. Although Figure 8 Eight screws are shown, but it should be understood that any appropriate number of screws may be included, including fewer or more than eight. User 34 can view the display device 44 to see a visualization of subject 28, including a representation of screws 656.

[0123] In various embodiments, the system can execute further instructions to connect screw representations 656, such as including a first line or bar 660 and a second line or bar 664. In various embodiments, the bars can be used to interconnect selected screws to achieve a selected or desired result or shape of the spine of subject 28. For example, subject 28 may be diagnosed with a spinal deformity, such as scoliosis. Implanting screws 320 and connecting them to bars of selected shapes can be used to attempt to achieve a selected or desired spinal shape result. Thus, the shapes of bars 660, 664 can be shown on a registration image 650, which includes the connection of identified or registered screw heads of screw representations 656. However, as further discussed herein, the registration position of the screws in the registration image 650 can be used to define or determine the shape of the bars to move the screws (and associated anatomical structures) during placement of bars 330 to achieve the selected result.

[0124] Furthermore, as discussed above, the registered image 650 may include one or more representations 320a. Representation 320a may be, for example... Figure 8 The planned position of a screw, such as screw 656a, is shown. The registration position of screw 656a can be compared with the planned position 320a. The user can view a registration image 650 containing two representations, namely registration representation 656a and planned position 320a, to determine the success of the procedure relative to the planning.

[0125] In addition to the visualization by user 24, a system such as workstation 48 can use processor 56 to execute instructions to measure or determine the main axis of the registration screw and the main axis of the planned screw position 320a, as discussed above. The axis of the planned position 320a can be predetermined or known based on the known geometry of the planned screw 320. An information screen, such as planning success or information display 670, can be displayed on display device 44. Display frame 670 can show a representation of the determined position of the implanted screw relative to the planned position. For example, percentage deviation and / or distance deviation can be displayed in display 670 to provide user 24 with information about the difference between the planned position and the implanted position.

[0126] Therefore, in view of the above, Figure 7 and 8 The visualization shown can be generated without requiring secondary or post-processing three-dimensional scans of the subject. For example, as described above, imaging system 36 can acquire projections and / or generate long films or stitched long films of the subject 28 that can be based on multiple two-dimensional projections. Therefore, due to single-view (e.g., AP and / or lateral) scanning, radiation dose to the subject 28 and / or the individual near imaging system 36 can be reduced or minimized. Thus, user 34 can use confirmation or registration visualization 650 to confirm and / or plan further procedural steps while minimizing radiation to the subject 28 and the individual near the imaging system.

[0127] In various embodiments, for example, the registration image 650 can be displayed on the display device 44 in various ways, such as... Figure 8 The views shown are essentially three-dimensional and / or Figure 7 The selected projection is shown. It should be understood that... Figure 7 The various images shown can be displayed simultaneously and / or alternately with the registered image 650 on the display device 44. Furthermore, the images containing images 600, 614, and 630 can also be referred to as registered images with respect to the displayed portions therein.

[0128] Therefore, procedures and / or planning can be confirmed by viewing the substantially three-dimensional registration image 650 and portions thereof. In various embodiments, the registration image may be shown in part or expanded, for example, viewing a graphical representation of screw 626 and / or the screw's long axis or main axis, such as axis 610. User 24 can view the registration position of the screw for various purposes, such as confirming procedures and / or performing or planning subsequent procedures.

[0129] In various embodiments, after the screw 320 is placed, the rod shape can be determined to achieve or attempt to achieve a selected result for subject 28. For example, refer to Figure 9The process 700 can be used to plan or determine a geometry for the rods 330 to be implanted, which can or can not be shown as the rods 660, 664. In various embodiments, the rods 330 can define between two terminals to interconnect a plurality of screws implanted in the subject 28. For example, eight screws can be implanted in the left and right sides of the subject to be interconnected by selected rods. The selected one or more rods connecting the left and right sets of screws, respectively, can be designed and shaped to achieve a selected shape of the subject's spine after implantation and fixation of the rods. Thus, once the screws are implanted, the region of interest of the subject can comprise the subject's spine.

[0130] The geometry of the subject's spine, which can be the subject's region of interest, can be computed according to the process 700 in block 710. Computing the geometry can comprise identifying various bone structures of the spine in the images and / or based on the registration screws. As discussed above, a principal or primary axis of each of the screws can be identified, such as the axis 610. Thus, a geometric structure or spatial position between the relative principal axes, such as between the principal axis 610 and the principal axis 620, can be computed. The geometry between or defined by the registration screws in the registration image 650 can be used to determine the geometry or shape of the spine. Thus, as discussed above, the determination of the current and / or selected final or corrected geometry can be based at least on the registration of the positions of the screws in the 3D model. Thus, the screws can be used to determine the geometry of the spine, and thus the screws are also determined or positioned.

[0131] The current geometry (e.g., morphology or curvature) of the region of interest can thus be determined by computing the spatial differences between each screw in the selected set. For example, in block 710, the geometry between each left screw and each right screw can be computed to determine the geometry of the region of interest.

[0132] In block 720, the selected and / or computed selected corrected geometry of the region of interest, such as the spine, can be computed and / or accessed. In various embodiments, the selected corrected geometry can comprise the geometry of the spine in the preoperative configuration or substantially without change. Thus, the selected corrected geometry can be the geometry of the patient's spine. For example, degenerative bone or disc disease can be identified, and the current shape of the spine can be maintained using the screws 230 connected by the selected slides.

[0133] However, in various embodiments, the subject 28 can be diagnosed with a spinal deformity. For example, a scoliosis can include a non-selected or non-optimal curvature of the spine. Thus, the selected correction geometry calculated in block 720 can include selected movements of the spinal vertebrae to achieve a final selected geometry of the spine. The final or corrected geometry can be calculated based on the current geometry, such as determined positions of the implanted screws and the registered positions. Further, the user 24 can determine or predefine a selected or determined final geometry, and the pre-defined (e.g., user-defined or determined) geometry can be called or accessed in block 720. In various embodiments, a global spinal alignment (GSA) analysis can be performed, and can be related to an assessment of spinal curvature and related metrics. Specific GSA measurements can include a sagittal alignment (SA), a thoracic kyphosis (TK). Additional and / or alternative measurements of global spinal curvature can be assessed in terms of a "Cobb" angle, a pelvic incidence (PI), and a pelvic tilt (PT).

[0134] Once the selected correction geometry is calculated and / or accessed in block 720, a final implant placement and / or final geometry can be determined in block 730. As discussed herein, the final geometry can include final relative screw positions in block 732, and a rod geometry (e.g., a bend) can be made in block 740. The final relative screw positions can include selected positions and / or movements (e.g., 2 mm up or 5 mm laterally) of the screws to achieve the selected correction geometry in block 720. As discussed above, the registered positions of the screws can be used as a proxy or to determine the position of each vertebra in the spine. Thus, the positions of the screws can be calculated in block 732 to achieve the selected correction geometry. All of the right side screws can be calculated to have a selected final geometry relative to each other to achieve the selected correction geometry of the region of interest including the spine. For example, if the uppermost screw and the lowermost screw are substantially aligned and the middle screw is not aligned, the calculation can include more aligning the upper screw with the middle screw. Thus, a calculation can be performed to determine a selected amount of movement relative to a superior-inferior axis of the subject 28 to achieve the selected correction geometry from block 720. The processor system 56 can calculate the selected positions based on attempting to achieve more axial positions or selected positions of the spine after connecting the plurality of screws with the rod. For example, the processor system 56 can determine an intermediate amount of movement of the middle screw to achieve alignment, thereby achieving the corrected geometry of the spine calculated.

[0135] One or more bends in one or more rods can be determined in block 740 to achieve the selected positions. The determination of whether one or more rods are needed can be based on the number of screws and / or the spacing of the screws. For example, a left set of screws and a right set of screws can be determined, and thus a left rod and a right rod for interconnecting the respective screws. Further, the rods can contain a selected number of bends to achieve the final selected positions of the screws, which can be determined in block 740. For example, a spline determination of the final shape of the spine can be used to define a spline shape of the rods to interconnect the screws into the selected shape. Thus, the definition of the rods to achieve the final shape can be used to determine the number of bends and / or the location of the bends in the one or more rods to achieve the selected final positions of the screws.

[0136] However, it is further understood that once the rods are positioned within the heads of the screws, the implantation of the rods can involve movement of the rods. The bends determined in the rods can not align with the final positions of the screws, but can be based on a current position where the rods will be rotated or moved to achieve movement of the screws during implantation. Thus, the processor system 56 can determine the bends in the rods and / or their locations by defining the rods in an appropriate manner, such as using a spline determination between a plurality of points, such as the locations or intermediate locations between the screws and the registration image 650, to achieve the selected final geometry of the spine.

[0137] Thus, the final positions of the screws and one or more rod bends in one or more rods can be determined in block 730. Once the determination is made in block 730, the geometry of the rods, including the one or more bends in one or more rods, can be output in block 744. Outputting the determined one or more bends can involve transmitting the bends, storing the bends, or any other appropriate process based on the determination in block 740. The process 700 can be used to determine the shape of the selected rods to achieve the selected or determined corrective geometry of the spine.

[0138] In various embodiments, the output determined rod bends can be used to bend the rods in block 760. The rods can be bent in any appropriate manner, such as manually bent by the user 24 using a manual rod bending device, or substantially automatically bent or using a robotic bending system. However, the rods can be bent according to the output determined bends in block 760.

[0139] The curved rod from block 760 can then be implanted into the subject 28 in block 766. The rod can be implanted in any appropriate manner, such as in a non-navigated procedure that includes a substantially open procedure. However, in various embodiments, the rod can be navigated, such as using the instrument or tool 144. As discussed above, the instrument 144 can be navigated. The subject can be registered to images, such as the prior 3D image 300 and / or the long image 390, according to various techniques, such as those discussed above. Thus, for example, using the registration discussed above, the registered image 650 can also be registered to the patient 28. Further, the patient tracker 140 can be used to maintain registration to any selected images based on tracking the subject 28, even during movement of the subject 28.

[0140] The registered image 650, including representations of, for example, the screw 320 locations represented by the representations 656, can also be used for navigation of the rod relative to the subject 28. Since the registered screws 656 can be displayed on the display device 44, an icon or graphical representation, such as the graphical representation 180, can represent the rod relative to the screw representations 656. Referring back to Figure 8 For example, the representations 660, 664 of the rod can be understood as a tracked or graphical representation of a navigated rod being positioned or positioned relative to a plurality of screws in the subject. Thus, since the screws are registered to the subject 28 and based on the registration between the long image 390 and the 3D image 300 as discussed above, navigation can be performed for the rod implantation.

[0141] Thus, the curved rod 330 can be implanted into the subject, and the procedure or process can end in block 780. The end procedure can be any appropriate process, such as securing the screws to implant the rod, closing an incision of the subject, or any other appropriate end procedure. However, as discussed above, the rod can be implanted between a plurality of screws.

[0142] Thus, a procedure can be performed on the subject 28 and confirmed without requiring a second three-dimensional scan of the subject, to help reduce or minimize radiation to the subject 28 and individuals near or adjacent to the imaging system. Further, as discussed above, non-imaged portions can be navigated relative to the registered image portions to help perform a navigated procedure using tracked instruments and / or implantation devices. The navigated position of an implant, such as a rod, can then be displayed on the display device 44 relative to the registered image, such as using a graphical representation of the implant relative to a previously registered representation, such as the screw representations 656.

[0143] The foregoing description of implementations has been presented for the purposes of illustration and description. It is not intended to be exhaustive or to limit the application to the precise form disclosed. Individual elements or features of a particular implementation are generally not limited to that particular implementation, but are interchangeable with other implementations, as will be understood by those skilled in the art. In addition, it should be understood that elements or features from one example implementation can be used in a different example implementation without departing from the scope of the present disclosure. Such variations are not to be regarded as a departure from the scope of the present disclosure, and all such modifications are intended to be included within the scope of the present disclosure.

[0144] It should be understood that various aspects disclosed herein can be combined in different combinations than the combinations expressly presented in the description and accompanying drawings. It should also be understood that, depending on the example, certain acts or events of any of the processes or methods described herein can be performed in a different sequence, omitted, combined, or partitioned differently from that described in the example. Furthermore, although processes or methods described herein can be described as being performed by a single module or unit, it should be understood that the techniques of this disclosure can be performed by a combination of modules or units associated with, for example, a medical device.

[0145] In one or more examples, the described techniques can be implemented in hardware, software, firmware, or any combination thereof. If implemented in software, the functions can be stored on or transmitted over as one or more instructions or code on a computer-readable medium and executed by a hardware-based processing unit. Computer-readable media can include non-transitory computer-readable media, which corresponds to a tangible medium such as data storage media (e.g., RAM, ROM, EEPROM, flash memory, or any other medium that can be used to store desired program code in the form of instructions or data structures and that can be accessed by a computer).

[0146] Instructions can be executed by one or more processors, such as one or more digital signal processors (DSPs), general purpose microprocessors, application specific integrated circuits (ASICs), field programmable logic arrays (FPGAs), or other equivalent integrated or discrete logic circuitry. Accordingly, the term "processor," as used herein can refer to any of the foregoing structure or any other physical structure that can harness mathematical calculations to implement the described techniques. Moreover, the described techniques can be embodied entirely in one or more circuits or logic elements.

Claims

1. A method of determining a location of a component in first image data based on second image data, comprising: accessing the first image data of a subject; accessing the second image data of the subject, wherein the second image data comprises 2D image data of the subject; registering the first image data with the second image data; determining a location of a component in the second image data; and correlating the location of the component in the second image data with the first image data based at least on the registration of the first image data with the second image data, wherein determining the location of the component in the second image data comprises: accessing parameters of the component; generating a component projection based on the accessed parameters; comparing the generated component projection with the 2D image data; and optimizing a component similarity measure between the generated component projection and the 2D image data at least by altering a rotation or translation of the component when generating the component projection.

2. The method of claim 1, wherein the second image data of the subject is acquired after the first image data such that the first image data does not comprise image data of the component.

3. The method of claim 1, wherein the first image data comprises a 3D image of the subject; wherein registering the first image data with the second image data further comprises: generating a 2D projection from the 3D image; comparing the generated 2D projection with the 2D image data; and optimizing a similarity measure between the generated 2D projection and the 2D image data at least by altering a rotation or translation of the 3D image when generating the 2D projection.

4. The method of claim 3, further comprising: selecting the 2D image data to comprise a single projection of the subject.

5. The method of claim 3, further comprising: selecting the 2D image data to comprise a single stitched image formed by stitching together multiple projections of the subject; wherein the multiple projections are generated using one or more x-ray fan beams.

6. The method of any one of claims 1-5, further comprising: positioning the component.

7. The method of claim 6, further comprising: after positioning the component, operating an imaging system to acquire the second image data of the subject.

8. A method of determining a location of a structure in 3D image data based on 2D image data, comprising: accessing the 3D image data of a subject; acquiring the 2D image data of the subject; generating a 2D long view of the subject comprising a region of interest of the subject based on the acquired 2D image data; registering the 3D image data with the generated 2D long view; determining a location of a structure in the generated 2D long view; and ​ ​ based at least on the registration of the 3D image data with the generated 2D long view, correlating the position of the member in the generated 2D long view with the 3D image data, wherein determining a position of a member in a generated 2D long view further comprises: accessing parameters of the member; generating a member projection based on the accessed parameters; comparing the generated 2D projection and the member projection with the generated 2D long view; and optimizing a similarity measure between the generated 2D projection and the member projection and the generated 2D long view at least by altering a rotation or translation of the member in generating the generated member projection and the generated 2D projection.

9. The method of claim 8, wherein acquiring the 2D image data of the subject further comprises: filtering an x-ray beam into at least a fan beam; acquiring a plurality of projections of the subject using the fan beam along a selected axis of the subject.

10. The method of claim 9, wherein generating the 2D long view of the subject further comprises: stitching together at least a selected sub-plurality of the acquired plurality of projections of the subject.

11. A system for evaluating images of a subject, comprising: an imaging system for acquiring 2D image data of the subject; a processor system operable to execute the following instructions: accessing 3D image data of a subject; generating a 2D long view of the subject based on the acquired 2D image data; registering the 3D image data with the generated 2D long view; determining a position of a member in the generated 2D long view; and correlating the position of the member in the generated 2D long view with the 3D image data based at least on the registration of the 3D image data with the generated 2D long view; a display device operable to display a visualization of the correlated position of the member in the 3D image, wherein the processor system is operable to execute further following instructions in order to determine a position of a member in a generated 2D long view: accessing parameters of the member; generating a member projection based on the accessed parameters; comparing the generated 2D projection and the member projection with the generated 2D long view; and optimizing a similarity measure between the generated 2D projection and the member projection and the generated 2D long view at least by altering a rotation or translation of the member in generating the generated member projection and the generated 2D projection.

12. The system of claim 11, wherein the processor system is operable to execute further instructions for generating the 2D long view, comprising: filtering an x-ray beam into at least one fan beam; and acquiring a plurality of projections of the subject using the fan beam along a selected axis of the subject.

13. The system of claim 11, wherein the processor system is operable to execute further instructions for generating the 2D long view, comprising: filtering an x-ray beam into a plurality of fan beams; and acquiring a plurality of projections of the subject using the plurality of fan beams at different view orientations along a selected axis of the subject.

14. The system of any one of claims 12 or 13, wherein the processor system is operable to execute further instructions for generating the 2D long view, comprising: ​ stitching together at least a selected sub-plurality of the acquired projections of the subject.

15. The system of any one of claims 11 to 13, wherein the imaging system comprises a slotted light filter.

Images