A semi-automated method using interpolation and optimisation for the 3D reconstruction of the spine from bi-planar radiography: a precision and accuracy study

Identification of a lumped-parameter model of the intervertebral joint from experimental data

Through predictive simulations, multibody models can aid the treatment of spinal pathologies by identifying optimal surgical procedures. Critical to achieving accurate predictions is the definition of the intervertebral joint. The joint pose is often defined by virtual palpation. Intervertebral joint stiffnesses are either derived from literature, or specimen-specific stiffnesses are calculated with optimisation methods. This study tested the feasibility of an optimisation method for determining the specimen-specific stiffnesses and investigated the influence of the assigned joint pose on the subject-specific estimated stiffness. Furthermore, the influence of the joint pose and the stiffness on the accuracy of the predicted motion was investigated. A computed tomography based model of a lumbar spine segment was created. Joints were defined from virtually palpated landmarks sampled with a Latin Hypercube technique from a possible Cartesian space. An optimisation method was used to determine specimen-specific stiffnesses for 500 models. A two-factor analysis was performed by running forward dynamic simulations for ten different stiffnesses for each successfully optimised model. The optimisations calculated a large range of stiffnesses, indicating the optimised specimen-specific stiffnesses were highly sensitive to the assigned joint pose and related uncertainties. A limited number of combinations of optimised joint stiffnesses and joint poses could accurately predict the kinematics. The two-factor analysis indicated that, for the ranges explored, the joint pose definition was more important than the stiffness. To obtain kinematic prediction errors below 1 mm and 1° and suitable specimen-specific stiffnesses the precision of virtually palpated landmarks for joint definition should be better than 2.9 mm.

Assessment of spinal alignment in standing position using Biplanar X-ray images and three-dimensional vertebral models

We developed two methods for three-dimensional (3D) evaluation of spinal alignment in standing position by image matching between biplanar x-ray images and 3D vertebral models. One used a Slot-Scanning 3D x-ray Imager (sterEOS) to obtain biplanar x-ray images, and the other used a conventional x-ray system and a rotating table. The 3D vertebral model was constructed from the CT scan data. The spatial position of the vertebral model was determined by minimizing the contour difference between the projected image of the model and the biplanar x-ray images. Verification experiments were conducted using a torso phantom. The relative positions of the upper vertebrae to the lowest vertebrae of the cervical, thoracic, and lumbar vertebrae were evaluated. The mean, standard deviation, and mean square error of the relative position were less than 1° and 1 mm in all cases for sterEOS. The maximum mean squared errors of the conventional x-ray system and the rotating table were 0.7° and 0.4 mm for the cervical spine, 1.0° and 1.2 mm for the thoracic spine, and 1.1° and 1.2 mm for the lumbar spine. Therefore, both methods could be useful for evaluating the spinal alignment in standing position.

Three Dimensional Reconstruction Models for Medical Modalities: A Comprehensive Investigation and Analysis

BACKGROUND

Image reconstruction is the mathematical process which converts the signals obtained from the scanning machine into an image. The reconstructed image plays a fundamental role in the planning of surgery and research in the medical field.

DISCUSSION

This paper introduces the first comprehensive survey of the literature about medical image reconstruction related to diseases, presenting a categorical study about the techniques and analyzing advantages and disadvantages of each technique. The images obtained by various imaging modalities like MRI, CT, CTA, Stereo radiography and Light field microscopy are included. A comparison on the basis of the reconstruction technique, Imaging Modality and Visualization, Disease, Metrics for 3D reconstruction accuracy, Dataset and Execution time, Evaluation of the technique is also performed.

CONCLUSION

The survey makes an assessment of the suitable reconstruction technique for an organ, draws general conclusions and discusses the future directions.

Review of 2-D/3-D Reconstruction Using Statistical Shape and Intensity Models and X-Ray Image Synthesis: Toward a Unified Framework

Patient-specific three-dimensional (3-D) bone models are useful for a number of clinical applications such as surgery planning, postoperative evaluation, as well as implant and prosthesis design. Two-dimensional-to-3-D (2-D/3-D) reconstruction, also known as model-to-modality or atlas-based 2-D/3-D registration, provides a means of obtaining a 3-D model of a patient's bones from their 2-D radiographs when 3-D imaging modalities are not available. The preferred approach for estimating both shape and density information (that would be present in a patient's computed tomography data) for 2-D/3-D reconstruction makes use of digitally reconstructed radiographs and deformable models in an iterative, non-rigid, intensity-based approach. Based on a large number of state-of-the-art 2-D/3-D bone reconstruction methods, a unified mathematical formulation of the problem is proposed in a common conceptual framework, using unambiguous terminology. In addition, shortcomings, recent adaptations, and persisting challenges are discussed along with insights for future research.

Geometric Torsion in Adolescent Idiopathic Scoliosis: A New Method to Differentiate Between Lenke 1 Subtypes

STUDY DESIGN

Consecutive case series.

OBJECTIVE

To study geometric torsion in thoracic adolescent idiopathic scoliosis (AIS) to propose it as a numerical three-dimensional (3D) parameter that quantifies the scoliosis deformity.

SUMMARY OF BACKGROUND DATA

AIS is a 3D deformity of the spine. The most widely accepted and used classification systems, however, still rely on two-dimensional aspects of x-rays. Yet, a 3D classification of AIS remains elusive because there is no widely accepted 3D parameter in the clinical practice.

METHODS

Analysis of 141 patients with Lenke type-1 deformity recruited in our institution. The Lenke classification was identified by two observers and 3D reconstructions were obtained using biplanar radiographs. Geometric torsion measuring the twisting effect of the spine was computed using a novel technique by approximating local arc lengths at the neutral vertebra in the thoracolumbar segment. An inter- and intragroup statistical analysis was performed to evaluate the torsion index, and how it relates to other 3D indices.

RESULTS

A statistically significant increase in torsion was observed between Lenke 1A (1.15 mm) and Lenke 1C (2.10 mm) subgroups. No differences were found between the Lenke 1B (1.75 mm) subgroup with either of the other two subgroups. An automatic classification based on torsion indices identified two groups: one with high torsion values (3.02 mm) and one with low torsion values (0.82 mm). Statistically significant differences were found between the main thoracic planes of maximum curvature (PMC) orientation of the high-torsion group (73.72°) and the low-torsion group (79.85°). Statistically significant differences were also found for the thoracolumbar/lumbar PMC orientation between the high-torsion group (56.41°) and the low-torsion group (49.25°).

CONCLUSION

These results suggest that a numerical method of describing scoliosis in 3D is within reach. They also suggest the existence of two subgroups of 3D deformations based on torsion values (high and low) with links to PMC orientation.

LEVEL OF EVIDENCE

4.

Improving Visibility of Stereo-Radiographic Spine Reconstruction with Geometric Inferences

Complex deformities of the spine, like scoliosis, are evaluated more precisely using stereo-radiographic 3D reconstruction techniques. Primarily, it uses six stereo-corresponding points available on the vertebral body for the 3D reconstruction of each vertebra. The wireframe structure obtained in this process has poor visualization, hence difficult to diagnose. In this paper, a novel method is proposed to improve the visibility of this wireframe structure using a deformation of a generic spine model in accordance with the 3D-reconstructed corresponding points. Then, the geometric inferences like vertebral orientations are automatically extracted from the radiographs to improve the visibility of the 3D model. Biplanar radiographs are acquired from five scoliotic subjects on a specifically designed calibration bench. The stereo-corresponding point reconstruction method is used to build six-point wireframe vertebral structures and thus the entire spine model. Using the 3D spine midline and automatically extracted vertebral orientation features, a more realistic 3D spine model is generated. To validate the method, the 3D spine model is back-projected on biplanar radiographs and the error difference is computed. Though, this difference is within the error limits available in the literature, the proposed work is simple and economical. The proposed method does not require more corresponding points and image features to improve the visibility of the model. Hence, it reduces the computational complexity. Expensive 3D digitizer and vertebral CT scan models are also excluded from this study. Thus, the visibility of stereo-corresponding point reconstruction is improved to obtain a low-cost spine model for a better diagnosis of spinal deformities.

Patient-specific 3D models created by 3D imaging system or bi-planar imaging coupled with Moiré-Fringe projections: a comparative study of accuracy and reliability on spinal curvatures and vertebral rotation data

PURPOSE

The aim of this study is to compare the accuracy and reliability of spinal curvatures and vertebral rotation data based on patient-specific 3D models created by 3D imaging system or by bi-planar imaging coupled with Moiré-Fringe projections.

METHODS AND MATERIALS

Sixty-two consecutive patients from a single institution were prospectively included. For each patient, frontal and sagittal calibrated low-dose bi-planar X-rays were performed and coupled simultaneously with an optical Moiré back surface-based technology. The 3D reconstructions of spine and pelvis were performed independently by one radiologist and one technician in radiology using two different semi-automatic methods using 3D radio-imaging system (method 1) or bi-planar imaging coupled with Moiré projections (method 2). Both methods were compared using Bland-Altman analysis, and reliability using intraclass correlation coefficient (ICC).

RESULTS

ICC showed good to very good agreement. Between the two techniques, the maximum 95 % prediction limits was -4.9° degrees for the measurements of spinal coronal curves and less than 5° for other parameters. Inter-rater reliability was excellent for all parameters across both methods, except for axial rotation with method 2 for which ICC was fair. Method 1 was faster for reconstruction time than method 2 for both readers (13.4 vs. 20.7 min and 10.6 vs. 13.9 min; p = 0.0001).

CONCLUSION

While a lower accuracy was observed for the evaluation of the axial rotation, bi-planar imaging coupled with Moiré-Fringe projections may be an accurate and reliable tool to perform 3D reconstructions of the spine and pelvis.

Multi-view stereophotogrammetry for post-mastectomy breast reconstruction

A multi-view three-dimensional stereophotogrammetry system was developed to capture 3D shape of breasts for breast cancer patients. The patients had received immediate unilateral breast reconstruction after mastectomy by the extended latissimus dorsi flap and without contralateral surgery. In order to capture the whole breast shape including the inframammary fold, the patients were introduced to the imaging room and leaned over the imaging rig to open up the inframammary fold and to expose the entire area of each breast. The imaging system consisted of eight high-resolution ([Formula: see text] pixels) digital cameras and four flash units. The cameras were arranged in four stereo pairs from four different view angles to cover the whole surface of the breasts. The system calibration was carried out ahead of every capture session, and the stereo images were matched to generate four range images to be integrated using an elastic model proposed. A watertight breast mesh model was reconstructed to measure the volume of the breast captured. The accuracy of using the developed multi-view stereophotogrammetry system for breast volume measurement was 11.12cc with SEM 7.74cc, comparing to the measurements of the water displacement method. It was concluded that the 3D stereophotogrammetry image system developed was more reliable than the method of water displacement.

3D spine reconstruction of postoperative patients from multi-level manifold ensembles

The quantitative assessment of surgical outcomes using personalized anatomical models is an essential task for the treatment of spinal deformities such as adolescent idiopathic scoliosis. However an accurate 3D reconstruction of the spine from postoperative X-ray images remains challenging due to presence of instrumentation (metallic rods and screws) occluding vertebrae on the spine. In this paper, we formulate the reconstruction problem as an optimization over a manifold of articulated spine shapes learned from pathological training data. The manifold itself is represented using a novel data structure, a multi-level manifold ensemble, which contains links between nodes in a single hierarchical structure, as well as links between different hierarchies, representing overlapping partitions. We show that this data structure allows both efficient localization and navigation on the manifold, for on-the-fly building of local nonlinear models (manifold charting). Our reconstruction framework was tested on pre- and postoperative X-ray datasets from patients who underwent spinal surgery. Compared to manual ground-truth, our method achieves a 3D reconstruction accuracy of 2.37 +/- 0.85 mm for postoperative spine models and can deal with severe cases of scoliosis.

Real-scale 3D models of the scoliotic spine from biplanar radiography without calibration objects

This paper presents a new method for modelling the spines of subjects and making accurate 3D measurements using standard radiologic systems without requiring calibration objects. The method makes use of the focal distance and statistical models for estimating the geometrical parameters of the system. A dataset of 32 subjects was used to assess this method. The results show small errors for the main clinical indices, such as an RMS error of 0.49° for the Cobb angle, 0.50° for kyphosis, 0.38° for lordosis, and 2.62mm for the spinal length. This method is the first to achieve this level of accuracy without requiring the use of calibration objects when acquiring radiographs. We conclude that the proposed method allows for the evaluation of scoliosis with a much simpler setup than currently available methods.

Three-dimensional spine parameters can differentiate between progressive and nonprogressive patients with AIS at the initial visit: a retrospective analysis

BACKGROUND

Knowledge concerning morphology of the spine is reported in 2-dimensional (2D) or focuses on modification of parameters with progression of spinal deformation. The objective of this study was to compare 3-dimensional (3D) morphologic parameters of the spine at the first visit between progressive and a nonprogressive group of immature adolescent idiopathic scoliosis (AIS).

METHODS

The first group was made up of surgically corrected AIS patients (E) (n=19), whereas the second group was composed of nonprogressive AIS that had reached skeletal maturity (n=18). Computerized measurements were undertaken on reconstructed 3D spines. There were 5 categories of measurement: Cobb angles (scoliosis, kyphosis, lordosis), 3D wedging (apical vertebra, mean 2 apical disks), rotation (upper and lower junctional vertebra, apical vertebra, and disk), torsion, and slenderness (height/width ratio of T6, L4, and T1-L5). Nonparametric Mann-Whitney tests were also undertaken.

RESULTS

There was no statistical difference between the 2 groups for age, 3D Cobb angle, lordosis, and kyphosis. Mean 3D wedging of the apical disks, lower junctional vertebral axial rotation, torsion and T6, and whole spine height/width ratio were all significantly affected.

CONCLUSIONS

This study supports the theory that wedging begins in the disks and then in the vertebral body and identifies 3D morphologic parameters that could be used in the prediction of AIS evolution. The findings in the junctional area illustrate that a torsional deformity seems to occur distally from the apex and creates a progressive scoliosis. Curve progression could be predicted based on 3D morphometric parameters, as early as the initial visit.

3D analysis of congenital scoliosis due to hemivertebra using biplanar radiography

INTRODUCTION

This study aims to investigate the use of biplanar radiography for assessing congenital scoliosis due to hemivertebra in 3D.

MATERIALS AND METHODS

A reconstruction method was developed to model 3D spines with congenital scoliosis from biplanar radiography. 3D measurements quantifying the global posture, scoliotic deformities and imbalance and describing the shape and pose of the hemivertebra were automatically computed. Five cases of congenital scoliosis were analyzed and the accuracy of the method was evaluated by comparing 3D reconstructions from biplanar radiography with 3D segmentations generated from CT.

RESULTS

The mean shape accuracy was 1.8 mm (1.5 mm for the vertebral bodies and pedicles and 2.2 mm for the posterior arches).

CONCLUSION

Biplanar radiography can be considered an interesting tool for clinical follow-up of congenital scoliosis as it overcomes some limitations of the analyses based on CT or anteroposterior X-ray: head to feet acquisition, low radiation dose and provides a set of automatically computed postural and morphological parameters in 3D.

The assessment of the postoperative spinal alignment: MRI adds up on accuracy

INTRODUCTION

The sagittal profile of conventionally and surgically treated scoliotic spines is usually analyzed via lateral views of whole-spine X-rays in an upright position. Due to a more hypokyphotic configuration of scoliotic spines, the view onto the upper thoracic vertebrae is often difficult. We investigated whether additional supine MRI measurement supports valid kyphosis angle measurement.

PATIENTS AND METHODS

Twenty patients with either short (n = 10, Halm-Zielke, VDS) or long spondylodesis (n = 10, dorsoventral) were assessed 5 years after surgery with standing radiographs and supine whole-spine MRI.

RESULTS

Up to 90% of the upper thoracic vertebrae were invisible on radiographs, whereas MRI allowed visibility of almost many vertebrae. No significant difference in thoracal kyphosis angles could be observed in the comparison of X-ray and MRI data.

CONCLUSION

Thoracal kyphosis measurement of postoperative spines in MRI is a valid diagnostic tool with reliability comparable to that of X-ray. These results cannot be transferred to lumbar lordosis measurement and transferred only partly to coronal COBB angle measurement.

Interactive 3D reconstruction of the spine from radiographs using a statistical shape model and second-order cone programming

Three-dimensional models of the spine are commonly used to diagnose, to treat, and to study spinal deformities. Creating these models is however time-consuming and, therefore, expensive. We propose in this paper a reconstruction method that finds the most likely 3D reconstruction given a maximal error bound on a limited set of landmark locations supplied by the user. This problem can be solved using second-order cone programming, leading to a globally convergent method that is considerably faster than currently available methods. A user can, with our current implementation, interactively modify the landmark locations and receive instantaneous feedback on the effect of those changes on the 3D reconstruction instead of blindly selecting landmarks. The proposed method was validated on a set of 53 patients who had adolescent idiopathic scoliosis using real and synthetic tests. Test results showed that the proposed method is considerably faster than currents methods (about forty times faster), is extremely flexible, and offers comparable accuracy.

Coupling 2D/3D registration method and statistical model to perform 3D reconstruction from partial x-rays images data

3D reconstructions of the spine from a frontal and sagittal radiographs is extremely challenging. The overlying features of soft tissues and air cavities interfere with image processing. It is also difficult to obtain information that is accurate enough to reconstruct complete 3D models. To overcome these problems, the proposed method efficiently combines the partial information contained in two images from a patient with a statistical 3D spine model generated from a database of scoliotic patients. The algorithm operates through two simultaneous iterating processes. The first one generates a personalized vertebra model using a 2D/3D registration process with bone boundaries extracted from radiographs, while the other one infers the position and the shape of other vertebrae from the current estimation of the registration process using a statistical 3D model. Experimental evaluations have shown good performances of the proposed approach in terms of accuracy and robustness when compared to CT-scan.

Computer-aided assessment of scoliosis on posteroanterior radiographs

In order to reduce the observer variability in radiographic scoliosis assessment, a computer-aided system was developed. The system semi-automatically measured the Cobb angle and vertebral rotation on posteroanterior radiographs based on Hough transform and snake model, respectively. Both algorithms were integrated with the shape priors to improve the performance. The system was tested twice by each of three observers. The intraobserver and interobserver reliability analyses resulted in the intraclass correlation coefficients higher than 0.9 and 0.8 for Cobb measurement on 70 radiographs and rotation measurement on 156 vertebrae, respectively. Both the Cobb and rotation measurements resulted in the average intraobserver and interobserver errors less than 2 degrees and 3 degrees , respectively. There were no significant differences in the measurement variability between groups of curve location, curve magnitude, observer experience, and vertebra location. Compared with the documented results, measurement variability is reduced by using the developed system. This system can help orthopedic surgeons assess scoliosis more reliably.

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.

Personalized X-ray 3-D reconstruction of the scoliotic spine from hybrid statistical and image-based models

This paper presents a novel 3-D reconstruction method of the scoliotic spine using prior vertebra models with image-based information taken from biplanar X-ray images. We first propose a global modeling approach by exploiting the 3-D scoliotic curve reconstructed from a coronal and sagittal X-ray image in order to generate an approximate statistical model from a 3-D database of scoliotic patients based on a transformation algorithm which incorporates intuitive geometrical properties. The personalized 3-D reconstruction of the spine is then achieved with a novel segmentation method which takes into account the variable appearance of scoliotic vertebrae (rotation, wedging) from standard quality images in order to segment and isolate individual vertebrae on the radiographic planes. More specifically, it uses prior 3-D models regulated from 2-D image level set functionals to identify and match corresponding bone structures on the biplanar X-rays. An iterative optimization procedure integrating similarity measures such as deformable vertebral contours regulated from high-level anatomical primitives, morphological knowledge and epipolar constraints is then applied to globally refine the 3-D anatomical landmarks on each vertebra level of the spine. This method was validated on twenty scoliotic patients by comparing results to a standard manual approach. The qualitative evaluation of the retro-projection of the vertebral contours confirms that the proposed method can achieve better consistency to the X-ray image's natural content. A comparison to synthetic models and real patient data also yields good accuracy on the localization of low-level primitives such as anatomical landmarks identified by an expert on each vertebra. The experiments reported in this paper demonstrate that the proposed method offers a better matching accuracy on a set of landmarks from biplanar views when compared to a manual technique for each evaluated cases, and its precision is comparable to 3-D models generated from magnetic resonance images, thus suitable for routine 3-D clinical assessment of spinal deformities.

A review of methods for quantitative evaluation of spinal curvature

The aim of this paper is to provide a complete overview of the existing methods for quantitative evaluation of spinal curvature from medical images, and to summarize the relevant publications, which may not only assist in the introduction of other researchers to the field, but also be a valuable resource for studying the existing methods or developing new methods and evaluation strategies. Key evaluation issues and future considerations, supported by the results of the overview, are also discussed.

3D reconstruction of the spine from biplanar X-rays using parametric models based on transversal and longitudinal inferences

Reconstruction methods from biplanar X-rays provide 3D analysis of spinal deformities for patients in standing position with a low radiation dose. However, such methods require an important reconstruction time and there is a clinical need for fast and accurate techniques. This study proposes and evaluates a novel reconstruction method of the spine from biplanar X-rays. The approach uses parametric models based on longitudinal and transversal inferences. A first reconstruction level, dedicated to routine clinical use, allows to get a fast estimate (reconstruction time: 2 min 30 s) of the 3D reconstruction and accurate clinical measurements. The clinical measurements precision (evaluated on asymptomatic subjects, moderate and severe scolioses) was between 1.2 degrees and 5.6 degrees. For a more accurate 3D reconstruction (complex pathologies or research purposes), a second reconstruction level can be obtained within a reduced reconstruction time (10 min) with a fine adjustment of the 3D models. The mean shape accuracy in comparison with CT-scan was 1.0 mm. The 3D reconstruction method precision was 1.8mm for the vertebrae position and between 2.3 degrees and 3.9 degrees for the orientation. With a reduced reconstruction time, an improved accuracy and precision and a method proposing two reconstruction levels, this approach is efficient for both clinical routine uses and research purposes.