Robotic drill guide positioning using known-component 3D-2D image registration

A method for x-ray image-guided robotic instrument positioning is reported and evaluated in preclinical studies of spinal pedicle screw placement with the aim of improving delivery of transpedicle K-wires and screws. The known-component (KC) registration algorithm was used to register the three-dimensional patient CT and drill guide surface model to intraoperative two-dimensional radiographs. Resulting transformations, combined with offline hand–eye calibration, drive the robotically held drill guide to target trajectories defined in the preoperative CT. The method was assessed in comparison with a more conventional tracker-based approach, and robustness to clinically realistic errors was tested in phantom and cadaver. Deviations from planned trajectories were analyzed in terms of target registration error (TRE) at the tooltip (mm) and approach angle (deg). In phantom studies, the KC approach resulted in TRE=1.51±0.51  mm and 1.01  deg±0.92  deg, comparable with accuracy in tracker-based approach. In cadaver studies with realistic anatomical deformation, the KC approach yielded TRE=2.31±1.05  mm and 0.66  deg±0.62  deg, with statistically significant improvement versus tracker (TRE=6.09±1.22  mm and 1.06  deg±0.90  deg). Robustness to deformation is attributed to relatively local rigidity of anatomy in radiographic views. X-ray guidance offered accurate robotic positioning and could fit naturally within clinical workflow of fluoroscopically guided procedures.