Method for planning an orthopedic surgical procedure

Abstract

A method and apparatus for planning an orthopedic surgical procedure are disclosed. The method includes searching medical imaging data and identifying a plurality of landmarks, including at least one first landmark on a portion of a first bone and at least one second landmark on a portion of a second bone, contained in the medical imaging data. The first and second bone portions may be segmented such that the portion of the first bone is movable relative to the portion of the second bone. At least one of a first implant component and a second implant component may be selected from a plurality of implant components in a database based on information obtained from the first and second landmarks. The first implant component and / or the second implant component may be fitted into a space at least partially defined by the first and second landmarks.

Description

[Technical Field]

[0001] FIELD OF THE INVENTION The present invention relates generally to the field of orthopedics, such as orthopedic procedures for the hip, knee, spine, shoulder, trauma, or extremity. More specifically, the present invention relates to a computer-implemented method and apparatus for planning an orthopedic procedure. The method includes retrieving medical imaging data including a first bone portion and a second bone portion. In the retrieved medical imaging data, the first bone portion and the second bone portion are not segmented, and in particular, the first bone portion and the second bone portion are not labeled in the medical imaging data so as to be separately identifiable. The first bone portion and the second bone portion are segmented such that the first bone portion is movable relative to the second bone portion. A plurality of landmarks may be identified, including at least one first landmark in the first bone portion and at least one second landmark in the second bone portion. This may be done before, after, or without segmentation. At least one of a first implant component and a second implant component may be selected from a plurality of implant components in a database based on information obtained from the first landmark and the second landmark. The first implant component and / or the second implant component may fit into a space at least partially defined by the first landmark and the second landmark. [Background technology]

[0002] Background of the Invention Orthopedic surgical procedures, such as orthopedic procedures of the hip, knee, spine, shoulder, trauma, or extremity, can be digitally planned using digital medical imaging data. For example, the type, size, and position of implant components relative to the medical imaging data can be planned preoperatively, i.e., before the patient enters the operating room, or intraoperatively, i.e., when the patient is in the operating room. Planning the type, size, and position of implant components relative to the medical imaging data is also called templating. Traditionally, this was performed using 2D imaging data, but more modern approaches use 3D imaging data for orthopedic procedure planning.

[0003] Medical imaging data may come from a variety of sources, such as x-ray, fluoroscopy, CT (Computed Tomography), CBCT (Cone Beam Computed Tomography), ultrasound, and MRI (Magnetic Resonance Imaging).

[0004] A challenge with planning orthopedic implant procedures is that the relative positions of a patient's various bones when the patient is scanned to generate medical imaging data may not correspond to the relative positions those bones have intraoperatively or the relative positions those bones will have postoperatively when an implant is implanted. For example, a hip surgery such as a total hip arthroplasty (THA), which involves restoring the patient's biomechanics, may include lengthening / shortening the leg, adjusting various offsets, etc. For example, to achieve better biomechanics, it may be desirable to move the femur relative to the patient's pelvis. This can be done by selecting implant components of the appropriate type and size to achieve the desired biomechanics. However, selecting the correct implant components to achieve the desired outcome of the procedure is difficult because, when unsegmented, the femur and pelvis have a fixed positional relationship in the medical imaging data, which does not represent the relative positions desired to achieve the desired biomechanics. This becomes even more difficult when, given the unsegmented nature of the imaging data, multiple components are selected that do not have the same relationship on screen during planning as they will postoperatively. Similar challenges exist, for example, in TKA (total knee arthroplasty) or PKA (partial knee arthroplasty) procedures, shoulder procedures, etc., where the relative positions of bones are changed as part of the orthopedic procedure.

[0005] In some types of procedures, the position of the patient in the medical imaging scanner where the medical imaging data is captured may not correspond to the position of the patient on the operating table. This is the case, for example, in spine surgery, where medical imaging data is captured preoperatively with the patient in a supine position in a CT or MRI scanner, but intraoperatively the patient is in a lateral or prone position. The vertebrae of the spine have different relationships to one another in various positions. For example, in the case of pedicle screw fixation, the relative positions of the vertebrae to be fixed are acquired while the patient is lying on the operating table. During surgery, a 2D or 3D C-arm may be used, for example, to identify the entry level of the spine and / or to match intraoperative image data with intraoperative image data to use preoperative planning data for navigational or robotic surgery. However, because the vertebrae have different relationships to one another in the two data sets, such matching may be difficult or impossible. This results in preoperative planning not being possible or in suboptimal implants or implant positions being planned.

[0006] In summary, bone correlations in medical imaging data may not be optimal for planning and / or performing surgery, which may introduce inaccuracies into the planning or surgery, or even lead to suboptimal implant selection, or in the worst case scenario, the implant may be placed in a suboptimal position that may even be dangerous to the patient. Summary of the Invention [Problem to be solved by the invention]

[0007] Therefore, improved methods for planning orthopedic surgical procedures would be advantageous, particularly those that improve accuracy, flexibility, cost-effectiveness, and / or patient integrity. [Means for solving the problem]

[0008] Summary of the Invention Accordingly, embodiments of the present invention preferably seek to mitigate, alleviate or eliminate one or more of the drawbacks, disadvantages or problems in the art, such as those identified above, singly or in any combination, by providing methods, apparatus, and computer program products for planning orthopedic surgical procedures.Embodiments of the present invention are defined by the following detailed description and the appended claims.

[0009] Some embodiments include a computer-implemented method for planning an orthopedic surgical procedure, the method including searching medical imaging data including a first bone portion and a second bone portion, the first bone portion and the second bone portion being unsegmented, and identifying a plurality of landmarks including at least one first landmark on the first bone portion and at least one second landmark on the second bone portion.

[0010] The first bone portion and the second bone portion may be segmented such that the first bone portion is movable relative to the second bone portion.

[0011] At least one of the first implant component and the second implant component may be selected from among the plurality of implant components in the database based on information obtained from the first landmark and the second landmark.

[0012] At least one of the first implant component and the second implant component may be fitted into a space at least partially defined by the first landmark and the second landmark.

[0013] In some embodiments, the method includes segmenting the first bone portion and the second bone portion, and then moving the first bone portion relative to the second bone portion based on at least one landmark of the plurality of landmarks. Alternatively or additionally, the method includes moving the first bone portion relative to the second bone portion based on a contour of the segmented portion of the first bone and / or a contour of the segmented portion of the second bone.

[0014] In some embodiments, before selecting the first implant component and the second implant component, the first bone portion is moved relative to the second bone portion to obtain a desired position of the first landmark relative to the position of the second landmark.

[0015] The information obtained from the first bone portion and the second bone portion may be obtained after segmenting the first bone portion and the second bone portion and after the first bone portion has been moved relative to the second bone portion.

[0016] The first landmark and the second landmark can be landmarks of the first bone portion or the second bone portion, or alternatively, the first landmark is a landmark of the first bone portion and the second landmark is a landmark of the second bone portion.

[0017] An embodiment of the method may include identifying at least one third landmark on the first bone portion and the second bone portion, and obtaining information on which the first landmark, the second landmark, and the third landmark are based.

[0018] Obtaining information from the first landmark and the second landmark may include obtaining at least one dimension, the at least one dimension including at least one of a diameter, a length, a width, and an angle.

[0019] Embodiments may include storing each implant component in a database along with implant information, which may optionally include at least one of diameter, length, width, and angle.

[0020] Selecting at least one of the first implant component and the second implant component may include selecting an implant component having implant information that best matches information obtained from the first landmark and the second landmark.

[0021] Embodiments include a computer-readable storage medium having program instructions stored therein that, when executed by a processor, perform the methods of the embodiments described herein.

[0022] An embodiment includes an apparatus for planning an orthopedic surgical procedure configured to: access a memory to retrieve medical imaging data including a first bone portion and a second bone portion, where the first bone portion and the second bone portion are not segmented; identify, using a processing unit, a plurality of landmarks including at least one first landmark in the first bone portion and at least one second landmark in the second bone portion; segment, using the processing unit, the first bone portion and the second bone portion such that the first bone portion is movable relative to the second bone portion; select, using the processing unit, at least one of a first implant component and a second implant component from a plurality of implant components in a database based on information obtained from the first landmark and the second landmark; and fit, using the processing unit, at least one of the first implant component and the second implant component into a space at least partially defined by the first landmark and the second landmark.

[0023] The processing unit may be configured to, after segmenting the first bone portion and the second bone portion, move the first bone portion relative to the second bone portion based on at least one landmark of the plurality of landmarks and / or based on a contour of the segmented portion of the first bone and / or a contour of the segmented portion of the second bone.

[0024] The processing unit may be configured to move the first bone portion relative to the second bone portion to obtain a desired position of the first landmark relative to the position of the second landmark before selecting the first implant component and the second implant component.

[0025] The processing unit may be configured to obtain the information after segmenting the first bone portion and the second bone portion and after the first bone portion has moved relative to the second bone portion.

[0026] Further embodiments of the invention are defined in the dependent claims.

[0027] Some embodiments of the present invention provide efficient and accurate planning of orthopedic surgical procedures. Since bone parts are segmented, the actual positions of the bone parts can be easily identified. Desire, allowing the bone portions to be moved relative to one another to simulate the desired outcome of the procedure. After this is done, implant components can be selected. This optimizes the selection of implant components that fit the desired outcome of the procedure, even before the surgery begins. Furthermore, the segmented bone portions can be rendered in different colors, which can also aid in treatment planning. Landmarks on the bone portions can also be identified. The landmarks can be used for implant component selection. Furthermore, the landmarks can be used to move the bone portions relative to one another to plan the treatment. For example, the landmarks can be used to plan for biomechanical symmetry or biomechanical restoration by moving the bone portions. This is possible due to the combination with the segmentation of the bone portions. Thus, the identification of landmarks also contributes to efficient and accurate planning of orthopedic treatments.

[0028] It should be emphasized that as used in this specification, the term "comprises / comprising" is to be interpreted as specifying the presence of stated features, integers, steps or components, but not excluding the presence or addition of one or more other features, integers, steps, components or groups thereof.

[0029] BRIEF DESCRIPTION OF THE DRAWINGS These and other aspects, features and advantages of possible embodiments of the present invention will become apparent from and elucidated in the following description of embodiments of the invention, which refers to the accompanying drawings. [Brief explanation of the drawings]

[0030] [Figure 1] 1 is a flowchart of an embodiment of a method for planning an orthopedic surgical procedure. [Figure 2] 1 is a block diagram of an apparatus for planning an orthopedic surgical procedure. [Figure 3] 1 is a schematic diagram of an embodiment of a user interface for user input and manipulation in which example landmarks of medical imaging data are identified. [Figure 4] 1 is a schematic diagram of an embodiment of a user interface for user input and manipulation in which example landmarks of medical imaging data are identified. [Figure 5] 1 is a schematic diagram of an embodiment of a user interface for user input and manipulation in which example landmarks of medical imaging data are identified. [Figure 6] 1 is a schematic diagram of an embodiment of a user interface for user input and manipulation in which example landmarks of medical imaging data are identified. [Figure 7] 10A-10C are schematic diagrams of an embodiment of a user interface showing implant components fitting into spaces defined by landmarks and bone portions moved relative to one another. [Figure 8] 10A-10C are schematic diagrams of an embodiment of a user interface showing implant components fitting into spaces defined by landmarks and bone portions moved relative to one another. DETAILED DESCRIPTION OF THE INVENTION

[0031] Description of the embodiment Specific embodiments of the present invention will now be described with reference to the accompanying drawings. However, the present invention may be embodied in many different forms and should not be construed as limited to the embodiments set forth herein; rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the scope of the invention to those skilled in the art. The terminology used in the detailed description of the embodiments shown in the accompanying drawings is not intended to be limiting of the invention. In the drawings, like reference numerals refer to like elements.

[0032] The following description will focus on embodiments of the invention applicable to planning orthopedic procedures, exemplified by planning a THA (total hip arthroplasty). However, it will be understood that the invention is not limited to this application and is applicable to many other procedures, including orthopedic procedures of the knee, spine, shoulder, extremities, and trauma, among others, where orthopedic implants are used.

[0033] 1 and 2 illustrate an embodiment of a computer-implemented method and apparatus 10 for planning an orthopedic surgical procedure.

[0034] According to the method shown in FIG. 1, medical imaging data is retrieved (1). The medical imaging data may include a first bone portion and a second bone portion. Additional bone portions may also be included. The first bone portion and the second bone portion may be unsegmented when retrieved, such as from a storage medium. At least one landmark 100-121 (shown in FIGS. 3-6), preferably multiple landmarks, is then identified (2). The landmarks 100-121 may include at least one landmark in the first bone portion and at least one second landmark in the second bone portion. Once the landmarks are identified, the imaging data including the landmarks 100-121 may be stored in memory or presented on a screen.

[0035] Identifying the landmarks 100-121 (2) may be performed by a user providing input to a computer by selecting portions or areas on the medical imaging data when presented on a screen. Alternatively or additionally, the landmarks 100-121 may be identified by a computer-implemented analytical model. Such an analytical model may be set up using a machine learning model trained through an iterative learning process. For example, the analytical model may be set up using a neural network capable of clustering and recognizing patterns in the imaging data. In the learning process, the landmarks 100-121 are defined, and then a user, through user interaction, defines where the landmarks are located in the imaging data. Over time, the analytical model may continuously learn and be refined to more precisely identify the landmarks 100-121 in the medical imaging data. Once sufficiently trained, the analytical model may recognize the landmarks 100-121 with high accuracy without human interaction. Nevertheless, as discussed further below, human confirmation or accuracy enhancement may be desirable.

[0036] The imaging data may include at least one of x-ray, fluoroscopy, CT (Computed Tomography), CBCT (Cone Beam Computed Tomography), ultrasound, and MRI (Magnetic Resonance Imaging), and may be generated by a medical imaging device. When generated, the medical imaging data is not classified or labeled, and therefore, it is not possible to distinguish one bone of a patient from another bone of the patient. Therefore, it is not possible to move one bone of a patient relative to another bone without further processing. The process of distinguishing one bone from another is commonly referred to as segmentation.

[0037] The method may include segmenting the medical imaging data (3). Segmenting the imaging data (3) may be performed before or after identifying the landmarks 100-121 (2). In some embodiments, segmentation may even be performed independently of identifying the landmarks 100-121. According to embodiments, segmenting the medical imaging data (3) may include dividing the medical imaging data into at least two data sets. This may be used to move a portion of a first bone relative to a portion of a second bone, as further illustrated in the embodiments described below. Segmentation may be performed manually by a user. Alternatively or additionally, an analytical model may be implemented, e.g., using machine learning similar to the model that identifies landmarks. A combination approach may also be used, in which the analytical model first prepares suggested segments, which the user may then modify by tagging specific medical imaging data as belonging to a specific portion of the bone. At the most detailed level, each voxel in a set of medical imaging data may be tagged as belonging to a specific bone.

[0038] According to embodiments, the method may also include selecting (4) at least one implant component 201, 202 (FIGS. 7 and 8) based on information obtained from at least one landmark, such as a first landmark and a second landmark. Some embodiments include selecting (4) a plurality of implant components, such as at least one first implant component and a second implant component, from among the plurality of implant components. The implant component 201, 202 may be selected from a plurality of implant components in a database based on information obtained from the first landmark and the second landmark. Selecting (4) the implant component 201, 202 from the database based on information obtained from at least one landmark 100-121 may be performed with or without segmentation 3, as described above.

[0039] After the appropriate implant component or components 201, 202 are selected (4), the implant components, such as the first implant component 201 and the second implant component 202, may be fitted (5) into a space at least partially defined by the landmarks, as further illustrated with respect to embodiments described below. Thus, at least one landmark used in selecting (4) can also be used to fit (5) the implant components 201, 202 into the space defined by the landmarks.

[0040] FIG. 2 shows an embodiment of an apparatus 10 for planning an orthopedic surgical procedure. The apparatus 10 may include a computer system, which may retrieve and input medical imaging data into the computer system to plan a surgical procedure. If imaging data is generated intraoperatively, the apparatus 10 may also be used intraoperatively. The planning results may be provided to other medical devices and systems, such as navigation systems, robotic systems, or to generate patient-specific implants. For example, a navigation or surgical system may use positional information of implant components relative to the medical imaging data to visually guide a surgeon via a display or to control a robotic arm. The apparatus 10 may include a CPU / processor or data processing unit 11, one or several memories 12, a communication unit 13, an input device 14 such as a mouse and / or keyboard for user interaction, and an output unit 15 capable of rendering medical imaging data, landmarks, etc. The imaging data, models of implant components, and information related to the imaging data and implant components may be stored in a database 16 and / or a storage medium such as the memory 12. The database 16 may be a local database or a network resource accessible by multiple apparatuses 10 according to the present invention. The medical imaging data can be uploaded to a storage medium from a medical scanner where the data is generated. The processing unit can access the memory and retrieve the data based on user input as needed throughout the planning session.

[0041] The computer software, when executed by the CPU 11, implementing the present invention may include a CAD system in which a 3D model of a surgical object or a 3D volume of scan data and / or medical imaging data, such as multiple 2D views of scan data, such as MRI or CT data, generated from the 3D volume of medical imaging data, may be rendered simultaneously and partially overlaid to increase information.

[0042] FIGS. 3-6 illustrate volume renderings of 3D medical imaging data, such as CT, CBCT, MRI, or ultrasound data, in multiple views. Landmarks may be identified as described above (2) and presented in multiple 2D views on a screen or display. The 2D views may be, for example, cross-sections or projections of the 3D volume. Rendering data generated from orthogonal views of the volume of medical imaging data in multiple views facilitates user interaction. In each view, the user may adjust the position of landmarks 100-121 in only one or two dimensions. Because the same landmarks 100-121 are rendered at different angles in some of the views, user interaction in at least two views by repositioning the landmarks 100-121 may redefine their location in three dimensions relative to the medical imaging data. A more detailed description of rendering medical imaging data in multiple 2D views is provided in International Publication No. WO2014062125, which is incorporated herein by reference. Thus, identifying landmarks may include user input identifying the exact location of the landmarks relative to the medical imaging data. Thus, user input can fine-tune the identification, making it more accurate, which makes the process for identifying landmarks 100-121 more reliable. As a safety measure, the user may be required to verify each landmark portion before the plan can be finally approved.

[0043] As described above, embodiments of the present invention may include identifying (2) a plurality of landmarks 100-121, such as anatomical landmarks of bony portions, in medical imaging data. FIGS. 3-6 show various anatomical landmarks in multiple 2D views. The landmarks are exemplary embodiments. In other embodiments, several of the landmarks shown in FIGS. 3-6 are identified (2). In other embodiments, additional or other landmarks on the human body may be identified depending on the type of orthopedic surgical procedure and the type of implant component planned.

[0044] FIG. 3 illustrates the identification of a plurality of landmarks 100-106 on a portion of a bone including at least a portion of the left and right femurs, the landmarks including: -right femoral head 100 (left view, upper left landmark; upper right view, left landmark; second lower right view, upper landmark); - left femoral head 102 (left view, upper right landmark; upper right view, right landmark; first lower right view, upper landmark); - right proximal femoral shaft 103 (left view, central left landmark; second upper right view, left landmark; second lower right view, central landmark); the right proximal femoral shaft 103 can be identified in the femoral canal at the level of the lesser trochanter of the femur; - left proximal femoral shaft 104 (left view, center right landmark; second upper right view, right landmark; first lower right view, center landmark); the left proximal femoral shaft 104 can be identified in the femoral canal at the level of the lesser trochanter of the femur; - right distal femoral shaft 105 (left view, lower left landmark; third upper right view, left landmark; second lower right view, lower landmark); the right distal femoral shaft 105 can be identified at a predefined distance from the right proximal femoral shaft 103; - Left distal femoral shaft 106 (left view, lower right landmark; third upper right view, right landmark; first lower right view, lower landmark); the left distal femoral shaft 106 can be identified at a predefined distance from the left proximal femoral shaft 104.

[0045] FIG. 4 illustrates the identification of a plurality of landmarks on portions of bones including at least a portion of the left and right femurs and the left and right tibias, the landmarks including: - Right lateral posterior condyle 107 (upper left view, upper landmark; upper right view, upper left landmark): -108 Right lateral posterior condyle (upper left view, lower landmark; upper right view, lower left landmark); -109 Right medial posterior condyle (left upper view, superior landmark; right upper view, superior landmark); -110 Right medial distal condyle (upper middle view, lower landmark; upper right view, lower right landmark); -111Left lateral posterior condyle (left lower view, upper landmark; right lower view, left upper landmark); -112 Left lateral posterior condyle (left lower view, inferior landmark; right lower view, right inferior landmark); -113 Left medial posterior condyle (lower middle view, upper landmark; lower right view, upper left landmark); -114Left medial distal condyle (lower middle view, inferior landmark; lower right view, left inferior landmark).

[0046] FIG. 5 illustrates the identification of a plurality of landmarks on a portion of a bone including the left and right tibia and at least a portion of the left and right tibia, the landmarks including: -115 Left tibia (upper right and lower right views); -116 Right tibia (upper left and lower left images).

[0047] FIG. 6 includes identification of a plurality of landmarks on a bony portion comprising at least a portion of a pelvis, the landmarks including: -Right acetabular notch 117 (left view, left landmark); -Left acetabular notch 118 (left view, right landmark); -central pubic tubercle 119 (left view, central landmark; upper right view, central landmark); -Right SIAS (anterior superior iliac spine) 120 (upper right view, right landmark; lower right view, upper landmark), - Left SIAS121 (upper right view, left landmark).

[0048] The landmarks 100-121 may be indicated in the medical imaging data in the on-screen view using indicators, which may have predefined shapes. The shapes may be, for example, circles, crosses, lines, etc. The indicators may have a fixed size, such as a cross or a dot, to indicate landmarks defined by specific points on the bone portion. Such points may be, for example, the center of rotation or specific points on the surface of the bone portion. The landmarks 107-121 are indicators with a fixed size. When a user clicks on one of the circular indicators, a cross appears in the center of the circle, facilitating precise positioning of the indicator. Thus, the indicators may have multiple shapes. Alternatively, the size of the indicator may be adjustable, as exemplified by the indicators identifying the landmarks 101-106. For example, the indicators identifying the femoral heads 101 and 102 may include circles with adjustable diameters. The outline of the circle can be used to identify the outline of the femoral head. At the same time, a cross in the center of the circle can identify the center of rotation of the femoral head. In other words, one indicator may identify multiple landmarks on one bone portion. Another example of an indicator with an adjustable size is the indicator for the femoral shaft 103-106. These landmarks may include dimensions and locations. In the illustrated example, the proximal femoral shaft is a landmark at the lesser trochanter, where the diameter of the femoral shaft can be indicated. The center of the indicator identifies the location within the femoral shaft, while the diameter of the indicator identifies the diameter of the femoral shaft at a particular location. Similarly, the distal femoral shaft 105, 106 can be indicated, with the location defined at a predefined distance from the proximal femoral shaft landmark 103, 104. The diameter of the circle can be set based on specific values ​​of medical imaging data. Such values ​​of medical imaging data may include, for example, gray values ​​identifying cortical bone or the boundary between hard and soft bone. Thus, landmarks may be identified based on specific shape characteristics of portions of bone. Additionally or alternatively, landmarks may be identified based on the condition, status, or quality of the bone, such as relatively soft and relatively dense bone.

[0049] Adjusting the position of the landmark indicators may be performed by user interaction / input. An anatomical model may be used to suggest the locations of landmarks 100-121. The user may adjust the location of the landmark indicators by moving the indicators relative to the bone portions on the screen using an input device, such as a mouse or keyboard. This is shown, for example, for landmark 101 in FIG. 3, for landmark 112 in FIG. 4, for landmark 115 in FIG. 115, and for landmark 117 in FIG. 6. Furthermore, the user may finally verify that landmarks 100-121 have been correctly identified as a safety measure and verification that all landmarks have been correctly identified by the analytical model.

[0050] As described above, bone portions may be segmented to generate subvolumes. Each subvolume may contain one or several portions of the bone. After segmentation, bone portions may be stored as separate entities or as separate subvolumes. The subvolumes may be manipulated separately. For example, a subvolume may be moved individually relative to another subvolume. Furthermore, one subvolume may be rendered in a different color compared to another subvolume. This makes it easier to distinguish bone portions and verify the accuracy of the segmentation. Verification of accuracy in total hip replacement surgery can be difficult due to arthritis. In such situations, it is common for the kaput (femoral head) to abut directly against the acetabulum. This makes it difficult for the user to determine whether the segmentation was successful. After segmentation, rendering the bone portions (femur and pelvis in this example) in different colors makes this determination easier.

[0051] 7 and 8 illustrate embodiments that include moving a portion of a first bone, exemplified by the pelvis, relative to a portion of a second bone, exemplified by the femur, based on at least one landmark 101-121 of a plurality of landmarks. These embodiments may be combined with the embodiments described above. The movement of bone portions may be performed after segmenting the first and second bone portions. Furthermore, multiple bone portions may be moved as a unit relative to one or other bone portions. In the examples of FIGS. 7 and 8, the femur and tibia have been moved relative to the pelvis. In FIGS. 7 and 8, the femur and tibia have been moved so that the left leg length of the patient (the patient for whom the implant planning is performed in this example) has a length equal to the patient's left leg length. This is also shown in the table below the left window of FIG. 7. Before moving the first bone portion relative to the second bone portion, the leg length difference (LLD) is −5 mm ( FIG. 7 ) and −4 mm ( FIG. 8 ). After the movement, the LLD is 0 mm. Leg length may be determined using landmarks 101-121. Leg length may be calculated using the acetabular notch 117, 118, one or more landmarks 107-117 at the knee (which may be used to determine the knee center), and landmarks 115, 116 at the ankle. In this case, the patient has a leg length discrepancy, meaning the leg in which the implant is placed should be longer. To this end, landmarks at the ankle 115, 116 and / or landmarks at the knee may be used. For example, the femur may be shifted so that the center of the left knee is in the same transverse plane as the right knee. As noted, the center of the knee may be determined by landmarks 107-117. Additionally or alternatively, portions of a bone, such as the right femur and right tibia, may be shifted as a unit such that landmark 115 at the left ankle is shifted to the transverse plane at landmark 116 at the right ankle. The result of moving the femur relative to the pelvis based on the landmarks, i.e., moving a first bone segment relative to a second bone segment, can be seen as black silhouettes 200, 300 in Figures 7 and 8. The silhouettes show the location of the femur used before moving the femur. Similarly, bone segments can be moved in the coronal and / or sagittal planes of the patient.

[0052] Moving one or more portions of bone relative to one or more portions of bone can be useful for planning the restoration of biomechanics, i.e., the desired outcome of the procedure, before the implant components 201, 202 are selected and the component positions are planned. Thus, the desired position of the post-operative anatomy can be planned before the surgery actually begins. This more closely tracks what will happen in surgery, where bone portions are first positioned in the desired location, and then the implant components 201, 202 are inserted to match that desired location. In Figures 7 and 8, the implant components are exemplified by a cup / shell 201 and femoral component 202 of a total hip replacement.

[0053] Alternatively or additionally, rather than moving a first bone portion relative to a second bone portion (or portions) based on landmarks, the bone portions may be moved using the contour of a segmented portion of the first bone and / or the contour of a segmented portion of the second bone. For example, this may be useful in a 3D-2D matching procedure in which a first set of medical imaging data of a patient is generated using a first medical imaging device such as a CT or MR scanner, and one or several sets of medical imaging data of the patient are generated using a second medical imaging device such as a fluoroscopy or X-ray scanner. Preferably, the first set of 3D medical imaging data can be generated preoperatively, and the second set of 3D or 2D medical imaging data can be generated intraoperatively. In some situations, the patient's position in the medical imaging data for generating the 3D medical imaging data preoperatively is not the same as the patient's position on the operating table. One such example is spinal surgery. The 3D medical imaging data can be generated preoperatively with a 3D medical imaging device such as a CT or MR scanner while the patient is lying supine. The positions of the vertebrae relative to each other when a patient is lying in the supine position are not the same as when the patient is lying in the prone or lateral position, and therefore the positions of the bone parts in the 3D medical imaging data generated preoperatively do not perfectly match the positions of the bone parts in the 2D / 3D medical imaging data generated intraoperatively.

[0054] According to the present invention, it is still possible to plan a surgery preoperatively. Alternatively or additionally, the surgery can be planned preoperatively. When planned preoperatively, the positions of the implant components are planned with respect to the 3D medical imaging data generated preoperatively. The positions of the bone portions in the 3D medical imaging data can be matched to the positions of the bone portions in the 2D / 3D medical imaging data generated intraoperatively. Thus, the bone portions in the 3D medical imaging data generated preoperatively can be moved. This can be based on the contours of the bone portions appearing in the 3D medical imaging data generated preoperatively and the 2D / 3D medical imaging data generated intraoperatively. If necessary, the positions of the implant components 201, 202 planned with respect to the 3D medical imaging data generated preoperatively can be tracked and / or adjusted if necessary. For example, in the case of spinal surgery, pedicle screws can be planned with respect to multiple portions of the bone (vertebrae). If the screws are placed in only one vertebra, the screws can be tracked. However, rods placed between the pedicle screws to fix the vertebrae to each other can be planned intraoperatively. Alternatively or additionally, the rods can be pre-operative and adjusted intra-operatively based on any movement of the bone portions.

[0055] In other embodiments, where bone segments are displaced, such as in knee surgery, the tibia moves relative to the femur before the appropriate implant components and their relative positions on the tibia and / or femur are determined. Landmarks for knee implant surgery generally correspond to landmarks for hip implant surgery. Additional landmarks may include, for example, the tibial tunnel. For lumbar spine surgery, the insertion point for a pedicle screw may be defined as the confluence of any of four lines: the facet joint, the mammillary process, the lateral aspect of the superior glenoid fossa, and / or the mid transverse process. Landmarks can be identified to define these lines. For thoracic spine surgery, the insertion point for a pedicle screw in the distal thoracic segment may be determined after identifying the intersection of the midpoint of the facet joint and the upper edge of the transverse process. The specific insertion point can be directly lateral and caudal to this intersection. Insertion points tend to be more cranial at more proximal thoracic spinal levels. The landmarks may include the lateral surface of the superior surface, the lateral surface of the inferior surface, and / or the facets and transverse process prominences. These and other landmarks can be used to select optimal implant components, such as pedicle screws with optimal length, diameter, thread type, and / or thread pitch.

[0056] Thus, according to embodiments, a first bone portion can be moved relative to a second bone portion. This can be done to obtain a desired position of the first landmark or first set of landmarks relative to the position of the second landmark or second set of landmarks. Furthermore, segmentation of the first bone portion and the second bone portion can be performed prior to selecting at least one of the first implant components from among the plurality of implant components. This facilitates selecting the implant component best suited to achieving the desired outcome of the surgery defined by moving the bone portions to the desired relative position.

[0057] In some embodiments, such as those described above, the information obtained from the first landmark and the second landmark may be obtained after segmenting the first bone portion and the second bone portion and moving the first bone portion relative to the second bone portion. For example, the information obtained from the first landmark and the second landmark may include obtaining at least one dimension, where the at least one dimension includes at least one of a diameter, a length, a width, and an angle. In one exemplary embodiment, as shown in FIGS. 7 and 8 , the length may be a desired leg length, a desired offset distance (length), a femoral canal length, a femoral canal width, an acetabular diameter, an angle of the femoral canal relative to the transverse plane, etc. The leg length may be determined as described above by locating the left and right tibial landmarks 115, 116 in the same transverse plane. Alternatively or additionally, the length of the right leg (the healthy side on the left in FIGS. 7 and 8 ) may be determined using the landmarks on the healthy side. The length of the left leg (the planned treatment side on the right in FIGS. 7 and 8 ) may be determined using the corresponding landmarks on the treatment side. If there is a mismatch, the treating bone segment can be moved to achieve the desired leg length. In FIG. 7, the treating leg is extended, as seen in silhouette 201. Additionally, the length and / or angle from the landmarks 103, 104 at the proximal femoral shaft to the femoral heads 101, 102 can be determined. The femoral shaft diameter at the landmarks 101, 104 at the proximal femoral shaft and / or the landmarks 105, 105 at the distal femoral shaft can be determined. These are all values ​​that can be used to select optimal femoral components 201, 202 that fit the relative positions of the first and second bone segments, as shown in FIG. 7. Additionally, the femoral head landmarks can be used to select the appropriate cup / shell 201. For example, the femoral head diameter can be used to select the appropriate cup / shell 201 to fit the desired anatomy. Thus, selection of optimal implant components 201, 202 and relative positions is facilitated if the dimensions are specified after the bone portions have been segmented and after the bone portions have been moved to the desired relative positions.

[0058] As will become clear from the above-described embodiment, at least one implant component 201, 202 can be selected from a plurality of implant components in the database based on information acquired from the first landmark and the second landmarks 100-121. Furthermore, another implant component 201, 202, such as a second implant component, can be selected based on information acquired from the first landmark and the second landmark. The landmarks used for the selection can be landmarks of a portion of the first bone or a portion of the second bone. Alternatively or additionally, the first landmark can be a landmark of the portion of the first bone, and the second landmark can be a landmark of the portion of the second bone. Furthermore, at least one third landmark of the portion of the first bone and the portion of the second bone can be identified, and information based on the first landmark, the second landmark, and the third landmark can be acquired, as described in the embodiment shown in FIGS. 7 and 8.

[0059] In some embodiments, each implant component available for planning can be stored in the database 16 along with implant information. The implant information can include at least one of size, diameter, length, width, angle, material type, surface treatment, etc.

[0060] According to embodiments such as those described above, selecting at least one of the first and second implant components can include selecting an implant component having implant information that best matches information obtained from the first and second landmarks. Thus, diameter, length, width, etc., can be obtained from landmarks 100-121, and these dimensions can be used to search for an implant component having dimensions that most closely match the dimensions identified based on the landmarks. This means that the person performing the planning does not need to try to determine which implant component will best fit, but rather can focus on achieving the desired outcome of the surgery by moving bone segments relative to each other. Then, after moving the bone segments, the optimal component is determined based on dimensions obtained from the landmarks. User input can be an indication of the desired location of the bone segments post-operatively, which can determine the location of the landmarks. These locations of the landmarks can be used to determine dimensions, which can then be used to select the optimal implant component.

[0061] Some embodiments include a computer-readable storage medium 12 having program instructions stored therein that, when executed by the processor 11, perform the methods described above.

[0062] As will become apparent, the features and attributes of the specific embodiments disclosed above can be combined in various ways to form additional embodiments, all of which fall within the scope of the present disclosure.

[0063] Conditional terms such as "can," "could," "might," "may," "for example," and the like, among others, as otherwise specified or understood within the context in which they are used, are generally intended to convey that certain embodiments include particular features, elements, and / or conditions, while other embodiments do not include those particular features, elements, and / or conditions. Thus, such conditional terms are generally not intended to imply that features, elements, and / or conditions are in any way required for one or more embodiments, or that one or more embodiments necessarily include logic for determining, with or without author input or prompts, whether or not those features, elements, and / or conditions are included in or implemented in any particular embodiment.

[0064] Any process descriptions, elements, or blocks in the flow diagrams described herein and / or shown in the accompanying figures should be understood as potentially representing modules, segments, or portions of code that comprise one or more executable instructions for implementing specific logical functions or steps in the process. As will be appreciated by those skilled in the art, alternative implementations in which elements or functions may be omitted or performed in a different order than that shown or discussed, including substantially simultaneously or in reverse order, depending on the functionality involved, are included within the scope of the embodiments described herein.

[0065] It should be emphasized that many variations and modifications may be made to the above-described embodiments, and that the elements are to be understood as being among the permissible examples. All such variations and modifications are intended to be included herein within the scope of this disclosure and protected by the following claims.

[0066] The present invention has been described above with reference to specific embodiments. However, other embodiments than those described above are equally possible within the scope of the present invention. Different method steps than those described may be provided within the scope of the present invention. Different features and steps of the present invention may be combined in combinations other than those described. The scope of the present invention is limited only by the appended claims.

Claims

1. retrieving medical imaging data including a portion of a first bone and a portion of a second bone, wherein the portion of the first bone and the portion of the second bone are not segmented; identifying a plurality of anatomical landmarks within the medical imaging data, the anatomical landmark including at least one first anatomical landmark in the portion of the first bone and at least one second anatomical landmark in the portion of the second bone; 1. A computer-implemented method for planning an orthopedic surgical procedure, comprising: segmenting the portion of the first bone and the portion of the second bone such that the portion of the first bone is movable relative to the portion of the second bone; moving the portion of the first bone relative to the portion of the second bone to obtain a desired position of the first anatomical landmark relative to a position of the second anatomical landmark; selecting at least one of a first implant component and a second implant component from among a plurality of implant components in a database, the selecting being based on information obtained from the first anatomical landmark and the second anatomical landmark; fitting at least one of the first implant component and the second implant component into a space at least partially defined by the first anatomical landmark and the second anatomical landmark; A method characterized by:

2. The method described in claim 1, wherein the moving is based on at least one anatomical landmark among the plurality of anatomical landmarks, or based on the contour of the segmented portion of the first bone and / or the contour of the segmented portion of the second bone.

3. The method of claim 1 or 2, wherein the first anatomical landmark and the second anatomical landmark are anatomical landmarks of the portion of the first bone or the portion of the second bone.

4. 3. The method of claim 1, wherein the first anatomical landmark is an anatomical landmark of the portion of the first bone and the second anatomical landmark is an anatomical landmark of the portion of the second bone.

5. 5. The method of claim 1, further comprising: identifying at least one third anatomical landmark of the portion of the first bone and the portion of the second bone; and obtaining the information based on the first anatomical landmark, the second anatomical landmark, and the third anatomical landmark.

6. 6. The method of claim 1, wherein obtaining information from the first anatomical landmark and the second anatomical landmark comprises obtaining at least one dimension, and the at least one dimension comprises at least one of a diameter, a length, a width, and an angle.

7. 7. The method of any one of claims 1 to 6, comprising storing each implant component in the database together with implant information, which may optionally include at least one of diameter, length, width, and angle.

8. 8. The method of claim 7, wherein selecting at least one of the first implant component and the second implant component comprises selecting an implant component having implant information that best matches the information obtained from the first anatomical landmark and the second anatomical landmark.

9. A computer readable storage medium having program instructions stored therein, the program instructions, when executed by a processor, performing the method of any one of claims 1 to 8.

10. 1. An apparatus for planning an orthopedic surgical procedure, comprising: accessing a memory to retrieve medical imaging data including a portion of a first bone and a portion of a second bone, wherein the portion of the first bone and the portion of the second bone are not segmented; using a processing unit to identify within the medical imaging data a plurality of anatomical landmarks, the anatomical landmark including at least one first anatomical landmark in the portion of the first bone and at least one second anatomical landmark in the portion of the second bone; segmenting, using the processing unit, the portion of the first bone and the portion of the second bone such that the portion of the first bone is movable relative to the portion of the second bone; using the processing unit to move the portion of the first bone relative to the portion of the second bone to obtain a desired position of the first anatomical landmark relative to a position of the second anatomical landmark; using the processing unit to select at least one of a first implant component and a second implant component from among a plurality of implant components in a database based on information obtained from the first anatomical landmark and the second anatomical landmark after the portion of the first bone has moved relative to the portion of the second bone; using the processing unit to fit at least one of the first implant component and the second implant component to a space at least partially defined by the first anatomical landmark and the second anatomical landmark; 1. An apparatus configured to:

11. 11. The apparatus of claim 10, wherein the processing unit is configured such that the moving is performed based on at least one anatomical landmark of the plurality of anatomical landmarks, or based on a contour of the segmented portion of the first bone and / or a contour of the segmented portion of the second bone.

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