3D reconstruction of ribcage geometry from biplanar radiographs using a statistical parametric model approach

Rib cage 3D reconstruction is an important prerequisite for thoracic spine modelling, particularly for studies of the deformed thorax in adolescent idiopathic scoliosis. This study proposes a new method for rib cage 3D reconstruction from biplanar radiographs, using a statistical parametric model approach. Simplified parametric models were defined at the hierarchical levels of rib cage surface, rib midline and rib surface, and applied on a database of 86 trunks. The resulting parameter database served to statistical models learning which were used to quickly provide a first estimate of the reconstruction from identifications on both radiographs. This solution was then refined by manual adjustments in order to improve the matching between model and image. Accuracy was assessed by comparison with 29 rib cages from CT scans in terms of geometrical parameter differences and in terms of line-to-line error distance between the rib midlines. Intra and inter-observer reproducibility were determined regarding 20 scoliotic patients. The first estimate (mean reconstruction time of 2’30) was sufficient to extract the main rib cage global parameters with a 95% confidence interval lower than 7%, 8%, 2% and 4° for rib cage volume, antero-posterior and lateral maximal diameters and maximal rib hump, respectively. The mean error distance was 5.4 mm (max 35mm) down to 3.6 mm (max 24 mm) after the manual adjustment step (+3’30). The proposed method will improve developments of rib cage finite element modeling and evaluation of clinical outcomes.This work was funded by Paris Tech BiomecAM chair on subject specific muscular skeletal modeling, and we express our acknowledgments to the chair founders: Cotrel foundation, Société générale, Protéor Company and COVEA consortium. We extend your acknowledgements to Alina Badina for medical imaging data, Alexandre Journé for his advices, and Thomas Joubert for his technical support

Biomechanical Morphing for Personalized Fitting of Scoliotic Torso Skeleton Models

The use of patient-specific biomechanical models offers many opportunities in the treatment of adolescent idiopathic scoliosis, such as the design of personalized braces. The first step in the development of these patient-specific models is to fit the geometry of the torso skeleton to the patient’s anatomy. However, existing methods rely on high-quality imaging data. The exposure to radiation of these methods limits their applicability for regular monitoring of patients. We present a method to fit personalized models of the torso skeleton that takes as input biplanar low-dose radiographs. The method morphs a template to fit annotated points on visible portions of the spine, and it relies on a default biomechanical model of the torso for regularization and robust fitting of hardly visible parts of the torso skeleton, such as the rib cage. The proposed method provides an accurate and robust solution to obtain personalized models of the torso skeleton, which can be adopted as part of regular management of scoliosis patients. We have evaluated the method on ten young patients who participated in our study. We have analyzed and compared clinical metrics on the spine and the full torso skeleton, and we have found that the accuracy of the method is at least comparable to other methods that require more demanding imaging methods, while it offers superior robustness to artifacts such as interpenetration of ribs. Normal-dose X-rays were available for one of the patients, and for the other nine we acquired low-dose X-rays, allowing us to validate that the accuracy of the method persisted under less invasive imaging modalities

A Novel Method for the 3-D Reconstruction of Scoliotic Ribs From Frontal and Lateral Radiographs

Among the external manifestations of scoliosis, the rib hump, which is associated with the ribs' deformities and rotations, constitutes the most disturbing aspect of the scoliotic deformity for patients. A personalized 3-D model of the rib cage is important for a better evaluation of the deformity, and hence, a better treatment planning. A novel method for the 3-D reconstruction of the rib cage, based only on two standard radiographs, is proposed in this paper. For each rib, two points are extrapolated from the reconstructed spine, and three points are reconstructed by stereo radiography. The reconstruction is then refined using a surface approximation. The method was evaluated using clinical data of 13 patients with scoliosis. A comparison was conducted between the reconstructions obtained with the proposed method and those obtained by using a previous reconstruction method based on two frontal radiographs. A first comparison criterion was the distances between the reconstructed ribs and the surface topography of the trunk, considered as the reference modality. The correlation between ribs axial rotation and back surface rotation was also evaluated. The proposed method successfully reconstructed the ribs of the 6th-12th thoracic levels. The evaluation results showed that the 3-D configuration of the new rib reconstructions is more consistent with the surface topography and provides more accurate measurements of ribs axial rotation.Natural Sciences and Engineering Research Council of Canada and MENTOR, a strategic training program of the Canadian Institutes of Health Research

A 3D computer assisted Orthopedic Surgery Planning approach based on planar radiography

Dissertação de mestrado integrado em Engenharia Biomédica (área de especialização em Informática Médica)The main goal of this work consisted in develop a system to perform the 3D reconstruction of bone models from radiographic images. This system can be then integrated with a commercial software that performs pre-operative planning of orthopedic surgeries. The benefit of performing this 3D reconstruction from planar radiography is that this modality has some advantages over other modalities that perform this reconstruction directly, like CT and MRI. To develop the system it was used radiographic images of the femur obtained from medical image databases online. It was also used a generic model of the femur available in the online repository BEL. This generic model completes the information missing in the radiographic images. It was developed two methods to perform the 3D reconstruction through the deformation of the generic model, one uses triangulation of extracted edge points and the other don't. The first method was not successful, the final model had very low thickness, possibly because the triangulation process was not performed correctly. With the second method it was obtained a 3D bone model of the femur aligned with the radiographic images of the patient and with the same size as the patient's bone. However, the obtained model still needs some adjustment to coincide fully with reality. To perform this is necessary to enhance the deformation step of the model so that it will have the same shape as the patient's bone. The second method is more advantageous because it doesn't need the parameters of the x-ray imaging system. However, it's necessary to enhance the step deformation of this method so that the final model matches patient's anatomy.O principal objetivo deste trabalho consistiu em desenvolver um sistema capaz de realizar a reconstrução 3D de modelos ósseos a partir de imagens radiográficas. Este sistema pode posteriormente ser integrado num produto comercial que realiza o planeamento pré-operativo de cirurgias ortopédicas. O benefício de realizar esta reconstrução 3D a partir de radiografias está relacionado com o facto desta modalidade ter vantagens em relação às outras modalidades que fazem esta reconstrução diretamente, como as modalidades CT e MRI. Para desenvolver este sistema foram usadas imagens radiográficas do fémur obtidas através de bases de dados online de imagens médicas. Também foi usado um modelo genérico do fémur disponível no repositório online BEL. Este modelo genérico completa a informação que está em falta nas imagens radiográficas. Foram desenvolvidos dois métodos, que realizam a reconstrução 3D através da deformação do modelo genérico sendo que num é feita a triangulação de pontos dos contornos e noutro não. O primeiro método não foi bem sucedido, visto que o modelo final tinha uma espessura muito pequena, possivelmente devido ao facto do processo de triangulação não ter sido executado corretamente. Com o segundo método foi obtido um modelo 3D do fémur alinhado com as imagens radiográficas do paciente e com o mesmo tamanho do osso do paciente. No entanto, o modelo obtido carece ainda de alguma afinação de modo a coincidir na íntegra com a realidade. Para fazer isto é necessário melhorar o passo de deformação do modelo, para que este fique com a mesma forma do osso do paciente. O segundo método é mais vantajoso porque não necessita dos parâmetros dos sistema de raios- X. No entanto, é necessário melhorar o passo de deformação deste método para que o modelo final coincida com a anatomia do paciente

Porcine Spine Finite Element Model of Progressive Experimental Scoliosis and Assessment of a New Dual-Epiphyseal Growth Modulating Implant

RÉSUMÉ La scoliose est une déformation tridimensionnelle de la colonne vertébrale dont l’étiologie reste encore à élucider. Il est généralement admis que la progression de la déformation scoliotique pédiatrique est liée au principe d’Hueter-Volkmann qui stipule une réduction de la croissance suite à des contraintes en compression excessives au niveau de la concavité de la courbure scoliotique vs. sa convexité. Les stratégies de traitement des courbures sont difficiles, surtout chez les jeunes enfants. Typiquement, une intervention chirurgicale avec une instrumentation rachidienne accompagnée d’une arthrodèse segmentaire est nécessaire pour des courbures progressant au-delà de 40° d’angle de Cobb. De nouveaux dispositifs visent à manipuler la croissance vertébrale en exploitant le principe d’Hueter-Volkmann pour contrôler la progression de et corriger la courbure. Ces implants sans fusion exploitent la croissance vertébrale résiduelle en manipulant des gradients de croissance pour localement inverser la cunéiformisation vertébrale et, au fil du temps, réaligner la colonne vertébrale globalement. Des essais cliniques ont démontré une correction prometteuse pour les courbures généralement inférieures à 45°; cependant, les dispositifs actuels chevauchent l’espace du disque intervertébral et le compriment augmentant les risques de dégénérescence du disque à long terme. Par ailleurs, les implants nouvellement conçus sont généralement testés en utilisant des modèles animaux équivalents pour évaluer leur efficacité à corriger des déformations par l'intermédiaire de l’approche inverse (création d'une déformation) ou l’approche à 2- étapes (création d'une déformation suivie d’une correction). Néanmoins, une plate-forme de conception efficace est nécessaire pour évaluer la manipulation de la croissance à court et long termes par de nouveaux implants et de raccourcir le transfert de connaissances vers des applications cliniques. L’objectif général de cette thèse était de développer et de vérifier un modèle par éléments finis porcin (MEFp) unique en tant qu’une plateforme alternative pour la simulation de scolioses expérimentales progressives et des implants sans fusion, et d’évaluer un nouvel implant double-épiphysaire local ne chevauchant pas l’espace du disque sur des porcs immatures. Ainsi, les objectifs spécifiques suivants ont été complétés : 1) développer et----------ABSTRACT Scoliosis is a complex three-dimensional deformity of the spine whose etiology is yet to be elucidated. The pathomechanism of scoliosis progression is believed to be linked to the Hueter-Volkmann principle, by which growth is reduced due to increased growth plate compression, with the inverse also valid. Treatment strategies are challenging, especially in young children. Curves progressing beyond 40° Cobb angle are typically treated via invasive surgical interventions requiring spinal instrumentation accompanied by segmental spinal arthrodesis, impairing spinal mobility. New devices aim at manipulating vertebral growth by exploiting the Hueter-Volkmann principle to control curvature progression. These fusionless implants harness remaining vertebral growth by manipulating growth gradients to reverse vertebral wedging locally and, over time, globally realign the spine. Clinical trials have demonstrated promising deformity correction for curves generally below 45°; however, current devices bridge the intervertebral disc gap and predominantly compress the disc increasing the risks of longterm disc degeneration. Moreover, in a time-consuming manner, newly designed implants are commonly tested using equivalent animal models to assess their efficacy in correcting spinal deformities via the inverse (creation of a deformity) or the 2-step approaches (creation of a deformity followed by its subsequent correction). Nevertheless, a solid design platform is required to evaluate the short- and long-term growth manipulating efficacy of new implant designs and shorten knowledge transfer to clinical applications. The general objective of this thesis was to develop and verify a unique porcine spine finite element model (pFEM) as an alternative testing platform for the simulation of progressive experimental scoliosis and fusionless implants, and assess a new localized dualepiphyseal implant on immature pigs. Thus, specific objectives were devised as follows: 1) develop and verify a distinctive pFEM of the spine and ribcage, 2) develop and test, in vivo, a dual-epiphyseal implant incorporating a custom expansion mechanism, 3) exploit the developed pFEM to investigate differences between the inverse and 2-step fusionless implant testing approaches, and 4) exploit the pFEM to evaluate the biomechanical contribution of the ribcage in fusionless scoliosis surgery

Fossil apes and human evolution

Humans diverged from apes (chimpanzees, specifically) toward the end of the Miocene ~9.3 million to 6.5 million years ago. Understanding the origins of the human lineage (hominins) requires reconstructing the morphology, behavior, and environment of the chimpanzee-human last common ancestor. Modern hominoids (that is, humans and apes) share multiple features (for example, an orthograde body plan facilitating upright positional behaviors). However, the fossil record indicates that living hominoids constitute narrow representatives of an ancient radiation of more widely distributed, diverse species, none of which exhibit the entire suite of locomotor adaptations present in the extant relatives. Hence, some modern ape similarities might have evolved in parallel in response to similar selection pressures. Current evidence suggests that hominins originated in Africa from Miocene ape ancestors unlike any living species

Innovative optical non-contact measurement of respiratory function using photometric stereo

Pulmonary functional testing is very common and widely used in today's clinical environment for testing lung function. The contact based nature of a Spirometer can cause breathing awareness that alters the breathing pattern, affects the amount of air inhaled and exhaled and has hygiene implications. Spirometry also requires a high degree of compliance from the patient, as they have to breathe through a hand held mouth piece. To solve these issues a non-contact computer vision based system was developed for Pulmonary Functional Testing. This employs an improved photometric stereo method that was developed to recover local 3D surface orientation to enable calculation of breathing volumes. Although Photometric Stereo offers an attractive technique for acquiring 3D data using low-cost equipment, inherent limitations in the methodology have served to limit its practical application, particularly in measurement or metrology tasks. Traditional Photometric Stereo assumes that lighting directions at every pixel are the same, which is not usually the case in real applications and especially where the size of object being observed is comparable to the working distance. Such imperfections of the illumination may make the subsequent reconstruction procedures used to obtain the 3D shape of the scene, prone to low frequency geometric distortion and systematic error (bias). Also, the 3D reconstruction of the object results in a geometric shape with an unknown scale. To overcome these problems a novel method of estimating the distance of the object from the camera was developed, which employs Photometric Stereo images without using other additional imaging modality. The method firstly identifies the Lambertian Diffused Maxima regions to calculate the object's distance from the camera, from which the corrected per-pixel light vector is derived and the absolute dimensions of the object can be subsequently estimated. We also propose a new calibration process to allow a dynamic (as an object moves in the field of view) calculation of light vectors for each pixel with little additional computational cost. Experiments performed on synthetic as well as real data demonstrate that the proposed approach offers improved performance, achieving a reduction in the estimated surface normal error by up to 45% as well as the mean height error of reconstructed surface of up to 6 mm. In addition, compared with traditional photometric stereo, the proposed method reduces the mean angular and height error so that it is low, constant and independent of the position of the object placement within a normal working range. A high (0.98) correlation between breathing volume calculated from Photometric Stereo and Spirometer data was observed. This breathing volume is then converted to absolute amount of air by using distance information obtained by Lambertian Diffused Maxima Region. The unique and novel feature of this system is that it views the patients from both front and back and creates a 3D structure of the whole torso. By observing the 3D structure of the torso over time, the amount of air inhaled and exhaled can be estimated

Identifying Humans by the Shape of Their Heartbeats and Materials by Their X-Ray Scattering Profiles

Security needs at access control points presents itself in the form of human identification and/or material identification. The field of Biometrics deals with the problem of identifying individuals based on the signal measured from them. One approach to material identification involves matching their x-ray scattering profiles with a database of known materials. Classical biometric traits such as fingerprints, facial images, speech, iris and retinal scans are plagued by potential circumvention they could be copied and later used by an impostor. To address this problem, other bodily traits such as the electrical signal acquired from the brain (electroencephalogram) or the heart (electrocardiogram) and the mechanical signals acquired from the heart (heart sound, laser Doppler vibrometry measures of the carotid pulse) have been investigated. These signals depend on the physiology of the body, and require the individual to be alive and present during acquisition, potentially overcoming circumvention. We investigate the use of the electrocardiogram (ECG) and carotid laser Doppler vibrometry (LDV) signal, both individually and in unison, for biometric identity recognition. A parametric modeling approach to system design is employed, where the system parameters are estimated from training data. The estimated model is then validated using testing data. A typical identity recognition system can operate in either the authentication (verification) or identification mode. The performance of the biometric identity recognition systems is evaluated using receiver operating characteristic (ROC) or detection error tradeoff (DET) curves, in the authentication mode, and cumulative match characteristic (CMC) curves, in the identification mode. The performance of the ECG- and LDV-based identity recognition systems is comparable, but is worse than those of classical biometric systems. Authentication performance below 1% equal error rate (EER) can be attained when the training and testing data are obtained from a single measurement session. When the training and testing data are obtained from different measurement sessions, allowing for a potential short-term or long-term change in the physiology, the authentication EER performance degrades to about 6 to 7%. Leveraging both the electrical (ECG) and mechanical (LDV) aspects of the heart, we obtain a performance gain of over 50%, relative to each individual ECG-based or LDV-based identity recognition system, bringing us closer to the performance of classical biometrics, with the added advantage of anti-circumvention. We consider the problem of designing combined x-ray attenuation and scatter systems and the algorithms to reconstruct images from the systems. As is the case within a computational imaging framework, we tackle the problem by taking a joint system and algorithm design approach. Accurate modeling of the attenuation of incident and scattered photons within a scatter imaging setup will ultimately lead to more accurate estimates of the scatter densities of an illuminated object. Such scattering densities can then be used in material classification. In x-ray scatter imaging, tomographic measurements of the forward scatter distribution are used to infer scatter densities within a volume. A mask placed between the object and the detector array provides information about scatter angles. An efficient computational implementation of the forward and backward model facilitates iterative algorithms based upon a Poisson log-likelihood. The design of the scatter imaging system influences the algorithmic choices we make. In turn, the need for efficient algorithms guides the system design. We begin by analyzing an x-ray scatter system fitted with a fanbeam source distribution and flat-panel energy-integrating detectors. Efficient algorithms for reconstructing object scatter densities from scatter measurements made on this system are developed. Building on the fanbeam source, energy-integrating at-panel detection model, we develop a pencil beam model and an energy-sensitive detection model. The scatter forward models and reconstruction algorithms are validated on simulated, Monte Carlo, and real data. We describe a prototype x-ray attenuation scanner, co-registered with the scatter system, which was built to provide complementary attenuation information to the scatter reconstruction and present results of applying alternating minimization reconstruction algorithms on measurements from the scanner