541 research outputs found
Interlandmark measurements from lodox statscan images with application to femoral neck anteversion assessment
Includes abstract.Includes bibliographical references.Clinicians often take measurements between anatomical landmarks on X-ray radiographs for diagnosis and treatment planning, for example in orthopaedics and orthodontics. X-ray images, however, overlap three-dimensional internal structures onto a two-dimensional plane during image formation. Depth information is therefore lost and measurements do not truly reflect spatial relationships. The main aim of this study was to develop an inter-landmark measurement tool for the Lodox Statscan digital radiography system. X-ray stereophotogrammetry was applied to Statscan images to enable three-dimensional point localization for inter-landmark measurement using two-dimensional radiographs. This technique requires images of the anatomical region of interest to be acquired from different perspectives as well as a suitable calibration tool to map image coordinates to real world coordinates. The Statscan is suited to the technique because it is capable of axial rotations for multiview imaging. Three-dimensional coordinate reconstruction and inter-landmark measurements were taken using a planar object and a dry pelvis specimen in order to assess the intra-observer measurement accuracy, reliability and precision. The system yielded average (X, Y, Z) coordinate reconstruction accuracy of (0.08 0.12 0.34) mm and resultant coordinate reconstruction accuracy within 0.4mm (range 0.3mm β 0.6mm). Inter-landmark measurements within 2mm for lengths and 1.80 for angles were obtained, with average accuracies of 0.4mm (range 0.0mm β 2.0 mm) and 0.30 (range 0.0 β 1.8)0 respectively. The results also showed excellent overall precision of (0.5mm, 0.10) and were highly reliable when all landmarks were completely visible in both images. Femoral neck anteversion measurement on Statscan images was also explored using 30 dry right adult femurs. This was done in order to assess the feasibility of the algorithm for a clinical application. For this investigation, four methods were tested to determine the optimal landmarks for measurement and the measurement process involved calculation of virtual landmarks. The method that yielded the best results produced all measurements within 10 of reference values and the measurements were highly reliable with very good precision within 0.10. The average accuracy was within 0.40 (range 0.10 β0.80).In conclusion, X-ray stereophotogrammetry enables accurate, reliable and precise inter-landmark measurements for the Lodox Statscan X-ray imaging system. The machine may therefore be used as an inter-landmark measurement tool for routine clinical applications
Benchmarking Encoder-Decoder Architectures for Biplanar X-ray to 3D Shape Reconstruction
Various deep learning models have been proposed for 3D bone shape
reconstruction from two orthogonal (biplanar) X-ray images. However, it is
unclear how these models compare against each other since they are evaluated on
different anatomy, cohort and (often privately held) datasets. Moreover, the
impact of the commonly optimized image-based segmentation metrics such as dice
score on the estimation of clinical parameters relevant in 2D-3D bone shape
reconstruction is not well known. To move closer toward clinical translation,
we propose a benchmarking framework that evaluates tasks relevant to real-world
clinical scenarios, including reconstruction of fractured bones, bones with
implants, robustness to population shift, and error in estimating clinical
parameters. Our open-source platform provides reference implementations of 8
models (many of whose implementations were not publicly available), APIs to
easily collect and preprocess 6 public datasets, and the implementation of
automatic clinical parameter and landmark extraction methods. We present an
extensive evaluation of 8 2D-3D models on equal footing using 6 public datasets
comprising images for four different anatomies. Our results show that
attention-based methods that capture global spatial relationships tend to
perform better across all anatomies and datasets; performance on clinically
relevant subgroups may be overestimated without disaggregated reporting; ribs
are substantially more difficult to reconstruct compared to femur, hip and
spine; and the dice score improvement does not always bring a corresponding
improvement in the automatic estimation of clinically relevant parameters.Comment: accepted to NeurIPS 202
Statistically Deformable 2D/3D Registration for Estimating Post-operative Cup Orientation from a Single Standard AP X-ray Radiograph
The widely used procedure of estimating post-operative cup orientation based on a single standard AP X-ray radiograph is known inaccurate, largely due to the wide variability in individual pelvic orientation relative to X-ray plate. CT-based 2D/3D rigid image registration methods have been developed to measure post-operative cup orientation. Although encouraging results have been reported, their extensive usage in clinical routine is still limited. This may be explained by their requirement of having a CT study of the patient at some point during treatment, which is not available for vast majority of Total Hip Arthroplasty procedures performed nowadays. To address this limitation, this article proposes a statistically deformable 2D/3D registration approach for estimating post-operative cup orientation. No CT study of the patient is required any more. Compared to ground truths established from post-operative CT images, the cup orientations measured by the present technique in a cadaver experiment showed differences of 1.7Β±1.4Β° for anteversion and difference of 1.5Β±1.5Β° for inclination. When the present technique was evaluated on patients' datasets, differences of 2.2Β±1.3Β° and differences of 2.0Β±0.8Β° were found for the anteversion and the inclination, respectively. The experimental results, though still preliminary, demonstrated the efficacy of the present approac
Doctor of Philosophy
dissertationGeometric abnormalities of the human hip joint, as found in femoroacetabular impingement (FAI) and acetabular dysplasia, alter hip biomechanics and may be the primary causes of osteoarthritis in young adults. However, empirical evidence of direct correlations between abnormal geometry, altered biomechanics, and osteoarthritis is scarce. Also, clinical measures used to diagnose FAI and dysplasia still have substantial limitations, including questions about their reliability, assumptions about hip joint geometry and their ability to definitively distinguish pathologic from normal hips. The goals of this dissertation are twofold. First, a set of tools are presented and applied to quantify three-dimensional (3D) anatomical differences between hips with FAI and control subjects. The 3D tools were developed, validated and applied to patients with a subtype of FAI, called cam FAI, to improve basic understanding of the spectrum of FAI deformities, and to provide meaningful new metrics of morphology that are relatable to current diagnostic methods and translate easily for clinical use. The second goal of this dissertation is to improve our understanding of intra-articular hip contact mechanics as well as hip joint kinematics and muscle forces. To do so, a finite element study of intraarticular cartilage contact mechanics was completed with a cohort of live human subjects, using a validated modeling protocol. Finally, musculoskeletal modeling was used with gait data from healthy subjects and acetabular dysplasia patients to provide preliminary estimates of hip joint kinematics, kinetics, and muscle forces and compare differences between the groups. The translational methods of this dissertation utilized techniques from orthopaedics, computer science, physical therapy, mechanics, and medical imaging. Results from this dissertation offer new insight into the complex pathomechanics and pathomorphology of FAI and acetabular dysplasia. Application and extension of the work of this dissertation has the potential to help establish links between FAI and dysplasia with osteoarthritis and to improve patient care
An Integrated System for 3D Hip Joint Reconstruction from 2D X-rays: A Preliminary Validation Study
The acquisition of conventional X-ray radiographs remains the standard imaging procedure for the diagnosis of hip-related problems. However, recent studies demonstrated the benefit of using three-dimensional (3D) surface models in the clinical routine. 3D surface models of the hip joint are useful for assessing the dynamic range of motion in order to identify possible pathologies such as femoroacetabular impingement. In this paper, we present an integrated system which consists of X-ray radiograph calibration and subsequent 2D/3D hip joint reconstruction for diagnosis and planning of hip-related problems. A mobile phantom with two different sizes of fiducials was developed for X-ray radiograph calibration, which can be robustly detected within the images. On the basis of the calibrated X-ray images, a 3D reconstruction method of the acetabulum was developed and applied together with existing techniques to reconstruct a 3D surface model of the hip joint. X-ray radiographs of dry cadaveric hip bones and one cadaveric specimen with soft tissue were used to prove the robustness of the developed fiducial detection algorithm. Computed tomography scans of the cadaveric bones were used to validate the accuracy of the integrated system. The fiducial detection sensitivity was in the same range for both sizes of fiducials. While the detection sensitivity was 97.96% for the large fiducials, it was 97.62% for the small fiducials. The acetabulum and the proximal femur were reconstructed with a mean surface distance error of 1.06 and 1.01mm, respectively. The results for fiducial detection sensitivity and 3D surface reconstruction demonstrated the capability of the integrated system for 3D hip joint reconstruction from 2D calibrated X-ray radiograph
Automatic image analysis of C-arm Computed Tomography images for ankle joint surgeries
Open reduction and internal fixation is a standard procedure in ankle surgery for treating a fractured fibula. Since fibula fractures are often accompanied by an injury of the syndesmosis complex, it is essential to restore the correct relative pose of the fibula relative to the adjoining tibia for the ligaments to heal. Otherwise, the patient might experience instability of the ankle leading to arthritis and ankle pain and ultimately revision surgery. Incorrect positioning referred to as malreduction of the fibula is assumed to be one of the major causes of unsuccessful ankle surgery. 3D C-arm imaging is the current standard procedure for revealing malreduction of fractures in the operating room. However, intra-operative visual inspection of the reduction result is complicated due to high inter-individual variation of the ankle anatomy and rather based on the subjective experience of the surgeon. A contralateral side comparison with the patientβs uninjured ankle is recommended but has not been integrated into clinical routine due to the high level of radiation exposure it incurs.
This thesis presents the ο¬rst approach towards a computer-assisted intra-operative contralateral side comparison of the ankle joint. The focus of this thesis was the design, development and validation of a software-based prototype for a fully automatic intra-operative assistance system for orthopedic surgeons. The implementation does not require an additional 3D C-arm scan of the uninjured ankle, thus reducing time consumption and cumulative radiation dose. A 3D statistical shape model (SSM) is used to reconstruct a 3D surface model from three 2D ο¬uoroscopic projections representing the uninjured ankle. To this end, a 3D SSM segmentation is performed on the 3D image of the injured ankle to gain prior knowledge of the ankle. A 3D convolutional neural network (CNN) based initialization method was developed and its outcome was incorporated into the SSM adaption step. Segmentation quality was shown to be improved in terms of accuracy and robustness compared to the pure intensity-based SSM. This allows us to overcome the limitations of the previously proposed methods, namely inaccuracy due to metal artifacts and the lack of device-to-patient orientation of the C-arm. A 2D-CNN is employed to extract semantic knowledge from all ο¬uoroscopic projection images. This step of the pipeline both creates features for the subsequent reconstruction and also helps to pre-initialize the 3D-SSM without user interaction. A 2D-3D multi-bone reconstruction method has been developed which uses distance maps of the 2D features for fast and accurate correspondence optimization and SSM adaption. This is the central and most crucial component of the workο¬ow. This is the ο¬rst time that a bone reconstruction method has been applied to the complex ankle joint and the ο¬rst reconstruction method using CNN based segmentations as features. The reconstructed 3D-SSM of the uninjured ankle can be back-projected and visualized in a workο¬ow-oriented manner to procure clear visualization of the region of interest, which is essential for the evaluation of the reduction result. The surgeon can thus directly compare an overlay of the contralateral ankle with the injured ankle.
The developed methods were evaluated individually using data sets acquired during a cadaver study and representative clinical data acquired during ο¬bular reduction. A hierarchical evaluation was designed to assess the inaccuracies of the system on different levels and to identify major sources of error. The overall evaluation performed on eleven challenging clinical datasets acquired for manual contralateral side comparison showed that the system is capable of accurately reconstructing 3D surface models of the uninjured ankle solely using three projection images. A mean Hausdorff distance of 1.72 mm was measured when comparing the reconstruction result to the ground truth segmentation and almost achieved the high required clinical accuracy of 1-2 mm. The overall error of the pipeline was mainly attributed to inaccuracies in the 2D-CNN segmentation. The consistency of these results requires further validation on a larger dataset.
The workο¬ow proposed in this thesis establishes the ο¬rst approach to enable automatic computer-assisted contralateral side comparison in ankle surgery. The feasibility of the proposed approach was proven on a limited amount of clinical cases and has already yielded good results. The next important step is to alleviate the identiο¬ed bottlenecks in the approach by providing more training data in order to further improve the accuracy.
In conclusion, the new approach presented gives the chance to guide the surgeon during the reduction process, improve the surgical outcome while avoiding additional radiation exposure and reduce the number of revision surgeries in the long term
A shape analysis approach to prediction of bone stiffness using FEXI
The preferred method of assessing the risk of an osteoporosis related fracture is currently a measure of bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA). However, other factors contribute to the overall risk of fracture, including anatomical geometry and the spatial distribution of bone. Finite element analysis can be performed in both two and three dimensions, and predicts the deformation or induced stress when a load is applied to a structure (such as a bone) of defined material composition and shape. The simulation of a mechanical compression test provides a measure of whole bone stiffness (N mmβ1).
A simulation system was developed to study the sensitivity of BMD, 3D and 2D finite element analysis to variations in geometric parameters of a virtual proximal femur model. This study demonstrated that 3D FE and 2D FE (FEXI) were significantly more sensitive to the anatomical shape and composition of the proximal femur than conventional BMD. The simulation approach helped to analyse and understand how variations in geometric parameters affect the stiffness and hence strength of a bone susceptible to osteoporotic fracture.
Originally, the FEXI technique modelled the femur as a thin plate model of an assumed constant depth for finite element analysis (FEA). A better prediction of tissue depth across the bone, based on its geometry, was required to provide a more accurate model for FEA. A shape template was developed for the proximal femur to provide this information for the 3D FE analysis.
Geometric morphometric techniques were used to procure and analyse shape information from a set of CT scans of excised human femora. Generalized Procrustes Analysis and Thin Plate Splines were employed to analyse the data and generate a shape template for the proximal femur. 2D Offset and Depth maps generated from the training set data were then combined to model the three-dimensional shape of the bone. The template was used to predict the three-dimensional bone shape from a 2D image of the proximal femur procured through a DXA scan. The error in the predicted 3D shape was measured as the difference in predicted and actual depths at each pixel. The mean error in predicted depths was found to be 1.7mm compared to an average bone depth of 34mm.
3D FEXI analysis on the predicted 3D bone along with 2D FEXI for a stance loading condition and BMD measurement were performed based on 2D radiographic projections of the CT scans and compared to bone stiffness results obtained from finite element analysis of the original 3D CT scans. 3D FEXI provided a significantly higher correlation (R2 = 0.85) with conventional CT derived 3D finite element analysis than achieved with both BMD (R2 = 0.52) and 2D FEXI (R2 = 0.44)
Correlations between the alpha angle and femoral head asphericity: Implications and recommendations for the diagnosis of cam femoroacetabular impingement
pre-printObjective: To determine the strength of common radiographic and radial CT views for measuring true femoral head asphericity. Patients and Methods: In 15 patients with cam femoroacetabular impingement (FAI) and 15 controls, alpha angles were measured by two observers using radial CT (0ΒΊ, 30ΒΊ, 60ΒΊ, 90ΒΊ) and digitally reconstructed radiographs (DRRs) for the: anterior-posterior (AP), standing frog-leg lateral, 45Β° Dunn with neutral rotation, 45Β° Dunn with 40Β°external rotation, and cross-table lateral views. A DRR validation study was performed. Alpha angles were compared between groups. Maximum deviation from a sphere of each subject was obtained from a previous study. Alpha angles from each view were correlated with maximum deviation. Results: There were no significant differences between alpha angles measured on radiographs and the corresponding DRRs (p = 0.72). Alpha angles were significantly greater in patients for all views (p β€0.002). Alpha angles from the 45Β° Dunn with 40Β° external rotation, cross-table lateral, and 60Β° radial views had the strongest correlations with maximum deviation (r = 0.831; r 20 = 0.823; r=0.808, respectively). The AP view had the weakest correlation (r = 0.358). Conclusion: DRRs were a validated means to simulate hip radiographs. The 45Β° Dunn with 40Β° external rotation, cross-table lateral, and 60ΒΊ radial views best visualized femoral asphericity. Although commonly used, the AP view did not visualize cam deformities well. Overall, the magnitude of the alpha angle may not be indicative of the size of the deformity. Thus, 3D reconstructions and measurements of asphericity could improve the diagnosis of cam FAI. Key Words: Cam Femoroacetabular Impingement Alpha Angle, Femur Asphericity, Digitally Introduction Cam-type femoroacetabular impingement (FAI) has been implicated as a cause of chondrolabral damage, hip osteoarthritis (OA), and musculoskeletal pain in young adults [1-3]. Cam FAI is characterized by an aspherical femoral head and/or insufficient femoral head-neck offset [4,5]. Identifying the degree of femoral head asphericity is important as the underlying goal of surgery to correct cam FAI is to restore a more normal, spherical morphology to the femoral head. The alpha angle is a two-dimensional (2D) radiographic measure of femoral head asphericity that is commonly used to diagnose cam FAI [6-8]. Although, first proposed by Notzli et al. for only an oblique axial view of the femur, use of the alpha angle has been extended to several radiographic projections and radial computed tomography (CT) or magnetic resonance (MR) views [7,9-14]. Unfortunately, alpha angle measurements can vary between views of the same femur [10,15,16]. Consequently, the ideal view to diagnose cam FAI remains unknown [15,17]. One approach to identify the optimal view in which to measure the alpha angle has been to quantify observer repeatability. However, reports of repeatability have not been consistent and repeatability is not necessarily a measure of effectiveness [18,19]. Another approach has been to correlate alpha angles from standard radiographic views to oblique axial or radial MRI/CT views [12,14,15,17]. Still, alpha angle measurements from radial views are not generated automatically, and thus do not provide a true reference standard. In addition, radial views do not consider the geometry of the entire femoral head. Alternatively, subject-specific 3D reconstructions of femur morphology, generated from volumetric CT or MR images, can be used to visualize the anatomy of the entire femoral head. By fitting the 3D reconstruction to a sphere, UU IR Author Manuscript UU IR Author Manuscript University of Utah Institutional Repository Author Manuscript one can quantify the size of a deformity as maximum deviation from the sphere, herein referred to as 'true femoral head asphericity' [20,21]
Scaled, patient-specific 3D vertebral model reconstruction based on 2D lateral fluoroscopy
Backgrounds: Accurate three-dimensional (3D) models of lumbar vertebrae are required for image-based 3D kinematics analysis. MRI or CT datasets are frequently used to derive 3D models but have the disadvantages that they are expensive, time-consuming or involving ionizing radiation (e.g., CT acquisition). An alternative method using 2D lateral fluoroscopy was developed. Materials and methods: A technique was developed to reconstruct a scaled 3D lumbar vertebral model from a single two-dimensional (2D) lateral fluoroscopic image and a statistical shape model of the lumbar vertebrae. Four cadaveric lumbar spine segments and two statistical shape models were used for testing. Reconstruction accuracy was determined by comparison of the surface models reconstructed from the single lateral fluoroscopic images to the ground truth data from 3D CT segmentation. For each case, two different surface-based registration techniques were used to recover the unknown scale factor, and the rigid transformation between the reconstructed surface model and the ground truth model before the differences between the two discrete surface models were computed. Results: Successful reconstruction of scaled surface models was achieved for all test lumbar vertebrae based on single lateral fluoroscopic images. The mean reconstruction error was between 0.7 and 1.6mm. Conclusions: A scaled, patient-specific surface model of the lumbar vertebra from a single lateral fluoroscopic image can be synthesized using the present approach. This new method for patient-specific 3D modeling has potential applications in spine kinematics analysis, surgical planning, and navigatio
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