DICOM%20International%20Conference%20

1
DICOM International Conference SeminarWork
Item Implants Current State and Outlook

• Michael Gessat
• michael.gessat_at_iccas.de
• Thomas Trommer, Armin Löpfe, Oliver Burgert

2
Outline

• Implant Templates and Implantation Planning
• Motivation
• Features
• Information Models
• Examples

3
Implant Templates Implantation Planning

• The pre-operative selection of the most suitable
  implant and the determination of the optimal
  position and fixation of an implant in the
  patients body is called implantation planning.
• Planning is done with radiological images and
  graphical representations of implants, called
  implant templates.

4
Implant Templates Implantation Planning
5
Motivation
PACS Server
HIS
EHR Data
Planning Report
Patient Images
Planning Workstation
Required Templates
Implant Templates
Vendor Template Repository
Intraoperative System
Patient Images

• At present
• No standardized semantics and syntax for implant
  templates
• No standardized format for planning results
• No integration of information flow into PACS

6
Motivation
Required Templates
HIS
EHR Data
Planning Workstation
Planning Report
Planning Report
PACS Server incl. Temp. Rep.
Patient Images
Required Templates
Implant Templates
Intraoperative System
Patient Images

• Our goal
• Implant templates standardized in DICOM
• Implantation plans standardizes in DICOM
• All data stored in PACS server
• Whole data is exchanged via PACS

7
Required Concepts

• Patients Morphology
• X-Rays, CTs, 3D Ultrasound
• Segmentation and Classification
• Implant Geometry
• 2D
• 3D
• Result Simulation
• Biomechanical properties
• Tissue deformation
• Transfer into the OR
• Network technology Displays
• Transfer protocols and formats

8
DICOM Sup. 131 and 134
Implants
Bone MountedImplants
Stents, Valves,
Many more
Implant RepositoryBone Mounted Implant Template
Storage SOP Class
Patient Specific Plan / ReportImplantation Plan
Document SOP Class
General SurfaceMesh Module
EncapsulatedHPGL 2
Based on SR
Hip
Shoulder
Dental
Spine
Middle Ear
9
Workshops

• In workshops with representatives from the
  implant industry and implantation planning
  software industry.
• Leipzig, December 13, 2007
• San Francisco, March 3, 2008
• A set of features and attributes was elaborated.
• Working Group 24 is working on the translation of
  the workshop results into DICOM Supplements.
• In parallel, ICCAS works on a test implementation
  of the new DICOM SOP Classes.

10
Features

• Implant Templates
• contain 2D and/or 3D representation,
• contain (anatomical) landmarks for registration
  with patient images,
• contain information about indication, and
• can consist of several components,
• Component assembly is described
• compatibility,
• geometric constraints,
• and degrees of freedom.

11
Information Model - Implant Templates
12
Example
Component 1 Hip Joint Head Material
Porcelain Contact 1 Coordinates Axes Link
Comp. 2, CP 1
Component 2 Hip Joint Shaft Material
Titan Contact 1 Coordinates Axes Link
Comp. 1, CP 1 Fiducial 1 Femur Axis
13
Implant Types

• Implants for different purposes differ very much
  in the Attributes and landmarks that describe
  them.
• We propose an encoding mechanism that leaves room
  for a lot of flexibility.
• Only the Attributes that are applicable to the
  type of implant that is described in one Instance
  need to be present.

General Implant Attributes
Hip Joint
Assembly
Dental Implant
14
Implantation Plan SR Document Features
Implantation Plan
Assembly description
Planning Information
Registration
Templates (Implant Components)
Derived Fiducials
Anatomical Fiducials
Patient Image
Visualization
Images ENDOTEC
15
Information Model - Implantation Plan SR Document
16
Thank you very much for your attention!
Acknowledgements The Innovation Center Computer
Assisted Surgery (ICCAS) at the Faculty of
Medicine at the University of Leipzig is funded
by the German Federal Ministry for Education and
Research (BMBF) and the Saxon Ministry of Science
and the Fine Arts (SMWK) in the scope of the
initiative Unternehmen Region with the grant
numbers 03 ZIK 031 and 03 ZIK 032. Gefördert im
Rahmen der Technologieförderung mit Mitteln des
Europäischen Fonds für regionale Entwicklung
(EFRE) und mit Mitteln des Freistaates Sachsen.