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Assessing Craniofacial Surgical Simulation
January 1996 (vol. 16 no. 1)
pp. 46-54
Craniofacial surgery is guided by 3D images reconstructed from CT or MR scans, but the validity of these graphically rendered images has not been tested under controlled circumstances. We simulated craniofacial surgical procedures and tested each step in the process used to create and apply the images against an independent standard for truth. The ability to measure 3D bony objects in these image volumes was tested for accuracy and repeatability. Surgery was simulated and performed on cadavers and the results compared with direct measurements. Surgical correction of craniofacial abnormalities in three pediatric patients was tested for the validity of the simulations. We found that the 3D spatial measurement accuracy of 3D image volumes obtained from CT scans was high, allowing surface landmark identification within 1 voxel, physical change detection within 1 mm and 2 degrees, and matching of surfaces within 1 degree and 1 voxel under ideal conditions. The error increased to 4 mm and 3 degrees on the average in cadaver and patient simulations. 3D CT reconstructions provide acceptable bony structural detail for planning and describing craniofacial surgical interventions, and surgical simulation images accurately depict post-operative outcome.

1. B. Zide, B. Grayson, and J.G. McCarthy, "Cephalometric Analysis for Upper and Lower Midface Surgery: Part II," Plastic and Reconstructive Surgery, Vol. 68, No. 6, Dec. 1981, pp. 961-968.
2. J.G. McCarthy, Plastic Surgery, Vol. 4, W.B. Saunders, Philadelphia, 1990, p. 2,974.
3. L.J. Lo et al., "Craniofacial Computer Assisted Surgical Planning and Simulation," Clinics in Plastic Surgery, Vol. 21, No. 4, Oct. 1994, pp. 501-516.
4. C.N. McEwan and K. Fukuta, "Recent Advances in Medical Imaging: Surgery Planning and Simulation," World J. of Surgery, Vol. 13, No. 4, July-Aug. 1989, pp. 343-348.
5. M.W. Vannier, J.L. Marsh, and J.O. Warren, "Three-Dimensional CT Reconstruction Images for Craniofacial Surgical Planning and Evaluation," Radiology, Vol. 150, No. 1, Jan. 1984, pp. 179-185.
6. C. Cutting et al., "Computer-Aided Planning and Evaluation of Facial and Orthognathic Surgery," Clinics in Plastic Surgery, Vol. 13, No. 3, July 1986, pp. 449-462.
7. T.J. Lambrecht and F. Brix, "Individual Skull Model Fabrication for Craniofacial Surgery," Cleft Palate J., Vol. 27, No. 4, Oct. 1990, pp. 382-387.
8. H.M. Klein et al., "Pediatric Craniofacial Surgery: Comparison of Milling and Stereolithography for 3D Model Manufacturing," Pediatric Radiology, Vol. 22, No. 6, 1992, pp. 458-60.
9. C.F. Hildebolt, M.W. Vannier, and R.H. Knapp, "Validation Study of Skull Three-Dimensional Computerized Tomography Measurements," Am. J. Physical Anthropology, Vol. 82, No. 3, July 1990, pp. 283-294.
10. R.A. Robb et al., "Analyze: A Comprehensive Operator-Interactive Software Package for Multidimensional Medical Image Display and Analysis," Computerized Medical Imaging Graphics, Vol. 13, No. 6, Nov.-Dec. 1989, pp. 433-454.
11. H. Jiang, R.A. Robb, and K.S. Holton, "A New Approach to 3-D Registration of Multimodality Medical Images by Surface Matching," SPIE Proc. Visualization in Biomedical Computing, R.A. Robb, ed., Vol. 1808, 1992, pp. 196-213.
12. W.A. Kalendar and A. Polacin, "Physical Performance Characteristics of Spiral CT scanning," Med. Phys., Vol. 18, No. 5, Sept.-Oct. 1991, pp. 910-915.
13. G. Wang and M.W. Vannier, "Longitudinal Resolution in Volumetric X-ray Computerized Tomography-Analytical Comparison Between Conventional and Helical Computerized Tomography," Med. Phys., Vol. 21, No. 3, March 1994, pp. 429-433.
14. E. Krestl, ed., Imaging Systems for Medical Diagnostics, Siemens Aktiengesellschaft, Munich, 1990, pp. 118-137.
15. J.P. Heiken, J.A. Brink, and M.W. Vannier, "Spiral (Helical) CT," Radiology, Vol. 189, No. 3, Dec. 1993, pp. 647-656.
16. D.J. McGill and W.W. King, Engineering Mechanics: An Introduction to Statics and Dynamics, Chap. 4, "Kinetics of a Rigid Body in Plane Motion / Development and Solution of the Differential Equations Governing the Motion," PWS Engineering Publ., Boston, 1985, pp. 220-318.
17. W. Gellert et al., eds., VNR Concise Encyclopedia of Mathematics, Chap. 24, "Analytic Geometry of Space," Van Nostrant Reinhold, New York, 1975, pp. 530-547.

Index Terms:
computer-aided surgery, surgical simulation, computer surgical simulation, surgical planning, biomedical computer graphics, 3D computed tomography, craniofacial surgery
Vikas V. Patel, Michael W. Vannier, Jeffrey L. Marsh, Lun-Jou Lo, "Assessing Craniofacial Surgical Simulation," IEEE Computer Graphics and Applications, vol. 16, no. 1, pp. 46-54, Jan. 1996, doi:10.1109/38.481602
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