Galileo Positioning System

Transcription

1 Galileo Positioning System Surgeon s Checklist Software Version Anterior Workflow

2 Anterior Workflow 1 Click the SURG S CHKLIST button from the bottom menu to launch the Surgeon s Checklist software. 2 In the upper left corner, select Anterior Hip from the dropdown menu. 3 Select L or R to select the operative hip. 1

3 Reconciling Pre-operative Pelvis Position with Intra-operative Pelvis Position Before intra-operative measurements can be taken, Surgeon s Checklist first needs to reconcile the position of the pelvis in the pre-operative image with the current, intra-operative position of the pelvis in the C-Arm images. If the pelvis was tilted or rotated a certain way during the pre-operative image, this step allows the image to be rotated so that pre-operative and intra-operative images have the same orientation. 1 Double-click the Pre-op viewer on the upper monitor and select the patient s pre-operative study (full pelvis image). 2 Open the Surgeon s Checklist software on the upper monitor. If a previously taken pre-operative pelvis image is not available, take a pre-operative image of the AP pelvis using the C-Arm. Click Grab Frame to acquire the pre-operative image on the lower monitor. Follow these steps to move the image to the upper monitor: On the lower monitor, Click SEND on the top menu Check the box next to Selected Image Hit SAVE Click QC Image Then open the Surgeon s Checklist software on the upper monitor. 3 On the upper monitor, click Trans-ischial or Teardrop Line and draw a line connecting the bottom of the ischium (Trans-ischial line) or the bottom of the tear-drops (Teardrop line). Trans-ischial Line Teardrop Line 2

4 Teardrop-Brim Line 1 1. On the upper monitor, click Teardrop-Brim Line and draw the Trans-ischial line on the operative side of pre-operative image. Draw the line from the bottom of the teardrop upward and tangent to the pelvic inlet. Teardrop-brim line The Teardrop-Brim angle will appear. 3

5 Teardrop-Brim Line 2 Enter the angle from the pre-operative image into the Teardrop- Brim line s Normal Inclination box on the lower monitor. 3 Press Enter. The C-Arm image will rotate to match the rotation of the pre-operative image. 4

6 Checking Cup Position Surgeon s Checklist offers two options to verify cup positioning: Use the Draw Ellipse function to input targeted inclination and anteversion angles and compare current cup position to the targeted, ideal cup position. The software will then show the targeted position as an ellipse. Use the Detect Ellipse function to see the current cup position and check the current inclination and anteversion angles. Checking Cup Position Using the Draw Ellipse Function 1 Click Draw Ellipse Input target inclination and anteversion angles. An ellipse will appear with the target angles. Adjust the cup size using the up/down arrows next to the Draw Ellipse box to more closely match the actual cup size being used. Compare the ellipse drawn with target angles to the actual cup ellipse and make adjustments to cup position as desired. 5

7 Checking Cup Position 5 Click Update Ellipse to see adjusted cup position in relation to the ellipse drawn with target angles. 6 Repeat as necessary until desired cup position is achieved. 7 Click Click Here to Move onto LLD/Offset 6

8 Checking Cup Position Using the Detect Ellipse Function 1 Click Detect Ellipse. 2 Use the touchscreen or left-click the mouse to touch the ellipse on each end and one other point (three points total). The cup s actual ellipse will appear, and the cup s true inclination and anteversion angles will appear in the boxes. 3 Make changes to cup position as desired, and repeat Detect Ellipse. 4 Repeat step 3 until the desired cup position is achieved. 5 Click Click Here to Move onto LLD/Offset To change the color of the ellipse, click the color pallette 7

9 Measuring Limb Length and Femoral Offset Surgeon s Checklist offers three ways to assess limb length and offset. The first method is to create an overlay of the intra-operative image and pre-operative image and compare selected bony landmarks. The second method is to position contra-lateral and intra-operative images side by side and stitch them into one full image, allowing for limb length and offset comparison. The third method is to take an intra-operative full AP pelvis image using the C-Arm and take limb length and offset measurements on that image. Measuring Limb Length and Offset: Comparison of Bony Landmarks 1 Take an image of the contra-lateral hip. 2 Click Show Edges. All bony landmark edges in the image will become highlighted in yellow. 8

10 Measuring Limb Length and Femoral Offset 3 4 Select the bony landmarks you would like to compare. To select, left-click with the mouse or use the touchscreen. The selected edges will turn blue. If a bony landmark you want to compare is not highlighted when you click Show Edges, select Free Style in the Annotations section and draw the bony landmark. 9

11 Measuring Limb Length and Femoral Offset 5 Click Hide Edges to see only the bony landmarks you have selected and drawn. 6 Flip the contra-lateral hip image horizontally by clicking FH in Image Orientation. 10

12 Measuring Limb Length and Femoral Offset 7 Take image of the intra-operative hip. Click Mark Key Image. 8 Click Show Edges. Select the bony landmarks you want to compare by clicking with the mouse or using the touchscreen. Those edges will turn blue. 11

13 Measuring Limb Length and Femoral Offset 9 Click Hide Edges to make the remaining bony landmark highlights disappear. 12

14 Measuring Limb Length and Femoral Offset 10 Select the Contra-lateral hip image from the image gallery at the bottom of the page Click the Overlay Images icon. Next, select the intra-operative hip image you previously marked as the Key Image. The selected edges on the intraoperative hip will now appear red. Grab and move the intra-operative image as necessary to compare bony landmarks and evaluate limb length and offset. Tips: Use the Page Up and Page Down keys on the keyboard to rotate the top image as necessary. Move the Transparency Control scroll bar from Bottom to Top to change the transparency of the top image. Note: The image clicked immediately after clicking the Overlay icon will appear as the top image on the overlay. To overlay the contra-lateral image on top of the intra-operative mage, click the intra-operative image first, click the Overlay icon, and then click the contra-lateral hip image. 13

15 Measuring Limb Length and Offset: Image Stitching 1 Click the pre-operative image of the contra-lateral hip. 2 Click the Stitching icon. 3 Click the final intra-operative image. 4 The images will appear side by side. 5 Move the Transparency Control scroll bar to the middle. You will now be able to grab and move the images. Tips Use the Page Up and Page Down keys on the keyboard to rotate the images as necessary. Use the arrow keys on the keyboard to move the images up and down as necessary. 14

16 Measuring Limb Length and Offset: Image Stitching 6 Grab and move the intra-operative image over until the mid-symphysis lines up to create an image of the complete pelvis. 7 Select HIP in the upper left drop-down menu to bring up the Surgeon s Checklist posterior software. 8 Check the operative hip side. 15

17 Measuring Limb Length and Offset: Image Stitching 9 Click Trans-ischial or Teardrop line and draw the Trans-ischial or Teardrop line. 10 Click Calibration in the lower right-hand corner of the screen. 16

18 Measuring Limb Length and Offset: Image Stitching 11 Draw the cup diameter and enter actual diameter in the Calibration Dialog box In the Limb Length section, click RT apex and click on the apex of the right lesser trochanter. A vertical line will drop to the Trans-ischial or Teardrop line. Click LT apex and click on the apex of the left lesser trochanter. A vertical line will drop to the Trans-ischial or Teardrop line. The difference in limb length will appear in the Diff (mm) box. 17

19 Measuring Limb Length and Offset: Image Stitching To evaluate femoral offset, click Right Center Point in the Offset section and click the point where the top of the right lesser trochanter intersects the femur. A horizontal line will appear between the femur and the ischial tuberosity. Adjust the length of the line so that the tips reach the edges of the femur and ischial tuberosity. The offset measurement for the right side will appear in the Offset (mm) box. Click Left Center Point in the Offset section and click the point where the top of the left lesser trochanter intersects the femur. A horizontal line will appear between the femur and the ischial tuberosity. Adjust the length of the line so that the tips reach the edges of the femur and the ischial tuberosity. The offset measurement for the left side will appear in the Offset (mm) box. The difference in offset will appear in the Diff (mm) box. Note: To compare intra-operative femoral offset with pre-operative offset, go to the pre-operative image on the upper monitor and repeat steps above. 18

20 Measuring Limb Length and Offset: Image Stitching 20 Click the monitor icon to the left of the Surgeon s Checklist drop-down menu to see all the lines you have drawn. Once limb length and offset comparisons have been made, adjust component size if desired. 19

21 Measuring Limb Length and Offset: Full AP Pelvis Image Taken with the C-Arm 1 2 Take a full AP pelvis image and click Grab Frame. Click Trans-ischial or Teardrop Line and draw a line In the Limb Length section, click RT Apex. Left-click the mouse on the edge of the right lesser trochanter. Hold the left-click button until the outer edge of the lesser trochanter is highlighted. Release the left-click button. A line will drop from the apex of the right lesser trochanter to the Trans-ischial or Teardrop line. Click LT apex. Left-click the mouse on the edge of the left lesser trochanter. Hold the left-click button until the outer edge of the lesser trochanter is highlighted. Release the left-click button and a line will drop from the apex of the left lesser trochanter to the Trans-ischial line or Teardrop line. The difference in limb length will appear in the Diff (mm) box. 20

22 Measuring Limb Length and Offset To evaluate femoral offset, click Right Center Point in the Offset section and click the point where the top of the right lesser trochanter intersects the femur. A horizontal line will appear between the femur and the ischial tuberosity. Adjust the length of the line so that the tips reach the edges of the femur and ischial tuberosity. The offset measurement for the right side will appear in the Offset (mm) box. Click Left Center Point in the Offset section and click the point where the top of the lesser trochanter intersects the femur. A horizontal line will appear between the femur and the ischial tuberosity. Adjust the length of the line so that the tips reach the edges of the femur and the ischial tuberosity. The offset measurement for the left side will appear in the Offset (mm) box. The difference in offset will appear in the Diff (mm) box. To compare intra-operative femoral offset with pre-operative offset, go to the pre-operative image on the upper monitor and repeat steps 8-12 above. 21

23 Measuring Limb Length and Offset Click the monitor icon in the upper left-hand corner to see all the lines that have been drawn on the image. Once limb length and offset comparisons have been made, adjust component size if desired.v 22

24 Radlink Inc. (310) N. Nash St. El Segundo, CA 90245