System and method for determining image alignment during surgery

Abstract

To provide guidance and feedback which makes early detection of relative movement between a patient's position and / or anatomical features associated with the patient and an imaging device, and simultaneously corrects difference.SOLUTION: Disclosed embodiments determine, at an early stage, suitability of an intraoperative image for further intraoperative surgical analysis. The determination of suitability may be made by using a first angle (such as a first obturator angle) based on at least three pelvic feature points in a preoperative image and a corresponding second angle (such as a corresponding second obturator angle) based on at least three corresponding pelvic feature points in an intraoperative image, and by comparing the first angle and the corresponding second angle to determine intraoperative image suitability. The first intra-operative image is indicated as suitable for further intraoperative analysis when an absolute value of a difference between the first angle and the corresponding second angle does not exceed a threshold. When the intraoperative image is determined as unsuitable for further intraoperative analysis, an indication of a movement direction for a fluoroscopy camera used to capture the intraoperative image is provided.SELECTED DRAWING: Figure 25

Description

Technical Field

[0001] This application relates to the analysis of medical images, and more particularly, to facilitating intraoperative medical decision-making support and guidance.

Background Art

[0002] During a medical procedure such as an orthopedic surgery, preoperative images may be compared with intraoperative images taken at various points during the performance of the medical procedure. The comparison between the preoperative and intraoperative images can assist medical practitioners in performing the medical procedure, such as in the guided selection, placement, and positioning of surgical implants or other components.

[0003] However, subtle intraoperative errors can occur due to the relative movement of the patient's position and / or the patient's relevant anatomical features between the imaging device and the patient during surgery. For example, the orientation of the imaging device in preoperative images relative to an anatomical feature of interest may differ from the corresponding relative orientation in intraoperative images, which can lead to erroneous intraoperative decision-making. Such intraoperative errors, which may not be detected by conventional systems, can have a significant impact on the final surgical outcome. For example, in orthopedic procedures such as total hip arthroplasty (THA), the positioning of functional components may be affected, which can lead to postoperative complications such as leg length discrepancies, collisions, and limited range of motion. These postoperative complications can ultimately lead to premature component failure, component dislocation, affect patient mobility, cause pain and / or discomfort, increase recovery time, and / or require additional surgery. Even if the possibility of intraoperative errors caused by patient movement relative to the imaging device is detected during the medical procedure, such detection typically does not occur until later in the medical procedure. Delayed detection can lead to the repetition of significant parts of the surgical process, resulting in longer surgery times, decreased trust in the system among healthcare professionals, increased procedure costs, and a greater possibility of other unrelated errors due to factors such as healthcare professional fatigue. Furthermore, even when detection occurs, conventional systems merely report the discrepancy without providing further guidance. [Overview of the Initiative] [Problems that the invention aims to solve]

[0004] The disclosed embodiments facilitate the early detection of relative movement between the patient's position and / or relevant anatomical features of the patient and the imaging device, while simultaneously providing guidance and feedback to correct errors. [Means for solving the problem]

[0005] The disclosed embodiments relate to a method for intraoperatively determining the suitability of an intraoperative image for further intraoperative surgical analysis. The method may include: determining a first angle based on at least three pelvic feature points in a preoperative image; determining a corresponding second angle based on at least three corresponding pelvic feature points in the first intraoperative image; determining the suitability of the intraoperative image for further intraoperative surgical analysis based on a comparison of the first angle and the corresponding second angle; and, in response to a determination that the first intraoperative image is not suitable for intraoperative surgical analysis, providing a direction of movement instruction for a fluoroscopy camera used to acquire the first intraoperative image.

[0006] In another embodiment, the apparatus may include a communication interface for receiving a first intraoperative image captured by a fluoroscopy camera, a memory capable of storing a preoperative image and the first intraoperative image, and a processor coupled to the memory and the communication interface. In some embodiments, the processor may be configured to determine a first angle based on at least three pelvic feature points in the preoperative image, determine a corresponding second angle based on at least three corresponding pelvic feature points in the first intraoperative image, determine the suitability of the intraoperative image for further intraoperative surgical analysis based on a comparison of the first angle and the corresponding second angle, and, in response to a determination that the first intraoperative image is not suitable for intraoperative surgical analysis, provide instructions for the direction of movement for the fluoroscopy camera used to acquire the first intraoperative image.

[0007] The disclosed embodiments also relate to means for determining a first angle based on at least three pelvic feature points in a preoperative image; means for determining a corresponding second angle based on at least three corresponding pelvic feature points in a first intraoperative image; means for determining the suitability of an intraoperative image for further intraoperative surgical analysis based on a comparison of the first angle and the corresponding second angle; and means for providing direction of movement instructions for a fluoroscopy means used to acquire a first intraoperative image in response to a determination that the first intraoperative image is not suitable for intraoperative surgical analysis.

[0008] In a further embodiment, a non-temporary computer-readable medium may include instructions, the processor configured to cause the instructions to: determine a first angle based on at least three pelvic feature points in a preoperative image; determine a corresponding second angle based on at least three corresponding pelvic feature points in a first intraoperative image; determine the suitability of an intraoperative image for further intraoperative surgical analysis based on a comparison of the first angle and the corresponding second angle; and, in response to a determination that the first intraoperative image is not suitable for intraoperative surgical analysis, provide instructions for the direction of movement of a fluoroscopy camera used to acquire the first intraoperative image. [Brief explanation of the drawing]

[0009] [Figure 1A] This is a schematic image of a frontal view of the pelvic girdle of a patient exhibiting various anatomical features of the pelvis. [Figure 1B] Various illustrative pelvic reference lines, or pelvic axes, are shown, which can be used to establish basic lines and facilitate hip arthroplasty. [Figure 2] This is a schematic image illustrating a template image for a hip joint prosthesis. [Figure 3] This shows the representation of a graphical user interface (GUI) menu presented to the user for intraoperative analysis. [Figure 4] This is an exemplary preoperative fluoroscopic image of a portion of the pelvic girdle of a patient exhibiting several anatomical features. [Figure 5] An exemplary displayed fluoroscopic image showing a circle drawn around the femoral head according to a specific disclosed embodiment is shown. [Figure 6] An exemplary displayed fluoroscopic image is shown illustrating a digital prosthesis template aligned with the femoral axis according to a specific disclosed embodiment. [Figure 7] An exemplary displayed fluorescence image is shown illustrating pelvic reference lines drawn between anatomical features according to a specific disclosed embodiment. [Figure 8] An exemplary displayed fluoroscopic image illustrating the marking of a pelvic teardrop-shaped radiographic feature according to a specific disclosed embodiment is shown. [Figure 9] An exemplary displayed fluorescence image showing markings of the closure hole angle according to a specific disclosed embodiment is shown. [Figure 10] This shows a representation of an alternative GUI menu presented to the user for intraoperative selection of implant size and implant components to facilitate intraoperative analysis and modeling. [Figure 11] A GUI of intraoperative images taken after hip reduction according to a specific disclosed embodiment is shown. [Figure 12A] A preoperative image is shown showing the marking of the first and second occlusion angles in an intraoperative image according to a specific disclosed embodiment. [Figure 12B] A preoperative image is shown showing the marking of the first and second occlusion angles in an intraoperative image according to a specific disclosed embodiment. [Figure 13] A flowchart is provided illustrating a method for determining the suitability of intraoperative images for further intraoperative surgical analysis. [Figure 14] This is an example GUI for displaying intraoperative fluoroscopic images of a portion of a patient's pelvic girdle. [Figure 15] An exemplary GUI is shown that displays an intraoperative fluoroscopic image showing a circle drawn around the acetabular component, according to a specific disclosed embodiment. [Figure 16] An exemplary GUI is shown displaying an intraoperative fluoroscopic image showing markings on the shoulder portion of a hip joint prosthesis implant, according to a specific disclosed embodiment. [Figure 17] An exemplary GUI is shown for displaying an intraoperative fluoroscopic image having pelvic reference lines drawn between anatomical features, according to a specific disclosed embodiment. [Figure 18A] The diagram shows an example GUI for displaying intraoperative fluoroscopic images with markings indicating pelvic teardrop-shaped radiographic features. [Figure 18B]Another figure of an exemplary GUI is shown that displays a preoperative image showing pelvic teardrop radiographic features alongside an intraoperative fluoroscopic image depicting markings of pelvic teardrop radiographic features. [Figure 19] An exemplary GUI is shown that demonstrates the alignment of a digital acetabular component template with an acetabular cup. [Figure 20] An exemplary GUI is shown that demonstrates the alignment of a digital femoral component template with an acetabular cup. [Figure 21] A section or cutout of an intraoperative image overlaid on a preoperative image is shown to align the femur in two images. [Figure 22] A GUI is shown that can be used to confirm detected features and reference lines in preoperative and intraoperative images before determining various biomechanical parameters. [Figure 23] A GUI is shown that includes an intraoperative analysis chart summarizing changes in leg length and offset corresponding to various femoral stem selections. [Figure 24A] A flowchart is shown that illustrates a method for performing intraoperative analysis on a suitable intraoperative image. [Figure 24B] A flowchart is shown that illustrates a method for performing intraoperative analysis on a suitable intraoperative image. [Figure 25] An exemplary system for intraoperative analysis is depicted according to a particular disclosed embodiment. [Figure 26] An exemplary computing subsystem for facilitating preoperative and intraoperative analysis is depicted according to a particular disclosed embodiment.

[0010] Identical labels and / or reference numbers in different figures refer to the same element. Different instances of a common element type may be indicated by appending the label of the common element with an additional label. For example, different instances of the femoral neck FN 150 may be labeled FN-R 150-R (for the right femoral neck) and FN-L 150-L (for the left femoral neck). Unless otherwise specified, actions applicable to an instance of a common element (e.g., right "R") may also be applicable to another instance of the common element (e.g., left "L"). For example, the figure shows the right side of the hip joint to illustrate the technique used herein, and it is understood that this technique is also applicable to the left side of the hip joint (with appropriate modifications).

[0011] References may also be made to common elements without additional labels (e.g., FN 150), which can refer to the generic term and / or any instance of the element.

[0012] In some cases, additional numerical suffixes (e.g., 1, 2...N) may be added to labels / reference numbers used for common elements. For example, when comparing a first image with a second image, an additional suffix (e.g., "-1" or "-2") may be added to distinguish the corresponding element in the second image ("-2") from the element in the first image ("-1"). [Modes for carrying out the invention]

[0013] The disclosed embodiments facilitate intraoperative image analysis and provide support for decision-making during medical procedures such as orthopedic surgery. In some embodiments, the disclosed methods may be applied during orthopedic hip surgery, including total hip arthroplasty (THA). The term arthroplasty refers to a surgical procedure to restore joint function. In some cases, prostheses or implants may be used during arthroplasty. In THA, both the acetabulum and femoral head may be replaced, while in hip hemi-arthroplasty (HHA), only the femoral head is typically replaced. Although arthroplasty is used as an example to illustrate the embodiments herein, the disclosed techniques and systems may also be applied to other medical procedures, including knee arthroscopy and wrist arthroscopy. Furthermore, although human subjects are used in the description herein, the disclosed techniques and systems may also be applied to non-human subjects with appropriate modifications. As used herein, the term arthroplasty includes a variety of surgical approaches, including posterior approaches, direct lateral approaches, and direct anterior approaches. In the anterior approach, the surgery is performed through an incision in the front of the hip joint, while in the posterior approach, the surgery is performed using an incision in the back of the hip joint. In the direct lateral approach, an incision is made on the side of the hip joint.

[0014] During arthroplasty, fluoroscopic evaluation of the patient is often performed using anterior-posterior (AP) images, which are taken from front to back. Fluorescein images can be acquired, for example, using a C-arm imaging device, where a C-shaped arm is used to couple a radiation source (e.g., X-rays) to a radiation image detector. The C-arm can also be coupled to a display, which can facilitate real-time viewing of high-resolution X-ray images. Medical professionals can view the images, monitor the progress, and take appropriate action based on the images. The C-arm can be moved and repositioned during surgery to focus on different regions of interest and / or acquire new images of the current region of interest.

[0015] During surgery, there may be relative movement between the patient (and / or the anatomical feature of the patient of interest) and the fluoroscopy source. For example, during total hip arthroplasty (THA) using a posterior approach, pelvic movement of the patient may occur. Therefore, relevant sections of intraoperative images (e.g., following pelvic movement) may not correspond in some respects when compared to preoperative images used for intraoperative analysis. Differences between preoperative and intraoperative images may be subtle and not immediately apparent to the surgeon and / or other healthcare professionals. For example, the relative orientation of the imaging device in a preoperative image may differ from the corresponding relative orientation in an intraoperative image, which can lead to erroneous intraoperative decision-making. The term relative orientation is used to refer to the position and orientation of the imaging source relative to the anatomical feature of interest. Orientation may be described using, for example, positional coordinates (x, y, z) and angular coordinates (φ, θ, ψ) relative to a reference frame (which may describe roll, pitch, and yaw, respectively). In some cases, the reference frame may be centered on the anatomical feature of interest.

[0016] As outlined earlier, if relevant differences (e.g., due to relative pelvic movement) are not detected between preoperative and intraoperative images, intraoperative analysis based on preoperative and intraoperative images may be inaccurate, potentially negatively impacting postoperative outcomes.

[0017] On the other hand, if relevant differences between preoperative and intraoperative images are detected in the later stages of the procedure after several intermediate steps have occurred, conventionally, (a) the C-arm is repositioned, the intraoperative image is recaptured, (b) the intermediate steps are repeated, and (c) the intraoperative analysis is performed again. Steps (a) to (c) are repeated until the intraoperative image is deemed acceptable, which may involve several repetitions. As outlined above, slow detection and repeated procedures can increase the length of the procedure, increase the possibility of errors, and increase costs. Furthermore, the resulting complexity leads to a decrease in the adoption of computer-aided tools, even when the tool may provide better results overall.

[0018] Accordingly, some disclosed embodiments facilitate early intraoperative image analysis of the surgical process, thereby facilitating immediate determination of intraoperative image inconsistencies. In some embodiments, early determination of any intraoperative image inconsistencies may occur before determination of biomechanical parameters and / or further analysis based on preoperative and intraoperative images. Some disclosed embodiments also provide decision-making support and guidance to healthcare professionals, including those related to C-arm positioning / repositioning. In some embodiments, information related to positional inconsistencies identified in intraoperative images may be provided to the imaging device and / or a computer or control system associated with the imaging device.

[0019] Figure 1A is a schematic frontal view of the pelvic girdle 100 of a patient exhibiting various pelvic anatomical features. PG 100 may also be referred to as the pelvis or hip joint. Pelvic anatomical features may also be referred to herein as pelvic feature points, pelvic landmarks, or anatomical landmarks. In some embodiments, anatomical features may be identified in a first image (e.g., a preoperative image) and a second image (e.g., an intraoperative image). Two or more feature points may also be concatenated to form lines (e.g., reference lines or axes), or curves, or other geometric shapes (e.g., depicting several anatomical features), and / or other descriptors that may be used during image registration. Thus, the first and second images may be aligned using image registration techniques based on the positions of feature points and / or other descriptors. Registration may involve one or more of scaling, rotation, and translation. In some embodiments, feature point identification may be automated. In some embodiments, feature point identification may be computer-assisted. Furthermore, users may be provided with the option to review and / or adjust the position of feature points in the image before registration.

[0020] Figure 1A shows, for example, the obturator foramen (OF) 135 (e.g., the right obturator foramen OF-R 135-R and the left obturator foramen OF-L 135-L) and the pubic symphysis PS 130. For explanatory purposes, the lower angle of PS 130 is referred to as the inferior PS, and the upper angle as the superior PS. OF 135 and PS 130 in two separate images may serve as reference points and / or descriptors for image comparison and / or image registration. Various other exemplary anatomical features are also shown in Figure 1, which may be used as pelvic reference points and / or descriptors. The features outlined in Figure 1 are merely examples, and other pelvic features may also be used to implement one or more of the techniques disclosed herein. In some cases, only right-sided or left-sided feature points are shown in Figure 1 for the sake of simplicity and ease of explanation.

[0021] Figure 1A also shows the femur F 155 (right femur FR 155-R and left femur FL 150-L) together with (a) femoral head FH 115 (right femoral head FH-R 115-R and left femoral head FH-L 115-L), (b) femoral neck FN 150 (right femoral neck FN-R 150-R and left femoral neck FN-L 150-L), (c) greater trochanter GT 120 (right greater trochanter GT-R 120-R and left greater trochanter GT-L 120-L), and (d) lesser trochanter LT 145 (right lesser trochanter LT-R 145-R and left lesser trochanter LT-L 145-L, respectively).

[0022] The left femoral head FH-L 115-L engages with the left acetabulum of the pelvic girdle PG 100, while the right femoral head FH-R 115-R engages with the right acetabulum of PG 100. Also shown in Figure 1 are the ischial tuberosities IT 140 (right ischial tuberosity IT-R 140-R and left ischial tuberosity IT-L 140-L) at the base of the ischium, the "teardrop shape" TD 125 (right teardrop shape TD-R 125-R and left teardrop shape TD 125-L), which is a pathological feature associated with bony prominences along the floor of the acetabular fossa, and the anterior superior iliac spine ASIS 110 (right ASIS ASIS-R 110-R and left ASIS ASIS-L 110-L) and anterior inferior iliac spine AIIS 105 (right AIIS AIIS-R 105R and left AIIS AIIS-L 105-L).

[0023] Similarly, other suitable features may be used when the techniques described herein are applied to other parts of anatomical structures. For example, the carpal bones may serve as a static base in images for radial fixation and other wrist-related procedures. In general, any relatively static anatomical feature associated with a patient may be used as a static base (as opposed to moving features that may be positioned differently in two or more images).

[0024] In some cases, a longer static base may be chosen over a shorter static base, as a longer base can improve the accuracy of the image overlay and facilitate more precise image scaling. In addition, a static base closer to the region of anatomical interest is preferable to reduce the risk of parallax-induced errors. For example, if the region of interest is the hip joint, the ideal static base would be near the hip joint.

[0025] As shown in Figure 1B, in some procedures involving hip joint surgery, a baseline can be established using, for example, various pelvic reference lines or pelvic axes. For example, as shown in Figure 1B, (i) the first pelvic baseline 165 may be a resting baseline starting from the inferior pubic symphysis PS 130, contacting or intersecting at least a portion of the obturator foramen OF (e.g., OF-R 135-R), and extending to the “teardrop-shaped” TD (e.g., TD-R 125-R), or (ii) the second pelvic baseline may be a resting baseline 160 starting from the inferior pubic symphysis PS 130, contacting or intersecting at least a portion of the obturator foramen OF (e.g., OF-R 135-R), and extending to the anterior inferior iliac spine AIIS 110 (e.g., ASIS-R 110-R), or (iii) the third pelvic baseline may be a resting baseline starting from the inferior pubic symphysis PS 130, and extending to the anterior superior iliac spine ASIS 105 (e.g., ASIS-R A stationary baseline 170 may extend to 105-L). Generally, a stationary baseline or axis can be established using any two feature points, such as two identifiable anatomical features or two locations on a single anatomical feature. In some embodiments, curves, shapes, and / or other nonlinear stationary baselines may be used. For example, they may be used to identify additional anatomical feature points and establish a nonlinear base.

[0026] In some embodiments, one or more additional identifiable anatomical feature points or landmarks (or sets of landmarks) located away from the baseline may be identified. These additional landmarks may also be stationary and may be located on or near the region of anatomical interest. In some cases, additional landmarks may be used to analyze the accuracy of the image overlay. For example, the lower portion of the ischial tuberosity IT 140 may be identified as an additional landmark. This landmark may be used in conjunction with the stationary base or baseline to detect any differences or errors in the pelvic anatomical structure or overlay, which allows a physician to verify or have greater confidence in the output of the system.

[0027] In some embodiments described herein, angular information between two reference lines may be used to determine the suitability of the intraoperative image for comparison with and / or overlay to a preoperative image, and / or the suitability of the intraoperative image for intraoperative analysis (e.g., related to the estimation of various anatomical and biomechanical parameters during surgery). Intraoperative analysis may be used to select a trial prosthesis, position and orient the trial prosthesis, and determine anatomical and biomechanical parameters based on the placement (position and / or orientation) of the selected trial prosthesis.

[0028] The term “trial hip prosthesis” is used herein to designate a first medical device for inserting an initial implant, selected by a surgeon, into a surgical site in the patient’s hip joint, which may be on either the right or left side. In some techniques, the trial prosthesis may be selected based on an initial digital template in a manner similar to the procedure described in relation to Figure 2 below.

[0029] Figure 2 is a schematic image showing a hip prosthesis 200. The hip prosthesis 200 includes a femoral prosthesis component 220, which further includes a support 280 having a femoral stem 240, a fastener recess 260, and a pivot axis 290, and an acetabular component 230 supported by the support 280. The dashed line 285 indicates the longitudinal axis of the support 280, as will be further described herein, and the dashed line 245 indicates the longitudinal main axis of the hip prosthesis 200 relative to the longitudinal axis of the femur F 155 (e.g., FL 150-L, not shown in Figure 2). The rotation centers 283 of the femoral component 220 relative to the support 280 and the rotation centers 233 of the acetabular component 230 are also shown.

[0030] Using the rotation centers 233 and 283 (related to the hip prosthesis template image 200), anatomical and / or biomechanical parameters such as the offset parameter and / or leg length difference parameter can be determined. The determination of these and other parameters is based on U.S. Provisional Applications 61 / 944,520 filed on 25 February 2014, 61 / 948,534 filed on 5 March 2014, 61 / 980,659 filed on 17 April 2014, 62 / 016,483 filed on 24 June 2014, 62 / 051,238 filed on 16 September 2014, and 17 November 2014. This is discussed in U.S. Provisional Application No. 62 / 080,953, and in U.S. Patent Application No. 14 / 974,225 (currently U.S. Patent No. 10,433,914), filed on 18 December 2015, which is a continuation-in-part application of U.S. Patent Application No. 14 / 630,300 (currently U.S. Patent No. 10,758,198), filed on 24 February 2015, claiming priority to U.S. Provisional Application No. 62 / 105,183, filed on 19 January 2015. All of the above applications are incorporated herein by reference in their entirety.

[0031] In some embodiments, the digital template image of the hip prosthesis 200 may be generated based on user-selected or input parameters such as size and type. The digital template image of the hip prosthesis 200 may be overlaid on a preoperative image and / or a suitable intraoperative image and appropriately aligned. In some embodiments, the preoperative image and / or intraoperative image may then be analyzed intraoperatively to determine various anatomical and / or biomechanical parameters before the final implantation of the prosthesis. In the following description, the labels and reference letters in Figure 2 are used to refer to components of the hip prosthesis 200 (whether in the form of a digital template, trial prosthesis, or final prosthesis).

[0032] Figure 3 shows an exemplary graphical user interface (GUI) 300 presented to the user for intraoperative analysis.

[0033] As shown in Figure 3, the GUI 300 provides an operator selection 302 for the user to select the operating side (left or right). In some embodiments, the selection of the operating side (left or right) may automatically load the appropriate (left or right) digital image template.

[0034] A preoperative menu 310, which can be invoked preoperatively and / or intraoperatively, can facilitate the retrieval of preoperative plans (e.g., when invoked preoperatively) and / or stored preoperative images, templates, and / or other analyses (e.g., when invoked intraoperatively). For example, selecting Create 315 to create a preoperative hip template can facilitate the creation of a preoperative hip template (e.g., using a hip prosthesis template image 200), and associate and / or align the hip prosthesis template image 200 with preoperative images. In some embodiments, selecting Add X-rays 318 can facilitate the import, storage, and / or addition of preoperative images and / or preoperative templates and / or other preoperative analyses associated with the patient.

[0035] In some embodiments, the GUI 300 may be part of a computer program running on a local computer or computer subsystem that has locally stored images (e.g., in close proximity to where the medical procedure is being performed—the same room or a nearby room). In other situations, some parts of the computer program associated with the GUI 300 may run on a local remote server (e.g., within the medical facility where the medical procedure is being performed) or a remote server (e.g., a private cloud). In some embodiments, a hybrid approach may be used, where one or more tasks are performed locally (e.g., on a local computer) during the medical procedure, while other tasks (pre- and / or post-operative) may be performed remotely, such as synchronization between the local and remote computers that occurs before the start of the medical procedure (e.g., exchange of stored images and / or other medical records). A hybrid system in which intraoperative functions are local may prevent problems arising from temporary networks and / or other external sources.

[0036] An intraoperative menu 320 that can be invoked during surgery may include trial length and offset modification 322, contralateral overlay 324, cup check 326, and selection of surgical approach 328 (e.g., anterior, posterior, lateral, etc.). Figure 3 shows that the posterior surgical approach 328 has been selected. In some embodiments, the program components trial length and offset modification 322, contralateral overlay 324, cup check 326, etc. may provide an analysis adjusted to the selected surgical approach 328.

[0037] In some embodiments, selecting trial length and offset changes 322 can invoke a program function to compare preoperative or intraoperative X-ray images of the patient's anatomical structure with initial intraoperative X-ray images of the trial prosthesis. In some embodiments, selecting trial length and offset changes 322 can also invoke a program function to select a trial (or final) prosthesis using a hip prosthesis template image 200 (Figure 2) and to determine the ease of offset and / or leg length modification to help in surgical decision-making regarding the guide.

[0038] In some embodiments, by selecting the contralateral overlay 324, programmatic functions may be invoked to compare contralateral preoperative radiographic images of the patient's anatomical structure with initial intraoperative radiographic images of the trial prosthesis. For example, in some situations, the ipsilateral hip joint may be degenerated (e.g., due to disease and / or injury), and therefore, a contralateral hip joint image may be used instead of an ipsilateral hip joint image. Thus, in the above example, the contralateral images may be inverted and superimposed to determine the alignment of bones and implants between the images, perform feature matching between the images, and / or analyze the offset, length difference, and orientation of at least one of the bones and implants in the images. In other situations, the contralateral overlay 324 may invoke functions to depict the degree of any differences and / or changes in the pelvic anatomical structure (e.g., between the ipsilateral and contralateral hip joints). Thus, the contralateral overlay may provide additional surgical decision support and verification.

[0039] In some embodiments, selecting CupCheck 326 may invoke a programmed function for performing anterior tilt and abduction analysis related to the acetabular component selected by the surgeon (e.g., trial acetabular cup, standard acetabular cup, reamer, etc.). In some embodiments, CupCheck 326 may invoke a programmed function for determining biomechanical parameters such as anterior tilt, abduction angle, or inclination of the reconstructed AP pelvis.

[0040] Hip anteroposterior tilt refers to the inward rotation of the femur. Anterior tilt can be calculated based on the rotation of the acetabular component. For example, anterior tilt can be understood as the sagittal plane angle between the acetabular axis and the patient's (assumed) longitudinal axis. The acetabular axis is a line passing through the center of the socket (or acetabular component) and perpendicular to the plane of the socket surface (or the surface of the acetabular component, e.g., the acetabular component surface 232 in Figure 2). In some embodiments, cup check 326 may invoke a program function to determine anterior tilt on the radiographic image based on identified features in the intraoperative image.

[0041] Hip abduction refers to the movement of the hip joint when the leg moves away from the longitudinal direction of the body. The abduction angle, or inclination, can be understood as the angle between the acetabular axis (e.g., parallel to the floor) and the horizontal plane. CupCheck 326 may invoke a programmed function to determine the abduction angle on radiographic images based on identified features in intraoperative images.

[0042] The use of digital template technology can assist in surgical decision-making and significantly improve medical outcomes. However, as outlined earlier, changes in the orientation of the imaging source relative to anatomical features can affect the analysis. Therefore, determining suitable images before performing comprehensive trial and / or analysis, overlay analysis, etc., allows for a timely determination of the image usefulness of the analysis tool, thereby reducing medical procedure time. In some embodiments, the disclosed technology may be performed first to determine the suitability of intraoperative images acquired for intraoperative analysis (e.g., performed when selecting a surgical approach 328 using selected preoperative images and triggered by the acquisition of new intraoperative images). In some embodiments, the disclosed technology may be performed before performing intraoperative analysis by trial length and offset change 322, contralateral overlay 324, cup check 326, or one or more of the other functional components (e.g., after the surgical approach 328 and preoperative images have been selected and intraoperative images have been captured). Performing a preliminary determination of image suitability can reduce the possibility of errors related to relative orientation changes of the imaging device during the above steps.

[0043] Figure 4 is an exemplary GUI 400 displaying a preoperative fluoroscopic image 430 of a portion of the pelvic girdle of a patient exhibiting several anatomical features. In some embodiments, the preoperative fluoroscopic image 400 may be acquired and / or displayed by selecting an appropriate stored image (for example, using the functionality provided by adding X-rays in GUI 300 in Figure 3, provided by 318). In some embodiments, the program may display GUIs 410, 430, and 440 during image acquisition and / or evaluation / confirmation following acquisition.

[0044] In some embodiments, the GUI 410 may provide a description of the displayed image (e.g., based on the function active when the preoperative image was acquired) and / or appropriate annotation by a healthcare professional. For example, the GUI 410 may describe the image shown in window 420 as "X-ray of ipsilateral anterior-posterior (AP) hip joint before cervical amputation." In some embodiments, the operator may be prompted to select the image type (e.g., "AP hip joint") and parameters associated with the image (e.g., "pre-cervical amputation") when the image is acquired.

[0045] Figure 4 shows exemplary anatomical features such as PS 130, GT-R 120-R, and sections of the pelvic bone (PB) above the acetabulum, which can be automatically identified in preoperative images (indicated as PB-R 420-R in Figure 4). In some embodiments, the user may be asked to confirm the identified features and / or to locate / relocate the identified features (e.g., PS 130, GT-R 120-R, and PB 420).

[0046] In addition, the hint window 440 may include information for medical / radiological personnel to properly capture and / or evaluate images, such as prompting the user to "center the acetabulum on the screen," to confirm that "the greater trochanter, femoral shaft, pubic symphysis & pelvic bones are shown above the acetabulum" in the image, and to ensure that (when capturing an image of the patient's hip joint) "rotate the patient's leg inward by 10 degrees and place the C-arm 10 degrees above the top to show the patient's true offset." The hint window 440 and exemplary anatomical features shown in Figure 4 are merely examples to illustrate the operation, and the hints and / or identifiable features shown in Figure 4 may vary depending on the type of medical procedure (e.g., total hip arthroplasty (THA)) and / or subtype (e.g., "posterior approach").

[0047] Figure 5 shows an exemplary GUI 500 displaying a fluoroscopic image 430 showing a circle 520 drawn around the femoral head, according to a particular disclosed embodiment. The GUI 500 displays the current action, indicated in window 510 as “Draw a circle around the femoral head”. In some embodiments, the circle 520 may be automatically positioned based on feature points in the fluoroscopic image 430. In some embodiments, the program may include functions to facilitate user adjustment of the size and position of the circle 520. The GUI 500 may include guide dots 525 to facilitate navigation and / or repositioning of the circle 520. The circle 520 may be used (e.g., in a suitably digitally calibrated radiographic image) to estimate the size of the final or trial acetabular component 230. In some embodiments, the GUI 500 may also indicate one or more feature points, such as PS 130, GT-R 120-R, etc. In Figures 5 to 12B, the feature points shown and the information displayed (e.g., hints, guides, etc.) may be based on one or more of the following: program settings, user profile, and / or patient profile.

[0048] Figure 6 shows an exemplary GUI 600 displaying a fluoroscopic image 430 showing a digital femoral prosthesis template 220 aligned with the femoral axis using a femoral axis tool 630, according to a particular disclosed embodiment. The GUI 600 displays the current operation, indicated in window 610 as “Align femoral axis tool in tube.” In some embodiments, the femoral axis tool 630 may be automatically positioned and aligned based on feature points in the fluoroscopic image 430. In some embodiments, the program may include functions to facilitate user adjustment of the size, position, and alignment of the femoral axis tool 630. The GUI 600 may include guide dots 625 to facilitate navigation and / or repositioning of the femoral axis tool 630. The femoral axis tool 630 may be associated with a digital femoral prosthesis template 220, which may include a digital femoral template axis 245 to facilitate alignment of the digital femoral prosthesis template 220 with the femur. Rotational adjustments for alignment can be made using the rotation tool 620. GUI 600 also shows the circle 520 at the center within the acetabulum, and previously identified feature points such as PS 130, GT-R 120-R, etc.

[0049] Figure 7 shows an exemplary GUI 700 displaying a fluoroscopic image 430 having pelvic reference lines 720 drawn between anatomical features, according to a particular disclosed embodiment. The GUI 700 displays the current action, indicated in window 710 as “Mark Pelvic Reference Lines”. In some embodiments, the pelvic reference lines 720 may be automatically positioned based on feature points in the fluoroscopic image 430. In some embodiments, the program may include functions to facilitate user adjustment of the position of the pelvic reference lines 720. The GUI 700 may include guide dots 725 to facilitate navigation and / or repositioning of the pelvic reference lines 720. The pelvic reference lines 720 may correspond to, for example, one pelvic reference line 160, 165, or 170 (as shown, for example, in Figure 1B). For example, the pelvic baseline 720 may correspond to baseline 170 (Figure 1B), starting from the inferior pubic symphysis PS 130 and extending to the right anterior superior iliac spine ASIS-R 105-R (not shown in Figure 7). In some embodiments, the pelvic baseline 720 may serve as a baseline to facilitate image comparison and / or image registration. GUI 700 also shows, here, a aligned digital femoral prosthesis template 220, a circle 520 at the center of the acetabulum, and previously identified feature points PS 130, GT-R 120-R, etc.

[0050] Figure 8 shows an exemplary GUI 800 displaying a fluoroscopic image 430 with a marking of the pelvic teardrop-shaped radiographic feature TD 125. Figure 8 shows the right pelvic teardrop-shaped radiographic feature TD-R 125-R. GUI 800 displays the current operation, indicated in window 810 as “Mark Teardrop Shape”. In some embodiments, TD-R 125-R may be automatically determined based on feature points in the fluoroscopic image 430. In some embodiments, the program may include a function to facilitate user adjustment of the position of TD-R 125-R. GUI 800 may include guide dots 825 to facilitate navigation and / or repositioning of TD-R 125-R in Figure 8. GUI 800 also shows a pelvic baseline 720, a aligned digital femoral prosthesis template 220, a circle 520 at the center of the acetabulum, and previously identified feature points PS 130, GT-R 120-R, etc.

[0051] Figure 9 shows an exemplary GUI 900 displaying a fluorescence-guided image 430 drawing a marking of the closure hole angle 920 according to a particular disclosed embodiment. The GUI 900 displays the current operation, indicated in window 910 as “Mark Closure Hole Angle”.

[0052] In some embodiments, the closure foramen angle 920 may be formed by the intersection of an upper reference line 924 from the lower pubic symphysis (PS) 130 to an upper feature point 930 on the upper boundary of OF-R 135-R in the preoperative image 430, and a lower reference line 926 from the lower PS 130 to a lower feature point 932 on the lower boundary of OF-R 135-R in the preoperative AP image 430. The upper feature point 930 and the lower feature point 932 may be any prominent feature points related to OF-R 135-R in the preoperative AP image 430. For example, in some embodiments, the upper reference line 924 and the lower reference line 926 may be tangent to the upper and lower boundaries of OF-R 135-R in the preoperative AP image 430. Therefore, in some embodiments, the occlusion foramen angle 920 may be determined based on three pelvic feature points: (1) PS 130 (e.g., lower PS 130 as a vertex), (2) upper feature point 930 (e.g., a point of contact on a line tangent to the upper boundary of OF-R 135-R in the AP preoperative image 430, drawn from PS 130 of (1)), and (3) lower feature point 932 (e.g., a point of contact on a line tangent to the lower boundary of OF-R 135-R in the AP preoperative image 430, drawn from PS 130 of (1) above).

[0053] In some embodiments, the obturator foramen angle 920 may be automatically determined based on feature points within a fluoroscopic image (e.g., preoperative image 430). In some embodiments, the program may include a function to facilitate user adjustment of the obturator foramen angle 920. The GUI 900 may include guide dots 928 to facilitate navigation and / or adjustment to the obturator foramen angle 920. In some embodiments, the obturator foramen angle measurement 922 may be displayed and updated as adjustment is made. The GUI 900 in Figure 9 also shows a circle 520 at the center of the acetabulum, a aligned digital femoral template 220, a pelvic baseline 720, a pelvic teardrop-shaped radiographic feature 820, and previously identified feature points 130, GT-R 120-R, etc. The preoperative image 430 is stored with all annotations, feature points, aligned template, etc., and may be appropriately labeled for easy retrieval.

[0054] Figure 10 shows a representation of GUI menu 1000 presented to the user for intraoperative selection of implant size and implant components to facilitate intraoperative analysis and modeling. GUI 1000 may be presented to the user as part of intraoperative menu 320 (Figure 3).

[0055] As shown in Figure 10, the cup position analysis provided by the function associated with selection 1002 has "Analyze cup position" skipped (as indicated by the "No" selection).

[0056] GUI 1000 may include multiple selections, and menu selections provide an interface where size information related to the selection can be entered. For example, in GUI 1010, the implant size may be entered. As shown in Figure 10, the cup selection information element (IE) 1015 indicates "Pinnacle 54mm Neutral" as the acetabular cup selection (corresponding, for example, to the acetabular cup 230 of hip prosthesis 200 in the template image of Figure 2), and the stem selection IE 1025 indicates "Corail AMT Color Size 11 Standard Offset" as the stem selection (corresponding, for example, to the femoral stem 240 of hip prosthesis 200 in Figure 2). The above selections may be entered based on the surgeon's initial selection (e.g., based on preoperative analysis and / or measurements). Various other parameters related to the implant may also be entered as needed (as indicated by dashed lines).

[0057] Furthermore, as shown in Figure 10, when the “femoral stem component” 1030 is selected, the user can input other stem parameters 1040, size parameters 1045, and type / sleeve parameters 1050. The user can also select a head diameter 1060, such as one of the following: head diameter 1060-1 for size 28, head diameter 1060-2 for size 32, or head diameter 1060-3 for size 36. In Figure 10, head diameter 1060-3 for size 36 is selected. Using the component, size, and parameter selections in GUI 1000, an appropriate trial (or final) digital template can be created, and / or intraoperative analysis such as determination of various biomechanical parameters can be performed.

[0058] Figure 11 shows the GUI 1100 of an intraoperative image 1130 taken after hip reduction according to a particular disclosed embodiment. In some embodiments, GUI 1100 may also display a trial prosthesis or digital template image of the hip prosthesis 200-1 based on selections, measurements, and parameters entered into GUI 1000 (Figure 10). Thus, in some embodiments, the digital template image displayed in GUI 1100 may be based on the selected implant and component sizes.

[0059] GUI 1100 displays the current operation, which is further specified in window 1110 as "Pre- and post-hip AP hip X-rays taken after hip reduction" and shown as "Import second image - ipsilateral hip X-ray". As shown in Figure 11, a femoral osteotomy was performed, and the femoral head FH-R 115-R and femoral neck FN-R 150-R were removed.

[0060] Figure 11 shows exemplary anatomical features identified in the preoperative image, such as PS 130, GT-R 120-R, and sections of the pelvic bone (PB) above the acetabulum (shown as PB-R 420-R in Figure 11). In some embodiments, anatomical features may be detected automatically. In some embodiments, the user may be asked to confirm the identified features and / or to locate / relocate any identified features (e.g., PS 130, GT-R 120-R, and PB 420).

[0061] As shown in Figure 11, the GUI 1100 may also include a hint window 1140 that provides user guidance. For example, the hint window may instruct the user to "maintain the same C-arm position used in the preoperative hip image when taking intraoperative hip images," "center the acetabulum in the image," and to ensure that in the image "the greater trochanter, femoral shaft, pubic symphysis & pelvic bones are shown above the acetabulum," and to ensure that (for example, when capturing an image of the patient's hip) "rotate the patient's leg 10 degrees inward and place the C-arm 10 degrees above the top to show the patient's true offset." The hint window 1140 and exemplary anatomical features shown in Figure 11 are merely examples to illustrate the operation, and the hints and / or features identified in Figure 11 may vary depending on the medical procedure.

[0062] The "Hint" window 1140 instructs the user to "maintain the same C-arm position used in the preoperative hip joint image when acquiring intraoperative hip joint images," but in reality, the intraoperative C-arm position may differ from the preoperative C-arm position. This positional difference can lead to analytical errors that may not be detected until the end of the analysis in conventional schemes, thereby increasing the possibility of errors, extension time, etc. The disclosed embodiment aims to detect C-arm positional differences early in the process and close to the time when the actual intraoperative images are acquired, so that C-arm positioning errors can be corrected and guidance is provided to the operator in a timely manner.

[0063] Figures 12A and 12B show a preoperative image 430 (left side) (as shown in Figure 9) indicating a first occlusion angle 922-1 and a marking of a second occlusion angle 922-2 (right side) in an intraoperative image 1130 (as shown in Figure 11), according to a particular disclosed embodiment.

[0064] GUI 1200 provides a description of the current operation 1210, indicated as “Mark Obturator Angle Intraoperatively,” showing that the intraoperative obturator angle 922-2 is determined in the intraoperative image 1130. As seen in Figure 12A, a correspondence can be established between a first (left) preoperative image 430 (shown in Figure 9) and a second (right) intraoperative image 1130 (shown in Figure 11). In Figures 12A and 12B, the suffix “-1” is added to the label to identify a feature in the first preoperative image, while the suffix “-2” is added to the label to identify a similar or corresponding feature in the second intraoperative image.

[0065] For example, in Figure 12A, features such as the lower PS 130-1 and TD 125-R-1 in the first (preoperative) image 430 correspond to the features lower PS 130-2 and TD 125-R-2, respectively, in the second (intraoperative) image 1130. Furthermore, in some embodiments (for example, as discussed in relation to Figure 9), the first preoperative obturator angle 920-1 may be formed with the lower PS 130-1 as its apex by the intersection of a first upper reference line 924-1 from the pubic symphysis (PS) 130-1 to a first upper preoperative feature point 930-1 on the upper boundary of OF-R-1 135-R-1 in preoperative image 430, and a first lower reference line 926-1 from the PS 130-1 to a first lower preoperative feature point 932-1 on the lower boundary of OF-R-1 135-R-1 in preoperative image 430.

[0066] In some embodiments, the second intraoperative occlusion angle 920-2 may be formed with the lower PS 130-2 as its apex by the intersection of the corresponding second upper reference line 924-2 from PS 130-2 to the corresponding second upper intraoperative feature point 930-2 on the upper boundary of OF-R-2 135-R-2 in the intraoperative image 1130 and the corresponding second lower reference line 926-2 from PS 130-2 to the corresponding second lower intraoperative feature point 932-2 on the lower boundary of OF-R-2 135-R-2 in the intraoperative image 1130. In some embodiments, the occlusion angle 920-2 may be automatically determined based on feature points in the fluoroscopic image 1130.

[0067] In some embodiments, the program may include features to facilitate user adjustment of the occlusion angle 920-2. For example, the GUI 1200 may include guide dots (not shown in Figure 12A) or an “angle tool” (e.g., showing automatically determined reference lines 922-2 and 924-2) to facilitate adjustment of the occlusion angle 920-2. In some embodiments, the occlusion angle measurement 922-2 may be displayed and updated as adjustment is made. In some embodiments, the “angle tool” for changing the occlusion angle may appear automatically when the intraoperative image 1130 is loaded or selected, or when the preoperative image 430 contains the occlusion angle measurement. In some embodiments, one or more of the angle tool, the automatically determined reference lines 922-2 and 924-2, and / or the automatically determined angle measurement 922-2 may first appear when the captured intraoperative image 1130 is loaded or received, and the determination of the occlusion angle 920-2 may precede other intraoperative image operations.

[0068] As shown in Figure 12A, the preoperative obturator angle measurement 922-1 is 32 degrees, and the intraoperative obturator angle measurement 922-2 is 29 degrees. If the measured preoperative obturator angle (922-1) exceeds the measured intraoperative obturator angle (922-2) by a threshold (e.g., 2 degrees), the operator is notified in window 1240 that "the angle difference exceeds the threshold," and further notified that "the intraoperative angle 920-2 is too low compared to the preoperative angle," and is therefore instructed to "tilt the C-arm Cepahalod toward the patient's foot and retake the X-ray." The threshold may be set by the surgeon or may be a predetermined threshold based on an accepted standard. In some embodiments, the threshold may be set to 2 degrees.

[0069] Figure 12B shows GUI 1250, which is similar to GUI 1200. Figure 12B illustrates a situation where the measured intraoperative obturator angle (922-2) exceeds the measured preoperative obturator angle (922-1) by a threshold (e.g., 2 degrees). As shown in Figure 12B, the measured preoperative obturator angle 922-1 is 32 degrees, and the measured intraoperative obturator angle 922-2 is 36 degrees. If the measured preoperative obturator angle (922-1) is smaller than the measured intraoperative obturator angle (922-2) by a threshold (e.g., 2 degrees), the operator is notified in window 1260 that "the angle difference exceeds the threshold," and further notified that "the intraoperative angle 920-2 is too high compared to the preoperative angle 920-1," and therefore is instructed to "tilt the C-arm Cepahalod toward the patient's head and retake the X-ray." Windows 1240 and 1260 refer to the patient's "feet" and "head," and generally, the movement of the C-arm can be guided using any appropriate prominent anatomical feature visible to the operator.

[0070] If the measured intraoperative obturator angle (922-2) and the measured preoperative obturator angle (922-1) do not differ by more than a threshold (e.g., absolute difference ≤ 2 degrees), an indication may be provided (e.g., in a window) that the intraoperative image is acceptable and further analysis (e.g., to evaluate and / or determine biomechanical parameters associated with the prosthesis and / or patient during surgery) can proceed. Thus, healthcare professionals are provided with early indication of the suitability of the intraoperative image for further intraoperative evaluation and / or analysis of biomechanical parameters. In addition, when the intraoperative image is determined to be unsuitable, the operator is provided with indications of the error, whether the intraoperative angle is too low or too high, and whether it is a C-arm repositioning command. As outlined above, the C-arm repositioning command (when the image is retaken) may be based on any appropriate prominent anatomical patient feature visible to the operator, thereby simplifying operator guidance.

[0071] Figure 13 is a flowchart of Method 1300 for determining the suitability of intraoperative images for further intraoperative surgical analysis. In some embodiments, Method 1300 may be performed on an imaging device, such as a fluoroscopy imaging device, and a processor, computer, computing subsystem, or computing device that may be coupled to a display. In some embodiments, Method 1300 may be triggered upon initial reception of the first (or subsequent) intraoperative image.

[0072] In step 1310, the first angle (e.g., the obturator foramen angle 920-1) may be determined based on at least three pelvic feature points in a preoperative image (e.g., preoperative image 430). In some embodiments, the first angle (e.g., the obturator foramen angle 920-1) may be obtained from a previously stored preoperative image containing (or annotated) the first angle information.

[0073] In step 1320, the corresponding second angle (e.g., the obturator foramen angle 920-2 corresponding to the obturator foramen angle 920-1) can be determined based on at least three corresponding pelvic feature points in the (first or next) intraoperative image (e.g., intraoperative image 1130).

[0074] In step 1330, a first angle (e.g., closure hole angle 920-1) and a corresponding second angle (e.g., closure hole angle 920-2) can be compared.

[0075] In some embodiments, a first obturator angle (e.g., obturator angle 920-1) may be used as the first angle. The first obturator angle (e.g., obturator angle 920-1) may be formed by the intersection of a first upper reference line (e.g., 924-1) from the lower PS (e.g., PS-1 130-1) to a first upper feature point (e.g., 930-1) on the upper boundary of the OF (e.g., OF-R-1 135-R-1) in the preoperative image, and a first lower reference line (e.g., 926-1) from the lower PS130-1 to a first lower feature point (e.g., 932-1) on the lower boundary of the OF (e.g., OF-R-1 135-R-1) in the preoperative image, with its apex at the lower pubic symphysis (e.g., PS-1 130-1). In some embodiments, a first upper reference line (e.g., 924-1) and a first lower reference line (e.g., 926-1) may be tangent to the upper and lower boundaries of OF-R-1 135-R-1, respectively (for example, the first upper feature point 930-1 and the first lower feature point 932-1 may be tangents).

[0076] Furthermore, in some embodiments, a second closure hole angle (e.g., closure hole angle 920-2) can be used as a corresponding second angle. A second occlusion angle (e.g., occlusion angle 920-2) may be formed (e.g., in the second intraoperative image 1130) with a vertex at the corresponding lower PS (e.g., PS-2 130-2) by the intersection of a corresponding second upper reference line (e.g., 924-2) from the corresponding lower PS (e.g., PS-2 130-2) to the corresponding second upper feature point (e.g., 930-2) on the upper boundary of the corresponding OF (e.g., OF-R-2 135-R-2) in the intraoperative image (e.g., intraoperative image 1130) and a corresponding second lower reference line (e.g., 926-1) from the corresponding lower PS-2 130-2 to the corresponding second lower feature point (e.g., 932-2) on the lower boundary of the corresponding OF (e.g., OF-R-2 135-R-2) in the intraoperative image. In some embodiments, the corresponding second upper reference line (e.g., 924-2) and the corresponding second lower reference line (e.g., 926-2) may be tangent to the upper and lower boundaries of the corresponding OF-R-2 135-R-2, respectively (for example, the corresponding second upper feature point 930-2 and the corresponding second lower feature point 932-2 may be tangents).

[0077] In step 1340, based on the comparison in step 1330 ("Y" in step 1330), an indication of the suitability of the (first or next) intraoperative image 1130 for intraoperative surgical analysis may be provided. For example, an indication may be provided that the intraoperative image 1130 is suitable for further intraoperative analysis when the absolute value of the difference between the obturator angle 920-1 and the corresponding obturator angle 920-2 does not exceed a threshold.

[0078] Method 1300 may be performed intraoperatively during a hip arthroplasty procedure, and in response to the determination of the suitability of the first intraoperative image, further intraoperative surgical analysis may include determination of at least one of the following parameters: leg length offset, acetabular anterior tilt, acetabular inclination, acetabular posterior tilt, center of rotation, or several combinations thereof. The method may then return control to a call program or routine.

[0079] In step 1350, based on the comparison in step 1330 ("N" in step 1330), an indication may be provided that the (first or next) intraoperative image 1130 is not suitable for intraoperative surgical analysis. For example, when the absolute value of the difference between the obturator angle 920-1 and the corresponding obturator angle 920-2 exceeds a threshold, an indication may be provided that (a) the intraoperative image is not suitable for further intraoperative analysis, and / or (b) the operator may be further instructed to acquire another image, and / or (c) an indication of the direction of movement of the fluoroscopy camera used to acquire the current intraoperative image 1130 is provided, or (d) any combination of (a), (b), or (c) above is performed. In some embodiments, the direction of movement indication (if provided) may include a directional indication for moving the fluoroscopy camera toward a prominent anatomical feature of the surgical object. For example, the direction of movement indication may point the fluoroscopy camera toward the patient's head or toward the patient's feet based on the comparison (in step 1330). This method may then proceed to step 1360.

[0080] In step 1360, once the next intraoperatively captured image is acquired, step 1320 may be called to initiate another iteration. In some embodiments, in response to an unfavorable indication of the first intraoperative image, an instruction to acquire a second (next) intraoperative image may be received in step 1360 (for example, by a computer performing method 1300 from a fluoroscopy imaging system).

[0081] Method 1300 can be repeated until it is determined that a suitable intraoperative image 1130 has been captured.

[0082] If the fluorescence imaging system includes or is coupled to a robot or automated mobile device capable of moving the imaging device, the angular information includes one or more of the following: (a) a first closure hole angle and a second closure hole angle and / or (b) the difference between the first closure hole angle and the second closure hole angle, which may be provided to the fluorescence imaging system and / or the robot or automated mobile device. The fluorescence imaging system and / or the robot or automated mobile device may use the angular information (e.g., together with any pre-stored calibration parameters) to perform appropriate camera orientation adjustments, capture another image when triggered, and indicate the availability of the second image.

[0083] In hip arthroplasty, for example, further intraoperative analysis may use at least one center of rotation associated with the prosthesis to calculate the offset and leg length, as well as the intraoperative changes in features in the preoperative image 430 and intraoperative image 1130, for a selected hip prosthesis 200 (or a component portion of the hip prosthesis 200). Therefore, for intraoperative analysis, the preoperative image 430 and / or intraoperative image 1130 can be consistently scaled. Furthermore, at least one static point on a static anatomical region (such as the pelvis) in both images is identified in each image. In addition, the center of rotation of the prosthesis in the intraoperative image 1130 can be determined. One center of rotation in the intraoperative image 1130 can be determined by overlaying an acetabular template or other digital annotation on the intraoperative image 1130.

[0084] As another example of intraoperative analysis, a femoral implant may be modeled using a digital template or other digital annotation, with at least one landmark point on a non-static anatomical region (e.g., femur F 150) in both preoperative image 430 and intraoperative image 1130, to generate data on how changing the modeled implant—that is, replacing or modifying the implant in at least one dimension—may affect offset and leg length. This additional intraoperative analysis allows surgeons to understand how altering the implant intraoperatively will affect offset and leg length before actually making the changes.

[0085] Therefore, (i) at least one of the preoperative ipsilateral (or contralateral) images 430 (referred to herein as preoperative images 430) may be obtained together with (ii) a suitable intraoperative image (for example, preferably determined using the procedure in Figure 13). The preoperative images 430 and intraoperative images 1130 may be scaled and aligned using various techniques. In some embodiments, the preoperative images 430 and intraoperative images 1130 may be displayed side by side or superimposed to facilitate further analysis.

[0086] As an example, the system may generate at least one static point (e.g., TD 125) on the static anatomical region in both the preoperative image 430 and the intraoperative image 1130. Furthermore, the system may generate digital representations, such as digital templates or other digital annotations, such as digital lines having at least two points, such as lines representing the longitudinal axis or the diameter of the implant or bone, or digital circles indicating the placement of actual prosthetic components (e.g., acetabular component 230) and the corresponding centers of rotation of those components (e.g., acetabular component 230).

[0087] In some cases, additional digital templates or other representative digital annotations associated with a different prosthesis (e.g., femoral stem 240) may be used to indicate placement within the intraoperative image 1130. In the example above, the femoral stem (240) and acetabular component (230) templates, or representative annotations, generated on the intraoperative image 1130 may be connected at the center of rotation (as described, for example, in relation to Figure 2) to replicate the actual positioning of the (implanted) prosthesis femoral stem and acetabular component. The system may further generate at least one landmark point on the femoral anatomical structure that is consistently identified in both images (e.g., a point on GT 120). In some embodiments, the system may use this landmark point (e.g., GT 120) to calculate estimated changes to the offset and leg length for possible replacement prostheses, if the surgeon can change the choice of femoral stem implant.

[0088] Landmark points may also be used to locate (i) femoral component images, (ii) intraoperative overlay images 1130 or a portion thereof, or a portion of the intraoperative prosthesis, and a portion of the patient's bone to which the prosthesis will be implanted, as described below in relation to Figures 14 to 23, (iii) femoral templates (e.g., at least a digital template of the intraoperative femoral stem and / or a digital template of the acetabular cup), or (iv) surrogate digital annotations in preoperative images.

[0089] In some embodiments, the system may determine a vector in the intraoperative image 1130 using the static pelvis TD 125 as the origin, and the vector is directed towards and terminates at the acetabular cup location, as determined by the rotation center of the acetabular component or representative acetabular template. The term vector, as used herein, means a Euclidean vector having an initial point or "origin" and an endpoint, with magnitude (e.g., vector length) and direction (between the origin and the endpoint). In some embodiments, the system may position an acetabular component template or representative digital annotation, such as a digital line or digital circle, in the preoperative image 430 based on the above vector.

[0090] In some embodiments, a femoral stem template or representative digital annotation uses information from the generated annotations and template in the intraoperative image 1130, but may be generated in the preoperative image 430 without generating a femoral component template or representative annotation in the intraoperative image 1130. For example, the system may determine a vector between a generated landmark point on the femoral anatomical structure (preferably the greater trochanter) and the rotation center of the acetabular component template. The system may also analyze the positional difference between femoral F 155 in the preoperative image 430 and femoral F 155 in the intraoperative image 1130 relative to a stationary pelvis and rotate the vector to explain any differences. Examples of the above techniques are illustrated and described below in relation to Figures 14 to 23.

[0091] Figure 14 shows an exemplary GUI 1400 displaying an intraoperative fluoroscopic image 1130 of a portion of the patient's pelvic girdle. In some embodiments, the intraoperative fluoroscopic image 1130 may be automatically acquired and / or displayed when the image is received by the system. In other embodiments, the intraoperative image may be stored and acquired (for example, using functions provided by the addition of X-rays 318 and / or other modules within the intraoperative menu 320 GUI 300 in Figure 3).

[0092] In some embodiments, window 1410 may provide a description of the shown image and / or the current action, which may include appropriate annotations by a medical professional. For example, GUI 1410 describes the action for the intraoperative image shown in 1130 as "Intraoperative: Marking the greater trochanter." Figure 14 shows exemplary anatomical features such as PS 130 and GT-R-2 120-R-2, which can be automatically identified.

[0093] Figure 14 also shows angle tools using intraoperative occlusion angle 920-2 and angle measurement 922-2. In some embodiments, the user may be asked to confirm identified features and / or to locate / relocate identified features (e.g., PS 130, GT-R-2 120-R-2). As shown in Figure 14, the GUI 1400 may include guide dots and / or other tools to facilitate user locate / relocate identified features. In Figures 14 to 22, the indicated feature points and displayed information (e.g., tools, hints, guides, etc.) may be based on one or more of the program settings, user profile, and / or patient profile.

[0094] Figure 15 shows an exemplary GUI 1500 displaying an intraoperative fluoroscopic image 1130 showing a circle 1520 around an acetabular component 230 according to a particular disclosed embodiment. The acetabular component 230 may be a trial component, for example, by user selection (e.g., as selected / entered in Figure 10) and / or entered by the user (e.g., using options in GUI 1500). GUI 1500 displays the current operation in a window 1510 labeled "Intraoperative: Enter component size and position circle around acetabulum".

[0095] In some embodiments, circle 1520 may be automatically positioned based on feature points in the fluoroscopic image 1130. Circle 1520 is merely an example. Generally, image recognition and / or feature recognition techniques may be used to identify and locate the acetabular component 230 and provide the user with appropriate visual, graphic, and / or other instructions. In some embodiments, the program may include functions to facilitate user adjustment of the size and position of circle 1520. The GUI 1500 may include guide dots to facilitate navigation, resizing, and / or repositioning of circle 520. Circle 520 may be used for analysis and / or to estimate biomechanical and other parameters (e.g., with a suitable digitally calibrated radiographic image at the appropriate stage). In some embodiments, the GUI 1500 may also indicate one or more feature points such as PS 130, GT-R-2 120-R-2, intraoperative occlusion angle 920-2, and intraoperative angle measurement 922-2.

[0096] Figure 16 shows an exemplary GUI 1600 displaying an intraoperative fluoroscopic image 1130 showing the marking of the shoulder portion of a hip prosthesis implant 1620 according to a particular disclosed embodiment. The hip prosthesis (e.g., hip prosthesis 200) may be a trial component according to user selection, as (e.g., selected / entered in Figure 10) and / or entered by the user (e.g., using the options of GUI 1600). GUI 1600 displays the current action in a window 1610 labeled "Intraoperative: Mark the shoulder portion of the implant".

[0097] In some embodiments, the hip prosthesis shoulder portion 1620 may be automatically marked based on feature points in the fluoroscopic image 1130. In some embodiments, the program may include features to facilitate user adjustment of the size and position of the markings on the hip prosthesis shoulder portion 1620. The GUI 1600 may include guide dots to facilitate navigation, resizing, and / or repositioning when marking the hip prosthesis shoulder portion 1620. In some embodiments, the GUI 1600 may also indicate one or more feature points such as PS 130, GT-R-2 120-R-2, intraoperative obturator foramen angle 920-2, and intraoperative angle measurement 922-2, the acetabular component 230 of the hip prosthesis 200, and a circle 1520 drawn around the acetabular component 1520.

[0098] Figure 17 shows an exemplary GUI 1700 displaying an intraoperative fluoroscopic image 1130 having pelvic reference lines 720-2 drawn between anatomical features, according to a particular disclosed embodiment. GUI 1700 displays the current action, indicated in window 1710 as “Intraoperative: Mark Pelvic Reference Lines”. In some embodiments, the pelvic reference lines 720-2 may be automatically positioned based on feature points in the intraoperative fluoroscopic image 1130. In some embodiments, the program may include functions to facilitate user adjustment of the position of the pelvic reference lines 720-2. GUI 1700 may include guide dots to facilitate navigation, sizing, and / or repositioning of the pelvic reference lines 720-2 in the intraoperative image 1130. The pelvic reference lines 720-2 may correspond to, for example, one pelvic reference line 160, 165, or 170 (as shown, for example, in Figure 1B). For example, the pelvic baseline 720-2 may correspond to baseline 170 (Figure 1B), starting from the inferior pubic symphysis PS 130 and extending to the right anterior superior iliac spine ASIS-R 105-R (not shown in Figure 17). In some embodiments, the pelvic baseline 720-2 may serve as a baseline to facilitate image comparison and / or image registration. GUI 1700 also indicates one or more feature points such as PS 130, GT-R-2 120-R-2, intraoperative obturator foramen angle 920-2, and intraoperative angle measurement 922-2, the acetabular component 230 of the hip prosthesis 200, a circle 1520 drawn around the acetabular component 1520, and the marked hip prosthesis shoulder portion 1620.

[0099] Figure 18A shows an exemplary GUI 1800 displaying an intraoperative fluoroscopic image 1130 with markings for the pelvic teardrop-shaped radiographic feature TD 125. Figure 8 shows the intraoperative right pelvic teardrop-shaped radiographic feature TD-R-2 125-R-2. GUI 1800 displays the current operation, indicated in window 1810 as "Intraoperative: Mark Teardrop Shape". In some embodiments, TD-R-2 125-R-2 may be automatically determined based on feature points in the intraoperative fluoroscopic image 1130. In some embodiments, the program may include a function to facilitate user adjustment of the position of TD-R-2 125-R-2. GUI 1800 may include guide dots to facilitate navigation and / or repositioning of TD-R-2 125-R-2, as shown in Figure 18A. GUI 1700 also shows one or more feature points such as PS 130, GT-R-2 120-R-2, acetabular component 230 of hip prosthesis 200, circle 1520 drawn around acetabular component 1520, marked hip prosthesis shoulder portion 1620, and pelvic baseline 720-2.

[0100] Figure 18B shows another illustration of the exemplary GUI 1800 displaying a preoperative image 430 (left) showing the pelvic teardrop radiographic feature TD125-R-1, and an intraoperative fluoroscopic image 1130 drawing the marking of the pelvic teardrop radiographic feature TD125-R-2 (right). Figure 18B also shows a line 1820-1 drawn between PS 130-1 and TD-R-1 125-R-1, and a reference line 1820-2 drawn between PS 130-2 and TD-R-2 125-R-2.

[0101] In some embodiments, the preoperative teardrop angle may be determined based on the angle between a reference line 1820-1 in the preoperative image 430 and another reference line, such as a pelvic reference line 720-1. The corresponding intraoperative teardrop angle may be determined in the intraoperative image 1130 based on the angle between a reference line 1820-2 and another reference line, such as a pelvic reference line 720-2. When the absolute value of the difference between the preoperative TD angle and the corresponding intraoperative TD angle exceeds a threshold, a warning may be displayed, as shown in window 1830, instructing the user to "retake the X-ray." The warning indicates that the C-arm position (e.g., relative to an anatomical feature of interest, such as TD125) at the time of acquisition of the intraoperative image 1130 does not correspond to the C-arm position at the time of acquisition of the preoperative image.

[0102] In conventional systems, the determination that the relative orientation of the imaging device (e.g., C-arm) in the preoperative image differs from the corresponding relative orientation in the intraoperative image may occur in the later stages of analysis. Therefore, a preliminary step may be repeated in which new intraoperative images are captured, without guaranteeing that the newly captured intraoperative images are acceptable.

[0103] In embodiments disclosed herein, early indication of the acceptability of intraoperative images is provided (e.g., as described in relation to Figures 12A, 12B, and 13), thereby reducing the likelihood that intraoperative images will be deemed unsuitable for further intraoperative analysis at a later stage (as in Figure 18B). Furthermore, in some embodiments, even if an image is deemed unsuitable for further intraoperative analysis (e.g., due to inaccuracy in the relative position of the imaging device at the time of current intraoperative image acquisition), the disclosed embodiments may provide explicit guidance for positioning relative to the imaging device when acquiring another intraoperative image. In some embodiments, the guidance may be based on whether the preoperative TD angle exceeds the corresponding intraoperative TD angle, or vice versa (e.g., whether the corresponding intraoperative TD angle exceeds the preoperative angle). Thus, based on the angular difference and magnitude of the preoperative TD angle and the corresponding intraoperative TD angle, in some embodiments, the user may be instructed via window 1840 to “tilt the C-arm Cephalod toward the foot and retake the X-ray - the angular difference exceeds the threshold (the angular difference is 5.2 degrees).” Therefore, when an intraoperative image is determined to be unsatisfactory, the operator is provided with indications of the error, whether the intraoperative TD angle is too low or too high, and whether it is a C-arm repositioning command. As outlined herein, the C-arm repositioning command (when the image is retaken) may be based on any appropriate prominent anatomical patient feature visible to the operator, providing clear guidance for positioning / repositioning the imaging device.

[0104] Figure 19 shows an exemplary GUI 1900 showing the alignment of a digital acetabular component template 230-T (which may form part of the digital template image of a hip prosthesis 200) with an acetabular cup 230 (which may be a trial prosthesis). The digital template is indicated with the suffix "-T" and is shown in Figure 19 by a dashed line. GUI 1900 displays the current operation, indicated in window 1910 as "Intraoperative: Rotate template to match cup". In some embodiments, window 1920 may display the size, type, and other parameters used to obtain the digital acetabular component template 230-T. Figure 19 shows an acetabular cup used to create the digital acetabular component template 230-T as a "pinnacle" of type "54 mm" with liner / offset 0 (in window 1920). In some embodiments, the selected / entered size of the acetabular component may be used to scale the intraoperative image 1130 for overlay, match, or comparison with the preoperative image 430.

[0105] As shown in Figure 19, the digital / acetabular component template 230-T is superimposed on the acetabular component 230 in the intraoperative image 1130 and can be rotated, repositioned, and / or aligned to match the underlying acetabular component 230. For example, the acetabular component template axis 1930 can be rotated using the alignment tool 1925 until the digital acetabular component template 230-T is aligned with the acetabular component 230 in the intraoperative image 1130. In some embodiments, the digital acetabular component template 230-T may be automatically positioned based on the features of the intraoperative image, and the user may adjust the position and alignment of the digital acetabular component template 230-T.

[0106] Figure 20 shows an exemplary GUI 1900 showing the alignment of a digital femoral component template 240-T (which may form part of the digital template image of a hip prosthesis 200) with an acetabular cup 230 (which may be a trial prosthesis). Digital templates are indicated using the suffix "-T". GUI 2000 displays the current operation, indicated in window 1910 as "Intraoperative: Aligning femoral template in the canal". In some embodiments, window 2020 may display the size, type, and other parameters related to the digital femoral template 220-T. For example, Figure 20 shows information related to the femoral stem 240 (related to the digital femoral template 240-T) as type "pinnacle" with size "54 mm" and type / sleeve as standard, offset, head diameter 36, and head 8.5 (in window 2020).

[0107] As shown in Figure 20, the digital femoral template 240-T is superimposed on the femur F 155 in the intraoperative image 1130 and can be rotated, repositioned, and / or aligned to match the underlying femur F 155. For example, the femoral axis 245-T of the digital femoral template 240-T can be rotated using the femoral alignment tool until the digital femoral template 240-T is aligned with the femur F 155 in the intraoperative image 1130. In some embodiments, the digital femoral template 240-T may be automatically positioned based on the features of the intraoperative image, and the user may adjust the position and alignment of the digital femoral template 240-T.

[0108] Figure 21 shows a section or crop 1130-C of intraoperative image 1130 (shown by a dashed line) superimposed on preoperative image 430 (shown by a solid gray line) to align the femur in two images. GUI 2100 displays the current operation, indicated in window 2110 as "Intraoperative: Align femur". The suffix "-1" is used to refer to a feature of the preoperative image, while the suffix "-2" is used to refer to the corresponding feature intraoperative image 1130 or intraoperative crop 1130-C.

[0109] When the intraoperative image 1130-C is superimposed, the system can generate a femoral template 220-T positioned on the superimposed intraoperative image 1130 so that the position of the intraoperative excision 1130-C matches how the femoral template 220-T was positioned on the intraoperative image (for example, as shown in Figure 20). In some embodiments, the system can remove the intraoperative excision 1130-C while retaining the (generated) femoral template 220 superimposed on the preoperative image 430.

[0110] In some embodiments, "+" buttons 2125 and "-" buttons 2130 facilitate the manipulation of the size of intraoperative excision 1130-C so that femur F 150-2 in intraoperative excision 1130-C precisely matches femur F 150-1 in preoperative image 430. The use of the scaling function is infrequent because intraoperative image 1130 and preoperative image 430 may already be consistently scaled (e.g., based on features, component sizes, anatomical measurements, etc.) and / or for fine-tuning when there are small alignment and scaling differences between femur F 150-1 in preoperative image 430 and femur F 150-2 in intraoperative excision 1130-C relative to the pelvis. The system can align images according to the pelvis (for example, based on pelvic reference lines 720-1 and 720-2), but because the femoral axis in the images may differ, alignment discrepancies may occur between the preoperative image 430 and the intraoperative crop 1130-C. By addressing any femoral scale and alignment discrepancies, it is possible to ensure that the offset and leg length parameters are correctly calculated during the intraoperative analysis in subsequent steps.

[0111] Figure 22 shows GUI 2200, which can be used to review the detected features and baselines in the preoperative image 430 (left) and intraoperative image 1130 (right) before determining various biomechanical parameters.

[0112] The GUI 2200 displays the current operation, indicated as "Intraoperative: Checkpoint - Verify and confirm point registration (Surgeon)," and instructs the operator to verify the detected features and reference lines in the preoperative image 430 and the intraoperative image 1130.

[0113] In some embodiments, upon confirmation, annotated preoperative images 430 and intraoperative images 1130 may be saved. Figure 22 also shows a legend for window 2230, which shows the representations used for various features and defined reference lines. As shown in Figure 22, the operator is instructed to confirm the positions of TD-R 125-1 and TD-R 125-2, pelvic reference lines 720-1 and 720-2, GT-R-1 120-R-1 (not shown in Figure 22) and GT-R-2 120-R-2, and the hip prosthesis shoulder portion 1620.

[0114] Figure 23 shows GUI 2300, which includes an intraoperative analysis chart 2320 outlining changes in leg length and offset corresponding to various femoral stem selections. GUI 2200 displays the current operation, indicated as “Intraoperative: Trial Analysis” in window 2310, and also indicates that “Trial” is selected. Window 2320 shows a legend illustrating the representation of preoperative and intraoperative points in the overlay image.

[0115] Chart 2350 provides changes in leg length and offset when a surgeon replaces or otherwise modifies a femoral stem prosthesis during surgery. Alternatively, the system may generate recommended femoral stem changes based on the surgeon's input of desired offset and leg length parameters. For example, if the surgeon lengthens the leg by only 7 mm and does not change the offset, the system will calculate the leg length and offset for all femoral stem options included in the system and present the femoral stem selection closest to achieving this. Chart 2350 shows femoral stem selection 8.5 with a leg length difference of 1 mm, indicated by a 4 mm offset.

[0116] In some embodiments, the system may generate chart 2350 (or recommendation) based on a vector between at least one identifiable point on the femoral anatomical structure, such as the previously identified greater trochanteric points (GT-R-1 120-R-1 and GT-R-2 120-R-2), and a hypothetical resting point on the femoral template, such as the center of rotation of the femoral stem shoulder 1620. To generate chart 2350, the position of the identified point on the femoral template cannot (or changes minimally) change when the surgeon implants different femoral stems. Therefore, the center of rotation of the stem shoulder 1620 may be an ideal point for such an approximation.

[0117] Window 2325 shows additional information from the overlay analysis, where the leg length difference was determined to be 1 mm. The selected component was a neutral type with a 54 mm cup, stem size 11, standard offset, and a head length of 8.5. GUI 2330 facilitates user adjustment of overlay transparency. Users can use GUI 2325 to analyze other images.

[0118] Figures 24A and 24B show flowcharts illustrating method 2400 for performing intraoperative analysis on a suitable intraoperative image. In some embodiments, method 2400 may be performed on an imaging device, such as a fluoroscopy imaging device, and a processor, computer, or computing device that may be coupled to a display.

[0119] In routine 1300, the suitability of the intraoperative image 1130 for further intraoperative analysis can be determined (for example, as outlined in relation to Figure 13).

[0120] In response to the determination that the intraoperative image 1130 is suitable, block 2405 may determine at least one feature point (e.g., GT-R-2 120-R-2) on a non-static anatomical region (e.g., on the femur F 150) within the intraoperative image 1130. The non-static point (e.g., GT-R-2 120-R-2) may be used in a subsequent step to model how changes in the implant in at least one dimension may affect the offset and leg length, which can assist in surgical decision-making before the actual changes are made.

[0121] In block 2410, circle 1520 may be drawn around the acetabulum in the intraoperative image 1130. The circle can facilitate the determination of the size and other parameters related to the actual prosthetic component (e.g., the acetabular component), as well as the rotational center of the component (e.g., based on known anatomical data). These parameters can be used to scale the intraoperative image 1130 and the preoperative image 430 in a consistent manner.

[0122] In block 2415, the femoral component shoulder portion 1620 may be identified. In addition, in some embodiments, at least one assumed resting point on the femoral component shoulder portion 1620, the center of rotation of the femoral stem shoulder portion 1620, etc., may be identified. The assumed resting point on the femoral component shoulder portion remains substantially stationary even when different femoral stems are implanted, thereby facilitating modeling.

[0123] In block 2420, static reference lines such as the pelvic reference line 720-2 on the intraoperative image 1130 can be determined. The pelvic reference line 720-2 may be used (in conjunction with the pelvic reference line 720-1 in the preoperative image 430), and other features include aligning the intraoperative image 1130 with the preoperative image 430 to scale, and / or facilitating the superposition and alignment of the intraoperative image 1130 on the preoperative image 430.

[0124] In block 2425, stationary points such as the teardrop-shaped TD-R-2 125-R-2 on the intraoperative image 1130 can be identified.

[0125] Referring to Figure 24B (a continuation of Method 2400), in some embodiments, in block 2430, additional confirmation of the suitability of the intraoperative image 1130 for further intraoperative analysis may be determined based on the location of the teardrop shape TD-R-2 125-R-2 in the intraoperative image 1130. For example, the preoperative section angle may be determined based on the angle between reference line 1820-1 (Figure 18B, PS 130-1 to TD 125-R-1) and another reference line such as the pelvic reference line 720-1 in the preoperative image 430. The corresponding intraoperative teardrop angle may be determined in the intraoperative image 1130 based on the angle between reference line 1820-2 (Figure 18, PS 130-2 to TD 125-R-2) and another reference line such as the pelvic reference line 720-2. When the absolute value of the difference between the preoperative TD angle and the corresponding intraoperative TD angle exceeds a threshold, the user may command that the current intraoperative image is not suitable for further intraoperative analysis. The likelihood of determining that the intraoperative image in block 2430 is unsuitable is significantly reduced for the image suitability analysis performed in block 1300, which is executed when the intraoperative image 1130 is captured.

[0126] In block 2435, if an unfavorable determination of the intraoperative image occurs ("N" in block 2435), block 1350 (Figure 13) can be invoked, and the user may be commanded to "retake the X-ray," and a warning may further indicate that the C-arm position (e.g., relative to an anatomical feature of interest such as TD 125) at the time of acquisition of the intraoperative image 1130 does not correspond to the C-arm position at the time of acquisition of the preoperative image. In some embodiments, guidance may be based on whether the preoperative TD angle exceeds the corresponding intraoperative TD angle, or vice versa (e.g., whether the corresponding intraoperative TD angle exceeds the preoperative angle). Thus, based on the angle difference and the magnitude of the preoperative TD angle and the corresponding intraoperative TD angle, the user may be commanded to "tilt the C-arm cephalod toward the feet" or "tilt the C-arm cephalod toward the head." Therefore, when an intraoperative image is determined to be unsatisfactory, the operator is provided with (a) an indication of error, (b) an indication that the intraoperative TD angle is too low or too high, and (c) an indication that it is a C-arm repositioning command. As outlined herein, the C-arm repositioning command (when the image is retaken) may be based on any appropriate prominent anatomical patient feature visible to the operator, providing clear guidance for positioning / repositioning the imaging device.

[0127] In block 2435, if the intraoperative image is preferable (more likely), then (yes in block 2435) block 2440 can be called.

[0128] In block 2440, the digital acetabular component template 230-T (which can form a portion of the digital template image of the hip prosthesis 200 based on user-selected size, type, and other parameters) can be aligned with the acetabular cup 230 used to obtain the digital acetabular component template 230-T. The digital acetabular component template 230-T may be superimposed on the acetabular component 230 in the intraoperative image 1130 and rotated, repositioned, and / or aligned to match the underlying applicator component 230.

[0129] When the intraoperative image is appropriate, TD-R-2 125-R-2 can also be used as the origin of a vector corresponding to a similar vector in the preoperative image 430, terminating at the rotation center of the acetabular component 230 in the intraoperative image. In some embodiments, a subsequent step may use the above vector to position an acetabular component template or representative digital annotation, such as a digital line or digital circle, in the preoperative image 430 based on the above vector.

[0130] In block 2445, the femoral template 240-T (based on, for example, size, type, and other user-selected parameters) can be aligned with femur F 150-R-2 in intraoperative image 1130. The digital femoral template 240-T is superimposed on femur F 155 in intraoperative image 1130 and can be rotated, repositioned, and / or aligned to match the underlying femur F 150. The femoral stem (240) and acetabular component (230) templates generated on intraoperative image 1130 are connected at the center of rotation (for example, as described in relation to Figure 2) and can be used to model the actual positioning of the (implanted) prosthesis femoral stem and acetabular component. In some embodiments, in block 2445, the femoral template 240-T and at least one additional feature point on the femoral anatomical structure identified in the intraoperative image 1130 and the preoperative image 430 (e.g., point GT 120 identified in block 2405) may be used to model estimated changes in offset and leg length when the surgeon is required to change the femoral stem implant selection using an available replacement prosthesis.

[0131] In block 2450, the intraoperative image crop 1130-C may be superimposed on the preoperative image 430 to align the femur in the two images. Once the intraoperative image 1130-C is superimposed and the femur alignment is complete, the system may generate a femoral template 220-T such that the position and orientation of the femur in the intraoperative image 1130-C matches how the femoral template 220-T is positioned in the intraoperative image (for example, as shown in Figure 20). In some embodiments, the system may remove the intraoperative image 1130-C while retaining the (generated) femoral template 220 superimposed on the preoperative image 430. In some embodiments, block 2450 may include a verification step to confirm that the detected features and reference lines in the preoperative image 430 and the intraoperative image 1130 are correct.

[0132] In block 2455, trial analysis and / or other actions are performed based on the prosthesis selection and parameters provided by the surgeon to determine various anatomical and biomechanical parameters. For example, in block 2455, one or more of the following may be determined: leg length difference, offset, acetabular anterior tilt, acetabular inclination, parameters indicating the center of rotation, acetabular posterior tilt, or several combinations of the above. In some embodiments, in block 2455, femoral stem selection may be proposed based on the surgeon's input of desired offset and leg length parameters.

[0133] Figure 25 illustrates an exemplary system 2500 for intraoperative analysis according to a particular disclosed embodiment. In some embodiments, the system 2500 may include a C-arm fluoroscopy imaging device (hereinafter, "C-arm") 2510, which may be capable of moving with several degrees of freedom. Figure 25 shows the C-arm 2510 as an exemplary fluoroscopy imaging device, and the techniques disclosed herein may be applied to any intraoperative fluoroscopy device that can change position relative to a patient 140 undergoing surgery and / or the region of interest being imaged.

[0134] In some embodiments, the C-arm 2510 may be coupled to an X-ray source 2525, which may generate X-rays from which an image is captured by a detector 2520. The movement of the C-arm 2510 may be controlled by a control system, which may include a processor and actuators, which may, in some cases (e.g., when the C-arm 2510 is a robot), respond to commands from a computer 2600. Images captured by the C-arm 2510 may be transmitted via a communication network (which may be wired or wireless) to a computing subsystem 2600, which may store, process, and display the raw and / or processed images on a display 2530.

[0135] In some embodiments, the operator may control the movement of the C-arm 2525. For example, guidance on the display 2530 may instruct the operator to tilt the arm in a specified direction to capture an intraoperative image, indicate the suitability of the captured image, and / or perform various other actions (as outlined, for example, in relation to Figures 13 and 24). Guidance may be provided for prominent visible anatomical features of the patient 2540 (e.g., head, feet, etc.). In Figure 25, the arrow 2550 indicates the anterior-posterior (AP) direction relative to the patient 2540. In Figure 25, the patient 2540 is shown as a human. However, the disclosed technique may also be used with other animal subjects.

[0136] In some embodiments, the computing subsystem 2600 may provide the C-arm 2510 with an angular difference and / or angular magnitude. For example, the computer 2600 may provide one or more of the following: (a) the magnitude of the preoperative occlusion angle, (b) the magnitude of the intraoperative occlusion angle, (b) the difference between the preoperative and intraoperative occlusion angles, (c) the magnitude of the preoperative teardrop angle, (e) the magnitude of the intraoperative teardrop angle, and / or (d) the difference between the preoperative and intraoperative teardrop angles. In some embodiments, (for example, when the C-arm is a robot,) the C-arm 2510 may use the received angular information to make appropriate adjustments to the C-arm relative to its position at the time of the last intraoperative image acquisition. In other embodiments, when the operator performs control over the movement of the C-arm, the operator may be commanded and guided about actions to be performed on the C-arm 2510 via messages or via visual instructions on the display 2530.

[0137] In some embodiments, the display 2530 may include touchscreen functionality to facilitate user input to the computing subsystem 2600. Thus, the display 2530 can function as both an input and output device. Therefore, the display 2530 may include functions such as facilitating user interaction with displayed images, user annotation input, and user menu selection. In some embodiments, the display interface may generate graphics and / or other visualizations, which may enhance or overlay stored and captured images. In some embodiments, the display 2530 may be further coupled to another input device (such as a keyboard, mouse, joystick, game controller, or tablet), and this other input device may be located remotely from the display 2530. Input from the remote input device may be processed by the computing subsystem 2600 and reflected on the display 2530.

[0138] Figure 26 illustrates an exemplary computing subsystem 2600 for facilitating preoperative and intraoperative analysis according to a particular disclosed embodiment. The computing subsystem 2600 may form part of an intraoperative medical system (for example, as shown in Figure 25) and may be coupled to one or more imaging devices, including a C-arm device. In some embodiments, the computing subsystem 2600 may receive images from an imaging device (e.g., a C-arm 2510) and / or request or trigger the acquisition of new preoperative and / or intraoperative images (e.g., when an image is determined to be unsuitable). The computing subsystem 2600 may perform methods disclosed herein, including methods 1300 and / or 2400.

[0139] As shown in Figure 26, the computing subsystem 2600 may include a processor 2650, memory 2670, and a communication interface 2602, which may be connected using a connection 2606. The connection 2606 may take the form of a bus, line, fiber, electronic interface, link, etc., which may operationally connect the above components.

[0140] The communication interface 2602 can communicate with other devices or components (e.g., the C-arm 2510, a remote server, a private cloud, etc.) via wired (e.g., wired communication interface 2602b) and / or wireless (e.g., wireless communication interface 2602a). In some embodiments, captured images (e.g., preoperative images 430 and intraoperative images 1130), imaging system (e.g., the C-arm 2510) status (which may include the current or previous orientation of the X-ray source 2525), etc., can be received via the communication interface 2602, stored in memory 2670, and / or displayed using display 2530. Wired communication can occur over a wired network. Wireless communication may include communication via a Wireless Local Area Network (WLAN) based on the IEEE 802.11 standard, and / or a Fifth Generation (5G) network, or a Wireless Wide Area Network (WWAN) based on a cellular communication standard such as Long Term Evolution (LTE).

[0141] In some embodiments, the computing subsystem 2600 may include a user interface (e.g., via a touchscreen on the display 2530) that facilitates user input provided by the computing subsystem 2600 (e.g., for storing, selecting, manipulating, annotating, comparing, analyzing, and / or overlaying images, and / or providing commands, loading programs, and / or performing other functions). In some embodiments, an optional control interface 2608 may communicate with the processor 2650 and the C-arm 2510, and may be used by the processor 2650 to exchange commands and control information with the C-arm 2510.

[0142] The computing subsystem 2600 may also include a display interface 2610 that can interact with the display 2530 to provide visual feedback (e.g., configuration information, displayed intraoperative images 430, displayed intraoperative images 1130, displayed procedure-related information, system status information, etc.). In some embodiments, the display 2530 may include touchscreen functionality to facilitate user input. Thus, the display 2530 may include functions to facilitate user interaction with displayed images, user annotation input, and user menu selection. In some embodiments, the display interface may relay computer-generated graphics and / or other visualizations, which may enhance or overlay stored and captured images. The display interface 2610 may communicate with and be controlled by the processor 2650. In some embodiments, the computing subsystem 2600 may also be coupled to another input device to facilitate user input that can be reflected on the display 2530.

[0143] In some embodiments, memory 2670 may include main or primary memory (e.g., RAM) and storage 2660 (e.g., hard disk, solid-state memory, optical media, etc.). Program code 2679 is stored in memory 2670 and read by processor 2650 to perform the techniques disclosed herein. Storage 2660 may include ROM, EPROM, NVRAM, flash memory, solid-state memory, other secondary storage, and other computer-readable media (e.g., fixed and / or removable drives, optical discs, etc.). Computer-readable media 2620 may be encoded with databases, data structures, data, etc., and / or computer programs. As an example, but not limited to, such computer-readable media may also include CD-ROMs, memory cards, portable drives, or other optical disc storage, magnetic disk storage, solid-state drives, other storage devices, or any other media that can be used to store desired program code in the form of instructions and / or data structures and can be accessed by a computer.

[0144] Memory 2670 may store images (preoperative and intraoperative images, including user annotations and / or other enhancements), patient data, anatomical measurements, and databases related to prosthetic devices. Memory 2670 may also include configuration information 2677, which may provide information related to program settings, user profile information, and user preferences.

[0145] The methods described herein may be implemented in hardware, firmware, software, or a combination thereof. In the case of hardware implementation, the processor 2650 may be implemented in one or more application-specific integrated circuits (ASICs), digital signal processors (DSPs), image processors, digital signal processing devices (DSPDs), programmable logic devices (PLDs), field programmable gate arrays (FPGAs), processors, controllers, microcontrollers, microprocessors, electronic devices, other electronic units designed to perform the functions described herein, or any combination thereof. In some embodiments, the processor 2650 may include the ability to perform one or more of the following: image analysis for determining and labeling features; image comparison; use of anatomical and / or other provided information in conjunction with image features to estimate size, distance, rotation center and / or angle between image features; image overlay; perform real-time image manipulation in response to user input for scaling, rotating and aligning images; and / or perform other functions outlined in the methods disclosed herein (e.g., methods 1300 and / or 2400). In some embodiments, the above functions may be performed using the image analysis engine 2656. In some embodiments, the processor 2650 may also include a trial analysis engine 2658, which can estimate biomechanical parameters and / or anatomical effects from the use of or modification of prostheses or prosthetic components.In some embodiments, the trial analysis engine 2658 may use information determined by the image analysis engine 2656 (e.g., size, distance, feature location, rotation center, reference line, etc.) along with known patient anatomical information, as well as information related to prostheses and prosthesis components, when estimating biomechanical parameters and / or anatomical effects.

[0146] While this disclosure is described in conjunction with specific embodiments for guidance purposes, it is not limited thereto. Various adaptations and modifications can be made to this disclosure without departing from the scope of the invention. Accordingly, the spirit and scope of the appended claims should not be limited to the foregoing description.

[0147] [Implementation Method] (1) A processor implementation method for determining the suitability of intraoperative images for further intraoperative surgical analysis during surgery, Based on at least three pelvic feature points in the preoperative image, the first angle is determined, Based on at least three corresponding pelvic feature points in the first intraoperative image, the corresponding second angle is determined, Based on a comparison between the first angle and the corresponding second angle, the suitability of the intraoperative image for further intraoperative surgical analysis is determined, A method comprising providing a direction of movement instruction for a fluoroscopy camera used to acquire the first intraoperative image in response to a determination that the first intraoperative image is unsuitable for the intraoperative surgical analysis. (2) The method of Embodiment 1, further comprising providing an indication that the first intraoperative image is not suitable for further intraoperative surgical analysis. (3) The method according to Embodiment 1, wherein the first angle is the first closure hole angle and the corresponding second angle is the corresponding second closure hole angle. (4) The first obturator foramen angle is formed in the lower pubic symphysis (PS) in the preoperative image by the intersection of a first upper reference line from the lower PS to a first upper feature point on the upper boundary of the obturator foramen (OF) in the preoperative image and a first lower reference line from the lower PS to a first lower feature point on the lower boundary of the OF in the preoperative image. The method according to Embodiment 3, wherein the corresponding second closure hole angle is formed in the lower PS in the intraoperative image by the intersection of a corresponding second upper reference line from the lower PS to a corresponding second upper feature point on the upper boundary of the OF in the first intraoperative image and a corresponding second lower reference line from the lower PS to a corresponding second lower feature point on the lower boundary of the OF in the first intraoperative image. (5) The method according to Embodiment 1, wherein the first intraoperative image is shown to be suitable for further intraoperative surgical analysis when the absolute value of the difference between the first angle and the corresponding second angle does not exceed a threshold.

[0148] (6) The method according to Embodiment 1, wherein the direction of movement for the fluorescence imaging camera is provided when the absolute value of the difference between the first angle and the corresponding second angle exceeds a threshold. (7) The method of Embodiment 6, wherein the instruction for the direction of movement includes a directional command for moving the fluoroscopy camera relative to a prominent anatomical feature of the surgical object. (8) The method according to Embodiment 1, wherein the instruction for the direction of movement for the fluoroscopy camera is relative to the orientation of the fluoroscopy camera at the time of acquiring the first intraoperative image. (9) The method according to Embodiment 1, further comprising providing an indication of unsuitability and one or more of the following: an angle difference between the first angle and the corresponding second angle, or the measured values ​​of the first angle and the measured values ​​of the second angle relative to the fluorescence imaging device, wherein the fluorescence camera is coupled to the fluorescence imaging device. (10) The method according to Embodiment 9, further comprising receiving an instruction to capture a second intraoperative image in response to the instruction of the unsuitability.

[0149] (11) The method according to Embodiment 1, wherein the method is triggered when the first intraoperative image is received. (12) The method described above is performed intraoperatively during a hip arthroplasty procedure, and in response to the determination of the suitability of the first intraoperative image, further intraoperative surgical analysis is performed. Leg length offset, or Acetabular anterior tilt, or Acetabular tilt, or A parameter indicating the center of rotation, or Posterior tilt of the acetabular bone, or The method according to Embodiment 1, comprising determining at least one of these combinations. (13) A device, A communication interface for receiving the first intraoperative image captured by a fluorescence fluoroscopy camera, A memory capable of storing preoperative images and the first intraoperative images, A processor coupled to the memory and the communication interface, wherein the processor is Based on at least three pelvic feature points in the aforementioned preoperative image, a first angle is determined, Based on at least three corresponding pelvic feature points in the first intraoperative image, the corresponding second angle is determined, Based on a comparison between the first angle and the corresponding second angle, the suitability of the intraoperative image for further intraoperative surgical analysis is determined, An apparatus comprising: a processor configured to provide instructions for the direction of movement of the fluoroscopy camera used to acquire the first intraoperative image in response to a determination that the first intraoperative image is unsuitable for the intraoperative surgical analysis. (14) The apparatus according to Embodiment 13, wherein the first angle is a first closure hole angle and the corresponding second angle is a corresponding second closure hole angle. (15) The first obturator foramen angle is formed in the lower pubic symphysis (PS) in the preoperative image by the intersection of a first upper reference line from the lower PS to a first upper feature point on the upper boundary of the obturator foramen (OF) in the preoperative image and a first lower reference line from the lower PS to a first lower feature point on the lower boundary of the OF in the preoperative image. The apparatus according to Embodiment 14, wherein the corresponding second closure hole angle is formed in the lower PS in the intraoperative image by the intersection of a corresponding second upper reference line from the lower PS to a corresponding second upper feature point on the upper boundary of the OF in the first intraoperative image and a corresponding second lower reference line from the lower PS to a corresponding second lower feature point on the lower boundary of the OF in the first intraoperative image.

[0150] (16) The apparatus according to Embodiment 13, wherein the first intraoperative image is shown to be suitable for further intraoperative surgical analysis when the absolute value of the difference between the first angle and the corresponding second angle does not exceed a threshold. (17) The apparatus according to Embodiment 13, wherein the direction of movement for the fluorescence imaging camera is provided when the absolute value of the difference between the first angle and the corresponding second angle exceeds a threshold. (18) The apparatus according to Embodiment 17, wherein the instruction for the direction of movement includes a directional command for moving the fluoroscopy camera relative to a prominent anatomical feature of the surgical object. (19) A non-temporary computer-readable medium containing instructions, wherein the instructions are Based on at least three pelvic feature points in the preoperative image, the first angle is determined, Based on at least three corresponding pelvic feature points in the first intraoperative image, the corresponding second angle is determined, Based on a comparison between the first angle and the corresponding second angle, the suitability of the intraoperative image for further intraoperative surgical analysis is determined, A computer-readable medium comprising a processor configured to provide instructions for the direction of movement of the fluoroscopy camera used to acquire the first intraoperative image, in response to a determination that the first intraoperative image is unsuitable for the intraoperative surgical analysis. (20) The computer-readable medium according to Embodiment 19, wherein the first angle is a first closure hole angle and the corresponding second angle is a corresponding second closure hole angle.

Claims

1. It is a device, A communication interface for receiving the first intraoperative image captured by a fluorescence fluoroscopy camera, A memory capable of storing preoperative images and the first intraoperative images, A processor coupled to the memory and the communication interface, wherein the processor is Based on at least three pelvic feature points in the aforementioned preoperative image, a first angle is determined, Based on at least three corresponding pelvic feature points in the first intraoperative image, the corresponding second angle is determined, Based on a comparison between the first angle and the corresponding second angle, the suitability of the first intraoperative image for further intraoperative surgical analysis is determined, A device comprising: a processor configured to provide instructions for the direction of movement of the fluoroscopy camera used to acquire the first intraoperative image in response to a determination that the first intraoperative image is unsuitable for the intraoperative surgical analysis.

2. The apparatus according to claim 1, wherein the first angle is the first closing hole angle, and the corresponding second angle is the corresponding second closing hole angle.

3. The first obturator foramen angle is formed in the lower pubic symphysis (PS) in the preoperative image by the intersection of a first upper reference line from the lower PS to a first upper feature point on the upper boundary of the obturator foramen (OF) in the preoperative image and a first lower reference line from the lower PS to a first lower feature point on the lower boundary of the OF in the preoperative image. The apparatus according to claim 2, wherein the corresponding second closure hole angle is formed in the lower PS in the first intraoperative image by the intersection of a corresponding second upper reference line from the lower PS to a corresponding second upper feature point on the upper boundary of the OF in the first intraoperative image and a corresponding second lower reference line from the lower PS to a corresponding second lower feature point on the lower boundary of the OF in the first intraoperative image.

4. The apparatus according to claim 1, wherein the first intraoperative image is indicated to be suitable for further intraoperative surgical analysis when the absolute value of the difference between the first angle and the corresponding second angle does not exceed a threshold.

5. The apparatus according to claim 1, wherein the indication of the direction of movement for the fluorescence imaging camera is provided when the absolute value of the difference between the first angle and the corresponding second angle exceeds a threshold.

6. The apparatus according to claim 5, wherein the instruction for the direction of movement includes a directional command for moving the fluoroscopy camera relative to a prominent anatomical feature of a surgical object.

7. A non-temporary computer-readable medium containing instructions, wherein the instructions are Based on at least three pelvic feature points in the preoperative image, the first angle is determined, Based on at least three corresponding pelvic feature points in the first intraoperative image, the corresponding second angle is determined, Based on a comparison between the first angle and the corresponding second angle, the suitability of the first intraoperative image for further intraoperative surgical analysis is determined, A computer-readable medium comprising a processor configured to provide instructions for the direction of movement of a fluoroscopy camera used to acquire the first intraoperative image, in response to a determination that the first intraoperative image is unsuitable for the intraoperative surgical analysis.

8. The computer-readable medium according to claim 7, wherein the first angle is a first closure hole angle, and the corresponding second angle is a corresponding second closure hole angle.

9. A processor implementation method for determining the suitability of a first intraoperative image for further intraoperative surgical analysis during surgery, Based on at least three pelvic feature points in the preoperative image, the first angle is determined, Based on at least three corresponding pelvic feature points in the first intraoperative image, the corresponding second angle is determined, Based on a comparison between the first angle and the corresponding second angle, the suitability of the first intraoperative image for further intraoperative surgical analysis is determined, A method comprising providing a direction of movement instruction for a fluoroscopy camera used to acquire the first intraoperative image in response to a determination that the first intraoperative image is unsuitable for the intraoperative surgical analysis.

10. The method according to claim 9, further comprising providing an indication that the first intraoperative image is not suitable for the further intraoperative surgical analysis.

11. The method according to claim 9, wherein the first angle is a first closure hole angle, and the corresponding second angle is a corresponding second closure hole angle.

12. The first obturator foramen angle is formed in the lower pubic symphysis (PS) in the preoperative image by the intersection of a first upper reference line from the lower PS to a first upper feature point on the upper boundary of the obturator foramen (OF) in the preoperative image and a first lower reference line from the lower PS to a first lower feature point on the lower boundary of the OF in the preoperative image. The method according to claim 11, wherein the corresponding second closure hole angle is formed in the lower PS in the first intraoperative image by the intersection of a corresponding second upper reference line from the lower PS to a corresponding second upper feature point on the upper boundary of the OF in the first intraoperative image and a corresponding second lower reference line from the lower PS to a corresponding second lower feature point on the lower boundary of the OF in the first intraoperative image.

13. The method according to claim 9, wherein the first intraoperative image is indicated to be suitable for further intraoperative surgical analysis when the absolute value of the difference between the first angle and the corresponding second angle does not exceed a threshold.

14. The method according to claim 9, wherein the indication of the direction of movement for the fluorescence imaging camera is provided when the absolute value of the difference between the first angle and the corresponding second angle exceeds a threshold.

15. The method according to claim 14, wherein the instruction for the direction of movement includes a directional command for moving the fluoroscopy camera relative to a prominent anatomical feature of a surgical object.

16. The method according to claim 9, wherein the instruction for the direction of movement for the fluorescence fluoroscopy camera is relative to the orientation of the fluorescence fluoroscopy camera at the time of acquiring the first intraoperative image.

17. The method according to claim 9, further comprising providing an indication of unsuitability, and one or more of the following: an angle difference between the first angle and the corresponding second angle, or the measured values ​​of the first angle and the measured values ​​of the second angle relative to a fluorescence imaging device, wherein the fluorescence camera is coupled to the fluorescence imaging device.

18. The method according to claim 17, further comprising receiving an instruction to capture a second intraoperative image in response to the instruction of the aforementioned unsuitability.

19. The method according to claim 9, wherein the method is triggered when the first intraoperative image is received.

20. The method described above is performed intraoperatively during a hip arthroplasty procedure, and in response to the determination of the suitability of the first intraoperative image, further intraoperative surgical analysis is performed. Leg length offset, or Acetabular anterior tilt, or Acetabular tilt, or A parameter indicating the center of rotation, or Posterior tilt of the acetabular bone, or The method according to claim 9, comprising determining at least one of these combinations.

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