Pre-planning of Individualized Ankle Implants Based on Computed Tomography - Automated Segmentation and Optimization of Acquisition Parameters

Abstract: The structure of the ankle joint complex creates an ideal balance between mobility and stability, which enables gait. If a lesion emerges in the ankle joint complex, the anatomical structure is altered, which may disturb mobility and stability and cause intense pain. A lesion in the articular cartilage on the talus bone, or a lesion in the subchondral bone of the talar dome, is referred to as an Osteochondral Lesion of the Talus (OLT). Replacing the damaged cartilage or bone with an implant is one of the methods that can be applied to treat OLTs. Episurf Medical develops and produces patient-specific implants (Episealers) along with the necessary associated surgical instruments by, inter alia, creating a corresponding 3D model of the ankle (talus, tibial, and fibula bones) based on either a Magnetic Resonance Imaging (MRI) scan or a Computed Tomography (CT) scan. Presently, the3D models based on MRI scans can be created automatically, but the 3Dmodels based on CT scans must be created manually, which can be very time-demanding. In this thesis project, a U-net based Convolutional Neural Network (CNN) was trained to automatically segment 3D models of ankles based on CT images. Furthermore, in order to optimize the quality of the incoming CT images, this thesis project also consisted of an evaluation of the specified parameters in the Episurf CT talus protocol that is being sent out to the clinics. The performance of the CNN was evaluated using the Dice Coefficient (DC) with five-fold cross-validation. The CNN achieved a mean DC of 0.978±0.009 for the talus bone, 0.779±0.174 for the tibial bone, and 0.938±0.091 for the fibula bone. The values for the talus and fibula bones were satisfactory and comparable to results presented in previous researches; however, due to background artefacts in the images, the DC achieved by the network for the segmentation of the tibial bone was lower than the results presented in previous researches. To correct this, a noise-reducing filter will be implemented.