ITM Web of Conferences 15, 01007 (2017) DOI: 10.1051/itmconf/20171501007 CMES’17

Segmentation and reconstruction of the 3D geometry of the middle and inner

Yanfei Lu1,*

1Warsaw University of Technology, Faculty of Production Engineering, Institute of Mechanics and Printing, Department of Construction Engineering and Biomedical Engineering, Narbutta 85, 02-524 Warsaw, Poland

Abstract. The anatomical model of the ear is of great importance in the design of ossicular prosthesis, cochlear implant electrodes, as well as for the preoperative planning and navigation of surgery. By means of micro-computed tomography (micro-CT) and technology of 3D reconstruction, an anatomical model of the middle and was built. Region of interest includes the ossicular chain (, , and ), (scala vestibule-ST, scala tympani- ST, -BM, -SL and osseous spiral lamina-OSL), tympanic membrane-TM, membrane-OWM, membrane-OWM and stapedial annular ligament-SAL. The micro-CT images of a cadaver’s temporal were acquired by “SkyScan 1076” (Kontich, Belgium, www.skyscan.be) and then reconstructed to cross-section images by SkyScan NRecon™ (v1.6.10.4). The image processing and 3D geometry reconstruction of were performed by software Mimics® (v14.0, Materialise NV, Leuven, Belgium). The obtained structures are measured and validated against literature data and the results are in good agreement.

1 Introduction spiral and filled with the fluid of . Scala tympani lies inferior to cochlea spiral and filled with the and inner ear are important structures fluid of . Between them, there is scala media responsible for sound transduction and balance. Sound containing also the fluid of endolymph. Normally, the wave in the air is firstly detected by (tympanic membrane between SV and SM, Reissner's membrane, is membrane), then transformed through ossicular chain to very thin and hard to illustrated by means of micro-CT. cochlea and there transduced to bioelectric signal. The basilar membrane, which separates apart the ST and Ossicular chain in the middle ear consists of malleus, SM, has some degrees of thickness that can be detected incus and stapes. The three are attached to by micro-CT. Mechanical waves excited by the OWM, surrounding bony structures by ligaments and tendons which locates on the bottom end of the SV, transfer and are connected with each other by two joints. In this along the spiral coli to the apex of the cochlea, the way, they keep a complex spatial structure and fulfill the , where the SV and ST merge, then come function of sound transmission. Malleus connects to back along another duct ST. Sensory hair cells on the tympanic membrane, and stapes connects to cochlea. BM are activated by the fluid wave in SV and ST, and Around the footplate of stapes, there is a ring of fibrous convert the mechanical signal to biological signal tissue that connects the stapes to the oval window of the transferred to the brain along the auditory nerve. The inner ear, called stapedial annular ligament. The opening other two parts of the , the vestibule and on the cochlea in contact with stapes is covered with , are responsible for the sensations of a membrane, called oval window membrane. balance and motion. They use the same kinds of lymph The bony labyrinth of the inner ear is the network of fluids and sensory cells as the cochlea uses, and detect passages with bony walls lined with periosteum in the the attitude and motion of the body. temporal bone. It consists of three parts: the vestibule, Diseases or injuries of the middle ear or inner ear semicircular canals, and cochlea. Inside these cavities, may cause severe healing loss. About 5% population there exists a system of endolymph filled tube, suffer from disability associated with problem , which is separated from bony worldwide [1]. The causes of are different labyrinth by a layer of perilymph fluid. Cochlea is from conductive (middle ear) or sensorineural (inner a spiral shaped cavity in the bony labyrinth. In humans, ear). Ossicles prosthesis are applied to middle ear it makes about 2.5 turns around its axis. There are three damage caused by chronic inflammatory or disease, such scalae in the cochlea: scala vestibule, scala tympani and as (stiffness of stapes), to reconstruct the scala media. Scala vestibule lies superior to the cochlea

* Corresponding author: [email protected]

© The Authors, published by EDP Sciences. This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (http://creativecommons.org/licenses/by/4.0/). ITM Web of Conferences 15, 01007 (2017) DOI: 10.1051/itmconf/20171501007 CMES’17

conduction system [2, 3]. While damage of inner ear The micro-CT system consists of the X-ray lamp requires the application of cochlear implant. with a high voltage power supply, one bed for the Optimal designed ossicular prosthesis and cochlear sample with a precise object positioning mechanism and implant electrodes, as well as their precise insertion are a CCD camera connected to a computer with software possible thanks to the development of computeraided for storing and processing of the received data. This engineering (C) and computer-aided surgery (CAS): equipment is able to emit X-ray on energy range from design of the ossicular prosthesis and cochlear implant 20kV to 100kV. The data are obtained by rotating the electrodes is greatly simplified by computer-aided design X-ray tube and the CCD cameras for up to 180 degrees (CAD) [4, 5]; afterwards verification and optimization of or 360 degrees, with adjustable increments (at least 0.02 them are achieved by finite element method (FEM) [6, 7, degree) around the axis of the immovable object. The 10]; due to the complexity and small scale of the resulting individual 2D projection x-ray images are structure of the middle and the inner ear, CAS is usually saved as 16-bit TIFF files. The rotation of the imaged applied in preoperative surgery planning and navigation sample relative to the x-ray source and camera allows during the surgery [8, 9]. the precise 3D location of the scanned objects to be Effectiveness of these computer-based approaches is calculated. based on a reliable geometric model. To obtain the 3D anatomical information of the analyzed structures, 2.2.2 Parameters of the scanning process several methods have been used, among them histological microgrinding [11], Magnetic Resonance The scan was performed with a source voltage and Imaging (MRI) [12] and micro computed tomography source current of, respectively, 100 kV and 100 μA. (micro-CT). Histological microgrinding traditionally An aluminum filter with a thickness of 1mm was used to used and features for high accuracy but destructive narrow the X-ray energy spectrum, reducing the low procedure. MRI features for large contract for soft tissue energy component, thus reducing beam hardening. The but low spatial resolution. Therefor micro-CT is CT images were acquired at a step angle of 0.6° for preferred for its high resolution and nondestructive a total circular orbit of 360°. Exposure time per frame procedure. was 620 ms. In order to improve quality of the final Aim of this work is to build a 3D anatomical model image file, averaging of four images was conducted. of the middle and inner ear by means of micro-CT and Scanning resolution in this study is set at 18 μm. All 3d reconstruction. Region of interest includes the projection images were saved as 16-bit TIFF files ossicular chain (malleus, incus, and stapes), cochlea (Fig.1). (scala vestibule-ST, scala tympani-ST, basilar membrane-BM, spiral ligament-SL and osseous spiral lamina-OSL), tympanic membrane-TM, oval window membrane-OWM, round window membrane-OWM and stapedial annular ligament-SAL.

2 Methods

2.1. Temporal bone preparation The human cadaver’s temporal bone was dissected at Warsaw Medical University from male cadaver. The temporal bone was harvested within 2 days of death and Fig. 1. ample D proection image of microCT scan. removed from soft tissues and frozen immediately. The specimen was cut to the size about 2 cm × 2 cm × 2 cm cubic, in order to minimize the X-ray absorption by 2.2.3 2D Reconstruction surrounding bone. Following projection images acquisition from multiple angles, cross-section reconstruction of from CT image 2.2 Micro-CT scanning process and the image was performed based on the Feldkamp algorithm which acquisition consists of back-projection and convolution. Back- projection derives object position from the shadow position from multiple angles, while convolution 2.2.1 Methodology of micro-CT scanning process removes a blurring halo from around the periphery of Micro-CT is a non-invasive and efficient technique to objects which back-projection alone would leave, by investigate the 3D geometry of anatomic structure. In a selective image subtraction method. In this study, this study, to examine the structure of the middle and SkyScan NRecon (Version 1.6.10.4) package was used inner ear, a piece of extracted calvarial specimen was to reconstruct cross-section images of the object from scanned using a micro-CT instrument “SkyScan 1076” tomography projection. (Kontich, Belgium, www.skyscan.be). Some imaging artifacts are peculiar to CT, such as ring artifacts and beam hardening. Beam hardening rises

2 ITM Web of Conferences 15, 01007 (2017) DOI: 10.1051/itmconf/20171501007 CMES’17

rom emission rom the microocus ray source o 3 Results a miture o low and hih enery rays in artiacts arise rom the incremental rotation o the obectcamera ue to the small space between incusmalleus oint eometry in combination with nonuniormity o the and incusstapes oint the separation o the ossicular ray detection perormance o individual camera piels chain was perormed manually by ask edit tool ter urin the reconstruction these artiacts could be sementation we ot three masks o alleus ncus and corrected by sotware to some etent Stapes as shown in i The inal proection imaes in 16bit T ormat Closely net to malleus there is a membranous were loaded and then the ollowin parameters o the structuretympanic membrane T which is marked in reconstruction process were adusted by a tryanderror liht reen as shown in i The view reveals the ashion and deined as in rtiact Correction10 topoloical relationship between T and the ossicular eam ardenin Correction 17 ostalinment chain The head o malleus attaches to the incus and the was set as to reduce tails doublin or blurrin in the handle o malleus is connected to the coneshaped reconstructed imaes membrane T eionointerest was chosen to include the ue to the bi contrast between bone and sot tissue ossicular chain malleus incus stapes tympanic it’s not too difficult to fill the bony labyrinth. Spiral membrane and bony labyrinth vestibule, semicircular structure o cochlear and spatial arranement o three canals and cochlea rey level threshold was adusted semicircular canals could be clearly observed in i accordin to a preview slice to make sure the structures ound window niche and oval window niche could also o interest obvious and in ood contrast total number be noticed o 600 slice imaes were saved in bit rayscale The net step was cut out o scala vestibuli and scala ormat at the resolution 2000 16 piels iure 2 tympani rom the mask o cochlear capsule Scala shows an eample o one slice imae o the inner ear vestibuli S lies superior to the cochlea spiral and scala tympani ST lies to the inerior oth o the two spiralshaped canals make about 2 turns about the etween the ducts o S and ST is scala media. rgan of corti (C) and basilar membrane (BM) were not marked separately in this proect because thickness of BM (13 μm) is less than 1 pixel (18 μm). SV and ST oin at the helicotrema, the tip of the heli.

Region of interest

Fig. 2. ample of cross sectional image.

2.3 Image processing and three-dimensional reconstruction n order to separate the reions o interest rom the rest o the imae a series o sementation tools include Thresholdin eion rowin oolean and orpholoy operations were used The irst step was a separation o bone rom sot tissue by Thresholdin tool The deined radiodensity or Incus bone is rom 226 to 02 and or sot tissue is rom Malleus 700 to 22 This deined CT value well relected the bone and sot tissue partition despite some o the unavoidable noise points which could be removed manually in later steps ecause the ossicular chain is connected to temporal bone only by liaments and tenders which were previously removed in thresholdin step we could separate it to a new mask by eion Stapes rowin tool owever there are some structures cannot be separated by automatic tools structures in between small ap such as the 2 oints between ossicles, SL and stapes structures have similar contrast such as BM, SL and SL thin layers such as RM and M. n this case, manually segmentation is applied. Fig. 3. Segmentation and 3D representation of ossicular chain.

3 ITM Web of Conferences 15, 01007 (2017) DOI: 10.1051/itmconf/20171501007 CMES’17

Malleus

TM

Malleus

TM

Fig. 4. Tympanic membrane (. ig.7. Basilar membrane and measurement.

BM

OSL SL

Fig. 5. ony labyrinth. Fig.8. Segmentation of basilar membrane, spiral ligament and osseous spiral lamina. n ig.6, the gap between SV and ST, consisted of SV SV three parts that are the copose of and spiral SV ST ST liaent S and osseous spiral laina S. ontrast Vestibule beteen those parts as not bi enouh to separate the directly therefore data reported in literature is referred SV ST that idth of is beteen . and . narroest at the base and idest at the ape of cochlear. as and reconstruction of the copose of oran of corti and basilar ebrane is shon in i.. S and S ere obtained by subtractin S and S fro the as of bony labyrinth as shon in i.. SV ound indo situated at the botto end of S is a ebranecoered openin beteen the iddle ear and the cochlea. iht as represents the . his saddleshaped ebrane seals the niche as shon in i.. nother tiny structure of interest is stapedial annular ST liaent S. S is a rin of fibrous tissue beteen the base of the stapes to the oal indo bony all hich allos the ibration of stapes and seals the oal Fig. 6. Seentation and representation of scala estibuli and scala typani. indo niche. eoetry of S is arious the aerae

4 ITM Web of Conferences 15, 01007 (2017) DOI: 10.1051/itmconf/20171501007 CMES’17

heiht is . and thicness is beteen . and . . respectiely hich are not larer than the error . as and reconstruction of S are shon as due to indiidual difference. in i.. or ebranous structure the thicness of ebranes is enerally ranin beteen seeral icroeters to doens of icroeters hich is saller or in the sae rane of icro resolution u. herefore it aes no sense to copare the thicness of ST ebranous structure. nstead the easureent is ade ST RWM alon the ebranous surface. has irreular RWM shape therefore the diaeter is easure as the distance oer the surface. RWM are . and . respectiely hich RWM are in line ith theShort study diameter perfored and by long oura diameter . n of ST histhe study the short diaeter of the round indo is ST ranin fro . to . aerae . and the lon diaeter is ranin fro . to . aerae . . herefore it can be concluded that the reconstructed Fig.9. Segmentation of the round window membrane. odel reflects the real structure of the iddle and inner ear. t proides reliable eoetric inforation for anatoical structures. his odel could be used for plannin surery and as ell as student education in the field of otoloy and audioloy. urtherore a odel could be enerated fro this odel after proper odification and eshin. pplication of this odel could be etended to the fields of and S.

his or is perfored under the proect of S founded by i.

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13. . rion, . ogstorp, K. adin, tol Neurotol, 1. . Nomura, dvances in toRhinoLaryngology, 30, 14 (00) 33, 1 (14) 14. L. risteguieta, L. cuna, nt Morphol, 28, 10 (010)

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