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Cheng X, Shen E, Cai Y, Fan K, Gong L, Wu J, Liu H, Wang Y, Chen Y, Ge Y, Yuan J, Kong W. Volumetric Ultrasound Imaging for the Whole Soft Tissue: Toward Enhanced Thyroid Disease Examination. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1426-1435. [PMID: 38876913 DOI: 10.1016/j.ultrasmedbio.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 05/06/2024] [Accepted: 05/21/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES Ultrasound imaging (USI) is the gold standard in the clinical diagnosis of thyroid diseases. Compared with two-dimensional (2D) USI, three-dimensional (3D) USI could provide more structural information. However, the unstable pressure generated by the hand-hold ultrasound probe scanning can cause tissue deformation, especially in soft tissues such as the thyroid. The deformation is manifested as tissue structure being compressed in 2D USI, which results in structural discontinuity in 3D USI. Furthermore, multiple scans apply pressure in different directions to the tissue, which will cause relative displacement between the 3D images obtained from multiple thyroid scans. METHODS In this work, we proposed a framework to minimize the influence of the variation of pressure in thyroid 3D USI. To correct pressure artifacts in a single scanning sequence, an adaptive method to smooth the position of the 2D ultrasound (US) image sequence is adopted before performing volumetric reconstruction. To build a whole 3D US image including both sides of the thyroid gland, an iterative closest point (ICP) based registration pipeline is adopted to eliminate the relative displacement caused by different pressure directions. RESULTS Our proposed method was validated by in vivo experiments, including healthy volunteers and volunteers with thyroid nodules at different grading levels. CONCLUSIONS The thyroid gland and nodule are rendered intelligently in the whole scanning region to facilitate the observation of 3D USI results by the doctor. This work might make a positive contribution to the clinical diagnosis of diseases of the thyroid or other soft tissues.
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Affiliation(s)
- Xu Cheng
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Enxiang Shen
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Yunye Cai
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Kai Fan
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Li Gong
- Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jie Wu
- Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Han Liu
- Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yuxin Wang
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Ying Chen
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Yun Ge
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Jie Yuan
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China.
| | - Wentao Kong
- Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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Pizones J, Moreno-Manzanaro L, Pupak A, Núñez-Pereira S, Larrieu D, Boissiere L, Richner-Wunderlin S, Loibl M, Zulemyan T, Yücekul A, Zgheib S, Charles YP, Chang DG, Kleinstueck F, Obeid I, Alanay A, Sánchez Pérez-Grueso FJ, Pellisé F. Reliability of a New Digital Tool for Photographic Analysis in Quantifying Body Asymmetry in Scoliosis. J Clin Med 2024; 13:2114. [PMID: 38610880 PMCID: PMC11012662 DOI: 10.3390/jcm13072114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Advancements in non-ionizing methods for quantifying spinal deformities are crucial for assessing and monitoring scoliosis. In this study, we analyzed the observer variability of a newly developed digital tool for quantifying body asymmetry from clinical photographs. Methods: Prospective observational multicenter study. Initially, a digital tool was developed using image analysis software, calculating quantitative measures of body asymmetry. This tool was integrated into an online platform that exports data to a database. The tool calculated 10 parameters, including angles (shoulder height, axilla height, waist height, right and left waistline angles, and their difference) and surfaces of the left and right hemitrunks (shoulders, waists, pelvises, and total). Subsequently, an online training course on the tool was conducted for twelve observers not involved in its development (six research coordinators and six spine surgeons). Finally, 15 standardized back photographs of adolescent idiopathic scoliosis patients were selected from a multicenter image bank, representing various clinical scenarios (different age, gender, curve type, BMI, and pre- and postoperative images). The 12 observers measured the photographs at two different times with a three-week interval. For the second round, the images were randomly mixed. Inter- and intra-observer variabilities of the measurements were analyzed using intraclass correlation coefficients (ICCs), and reliability was measured by the standard error of measurement (SEM). Group comparisons were made using Student's t-test. Results: The mean inter-observer ICC for the ten measurements was 0.981, the mean intra-observer ICC was 0.937, and SEM was 0.3-1.3°. The parameter with the strongest inter- and intra-observer validity was the difference in waistline angles 0.994 and 0.974, respectively, while the highest variability was found with the waist height angle 0.963 and 0.845, respectively. No test-retest differences (p > 0.05) were observed between researchers (0.948 ± 0.04) and surgeons (0.925 ± 0.05). Conclusion: We developed a new digital tool integrated into an online platform demonstrating excellent reliability and inter- and intra-observer variabilities for quantifying body asymmetry in scoliosis patients from a simple clinical photograph. The method could be used for assessing and monitoring scoliosis and body asymmetry without radiation.
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Affiliation(s)
- Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.M.-M.); (F.J.S.P.-G.)
| | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.M.-M.); (F.J.S.P.-G.)
| | - Anika Pupak
- Spine Research Unit, Vall d’Hebron Institute of Research, 08035 Barcelona, Spain;
| | - Susana Núñez-Pereira
- Spine Surgery Unit, Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain (F.P.)
| | - Daniel Larrieu
- Spine Surgery Unit, Pellegrin University Hospital, 33076 Bordeaux, France; (D.L.); (I.O.)
| | - Louis Boissiere
- Spine Surgery Unit, Pellegrin University Hospital, 33076 Bordeaux, France; (D.L.); (I.O.)
| | | | - Markus Loibl
- Department of Orthopedics, Schulthess Klinik, 8008 Zurich, Switzerland (M.L.); (F.K.)
| | - Tais Zulemyan
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey; (T.Z.); (A.Y.); (A.A.)
| | - Altug Yücekul
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey; (T.Z.); (A.Y.); (A.A.)
| | - Sara Zgheib
- Spine Surgery Unit, University Hospital Strasbourg, 67000 Strasbourg, France; (S.Z.); (Y.P.C.)
| | - Yann Philippe Charles
- Spine Surgery Unit, University Hospital Strasbourg, 67000 Strasbourg, France; (S.Z.); (Y.P.C.)
| | - Dong-Gune Chang
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, 01757 Seoul, Republic of Korea;
| | - Frank Kleinstueck
- Department of Orthopedics, Schulthess Klinik, 8008 Zurich, Switzerland (M.L.); (F.K.)
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, 33076 Bordeaux, France; (D.L.); (I.O.)
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey; (T.Z.); (A.Y.); (A.A.)
| | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain (F.P.)
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Ran QY, Miao J, Zhou SP, Hua SH, He SY, Zhou P, Wang HX, Zheng YP, Zhou GQ. Automatic 3-D spine curve measurement in freehand ultrasound via structure-aware reinforcement learning spinous process localization. ULTRASONICS 2023; 132:107012. [PMID: 37071944 DOI: 10.1016/j.ultras.2023.107012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/18/2023] [Accepted: 04/10/2023] [Indexed: 05/03/2023]
Abstract
Freehand 3-D ultrasound systems have been advanced in scoliosis assessment to avoid radiation hazards, especially for teenagers. This novel 3-D imaging method also makes it possible to evaluate the spine curvature automatically from the corresponding 3-D projection images. However, most approaches neglect the three-dimensional spine deformity by only using the rendering images, thus limiting their usage in clinical applications. In this study, we proposed a structure-aware localization model to directly identify the spinous processes for automatic 3-D spine curve measurement using the images acquired with freehand 3-D ultrasound imaging. The pivot is to leverage a novel reinforcement learning (RL) framework to localize the landmarks, which adopts a multi-scale agent to boost structure representation with positional information. We also introduced a structure similarity prediction mechanism to perceive the targets with apparent spinous process structures. Finally, a two-fold filtering strategy was proposed to screen the detected spinous processes landmarks iteratively, followed by a three-dimensional spine curve fitting for the spine curvature assessments. We evaluated the proposed model on 3-D ultrasound images among subjects with different scoliotic angles. The results showed that the mean localization accuracy of the proposed landmark localization algorithm was 5.95 pixels. Also, the curvature angles on the coronal plane obtained by the new method had a high linear correlation with those by manual measurement (R = 0.86, p < 0.001). These results demonstrated the potential of our proposed method for facilitating the 3-D assessment of scoliosis, especially for 3-D spine deformity assessment.
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Affiliation(s)
- Qi-Yong Ran
- The School of Biological Science and Medical Engineering, Southeast University, Nanjing, China; State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China; Jiangsu Key Laboratory of Biomaterials and Devices, Southeast University, Nanjing, China
| | - Juzheng Miao
- The School of Biological Science and Medical Engineering, Southeast University, Nanjing, China; Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Si-Ping Zhou
- The School of Biological Science and Medical Engineering, Southeast University, Nanjing, China; State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China; Jiangsu Key Laboratory of Biomaterials and Devices, Southeast University, Nanjing, China
| | - Shi-Hao Hua
- The School of Biological Science and Medical Engineering, Southeast University, Nanjing, China; State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China; Jiangsu Key Laboratory of Biomaterials and Devices, Southeast University, Nanjing, China
| | - Si-Yuan He
- The School of Biological Science and Medical Engineering, Southeast University, Nanjing, China; State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China; Jiangsu Key Laboratory of Biomaterials and Devices, Southeast University, Nanjing, China
| | - Ping Zhou
- The School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Hong-Xing Wang
- The Department of Rehabilitation Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Yong-Ping Zheng
- The Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Guang-Quan Zhou
- The School of Biological Science and Medical Engineering, Southeast University, Nanjing, China; State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China; Jiangsu Key Laboratory of Biomaterials and Devices, Southeast University, Nanjing, China.
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Zheng YP, Lee TTY. 3D Ultrasound Imaging of the Spine. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1364:349-372. [DOI: 10.1007/978-3-030-91979-5_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Garcia-Cano E, Cosio FA, Torres Robles F, Fanti Z, Bellefleur C, Joncas J, Labelle H, Duong L. A freehand ultrasound framework for spine assessment in 3D: a preliminary study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:2096-2100. [PMID: 33018419 DOI: 10.1109/embc44109.2020.9176689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
X-ray imaging is currently the gold standard for the assessment of spinal deformities. The purpose of this study is to evaluate a freehand 3D ultrasound system for volumetric reconstruction of the spine. A setup consisting of an ultrasound scanner with a linear transducer, an electromagnetic measuring system and a workstation was used. We conducted 64 acquisitions of US images of 8 adults in a natural standing position, and we tested three setups: 1) Subjects are constrained to be close to a wall, 2) Subjects are unconstrained, and 3) Subjects are constrained to performing fast and slow acquisitions. The spinous processes were manually selected from the volume reconstruction from tracked ultrasound images to generate a 3D point-based model depicting the centerline of the spine. The results suggested that a freehand 3D ultrasound system can be suitable for representing the spine. Volumetric reconstructions can be computed and landmarking can be performed to model the surface of the spine in the 3D space. These reconstructions promise to generate computer-based descriptors to analyze the shape of the spine in the 3D space.Clinical Relevance- We provide clinicians with a protocol that could be integrated in clinical setups for the assessment and monitoring of AIS, based on US image acquisitions, which constitutes a radiation-free technology.
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Ge S, Zeng H, Zheng R. Automatic Measurement of Spinous Process Angles on Ultrasound Spine Images. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:2101-2104. [PMID: 33018420 DOI: 10.1109/embc44109.2020.9176211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Ultrasound (US) imaging technique has been applied to measure the proxy Cobb angle and spinous process angle (SPA) for spinal curvatures of scoliosis. However manual measurement of ultrasound images is time consuming and greatly relying on the experience of raters. The objectives of this work are to develop an automatic measurement method to assess SPA of spine curves and to evaluate the accuracy and reliability of the method. The spinous process curves were identified and fitted on US images, and the automatically measured SPA were compared with the results from US manual and radiographic measurements. It illustrates that the US-auto measurement of SPA presents higher correlation and smaller difference with clinical standard radiographic results than the US-manual measurement.
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Wu HD, Liu W, Wong MS. Reliability and validity of lateral curvature assessments using clinical ultrasound for the patients with scoliosis: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:717-725. [DOI: 10.1007/s00586-019-06280-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/18/2019] [Accepted: 12/29/2019] [Indexed: 01/18/2023]
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8
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Lv P, Chen J, Dong L, Wang L, Deng Y, Li K, Huang X, Zhang C. Evaluation of Scoliosis With a Commercially Available Ultrasound System. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:29-36. [PMID: 31190407 DOI: 10.1002/jum.15068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/10/2019] [Accepted: 05/19/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Currently, radiography with measurement of the Cobb angle is still considered the reference standard for diagnosing scoliosis. However, the ionizing radiation hazard is drawing wide attention. Can 3-dimensional (3D) ultrasound (US) be an alternative modality for diagnosing and monitoring patients with scoliosis? The aim of our study was to assess the reliability and validity of 3D US imaging in the evaluation of scoliosis. METHODS A commercially available ultrasound system with a magnetic tracking system was selected for long-distance 3D US imaging. Straight phantoms and curved phantoms were scanned with the imaging system to evaluate the stability of the system for curvature measurements. Eight healthy adult volunteers and 28 patients with scoliosis were recruited for long-distance 3D US imaging. The intraclass correlation coefficient was used to test the reproducibility of the interobserver and intraobserver measurements for both the healthy adults and patients with scoliosis. A linear regression analysis and Bland-Altman plot were used to analyze the correlation and to determine the extent of agreement between the angles measured on US images and the Cobb angles measured on conventional radiographs. RESULTS The 28 patients with scoliosis included 10 male and 18 female patients aged 8 to 37 years (mean age ± SD, 17.7 ± 1.4 years; body mass index, <25 kg/m2 ). In the phantom study, there was no statistically significant difference between the angles measured by the 3D US imaging system and those measured by an angle gauge (P > 0.05). In the clinical study, there was very good interobserver and intraobserver reliability (intraclass correlation coefficients, >0.90) for the US imaging system, with a high correlation (r2 = 0.92) and agreement between the US and radiographic methods. CONCLUSIONS The long-distance 3D US imaging system offers a viable modality for diagnosing and monitoring scoliosis without radiation.
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Affiliation(s)
- Pin Lv
- Departments of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingyuan Chen
- Departments of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lujie Dong
- Departments of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Wang
- Departments of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Youbin Deng
- Departments of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaiyan Li
- Departments of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolin Huang
- Departments of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao Zhang
- Departments of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Huang Q, Deng Q, Li L, Yang J, Li X. Scoliotic Imaging With a Novel Double-Sweep 2.5-Dimensional Extended Field-of-View Ultrasound. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2019; 66:1304-1315. [PMID: 31170068 DOI: 10.1109/tuffc.2019.2920422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Extended field-of-view ultrasound (US EFOV) imaging is a technique used extensively in the clinical field to attain interpretable panorama of anatomy; 2.5-D US EFOV has recently been proposed for spine imaging. In the original 2.5-D US EFOV, it makes use of a six degrees-of-freedom positional sensor attached to the US probe to record the corresponding position of each B-scan. By combining the positional information and the B-scan images, the 2.5-D EFOV can reconstruct a panorama on a curved image plane when the scanning trajectory of the US probe is curved. In this paper, an improved method based on the Bezier interpolation is proposed to better reconstruct 2.5-D US EFOV imaging, producing the panoramas with smoother texture and higher quality. To make it more applicable for scoliosis patients, we designed a novel method called double-sweep 2.5-D EFOV to better image the spinal tissues and easily compute the Cobb angle. In vitro and in vivo experiments demonstrated that the 2.5-D EFOV images obtained by the proposed method can present anatomical structures of the scanning region accurately.
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Koo TK, Crews RL, Kwok WE. In Vivo Measurement of the Human Lumbar Spine Using Magnetic Resonance Imaging to Ultrasound Registration. J Manipulative Physiol Ther 2019; 42:343-352. [PMID: 31255312 DOI: 10.1016/j.jmpt.2019.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/08/2019] [Accepted: 03/30/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study aimed to refine a magnetic resonance imaging (MRI)-ultrasound registration (ie, alignment) technique to make noninvasive, nonionizing, 3-dimensional measurement of the lumbar segmental motion in vivo. METHODS Five healthy participants participated in this validation study. We scanned the lumbar region of each participant 5 times using an ultrasound probe while he or she kept a prone lying posture on a plinth. Participant-specific models of L1-L5 were constructed from magnetic resonance (MR) images and aligned with the 3-dimensional ultrasound dataset of each scan using 4 variants of MRI-ultrasound registration approach (simplified intensity-based registration [1] with and [2] without including the transverse processes and their surrounding soft tissues [denoted as TP complex]; and hierarchical intensity-based registration [3] with and [4] without including the TP complex). The robustness and precision of these registration approaches were compared. RESULTS Although all registration approaches converged to a similar solution, excluding the TP complex improved the percentage of successful registration from 92% to 100%. There was no significant difference in the precision among the 4 MRI-ultrasound registration variants. For the simplified intensity-based registration without including the TP complex, average precision at each degree of freedom was 1.33° (flexion-extension), 2.48° (lateral bending), 1.32° (axial rotation), 2.15 mm (left/right), 1.08 mm (anterior-posterior), and 1.16 (superior-inferior), respectively. CONCLUSION Given that using simplified intensity-based MRI-ultrasound registration can substantially streamline the registration process and excluding the TP complex would improve the robustness of the registration, we conclude that this combination is the method of choice for in vivo human applications.
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Affiliation(s)
- Terry K Koo
- Foot Levelers Biomechanics Research Laboratory, New York Chiropractic College, Seneca, Falls, NY.
| | - Robert L Crews
- Foot Levelers Biomechanics Research Laboratory, New York Chiropractic College, Seneca, Falls, NY
| | - Wingchi E Kwok
- Department of Imaging Sciences, University of Rochester, University of Rochester Center for Advanced Brain Imaging & Neurophysiology, Rochester, NY
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Actuator-Assisted Calibration of Freehand 3D Ultrasound System. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:9314626. [PMID: 29854371 PMCID: PMC5954878 DOI: 10.1155/2018/9314626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/21/2018] [Accepted: 04/11/2018] [Indexed: 11/23/2022]
Abstract
Freehand three-dimensional (3D) ultrasound has been used independently of other technologies to analyze complex geometries or registered with other imaging modalities to aid surgical and radiotherapy planning. A fundamental requirement for all freehand 3D ultrasound systems is probe calibration. The purpose of this study was to develop an actuator-assisted approach to facilitate freehand 3D ultrasound calibration using point-based phantoms. We modified the mathematical formulation of the calibration problem to eliminate the need of imaging the point targets at different viewing angles and developed an actuator-assisted approach/setup to facilitate quick and consistent collection of point targets spanning the entire image field of view. The actuator-assisted approach was applied to a commonly used cross wire phantom as well as two custom-made point-based phantoms (original and modified), each containing 7 collinear point targets, and compared the results with the traditional freehand cross wire phantom calibration in terms of calibration reproducibility, point reconstruction precision, point reconstruction accuracy, distance reconstruction accuracy, and data acquisition time. Results demonstrated that the actuator-assisted single cross wire phantom calibration significantly improved the calibration reproducibility and offered similar point reconstruction precision, point reconstruction accuracy, distance reconstruction accuracy, and data acquisition time with respect to the freehand cross wire phantom calibration. On the other hand, the actuator-assisted modified “collinear point target” phantom calibration offered similar precision and accuracy when compared to the freehand cross wire phantom calibration, but it reduced the data acquisition time by 57%. It appears that both actuator-assisted cross wire phantom and modified collinear point target phantom calibration approaches are viable options for freehand 3D ultrasound calibration.
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Zhou GQ, Jiang WW, Lai KL, Zheng YP. Automatic Measurement of Spine Curvature on 3-D Ultrasound Volume Projection Image With Phase Features. IEEE TRANSACTIONS ON MEDICAL IMAGING 2017; 36:1250-1262. [PMID: 28252393 DOI: 10.1109/tmi.2017.2674681] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This paper presents an automated measurement of spine curvature by using prior knowledge on vertebral anatomical structures in ultrasound volume projection imaging (VPI). This method can be used in scoliosis assessment with free-hand 3-D ultrasound imaging. It is based on the extraction of bony features from VPI images using a newly proposed two-fold thresholding strategy, with information of the symmetric and asymmetric measures obtained from phase congruency. The spinous column profile is detected from the segmented bony regions, and it is further used to extract a curve representing spine profile. The spine curvature is then automatically calculated according to the inflection points along the curve. The algorithm was evaluated on volunteers with the different severity of scoliosis. The results obtained using the newly developed method had a good linear correlation with those by the manual method (r ≥ 0.90, p <; 0.001) and X-ray Cobb's method (r = 0.83, p <; 0.001). The bigger variations observed in the manual measurement also implied that the automatic method is more reliable. The proposed method can be a promising approach for facilitating the applications of 3-D ultrasound imaging in the diagnosis, treatment, and screening of scoliosis.
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Berger S, Hasler CC, Grant CA, Zheng G, Schumann S, Büchler P. A software program to measure the three-dimensional length of the spine from radiographic images: Validation and reliability assessment for adolescent idiopathic scoliosis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2017; 138:57-64. [PMID: 27886715 DOI: 10.1016/j.cmpb.2016.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/09/2016] [Accepted: 10/18/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to validate a new program which aims at measuring the three-dimensional length of the spine's midline based on two calibrated orthogonal radiographic images. The traditional uniplanar T1-S1 measurement method is not reflecting the actual three dimensional curvature of a scoliotic spine and is therefore not accurate. The Spinal Measurement Software (SMS) is an alternative to conveniently measure the true spine's length. METHODS The validity, inter- and intra-observer variability and usability of the program were evaluated. The usability was quantified based on a subjective questionnaire filled by eight participants using the program for the first time. The validity and variability were assessed by comparing the length of five phantom spines measured based on CT-scan data and on radiographic images with the SMS. The lengths were measured independently by each participant using both techniques. RESULTS The SMS is easy and intuitive to use, even for non-clinicians. The SMS measured spinal length with an error below 2 millimeters compared to length obtained using CT scan datasets. The inter- and intra-observer variability of the SMS measurements was below 5 millimeters. CONCLUSIONS The SMS provides accurate measurement of the spinal length based on orthogonal radiographic images. The software is easy to use and could easily integrate the clinical workflow and replace current approximations of the spinal length based on a single radiographic image such as the traditional T1-S1 measurement.
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Affiliation(s)
- Steve Berger
- Computational Bioengineering Group, Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014 Bern, Switzerland.
| | - Carol-Claudius Hasler
- University Children's Hospital Basel, Spitalstrasse 33, PO Box, CH-4031 Basel, Switzerland
| | - Caroline A Grant
- Paediatric Spine Research Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane 4001, Australia
| | - Guoyan Zheng
- Information Processing in Medical Interventions, Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014 Bern, Switzerland
| | - Steffen Schumann
- Information Processing in Medical Interventions, Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014 Bern, Switzerland
| | - Philippe Büchler
- Computational Bioengineering Group, Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014 Bern, Switzerland
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A non-ionizing technique for three-dimensional measurement of the lumbar spine. J Biomech 2016; 49:4073-4079. [DOI: 10.1016/j.jbiomech.2016.10.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 11/17/2022]
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Zheng YP, Lee TTY, Lai KKL, Yip BHK, Zhou GQ, Jiang WW, Cheung JCW, Wong MS, Ng BKW, Cheng JCY, Lam TP. A reliability and validity study for Scolioscan: a radiation-free scoliosis assessment system using 3D ultrasound imaging. SCOLIOSIS AND SPINAL DISORDERS 2016; 11:13. [PMID: 27299162 PMCID: PMC4900244 DOI: 10.1186/s13013-016-0074-y] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/12/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radiographic evaluation for patients with scoliosis using Cobb method is the current gold standard, but radiography has radiation hazards. Several groups have recently demonstrated the feasibility of using 3D ultrasound for the evaluation of scoliosis. Ultrasound imaging is radiation-free, comparatively more accessible, and inexpensive. However, a reliable and valid 3D ultrasound system ready for clinical scoliosis assessment has not yet been reported. Scolioscan is a newly developed system targeted for scoliosis assessment in clinics by using coronal images of spine generated by a 3D ultrasound volume projection imaging method. The aim of this study is to test the reliability of spine deformity measurement of Scolioscan and its validity compared to the gold standard Cobb angle measurements from radiography in adolescent idiopathic scoliosis (AIS) patients. METHODS Prospective study divided into two stages: 1) Investigation of intra- and inter- reliability between two operators for acquiring images using Scolioscan and among three raters for measuring spinal curves from those images; 2) Correlation between the Cobb angle obtained from radiography by a medical doctor and the spine curve angle obtained using Scolioscan (Scolioscan angle). The raters for ultrasound images and the doctors for evaluating radiographic images were mutually blinded. The two stages of tests involved 20 (80 % females, total of 26 angles, age of 16.4 ± 2.7 years, and Cobb angle of 27.6 ± 11.8°) and 49 (69 % female, 73 angles, 15.8 ± 2.7 years and 24.8 ± 9.7°) AIS patients, respectively. Intra-class correlation coefficients (ICC) and Bland-Altman plots and root-mean-square differences (RMS) were employed to determine correlations, which interpreted based on defined criteria. RESULTS We demonstrated a very good intra-rater and intra-operator reliability for Scolioscan angle measurement with ICC larger than 0.94 and 0.88, respectively. Very good inter-rater and inter-operator reliability was also demonstrated, with both ICC larger than 0.87. For the thoracic deformity measurement, the RMS were 2.5 and 3.3° in the intra- and inter-operator tests, and 1.5 and 3.6° in the intra- and inter-rater tests, respectively. The RMS differences were 3.1, 3.1, 1.6, 3.7° in the intra- and inter-operator and intra- and inter-rater tests, respectively, for the lumbar angle measurement. Moderate to strong correlations (R(2) > 0.72) were observed between the Scolioscan angles and Cobb angles for both the thoracic and lumbar regions. It was noted that the Scolioscan angle slightly underestimated the spinal deformity in comparison with Cobb angle, and an overall regression equation y = 1.1797x (R(2) = 0.76) could be used to translate the Scolioscan angle (x) to Cobb angle (y) for this group of patients. The RMS difference between Scolioscan angle and Cobb angle was 4.7 and 6.2°, with and without the correlation using the overall regression equation. CONCLUSIONS We showed that Scolioscan is reliable for measuring coronal deformity for patients with AIS and appears promising in screening large numbers of patients, for progress monitoring, and evaluation of treatment outcomes. Due to it being radiation-free and relatively low-cost, Scolioscan has potential to be widely implemented and may contribute to reducing radiation dose during serial monitoring.
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Affiliation(s)
- Yong-Ping Zheng
- />Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People’s Republic of China
| | - Timothy Tin-Yan Lee
- />Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People’s Republic of China
| | - Kelly Ka-Lee Lai
- />Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People’s Republic of China
| | - Benjamin Hon-Kei Yip
- />School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Guang-Quan Zhou
- />Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People’s Republic of China
| | - Wei-Wei Jiang
- />Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People’s Republic of China
| | - James Chung-Wai Cheung
- />Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People’s Republic of China
| | - Man-Sang Wong
- />Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People’s Republic of China
| | - Bobby King-Wah Ng
- />Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Jack Chun-Yiu Cheng
- />Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Tsz-Ping Lam
- />Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
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Hierarchical CT to Ultrasound Registration of the Lumbar Spine: A Comparison with Other Registration Methods. Ann Biomed Eng 2016; 44:2887-2900. [DOI: 10.1007/s10439-016-1599-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/24/2016] [Indexed: 10/22/2022]
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Freehand three-dimensional ultrasound system for assessment of scoliosis. J Orthop Translat 2015; 3:123-133. [PMID: 30035049 PMCID: PMC5982385 DOI: 10.1016/j.jot.2015.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/30/2015] [Accepted: 06/02/2015] [Indexed: 11/23/2022] Open
Abstract
Background/Objective Standing radiograph with Cobb's method is routinely used to diagnose scoliosis, a medical condition defined as a lateral spine curvature > 10° with concordant vertebral rotation. However, radiation hazard and two-dimensional (2-D) viewing of 3-D anatomy restrict the application of radiograph in scoliosis examination. Methods In this study, a freehand 3-D ultrasound system was developed for the radiation-free assessment of scoliosis. Bony landmarks of the spine were manually extracted from a series of ultrasound images with their spatial information recorded to form a 3-D spine model for measuring its curvature. To validate its feasibility, in vivo measurements were conducted in 28 volunteers (age: 28.0 ± 13.0 years, 9 males and 19 females). A significant linear correlation (R2 = 0.86; p < 0.001) was found between the spine curvatures as measured by Cobb's method and the 3-D ultrasound imaging with transverse process and superior articular process as landmarks. The intra- and interobserver tests indicated that the proposed method is repeatable. Results The 3-D ultrasound method using bony landmarks tended to underestimate the deformity, and a proper scaling is required. Nevertheless, this study demonstrated the feasibility of the freehand 3-D ultrasound system to assess scoliosis in the standing posture with the proposed methods and 3-D spine profile. Conclusion Further studies are required to understand the variations that exist between the ultrasound and radiograph results with a larger number of volunteers, and to demonstrate its potential clinical applications for monitoring of scoliosis patients. Through further clinical trials and development, the reported 3-D ultrasound imaging system can potentially be used for scoliosis mass screening and frequent monitoring of progress and treatment outcome because of its radiation-free and easy accessibility feature.
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