The influence of metal artifacts on navigation and the reduction of artifacts by the use of polyether-ether-ketone

Registration is a crucial step in navigation assisted surgery. When performing anatomical pair-point registration, there are several potential sources of error, including inadequate data acquisition, improper segmentation, and distortion resulting from metal artifacts. The aim of this study was to evaluate the influence of metal artifacts on the precision of Iso-C3D and fluoroscopy-based navigation, and to assess any changes in precision from the use of a newly developed Schanz screw composed of polyether-ether-ketone (PEEK OPTIMA®). A T-shaped test specimen was manufactured from synthetic bone material. It was then scanned with a Siremobil® Iso-C3D while different types of implant were present in the specimen. Five Iso-C3D scans were acquired: one with a steel Schanz screw in the specimen, one with a titanium screw, one with a PEEK screw, one with a 5-hole plate, and one with no screw or plate present. The registration was analyzed by "reverse verification" with a pointer in a purpose-built, manipulable 3D holder. All experiments were then repeated using fluoroscopy-based navigation. Increasing presence of metal in the scan area resulted in an increase in mean error (0.55 mm with the steel Schanz screw, 0.7 mm with the 5-hole plate). Artifacts resulting from the titanium Schanz screw were less than those caused by the stainless steel Schanz screw. While this study demonstrates that metallic artifacts do have an influence on the precision of Iso-C3D navigation, such artifacts were not found to be a factor when performing fluoroscopy-based navigation.