1
|
Kojima T, Yamasaki Y, Matsuura Y, Mikayama R, Shirasaka T, Kondo M, Kamitani T, Kato T, Ishigami K, Yabuuchi H. The Feasibility of Deep Learning-Based Reconstruction for Low-Tube-Voltage CT Angiography for Transcatheter Aortic Valve Implantation. J Comput Assist Tomogr 2024; 48:77-84. [PMID: 37574664 DOI: 10.1097/rct.0000000000001525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
OBJECTIVE The purpose of this study is to evaluate the efficacy of deep learning reconstruction (DLR) on low-tube-voltage computed tomographic angiography (CTA) for transcatheter aortic valve implantation (TAVI). METHODS We enrolled 30 patients who underwent TAVI-CT on a 320-row CT scanner. Electrocardiogram-gated coronary CTA (CCTA) was performed at 100 kV, followed by nongated aortoiliac CTA at 80 kV using a single bolus of contrast material. We used hybrid-iterative reconstruction (HIR), model-based IR (MBIR), and DLR to reconstruct these images. The contrast-to-noise ratios (CNRs) were calculated. Five-point scales were used for the overall image quality analysis. The diameter of the aortic annulus was measured in each reconstructed image, and we compared the interobserver and intraobserver agreements. RESULTS In the CCTA, the CNR and image quality score for DLR were significantly higher than those for HIR and MBIR ( P < 0.01). In the aortoiliac CTA, the CNR for DLR was significantly higher than that for HIR ( P < 0.01) and significantly lower than that for MBIR ( P ≤ 0.02). The image quality score for DLR was significantly higher than that for HIR ( P < 0.01). No significant differences were observed between the image quality scores for DLR and MBIR. The measured aortic annulus diameter had high interobserver and intraobserver agreement regardless of the reconstruction method (all intraclass correlation coefficients, >0.89). CONCLUSIONS In low tube voltage TAVI-CT, DLR provides higher image quality than HIR, and DLR provides higher image quality than MBIR in CCTA and is visually comparable to MBIR in aortoiliac CTA.
Collapse
Affiliation(s)
- Tsukasa Kojima
- From the Division of Radiology, Department of Medical Technology, Kyushu University Hospital
| | | | | | | | | | - Masatoshi Kondo
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Toyoyuki Kato
- From the Division of Radiology, Department of Medical Technology, Kyushu University Hospital
| | | | - Hidetake Yabuuchi
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
2
|
Toggweiler S, Loretz L, Wolfrum M, Buhmann R, Fornaro J, Bossard M, Attinger-Toller A, Cuculi F, Roos J, Leipsic JA, Moccetti F. Relevance of Motion Artifacts in Planning Computed Tomography on Outcomes After Transcatheter Aortic Valve Implantation. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100214. [PMID: 38046862 PMCID: PMC10692358 DOI: 10.1016/j.shj.2023.100214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 06/12/2023] [Accepted: 06/22/2023] [Indexed: 12/05/2023]
Abstract
Background Motion artifacts in planning computed tomography (CT) for transcatheter aortic valve implantation (TAVI) can potentially skew measurements required for procedural planning. Whether such artifacts may affect safety or efficacy has not been studied. Methods We conducted a retrospective analysis of 852 consecutive patients (mean age, 82 years; 47% women) undergoing TAVI-planning CT at a tertiary care center. Two independent observers divided CTs according to the presence of motion artifacts at the annulus level (Motion vs. Normal group). Endpoints included surrogate markers for inappropriate valve selection: annular rupture, valve embolization or misplacement, need for a new permanent pacemaker, paravalvular leak (PVL), postprocedural transvalvular gradient, all-cause death. Results Forty-six (5.4%) patients presented motion artifacts on TAVI-planning CT (Motion group). These patients had more preexisting heart failure, moderate-severe mitral regurgitation, and atrial fibrillation. Interobserver variability of annular measurement (Normal vs. Motion group) did not differ for mean annular diameter but was significantly different for perimeter and area. Presence of motion artifacts on planning CT did not affect the prevalence of PVL (≥moderate PVL 0% vs. 2.5% p = 0.5), mean transvalvular gradient (6±3 mmHg vs 7±5 mmHg, p = 0.1), or the need for additional valve implantation (0% vs. 2.8%, p = 0.6). One annular rupture occurred (Normal group). Pacemaker implantation, procedural duration, hospital stay, 30-day outcomes, and all-cause mortality did not differ between the groups. Conclusions Motion artifacts on planning CT were found in about 5% of patients. Measurements for valve selection were possible without the need for repeat CT, with mean diameter-derived annulus measurement being the most accurate. Motion artifacts were not associated with worse outcomes.
Collapse
Affiliation(s)
- Stefan Toggweiler
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Lucca Loretz
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mathias Wolfrum
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Ralf Buhmann
- Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jürgen Fornaro
- Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matthias Bossard
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Florim Cuculi
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Justus Roos
- Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jonathon A. Leipsic
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Federico Moccetti
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| |
Collapse
|
3
|
Santaló-Corcoy M, Corbin D, Tastet O, Lesage F, Modine T, Asgar A, Ben Ali W. TAVI-PREP: A Deep Learning-Based Tool for Automated Measurements Extraction in TAVI Planning. Diagnostics (Basel) 2023; 13:3181. [PMID: 37892002 PMCID: PMC10606167 DOI: 10.3390/diagnostics13203181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to open-heart surgery for treating severe aortic stenosis. Despite its benefits, the risk of procedural complications necessitates careful preoperative planning. METHODS This study proposes a fully automated deep learning-based method, TAVI-PREP, for pre-TAVI planning, focusing on measurements extracted from computed tomography (CT) scans. The algorithm was trained on the public MM-WHS dataset and a small subset of private data. It uses MeshDeformNet for 3D surface mesh generation and a 3D Residual U-Net for landmark detection. TAVI-PREP is designed to extract 22 different measurements from the aortic valvular complex. A total of 200 CT-scans were analyzed, and automatic measurements were compared to the ones made manually by an expert cardiologist. A second cardiologist analyzed 115 scans to evaluate inter-operator variability. RESULTS High Pearson correlation coefficients between the expert and the algorithm were obtained for most parameters (0.90-0.97), except for left and right coronary height (0.8 and 0.72, respectively). Similarly, the mean absolute relative error was within 5% for most measurements, except for left and right coronary height (11.6% and 16.5%, respectively). A greater consensus was observed among experts than when compared to the automatic approach, with TAVI-PREP showing no discernable bias towards either the lower or higher ends of the measurement spectrum. CONCLUSIONS TAVI-PREP provides reliable and time-efficient measurements of the aortic valvular complex that could aid clinicians in the preprocedural planning of TAVI procedures.
Collapse
Affiliation(s)
- Marcel Santaló-Corcoy
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
| | - Denis Corbin
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
| | | | - Frédéric Lesage
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
- Department of Electrical Engineering, Polytechnique Montreal, Montreal, QC H3T 1J4, Canada
| | | | - Anita Asgar
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
| | - Walid Ben Ali
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
| |
Collapse
|
4
|
Annoni AD, Mancini ME, Carlicchi E, Belmonte M, Formenti A, Mushtaq S, Marchetti F, Cilia F, Baggiano A, Fusini L, Bonomi A, Gennari M, Montorsi P, Pepi M, Pontone G. Pre-TAVI aortic annulus sizing: comparison between manual and semi-automated new generation software measurements in operators with different experience. Br J Radiol 2023; 96:20220733. [PMID: 37449675 PMCID: PMC10461289 DOI: 10.1259/bjr.20220733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 04/07/2023] [Accepted: 04/28/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES Aim of the study is to compare manual and semi-automatic measurements for aortic annulus assessment among different operators. METHODS Eighty patients who underwent TAVI were retrospectively enrolled. The measurements manually performed by an experienced reader for aortic annulus (minimum and maximum diameters, perimeter, area), annulus-to-coronary ostia distance and time needed for the whole evaluation, were collected. The same operator (observer 1) and two less experienced readers (observer 2 and 3, with >5 years and 1 year of experience, respectively) assessed the same measurements using a semi-automatic software. Differences between manual and semi-automatic measurements, reading time and suggested valves size derived by CT were compared. RESULTS Very good correlations were found between manual and software-aided measurements for aortic annulus area and perimeter in comparison with standard measurements for the three readers (ICC range 0.81-0.98). Good correlations were found for the distance with coronary ostia(0.75-0.79). The same area-derived prosthesis size for manual and semi-automatic measurements was selected in 96% of cases for observer 1; very good correlations were also found for observer 2 and 3 (ICC = 0.89 and 0.88, respectively). Using semi-automatic measurements, the mean time needed for CT images was significantly lower for observers 1 and 2 (1.50 and 1.72versus 3.14 min), respectively. CONCLUSIONS Pre-TAVI CT using semi-automatic software allows accurate and reproducible measurements, reducing reconstruction time up to 50% and is reliable even for operators with different experience. ADVANCES IN KNOWLEDGE The use of semi-automatic dedicated software for CT in TAVI planning is reliable even for operators without long time experience and allows accurate and reproducible measurements improving pre-TAVI workflow.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Laura Fusini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | |
Collapse
|
5
|
Evertz R, Hub S, Kowallick JT, Seidler T, Danner BC, Hasenfuß G, Toischer K, Schuster A. Impact of observer experience on multi-detector computed tomography aortic valve morphology assessment and valve size selection for transcatheter aortic valve replacement. Sci Rep 2022; 12:21430. [PMID: 36509862 PMCID: PMC9744877 DOI: 10.1038/s41598-022-23936-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 11/08/2022] [Indexed: 12/14/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has become the standard treatment for aortic stenosis in older patients. It increasingly relies on accurate pre-procedural planning using multidetector computed tomography (MDCT). Since little is known about the required competence levels for MDCT analyses, we comprehensively assessed MDCT TAVR planning reproducibility and accuracy with regard to valve selection in various healthcare workers. 20 randomly selected MDCT of TAVR patients were analyzed using dedicated software by healthcare professionals with varying backgrounds and experience (two structural interventionalists, one imaging specialist, one cardiac surgeon, one general physician, and one medical student). Following the analysis, the most appropriate Edwards SAPIEN 3™ and Medtronic CoreValve valve size was selected. Intra- and inter-observer variability were assessed. The first structural interventionalist was considered as reference standard for inter-observer comparison. Excellent intra- and inter-observer variability was found for the entire group in regard to the MDCT measurements. The best intra-observer agreement and reproducibility were found for the structural interventionalist, while the medical student had the lowest reproducibility. The highest inter-observer agreement was between both structural interventionalists, followed by the imaging specialist. As to valve size selection, the structural interventionalist showed the highest intra-observer reproducibility, independent of the brand of valve used. Compared to the reference structural interventionalist, the second structural interventionalist showed the highest inter-observer agreement for valve size selection [ICC 0.984, 95% CI 0.969-0.991] followed by the cardiac surgeon [ICC 0.947, 95%CI 0.900-0.972]. The lowest inter-observer agreement was found for the medical student [ICC 0.507, 95%CI 0.067-0.739]. While current state-of-the-art MDCT analysis software provides excellent reproducibility for anatomical measurements, the highest levels of confidence in terms of valve size selection were achieved by the performing interventional physicians. This was most likely attributable to observer experience.
Collapse
Affiliation(s)
- Ruben Evertz
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Sebastian Hub
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, Georg-August-University, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Tim Seidler
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Bernhard C Danner
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
- Department of Cardiac, Thoracic and Vascular Surgery, Georg-August-University, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Karl Toischer
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical Center Göttingen (UMG), Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany.
| |
Collapse
|
6
|
Preoperative TAVR Planning: How to Do It. J Clin Med 2022; 11:jcm11092582. [PMID: 35566708 PMCID: PMC9101424 DOI: 10.3390/jcm11092582] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/25/2022] [Accepted: 03/15/2022] [Indexed: 02/06/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is a well-established treatment option for patients with severe symptomatic aortic stenosis (AS) whose procedural efficacy and safety have been continuously improving. Appropriate preprocedural planning, including aortic valve annulus measurements, transcatheter heart valve choice, and possible procedural complication anticipation is mandatory to a successful procedure. The gold standard for preoperative planning is still to perform a multi-detector computed angiotomography (MDCT), which provides all the information required. Nonetheless, 3D echocardiography and magnet resonance imaging (MRI) are great alternatives for some patients. In this article, we provide an updated comprehensive review, focusing on preoperative TAVR planning and the standard steps required to do it properly.
Collapse
|
7
|
Prospective Evaluation of the Learning Curve and Diagnostic Accuracy for Pre-TAVI Cardiac Computed Tomography Analysis by Cardiologists in Training: The LEARN-CT Study. J Cardiovasc Comput Tomogr 2022; 16:404-411. [DOI: 10.1016/j.jcct.2022.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 12/17/2022]
|
8
|
Aoyama G, Zhao L, Zhao S, Xue X, Zhong Y, Yamauchi H, Tsukihara H, Maeda E, Ino K, Tomii N, Takagi S, Sakuma I, Ono M, Sakaguchi T. Automatic Aortic Valve Cusps Segmentation from CT Images Based on the Cascading Multiple Deep Neural Networks. J Imaging 2022; 8:11. [PMID: 35049852 PMCID: PMC8780687 DOI: 10.3390/jimaging8010011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/22/2021] [Accepted: 12/30/2021] [Indexed: 02/01/2023] Open
Abstract
Accurate morphological information on aortic valve cusps is critical in treatment planning. Image segmentation is necessary to acquire this information, but manual segmentation is tedious and time consuming. In this paper, we propose a fully automatic aortic valve cusps segmentation method from CT images by combining two deep neural networks, spatial configuration-Net for detecting anatomical landmarks and U-Net for segmentation of aortic valve components. A total of 258 CT volumes of end systolic and end diastolic phases, which include cases with and without severe calcifications, were collected and manually annotated for each aortic valve component. The collected CT volumes were split 6:2:2 for the training, validation and test steps, and our method was evaluated by five-fold cross validation. The segmentation was successful for all CT volumes with 69.26 s as mean processing time. For the segmentation results of the aortic root, the right-coronary cusp, the left-coronary cusp and the non-coronary cusp, mean Dice Coefficient were 0.95, 0.70, 0.69, and 0.67, respectively. There were strong correlations between measurement values automatically calculated based on the annotations and those based on the segmentation results. The results suggest that our method can be used to automatically obtain measurement values for aortic valve morphology.
Collapse
Affiliation(s)
- Gakuto Aoyama
- Research and Development Center, Canon Medical Systems Corporation, 1385 Shimoishigami, Otawara 324-8550, Japan;
| | - Longfei Zhao
- Research and Development Center, Canon Medical Systems (CHINA) CO., LTD., Chao Yang District, Beijing 100015, China; (L.Z.); (S.Z.); (X.X.); (Y.Z.)
| | - Shun Zhao
- Research and Development Center, Canon Medical Systems (CHINA) CO., LTD., Chao Yang District, Beijing 100015, China; (L.Z.); (S.Z.); (X.X.); (Y.Z.)
| | - Xiao Xue
- Research and Development Center, Canon Medical Systems (CHINA) CO., LTD., Chao Yang District, Beijing 100015, China; (L.Z.); (S.Z.); (X.X.); (Y.Z.)
| | - Yunxin Zhong
- Research and Development Center, Canon Medical Systems (CHINA) CO., LTD., Chao Yang District, Beijing 100015, China; (L.Z.); (S.Z.); (X.X.); (Y.Z.)
| | - Haruo Yamauchi
- The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (H.Y.); (H.T.); (E.M.); (K.I.); (M.O.)
| | - Hiroyuki Tsukihara
- The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (H.Y.); (H.T.); (E.M.); (K.I.); (M.O.)
- School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan; (N.T.); (S.T.); (I.S.)
| | - Eriko Maeda
- The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (H.Y.); (H.T.); (E.M.); (K.I.); (M.O.)
| | - Kenji Ino
- The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (H.Y.); (H.T.); (E.M.); (K.I.); (M.O.)
| | - Naoki Tomii
- School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan; (N.T.); (S.T.); (I.S.)
| | - Shu Takagi
- School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan; (N.T.); (S.T.); (I.S.)
| | - Ichiro Sakuma
- School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan; (N.T.); (S.T.); (I.S.)
| | - Minoru Ono
- The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (H.Y.); (H.T.); (E.M.); (K.I.); (M.O.)
| | - Takuya Sakaguchi
- Research and Development Center, Canon Medical Systems Corporation, 1385 Shimoishigami, Otawara 324-8550, Japan;
| |
Collapse
|
9
|
Suchá D, Kino A, Bogart K, Molvin L, Cheng X, Fearon W, Fischbein M, Fleischmann D. Effect of low contrast medium-dose CTA on device sizing and access vessel assessment for TAVR. Eur J Radiol 2020; 124:108826. [DOI: 10.1016/j.ejrad.2020.108826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/09/2019] [Accepted: 01/06/2020] [Indexed: 01/22/2023]
|
10
|
Does clinical data quality affect fluid-structure interaction simulations of patient-specific stenotic aortic valve models? J Biomech 2019; 94:202-210. [DOI: 10.1016/j.jbiomech.2019.07.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 11/17/2022]
|