DiODe v2: Unambiguous and Fully-Automated Detection of Directional DBS Lead Orientation

Directional deep brain stimulation (DBS) leads are now widely used, but the orientation of directional leads needs to be taken into account when relating DBS to neuroanatomy. Methods that can reliably and unambiguously determine the orientation of directional DBS leads are needed. In this study, we provide an enhanced algorithm that determines the orientation of directional DBS leads from postoperative CT scans. To resolve the ambiguity of symmetric CT artifacts, which in the past, limited the orientation detection to two possible solutions, we retrospectively evaluated four different methods in 150 Cartesia (TM) directional leads, for which the true solution was known from additional X-ray images. The method based on shifts of the center of mass (COM) of the directional marker compared to its expected geometric center correctly resolved the ambiguity in 100% of cases. In conclusion, the DiODe v2 algorithm provides an open-source, fully automated solution for determining the orientation of directional DBS leads.

Automated summary

Directional deep brain stimulation (DBS) leads are widely used, but determining their orientation accurately from postoperative CT scans is crucial. An enhanced algorithm based on center of mass shifts of directional markers compared to their expected geometric center was found to be the most reliable method for resolving orientation ambiguity in DBS leads. This DiODe v2 algorithm offers an automated solution for determining the orientation of directional DBS leads.