Skolyoz için Kapsül Ağları Tabanlı Otomatik Ölçüm Sistemi

Skolyoz, omurganın eğrilmesi ile birlikte omurga genel yapısını deforme eden bir hastalıktır. Skolyoz tanı ve tedavi aşamasında çeşitli yöntemler olmakla birlikte, temel amaç Cobb açısı adı verilen eğrilik açısını azaltarak Skolyoz seviyesini düşürme çerçevesinde şekillenmektedir. Cobb açısı ölçümü esasında uzman tarafından, omurga röntgen filmleri üzerinde manuel olarak gerçekleştirilmektedir. Ancak bu sürecin derin öğrenme gibi bir Yapay Zeka yaklaşımıyla otomatikleştirilmesi hem hasta hem de uzman açısından büyük kolaylık ve kesinlik sağlayacaktır. Açıklamalardan hareketle bu çalışmada, öncelikli olarak Skolyoz ve derin öğrenme odaklı çalışmalar açısından literatürün güncel durumu ele alınmış, ardından Kapsül Ağları (CapsNet) tabanlı bir çözüm ile Cobb açısı ölçümlerinin otomatik bir hale getirilmesi sağlanmıştır. CapsNet çözümünün, ConvNet, BoostNet, RFR ve ResNet-50 modelleri ile karşılaştırılması neticesinde en iyi bulguları CapsNet modelinin verdiği tespit edilmiştir

DEVELOPMENT OF AN INTEGRATED SYSTEM FOR HUMAN SPINE DEFORMITY MEASUREMENT

Ph.DDOCTOR OF PHILOSOPH

Development of a low-cost postural measurement system to assist during assessment, optimal correction, and casting of the spinal orthosis for scoliosis patients

Adolescent idiopathic scoliosis (AIS) is a spine pathology in teenagers that causes 3-dimensional deformities. Radiographs are a standard outcome measurement method that can be evaluated for coronal and sagittal plane deformities but lack 3-dimensional information. Casting is a process of capturing the trunk shape under force correction by clinicians. Scoliosis casting frames are uncommon in clinical practice due to difficulty in usage and lack of evidence. There is a lack of information about the force magnitude, force locations and directions to correct deformity in three dimensions during casting. The study objective was to develop and validate a system that could quantify the spinal deformity of AIS patients in 3 dimensions, apply forces to correct the spinal deformity in three dimensions, measure the magnitude of forces and illustrate those force directions in three dimensions. This study also sought to clarify scoliosis deformity in 3 dimensions and how it changed on applying forces during casting. A low-cost postural measurement system was developed using 8 Raspberry Pi mini-computers with integrated cameras arranged in a circle that communicated wirelessly with a main computer. The software was written in C++ and ran on Visual Studio 2019 and Windows 10. The stereo camera concept was used and implemented with OpenCV for camera calibration and marker position calculations in 3 dimensions. Each Raspberry Pi captured an image of the marker, which was stored on the central computer where the marker position in 3D space was calculated and used to quantify relevant spinal parameters. Six load cells were calibrated and used to measure the magnitude of the forces applied during casting. A Scoliosis casting apparatus was designed in the SolidWorks program and built following the design to apply the casting forces using manipulator arms. Force measuring software was written in Python and ran on Visual Studio 2017 and Windows 10. Validation of the data obtained was demonstrated by a series of experiments during the development process. After completing development, the systems were tested with AIS patients, and the data were analysed using descriptive and inferential statistics. The RMSE of the developed postural measurement system when locating markers was 2.42 mm, appropriate for quantifying scoliosis deformity in clinical practice. The validity of the system for clinical practice was examined in a clinical experiment that recruited ten AIS participants. The experiment was approved by ethical committees from the University of Strathclyde and Mahidol University. The assessment result was that the postural measurement system had a high concurrent validity compared to radiographs for CSA (r-value: 0.57 - 0.96), SSA (r-value: 0.35 - 0.94) and trunk balance (r-value = 0.91). In coronal spinal parameters for the postural measurement system in assessment VS optimal correction and assessment VS casting, there was a reduction percentage of apical translation of approximately 50% with a statistically significant difference in reduction of apical translation. However, there was no statistically significant difference in CSA. For optimal correction VS casting, there was a statistically significant equivalence when the margin of equivalence (M) was 5°. In SSA, there was a statistically significant equivalence when M = 9° for assessment VS optimal correction and 8° for assessment VS casting and optimal correction VS casting. In 3DSA, there was no statistically significant difference for assessment VS optimal correction and assessment VS casting. There was statistically significant equivalence when M = 8° for optimal correction VS casting. There was a high reduction of trunk balance from assessment (-8.19 mm, SD = 11.58) to optimal correction (-1.25 mm, SD = 4.56) and casting (-0.71 mm, SD = 3.32). However, there was no statistically significant difference. There was a statistically significant equivalence when M = 3 mm for optimal correction VS casting. Trunk asymmetry (POTSI) improved from 33.54% (SD = 16.23) in assessment to 22.80% (SD = 12.41) in casting. The mean of the total reduction of the horizontal trunk rotation angle was 14.83° (SD = 12.44). The force to correct the deformity at each area was approximately 30 N, and the total force each patient had to tolerate during optimal correction was approximately 150 N. In conclusion, we produced a system that could quantify, in three dimensions, the spinal deformity of AIS patients, produce relevant spinal parameters and quantify casting force magnitude and direction. This could be done before and after casting and hence quantify the effects of casting. The scoliosis casting apparatus itself could be suitably adjusted to apply forces to correct deformity in three dimensions as part of clinical practice. The system as a whole has the potential to quantify spinal orthotic practice and hence base practice on a scientific evidential basis.Adolescent idiopathic scoliosis (AIS) is a spine pathology in teenagers that causes 3-dimensional deformities. Radiographs are a standard outcome measurement method that can be evaluated for coronal and sagittal plane deformities but lack 3-dimensional information. Casting is a process of capturing the trunk shape under force correction by clinicians. Scoliosis casting frames are uncommon in clinical practice due to difficulty in usage and lack of evidence. There is a lack of information about the force magnitude, force locations and directions to correct deformity in three dimensions during casting. The study objective was to develop and validate a system that could quantify the spinal deformity of AIS patients in 3 dimensions, apply forces to correct the spinal deformity in three dimensions, measure the magnitude of forces and illustrate those force directions in three dimensions. This study also sought to clarify scoliosis deformity in 3 dimensions and how it changed on applying forces during casting. A low-cost postural measurement system was developed using 8 Raspberry Pi mini-computers with integrated cameras arranged in a circle that communicated wirelessly with a main computer. The software was written in C++ and ran on Visual Studio 2019 and Windows 10. The stereo camera concept was used and implemented with OpenCV for camera calibration and marker position calculations in 3 dimensions. Each Raspberry Pi captured an image of the marker, which was stored on the central computer where the marker position in 3D space was calculated and used to quantify relevant spinal parameters. Six load cells were calibrated and used to measure the magnitude of the forces applied during casting. A Scoliosis casting apparatus was designed in the SolidWorks program and built following the design to apply the casting forces using manipulator arms. Force measuring software was written in Python and ran on Visual Studio 2017 and Windows 10. Validation of the data obtained was demonstrated by a series of experiments during the development process. After completing development, the systems were tested with AIS patients, and the data were analysed using descriptive and inferential statistics. The RMSE of the developed postural measurement system when locating markers was 2.42 mm, appropriate for quantifying scoliosis deformity in clinical practice. The validity of the system for clinical practice was examined in a clinical experiment that recruited ten AIS participants. The experiment was approved by ethical committees from the University of Strathclyde and Mahidol University. The assessment result was that the postural measurement system had a high concurrent validity compared to radiographs for CSA (r-value: 0.57 - 0.96), SSA (r-value: 0.35 - 0.94) and trunk balance (r-value = 0.91). In coronal spinal parameters for the postural measurement system in assessment VS optimal correction and assessment VS casting, there was a reduction percentage of apical translation of approximately 50% with a statistically significant difference in reduction of apical translation. However, there was no statistically significant difference in CSA. For optimal correction VS casting, there was a statistically significant equivalence when the margin of equivalence (M) was 5°. In SSA, there was a statistically significant equivalence when M = 9° for assessment VS optimal correction and 8° for assessment VS casting and optimal correction VS casting. In 3DSA, there was no statistically significant difference for assessment VS optimal correction and assessment VS casting. There was statistically significant equivalence when M = 8° for optimal correction VS casting. There was a high reduction of trunk balance from assessment (-8.19 mm, SD = 11.58) to optimal correction (-1.25 mm, SD = 4.56) and casting (-0.71 mm, SD = 3.32). However, there was no statistically significant difference. There was a statistically significant equivalence when M = 3 mm for optimal correction VS casting. Trunk asymmetry (POTSI) improved from 33.54% (SD = 16.23) in assessment to 22.80% (SD = 12.41) in casting. The mean of the total reduction of the horizontal trunk rotation angle was 14.83° (SD = 12.44). The force to correct the deformity at each area was approximately 30 N, and the total force each patient had to tolerate during optimal correction was approximately 150 N. In conclusion, we produced a system that could quantify, in three dimensions, the spinal deformity of AIS patients, produce relevant spinal parameters and quantify casting force magnitude and direction. This could be done before and after casting and hence quantify the effects of casting. The scoliosis casting apparatus itself could be suitably adjusted to apply forces to correct deformity in three dimensions as part of clinical practice. The system as a whole has the potential to quantify spinal orthotic practice and hence base practice on a scientific evidential basis

Establishing an evidence-base for erect pelvis radiography : positioning, radiation dose and image quality

Purpose: Pelvic radiography using X-ray imaging has traditionally been used for the identification of hip joint changes, including the identification of pathologies such as osteoarthritis. For patients suffering from hip pain, the supine pelvis X-ray examination is one of the initial diagnostic steps. Despite this, many recent studies have recommended that the position should now be undertaken erect and not supine to reflect the functional appearances of the hip joint. This thesis aims to establish an evidence base for erect pelvis radiography, and it will include assessing radiographic positioning, radiation dose and image quality. Methods: The experimental work described in this thesis was conducted in three phases. Each phase has its own methods with the purpose of achieving a specific set of aims. Phase One was the evaluation of the postural effects of different erect (standing) positions in order to recommend an optimal one for erect pelvic radiography. Eight different erect positions were investigated. A sample group of 67 healthy people participated, and a range of spinal and pelvis measurements were acquired using a 3D video rasterography system (Diers) and an inclinometer.Phase Two was a phantom study evaluating the potential changes to radiation dose and image quality when moving between supine and erect imaging. Phase two was undertaken using three experiments (experiment #1, experiment #2 and experiment #3). Experiment #1 evaluated the impact of increased patient size on the radiation dose and image quality. In this experiment, animal fat was positioned anteriorly on a pelvic anthropomorphic phantom and the thickness increased incrementally in 1cm steps from 1 to 15cm. Image quality was evaluated physically and visually. The effective dose was calculated using Monte Carlo simulation software (PCXMC). During experiment #2, the anterior thicknesses for 109 patients, with a range of BMIs, who were referred for pelvis radiography, was measured in the erect and supine position. Experiment #3 evaluated the potential differences between the positions (supine and erect) in terms of image quality and radiation dose by modelling patient thickness changes between positions using the data obtained in experiment #2. An anthropomorphic phantom was used and modified (by adding additional fat) to simulate tissue changes for both erect and supine X-ray positions. Visual grading analysis was used (VGA) to evaluate image quality. The effective dose and absorbed dose were calculated using PCXMC.During Phase Three, 60 patients were imaged in erect and supine positions. The paired pelvis X-ray images were then compared, taking into account radiation dose and image quality.Results: Phase One demonstrated no statistical differences between the eight-different standing positions for pelvic and spine metrics (P>0.05). Results also demonstrated no significant postural differences between BMIs across all eight standing positions (P>0.05). Also, no differences (P>0.05) were identified in the pelvis and spinal metrics when comparing between males and females .Standing relaxed with feet internally rotated by 20°and the upper arms supported was a recommendation derived from this phase. Results from Phase Two showed an increase in effective dose (E) as the fat thickness increased. Also, all physical and visual image quality metrics decreased as fat thickness increased. Physical and visual image quality measures also decreased for erect images when compared to supine images, and the E also increased. 90kVp, 130/145 SID, using both outer chambers, were the recommended exposure parameters settings for obtaining erect pelvis X-ray images. Results from Phase Three showed that anterior patient thickness was 17% (P<0.001) higher in an erect position .The DAP and absorbed dose were 46% and 45% (P<0.001) greater in the erect position. Also, the effective dose was 67% (P<0.001) higher in the erect position when compared with supine. In regard to the image quality (IQ), that of the erect position decreased by 10% when compared with supine (P<0.001).Conclusion: The eight proposed standing positions could theoretically be suitable for erect pelvis imaging. People in a relaxed standing position, with their feet internally rotated by 20°and their upper arms supported would be recommended. In terms of IQ and radiation dose for erect positions, this position decreases image quality (both physical and visual) and increased radiation dose. Changes were largely due to the effect of gravity on the anterior soft tissue distribution. These issues should be considered and optimised more fully when deciding if to move from supine to erect pelvis imaging