1
|
Zhang L, Xu J, Wang C, Luo Y, Tsai TY, Zhao J, Wang S. Optimal tibial tunnel angulation for anatomical anterior cruciate ligament reconstruction using transtibial technique. Med Eng Phys 2024; 129:104190. [PMID: 38906575 DOI: 10.1016/j.medengphy.2024.104190] [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: 10/18/2023] [Revised: 05/12/2024] [Accepted: 05/22/2024] [Indexed: 06/23/2024]
Abstract
Numerous studies have suggested that the primary cause of failure in transtibial anterior cruciate ligament reconstruction (ACLR) is often attributed to non-anatomical placement of the bone tunnels, typically resulting from improper tibial guidance. We aimed to establish the optimal tibial tunnel angle for anatomical ACLR by adapting the transtibial (TT) technique. Additionally, we aimed to assess graft bending angle (GBA) and length changes during in vivo dynamic flexion of the knee. Twenty knee joints underwent a CT scan and dual fluoroscopic imaging system (DFIS) to reproduce relative knee position during dynamic flexion. For the single-legged lunge, subjects began in a natural standing position and flexed the right knee beyond 90° When performing the lunge task, the subject supported the body weight on the right leg, while the left leg was used to keep the balance. The tibial and femoral tunnels were established on each knee using a modified TT technique for single-bundle ACLR. The tibial tunnel angulation to the tibial axis and the sagittal plane were measured. Considering that ACL injuries tend to occur at low knee flexion angles, GBA and graft length were measured between 0° and 90° of flexion in this study. The tibial tunnel angulated the sagittal plane at 42.8° ± 3.4°, and angulated the tibial axis at 45.3° ± 5.1° The GBA was 0° at 90° flexion of the knee and increased substantially to 76.4 ± 5.5° at 0° flexion. The GBA significantly increased with the knee extending from 90° to 0° (p < 0.001). The ACL length was 30.2mm±3.0 mm at 0° flexion and decreased to 27.5mm ± 2.8 mm at 90° flexion (p = 0.072). To achieve anatomic single-bundle ACLR, the optimal tibial tunnel should be angulated at approximately 43° to the sagittal plane and approximately 45° to the tibial axis using the modified TT technique. What's more, anatomical TT ACLR resulted in comparable GBA and a relatively constant ACL length from 0° to 90° of flexion. These findings provide theoretical support for the clinical application and the promotion of the current modified TT technique with the assistance of a robot to achieve anatomical ACLR.
Collapse
Affiliation(s)
- Ling Zhang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Cong Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; TaoImage Medical Technologies Corporation, Shanghai, China
| | - Ye Luo
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; TaoImage Medical Technologies Corporation, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Shaobai Wang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China.
| |
Collapse
|
2
|
Zhang L, Lin J, Zhao X, Liu M, Hou Y, Zhang Y, Zhao J, Wang S. Robotic-assisted anatomic anterior cruciate ligament reconstruction: a comparative analysis of modified transtibial and anteromedial portal techniques in cadaveric knees. Front Bioeng Biotechnol 2024; 12:1360560. [PMID: 38511128 PMCID: PMC10953503 DOI: 10.3389/fbioe.2024.1360560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/07/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction: This study employed surgical robot to perform anatomic single-bundle reconstruction using the modified transtibial (TT) technique and anteromedial (AM) portal technique. The purpose was to directly compare tunnel and graft characteristics of the two techniques. Methods: Eight cadaveric knees without ligament injury were used in the study. The modified TT and AM portal technique were both conducted under surgical robotic system. Postoperative data acquisition of the tunnel and graft characteristics included tibial tunnel position, tunnel angle, tunnel length and femoral tunnel-graft angle. Results: The mean tibial tunnel length of the modified TT technique was significantly shorter than in the AM portal technique (p < 0.001). The mean length of the femoral tunnel was significantly longer for the modified TT technique than for the AM portal technique (p < 0.001). The mean coronal angle of the tibial tunnel was significantly lower for the modified TT technique than for the AM portal technique (p < 0.001). The mean coronal angle of the femoral tunnel was significantly lower for the AM portal technique than for the modified TT technique (p < 0.001). The AM portal technique resulted in a graft bending angle that was significantly more angulated in the coronal (p < 0.001) and the sagittal planes (p < 0.001) compared with the modified TT technique. Discussion: Comparison of the preoperative planning and postoperative femoral tunnel positions showed that the mean difference of the tunnel position was 1.8 ± 0.4 mm. It suggested that the surgical navigation robot could make predictable tunnel position with high accuracy. The findings may support that the modified TT technique has benefits on femoral tunnel length and obliquity compared with AM portal technique. The modified TT technique showed a larger femoral tunnel angle in the coronal plane than the AM portal technique. Compared with the modified TT technique, the more horizontal trajectory of the femoral tunnel in the AM portal technique creates a shorter femoral tunnel length and a more acute graft bending angle.
Collapse
Affiliation(s)
- Ling Zhang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Jinpeng Lin
- Department of Orthopaedics, Guangdong Provincial Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xuan Zhao
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Mingwei Liu
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Yao Hou
- Shanghai Droidsurg Medical Technology Co., Ltd., Shanghai, China
| | - Yu Zhang
- Department of Orthopaedics, Guangdong Provincial Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shaobai Wang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| |
Collapse
|
3
|
Sun Y, Zhang H, Chen X, Huang S, Bai L. Fast X-ray/CT image registration based on perspective projection triangular features. Comput Med Imaging Graph 2024; 112:102334. [PMID: 38232631 DOI: 10.1016/j.compmedimag.2024.102334] [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: 10/11/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024]
Abstract
X-ray/CT image registration plays a pivotal role in enhancing surgical navigation success rates. However, challenges stemming from sparse and noisy X-ray image features, coupled with the complexities of multi-parameter optimization, impose limitations on existing methods in terms of registration accuracy and efficiency. In response, this paper presents an innovative approach-a fast X-ray/CT image registration method based on perspective projection triangular features(F-PPTF). By leveraging the conformal nature of perspective projection, the proposed method constructs perspective projection triangular features with rotation, translation, and scale invariance using point feature descriptors. Diverging from multi-parameter iterative optimization techniques, this approach achieves the decoupling of the six transformation parameters. This decoupling simplifies computational intricacies, thereby facilitating swift registration. Experimental evaluations conducted on synthetic and real X-ray images reveal an average rotational absolute error of 0.41°, an average translational absolute error of 1.16 mm, and an average registration time of 14.89 s. In comparison to conventional registration methodologies, the method presented in this paper demonstrates pronounced superiority in terms of both registration accuracy and efficiency, thereby exhibiting heightened potential for broader applicability.
Collapse
Affiliation(s)
- Yuanxi Sun
- State Key Laboratory of Mechanical Transmission, Chongqing University, 400044 Chongqing, China
| | - Huiqin Zhang
- State Key Laboratory of Mechanical Transmission, Chongqing University, 400044 Chongqing, China
| | - Xiaohong Chen
- State Key Laboratory of Mechanical Transmission, Chongqing University, 400044 Chongqing, China
| | - Shandeng Huang
- NoahTron Intelligence Medtech(Hangzhou) Co., Ltd., Hangzhou 310051, China
| | - Long Bai
- State Key Laboratory of Mechanical Transmission, Chongqing University, 400044 Chongqing, China.
| |
Collapse
|
4
|
Lu HY, Lin CC, Shih KS, Lu TW, Kuo MY, Li SY, Hsu HC. Integration of statistical shape modeling and alternating interpolation-based model tracking technique for measuring knee kinematics in vivo using clinical interleaved bi-plane fluoroscopy. PeerJ 2023; 11:e15371. [PMID: 37334125 PMCID: PMC10276557 DOI: 10.7717/peerj.15371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/18/2023] [Indexed: 06/20/2023] Open
Abstract
Background A 2D fluoroscopy/3D model-based registration with statistical shape modeling (SSM)-reconstructed subject-specific bone models will help reduce radiation exposure for 3D kinematic measurements of the knee using clinical alternating bi-plane fluoroscopy systems. The current study aimed to develop such an approach and evaluate in vivo its accuracy and identify the effects of the accuracy of SSM models on the kinematic measurements. Methods An alternating interpolation-based model tracking (AIMT) approach with SSM-reconstructed subject-specific bone models was used for measuring 3D knee kinematics from dynamic alternating bi-plane fluoroscopy images. A two-phase optimization scheme was used to reconstruct subject-specific knee models from a CT-based SSM database of 60 knees using one, two, or three pairs of fluoroscopy images. Using the CT-reconstructed model as a benchmark, the performance of the AIMT with SSM-reconstructed models in measuring bone and joint kinematics during dynamic activity was evaluated in terms of mean target registration errors (mmTRE) for registered bone poses and the mean absolute differences (MAD) for each motion component of the joint poses. Results The mmTRE of the femur and tibia for one image pair were significantly greater than those for two and three image pairs without significant differences between two and three image pairs. The MAD was 1.16 to 1.22° for rotations and 1.18 to 1.22 mm for translations using one image pair. The corresponding values for two and three image pairs were 0.75 to 0.89° and 0.75 to 0.79 mm; and 0.57 to 0.79° and 0.6 to 0.69 mm, respectively. The MAD values for one image pair were significantly greater than those for two and three image pairs without significant differences between two and three image pairs. Conclusions An AIMT approach with SSM-reconstructed models was developed, enabling the registration of interleaved fluoroscopy images and SSM-reconstructed models from more than one asynchronous fluoroscopy image pair. This new approach had sub-millimeter and sub-degree measurement accuracy when using more than one image pair, comparable to the accuracy of CT-based methods. This approach will be helpful for future kinematic measurements of the knee with reduced radiation exposure using 3D fluoroscopy with clinically alternating bi-plane fluoroscopy systems.
Collapse
Affiliation(s)
- Hsuan-Yu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, R.O.C.
| | - Cheng-Chung Lin
- Department of Electrical Engineering, Fu-Jen Catholic University, New Taipei, Taiwan, R.O.C.
| | - Kao-Shang Shih
- Department of Orthopedics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, R.O.C.
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, R.O.C.
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan, R.O.C.
| | - Mei-Ying Kuo
- Department of Physical Therapy, China Medical University, Taichung, Taiwan, R.O.C.
| | - Song-Ying Li
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, R.O.C.
| | - Horng-Chaung Hsu
- Department of Orthopaedic Surgery, China Medical University, Taichung, Taiwan, R.O.C.
| |
Collapse
|
5
|
Lin SH, Hung LW, Kuo MY, Lin CC, Lu HY, Weng PL, Fan CL, Kuo CC, Lu TW. Effects of lateral instability on ankle coupled motions in vivo using 3D fluoroscopy. J Orthop Res 2022; 41:1076-1087. [PMID: 36121190 DOI: 10.1002/jor.25448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 07/26/2022] [Accepted: 09/14/2022] [Indexed: 02/04/2023]
Abstract
Lateral ankle instability (LAI) compromises the normal kinematics of the ankle, affecting activities of daily living. In vitro kinematics of ankles with LAI during single-plane motions are available, but the active control stability of these motions remains unclear. The current study measured the 3D ankle kinematics during unresisted single-plane motion tests using a bi-plane fluoroscope with a CT model-based 2D/3D registration method in 12 patients with LAI and 14 healthy peers. The coupling of the kinematic components at the talocrural and subtalar joints was quantified by the path difference between the forward and return paths of the coupled motion. Significantly increased path differences were found in the subtalar dorsiflexion/plantarflexion and inversion/eversion components during internal/external rotation tests (p < 0.05). During inversion/eversion, significantly reduced tibiocalcaneal ranges of motion and the path differences in the talocrural and subtalar dorsiflexion/plantarflexion components were noted (p < 0.05). The current results suggest that chronic LAI had compromised control stability at the subtalar joint during internal/external rotation tests and a conservative motion control strategy with significantly reduced ranges of motion to maintain good control of out-of-plane motion components in response to direct challenges of the anterior talofibular ligament during inversion/eversion tests. The current results also suggest that, compared to kinematic patterns of individual components, the path difference of the coupled motion may serve as a better measure of the motion control stability of the ankle in differentiating LAI from healthy controls.
Collapse
Affiliation(s)
- Shang-His Lin
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Surgery, Division of Plastic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Li-Wei Hung
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Orthopedic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Mei-Ying Kuo
- Department of Physical Therapy, China Medical University, Taichung, Taiwan
| | - Cheng-Chung Lin
- Department of Electrical Engineering, Fu-Jen Catholic University, Taipei, Taiwan
| | - Hsin-Yi Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Pei-Ling Weng
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chia-Ling Fan
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chien-Chung Kuo
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Orthopedic Surgery, School of Medicine, China Medical University, Taipei, Taiwan
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
6
|
An efficient hybrid method for 3D to 2D medical image registration. Int J Comput Assist Radiol Surg 2022; 17:1313-1320. [PMID: 35435614 PMCID: PMC9206621 DOI: 10.1007/s11548-022-02624-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/23/2022] [Indexed: 12/02/2022]
Abstract
Purpose The purpose of this paper is to present a method for registration of 3D computed tomography to 2D single-plane fluoroscopy knee images to provide 3D motion information for knee joints. This 3D kinematic information has unique utility for examining joint kinematics in conditions such as ligament injury, osteoarthritis and after joint replacement. Methods We proposed a non-invasive rigid body image registration method which is based on two different multimodal similarity measures. This hybrid registration method helps to achieve a trade-off among different challenges including, time complexity and accuracy. Results We performed a number of experiments to evaluate the performance of the proposed method. The experimental results show that the proposed method is as accurate as one of the most recent registration methods while it is several times faster than that method. Conclusion The proposed method is a non-invasive, fast and accurate registration method, which can provide 3D information for knee joint kinematic measurements. This information can be very helpful in improving the accuracy of diagnosis and providing targeted treatment.
Collapse
|
7
|
In Vivo Knee Kinematics in Patients With Arthrofibrosis After Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2022. [DOI: 10.1123/jsr.2021-0339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Context: Arthrofibrosis after anterior cruciate ligament (ACL) reconstruction can be detrimental to the knee joint function and patient outcomes. However, the effects of arthrofibrosis on the in vivo tibiofemoral and patellofemoral joint kinematics after ACL reconstruction remain unclear. Objective: The objective of this study was to quantify the in vivo knee kinematics during a dynamic lunge task in the knee with arthrofibrosis after ACL reconstruction. Methods: Eleven patients with arthrofibrosis in one knee after ACL reconstruction participated in this study. Computed tomography and dual fluoroscopic imaging were used to evaluate in vivo kinematics of affected and contralateral knees during a lunge task. Differences in 6 degrees of freedom tibiofemoral kinematics and patellar tracking between limbs were assessed via repeated-measures analysis of variance. Results: Internal tibial rotation (5.2° vs 7.5°, respectively; P < .001) and inferior patellar shift (24.6 mm vs 28.9 mm, respectively; P < .001) were significantly lower in the arthrofibrotic knee compared with the contralateral knee from 15° to 75° of knee flexion. The patella in the arthrofibrotic knee significantly less flexed by 9.1° (P = .009) throughout the measured ROM and less laterally tilted by 3° (P = .017) compared with the contralateral knee from 30° to 75° of knee flexion. Conclusions: A significant superior shift and medial tilt of the patella were found in the affected knee compared with those in the contralateral knee during the dynamic lunge. Decreased internal tibial rotation and patellar flexion were found in knees with arthrofibrosis following ACL reconstruction; whether these kinematic changes are caused by arthrofibrosis need further investigation.
Collapse
|
8
|
Tanji A, Nagura T, Iwamoto T, Matsumura N, Nakamura M, Matsumoto M, Sato K. Total elbow arthroplasty using an augmented reality-assisted surgical technique. J Shoulder Elbow Surg 2022; 31:175-184. [PMID: 34175467 DOI: 10.1016/j.jse.2021.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 05/11/2021] [Accepted: 05/16/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Precision placement of implants in total elbow arthroplasty (TEA) using conventional surgical techniques can be difficult and riddled with errors. Modern technologies such as augmented reality (AR) and 3-dimensional (3D) printing have already found useful applications in many fields of medicine. We proposed a cutting-edge surgical technique, augmented reality total elbow arthroplasty (ARTEA), that uses AR and 3D printing to provide 3D information for intuitive preoperative planning. The purpose of this study was to evaluate the accuracy of humeral and ulnar component placement using ARTEA. METHODS Twelve upper extremities from human frozen cadavers were used for experiments performed in this study. We scanned the extremities via computed tomography prior to performing TEA to plan placement sites using computer simulations. The ARTEA technique was used to perform TEA surgery on 6 of the extremities, whereas conventional (non-ARTEA) techniques were used on the other 6 extremities. Computed tomography scanning was repeated after TEA completion, and the error between the planned and actual placements of humeral and ulnar components was calculated and compared. RESULTS For humeral component placement, the mean positional error ± standard deviation of ARTEA vs. non-ARTEA was 1.4° ± 0.6° vs. 4.4° ± 0.9° in total rotation (P = .002) and 1.5 ± 0.6 mm vs. 8.6 ± 1.3 mm in total translation (P = .002). For ulnar component placement, the mean positional error ± standard deviation of ARTEA vs. non-ARTEA was 5.5° ± 3.1° vs. 19.5° ± 9.8° in total rotation (P = .004) and 1.5 ± 0.4 mm vs. 6.9 ± 1.6 mm in total translation (P = .002). Both rotational accuracy and translational accuracy were greater for joint components replaced using the ARTEA technique compared with the non-ARTEA technique (P < .05). CONCLUSION Compared with conventional surgical techniques, ARTEA had greater accuracy in prosthetic implant placement when used to perform TEA.
Collapse
Affiliation(s)
- Atsushi Tanji
- Department of Orthopedic Surgery, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan; Department of Orthopedic Surgery, Keio University, Tokyo, Japan.
| | - Takeo Nagura
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan
| | | | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan
| | - Kazuki Sato
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan
| |
Collapse
|
9
|
Lu HY, Shih KS, Lin CC, Lu TW, Li SY, Kuo HW, Hsu HC. Three-Dimensional Subject-Specific Knee Shape Reconstruction with Asynchronous Fluoroscopy Images Using Statistical Shape Modeling. Front Bioeng Biotechnol 2021; 9:736420. [PMID: 34746102 PMCID: PMC8564181 DOI: 10.3389/fbioe.2021.736420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background and objectives: Statistical shape modeling (SSM) based on computerized tomography (CT) datasets has enabled reasonably accurate reconstructions of subject-specific 3D bone morphology from one or two synchronous radiographs for clinical applications. Increasing the number of radiographic images may increase the reconstruction accuracy, but errors related to the temporal and spatial asynchronization of clinical alternating bi-plane fluoroscopy may also increase. The current study aimed to develop a new approach for subject-specific 3D knee shape reconstruction from multiple asynchronous fluoroscopy images from 2, 4, and 6 X-ray detector views using a CT-based SSM model; and to determine the optimum number of planar images for best accuracy via computer simulations and in vivo experiments. Methods: A CT-based SSM model of the knee was established from 60 training models in a healthy young Chinese male population. A new two-phase optimization approach for 3D subject-specific model reconstruction from multiple asynchronous clinical fluoroscopy images using the SSM was developed, and its performance was evaluated via computer simulation and in vivo experiments using one, two and three image pairs from an alternating bi-plane fluoroscope. Results: The computer simulation showed that subject-specific 3D shape reconstruction using three image pairs had the best accuracy with RMSE of 0.52 ± 0.09 and 0.63 ± 0.085 mm for the femur and tibia, respectively. The corresponding values for the in vivo study were 0.64 ± 0.084 and 0.69 ± 0.069 mm, respectively, which was significantly better than those using one image pair (0.81 ± 0.126 and 0.83 ± 0.108 mm). No significant differences existed between using two and three image pairs. Conclusion: A new two-phase optimization approach was developed for SSM-based 3D subject-specific knee model reconstructions using more than one asynchronous fluoroscopy image pair from widely available alternating bi-plane fluoroscopy systems in clinical settings. A CT-based SSM model of the knee was also developed for a healthy young Chinese male population. The new approach was found to have high mode reconstruction accuracy, and those for both two and three image pairs were much better than for a single image pair. Thus, two image pairs may be used when considering computational costs and radiation dosage. The new approach will be useful for generating patient-specific knee models for clinical applications using multiple asynchronous images from alternating bi-plane fluoroscopy widely available in clinical settings. The current SSM model will serve as a basis for further inclusion of training models with a wider range of sizes and morphological features for broader applications.
Collapse
Affiliation(s)
- Hsuan-Yu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Kao-Shang Shih
- Department of Orthopedics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Cheng-Chung Lin
- Department of Electrical Engineering, Fu Jen Catholic University, Taipei, Taiwan
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Song-Ying Li
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Hsin-Wen Kuo
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Horng-Chaung Hsu
- Department of Orthopaedic Surgery, China Medical University, Taipei, Taiwan
| |
Collapse
|
10
|
Zhou C, Cha T, Peng Y, Li G. Transfer learning from an artificial radiograph-landmark dataset for registration of the anatomic skull model to dual fluoroscopic X-ray images. Comput Biol Med 2021; 138:104923. [PMID: 34638020 DOI: 10.1016/j.compbiomed.2021.104923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/19/2021] [Accepted: 10/04/2021] [Indexed: 01/01/2023]
Abstract
Registration of 3D anatomic structures to their 2D dual fluoroscopic X-ray images is a widely used motion tracking technique. However, deep learning implementation is often impeded by a paucity of medical images and ground truths. In this study, we proposed a transfer learning strategy for 3D-to-2D registration using deep neural networks trained from an artificial dataset. Digitally reconstructed radiographs (DRRs) and radiographic skull landmarks were automatically created from craniocervical CT data of a female subject. They were used to train a residual network (ResNet) for landmark detection and a cycle generative adversarial network (GAN) to eliminate the style difference between DRRs and actual X-rays. Landmarks on the X-rays experiencing GAN style translation were detected by the ResNet, and were used in triangulation optimization for 3D-to-2D registration of the skull in actual dual-fluoroscope images (with a non-orthogonal setup, point X-ray sources, image distortions, and partially captured skull regions). The registration accuracy was evaluated in multiple scenarios of craniocervical motions. In walking, learning-based registration for the skull had angular/position errors of 3.9 ± 2.1°/4.6 ± 2.2 mm. However, the accuracy was lower during functional neck activity, due to overly small skull regions imaged on the dual fluoroscopic images at end-range positions. The methodology to strategically augment artificial training data can tackle the complicated skull registration scenario, and has potentials to extend to widespread registration scenarios.
Collapse
Affiliation(s)
- Chaochao Zhou
- Orthopaedic Bioengineering Research Center, Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Thomas Cha
- Orthopaedic Bioengineering Research Center, Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Yun Peng
- NuVasive Inc, San Diego, CA, USA
| | - Guoan Li
- Orthopaedic Bioengineering Research Center, Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA.
| |
Collapse
|
11
|
Wang C, Kernkamp WA, Li C, Hu H, Li P, Tsai TY. Elongation and orientation pattern of the medial patellofemoral ligament during lunging. J Orthop Res 2021; 39:2036-2047. [PMID: 33002242 DOI: 10.1002/jor.24872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 09/18/2020] [Accepted: 09/29/2020] [Indexed: 02/04/2023]
Abstract
Unfavorable clinical outcomes after medial patellofemoral ligament (MPFL) reconstruction, such as early osteoarthritis of the patellofemoral joint, were considered to be associate with tunnel malpositioning. Length change studies have found that small changes in the femoral position can cause great changes in elongation trends. Further studying the MPFL kinematics may help us to understand the consequences of tunnel malpositioning and optimize the reconstruction techniques. Fifteen healthy subjects were studied with a combined computed tomography and biplane fluoroscopic imaging technique during a lunge motion. Five femoral and three patellar attachments were used to simulate different MPFL bundles. Kinematics of MPFL was defined as elongation and orientation changes (i.e., deviation angle and elevation angle). The mean deviation angle was 28.7° (95% confidence interval, 28.0°-29.4°) at full extension and remained nearly unchanged up to 60° of flexion, and increased to 56.5° (54.1°-58.9°) at 110°. The elevation angle decreased linearly from 12.6° (9.3°-15.9°) at full extension to -86.2° (-92.7-79.7°) at 110° of flexion. The MPFL was most stretched anteriorly and laterally relative to femur from full extension to 30° of flexion and remained near isometric beyond 30°. The current study found that proximal and anterior femoral attachments caused excessive lateral stretching of the MPFL at deeper flexion angles. Such abnormal MPFL kinematics may subsequently cause overconstraint and increased cartilage pressures of the medial patellofemoral joint.
Collapse
Affiliation(s)
- Cong Wang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, China.,Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Willem A Kernkamp
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Changzhao Li
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Department of Orthopedics, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Hai Hu
- Department of Orthopaedic Surgery, Orthopaedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Pingyue Li
- Department of Orthopedics, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, China.,Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
12
|
Lin CC, Lu M, Wang SN, Wu CH. In vivo three-dimensional isometry analysis of suture attachment sites for extracapsular suture stabilization of the canine stifle. Vet Rec 2021; 190:e560. [PMID: 34125444 DOI: 10.1002/vetr.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 05/07/2021] [Accepted: 05/23/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The study aimed to perform isometry analysis of a selection of suture attachment points for extracapsular stabilization with three-dimensional (3D) measurements and normal gait kinematics of the stifle joint. METHODS Thirteen client-owned dogs were recruited. Fluoroscopic images of the stifle during treadmill walking and computed tomography of the same joint were acquired. Stifle kinematics were reconstructed using 3D model-based fluoroscopic analysis. Variability of the distance between the femoral and tibial attachment sites across gait cycles was evaluated. The maximum length variation (MLV) and maximum length percent variation (MLPV) were quantified and used to determine the level of isometry of the attachment site combinations. RESULTS A selection of combinations with lower mean MLV (<2.5 mm) or MLPV (<8%) was identified from 315 combinations, and all the combinations involved femoral attachment sites near the distal pole of the lateral fabella. The combinations also involving tibial attachment sites near the proximal tibial crest showed improved isometry, with an MLPV < 6%. CONCLUSION Combinations using attachment sites around the distal pole of the lateral fabella and proximal tibial crest or caudal to the long digit extensor groove appeared to have improved isometry.
Collapse
Affiliation(s)
- Cheng-Chung Lin
- Department of Electrical Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ming Lu
- Institute of Veterinary Clinical Science, National Taiwan University, Taipei, Taiwan
| | - Shi-Nuan Wang
- Institute of Veterinary Clinical Science, National Taiwan University, Taipei, Taiwan
| | - Ching-Ho Wu
- Institute of Veterinary Clinical Science, National Taiwan University, Taipei, Taiwan.,Department of Surgery, National Taiwan University Veterinary Hospital, Taipei, Taiwan
| |
Collapse
|
13
|
Three-dimensional preoperative planning in the weight-bearing state: validation and clinical evaluation. Insights Imaging 2021; 12:44. [PMID: 33825985 PMCID: PMC8026795 DOI: 10.1186/s13244-021-00994-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/24/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives 3D preoperative planning of lower limb osteotomies has become increasingly important in light of modern surgical technologies. However, 3D models are usually reconstructed from Computed Tomography data acquired in a non-weight-bearing posture and thus neglecting the positional variations introduced by weight-bearing. We developed a registration and planning pipeline that allows for 3D preoperative planning and subsequent 3D assessment of anatomical deformities in weight-bearing conditions. Methods An intensity-based algorithm was used to register CT scans with long-leg standing radiographs and subsequently transform patient-specific 3D models into a weight-bearing state. 3D measurement methods for the mechanical axis as well as the joint line convergence angle were developed. The pipeline was validated using a leg phantom. Furthermore, we evaluated our methods clinically by applying it to the radiological data from 59 patients. Results The registration accuracy was evaluated in 3D and showed a maximum translational and rotational error of 1.1 mm (mediolateral direction) and 1.2° (superior-inferior axis). Clinical evaluation proved feasibility on real patient data and resulted in significant differences for 3D measurements when the effects of weight-bearing were considered. Mean differences were 2.1 ± 1.7° and 2.0 ± 1.6° for the mechanical axis and the joint line convergence angle, respectively. 37.3 and 40.7% of the patients had differences of 2° or more in the mechanical axis or joint line convergence angle between weight-bearing and non-weight-bearing states. Conclusions Our presented approach provides a clinically feasible approach to preoperatively fuse 2D weight-bearing and 3D non-weight-bearing data in order to optimize the surgical correction.
Collapse
|
14
|
Chen CC, Lin CC, Hsieh HP, Fu YC, Chen YJ, Lu TW. In vivo three-dimensional mandibular kinematics and functional point trajectories during temporomandibular activities using 3d fluoroscopy. Dentomaxillofac Radiol 2021; 50:20190464. [PMID: 32783637 DOI: 10.1259/dmfr.20190464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To measure in vivo three-dimensional kinematics of the mandible and associated end-point trajectories and to quantify their relationships during temporomandibular joint activities using 3D fluoroscopy. METHODS A novel fluoroscopy-based 3D measurement method was used to measure motions of the mandible and the associated end points (i.e. incisors and lateral poles of both condyles) during open close, lateral gliding and protrusion-retraction movements in healthy young individuals. The contributions of each of the rotational and translational components of the mandible to the end-point trajectories were quantified through experiment-based computer simulations. RESULTS The mandibular rotation was found to account for 91% of the maximal mouth-opening-capacity and 73% of the maximal lateral incisor movement, while the condylar translation contributed to 99% of the anterior protrusion distance. Incisor trajectories were nearly vertical within the first 60% of the maximal opening during the open-close movement. CONCLUSIONS Similar condylar downward rotation paths but with bilaterally asymmetrical ranges were used to perform basic mandibular movements of different targeted TI trajectories in three dimensions, that is, open-close, lateral-gliding and protrusion-retraction. Mandibular rotations contributed to the majority of the principal displacement components of the incisor, that is, vertical during open-close and towards the working-side-during lateral-gliding, while mandibular translation contributed mainly to the forward movement of the incisor during protrusion-retraction. Owing to the anatomical constraints, the freedom of mandibular translation is limited and mainly in the anteroposterior direction, which is considered helpful for the control and stability of the TMJ during oral activities.
Collapse
Affiliation(s)
- Chien-Chih Chen
- School of Dentistry, National Taiwan University, Taipei, Taiwan.,i-Change Dental Clinic, Taipei, Taiwan.,Department of Dentistry, Cardinal Tien Hospital, New Taipei City, Taiwan.,School of Dentistry, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Chung Lin
- Department of Electrical Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Hong-Po Hsieh
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Yang-Chieh Fu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Yunn-Jy Chen
- School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Orthopedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
15
|
Shih KS, Lin CC, Lu HL, Fu YC, Lin CK, Li SY, Lu TW. Patient-specific instrumentation improves functional kinematics of minimally-invasive total knee replacements as revealed by computerized 3D fluoroscopy. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 188:105250. [PMID: 31838341 DOI: 10.1016/j.cmpb.2019.105250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 10/17/2019] [Accepted: 11/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Minimally-invasive total knee arthroplasty (MIS-TKA) has demonstrated very good short-term success, but its mid- to long-term results remain inconclusive. The success may be related to the tradeoff between a small incision and accurate positioning of the implant components. Patient-specific instrumentation (PSI) aims to improve the accuracy in restoring the knee axis and the clinical outcomes for MIS-TKA, but the results are yet to be confirmed by accurate assessment during functional activities. The purpose of the current study was to measure and compare the in vivo three-dimensional (3D) rigid-body and surface kinematics of MIS-TKA implanted with and without PSI during isolated knee active flexion/extension and sit-to-stand using state-of-the-art 3D model-based fluoroscopy technology. METHODS Ten patients treated for advanced medial knee osteoarthritis by MIS-TKA without PSI (non-PSI group) and nine with PSI (PSI group) participated in the current study. Each subject performed non-weight-bearing knee flexion/extension and sit-to-stand tasks while the motion of the prosthetic knee was under bi-plane fluoroscopy surveillance. The computer models of each of the knee prosthesis components were registered to the measured fluoroscopy images for each time frame via a novel validated 3D fluoroscopy method. Non-parametric 1-tailed Mann-Whitney tests were performed to detect the differences in the joint and surface kinematic variables every 10° of knee flexion between the non-PSI and PSI groups. The 1-tailed significance level was at α = 0.05. RESULTS The PSI group showed clear, coupled flexion/internal rotation during activities, while the non-PSI group remained roughly at an externally rotated position with slight internal rotations. The coupled rotation in the PSI group was accompanied by an anterior displacement of the medial contact and a posterior displacement of the lateral contact, which was different from the screw-home mechanism. Neither of the two groups showed the normal roll-back phenomenon, i.e., posterior translation of the femur relative to the tibia during knee flexion. CONCLUSIONS With the state-of-the-art 3D fluoroscopy method, differences in both the rigid-body and surface kinematics of the prosthetic knees between MIS-TKA with and without PSI were identified. Patients with PSI demonstrated significant positive effects on the reconstructed rigid-body kinematics of the knee, showing clearer coupled flexion/internal rotations - an important kinematic characteristic in healthy knees - than those without PSI during activities with or without weight-bearing. However, none of them showed normal contact patterns. The current findings will be helpful for surgical instrument design, as well as for surgical decision-making in MIS total knee arthroplasty.
Collapse
Affiliation(s)
- Kao-Shang Shih
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, R.O.C.; Department of Orthopedics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, R.O.C
| | - Cheng-Chung Lin
- Department of Electrical Engineering, Fu Jen Catholic University, New Taipei City, Taiwan, R.O.C
| | - Hsuan-Lun Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, R.O.C
| | - Yang-Chieh Fu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, R.O.C
| | - Cheng-Kai Lin
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, R.O.C
| | - Song-Ying Li
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, R.O.C
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, R.O.C.; Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan, R.O.C..
| |
Collapse
|
16
|
Lin CC, Wu CH, Chou PY, Wang SN, Hsu WR, Lu TW. Evaluation of a multibody kinematics optimization method for three-dimensional canine pelvic limb gait analysis. BMC Vet Res 2020; 16:105. [PMID: 32245381 PMCID: PMC7118953 DOI: 10.1186/s12917-020-02323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 03/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Skin marker-based three-dimensional kinematic gait analysis were commonly used to assess the functional performance and movement biomechanics of the pelvic limb in dogs. Unfortunately, soft tissue artefact would compromise the accuracy of the reproduced pelvic limb kinematics. Multibody kinematics optimization framework was often employed to compensate the soft tissue artefact for a more accurate description of human joint kinematics, but its performance on the determination of canine pelvic limb skeletal kinematics has never been evaluated. This study aimed to evaluate a multibody kinematics optimization framework used for the determination of canine pelvic limb kinematics during gait by comparing its results to those obtained using computed tomography model-based fluoroscopy analysis. RESULTS Eight clinically normal dogs were enrolled in the study. Fluoroscopy videos of the stifle joint and skin marker trajectories were acquired when the dogs walked on a treadmill. The pelvic limb kinematics were reconstructed through marker-based multibody kinematics optimization and single-body optimization. The reference kinematics data were derived via a model-based fluoroscopy analysis. The use of multibody kinematics optimization yielded a significantly more accurate estimation of flexion/extension of the hip and stifle joints than the use of single-body optimization. The accuracy of the joint model parameters and the weightings to individual markers both influenced the soft tissue artefact compensation capability. CONCLUSIONS Multibody kinematics optimization designated for soft tissue artefact compensation was established and evaluated for its performance on canine gait analysis, which provided a further step in more accurately describing sagittal plane kinematics of the hip and stifle joints.
Collapse
Affiliation(s)
- Cheng-Chung Lin
- Department of Electrical Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ching-Ho Wu
- Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan.
| | - Po-Yen Chou
- Department of Surgical and Radiological Science, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Shi-Nuan Wang
- Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Ru Hsu
- Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
| | - Tung-Wu Lu
- Department of Biomedical Engineering and Department of Orthopedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
17
|
Postolka B, List R, Thelen B, Schütz P, Taylor WR, Zheng G. Evaluation of an intensity-based algorithm for 2D/3D registration of natural knee videofluoroscopy data. Med Eng Phys 2020; 77:107-113. [PMID: 31980316 DOI: 10.1016/j.medengphy.2020.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 09/24/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
The accurate quantification of in-vivo tibio-femoral kinematics is essential for understanding joint functionality, but determination of the 3D pose of bones from 2D single-plane fluoroscopic images remains challenging. We aimed to evaluate the accuracy, reliability and repeatability of an intensity-based 2D/3D registration algorithm. The accuracy was evaluated using fluoroscopic images of 2 radiopaque bones in 18 different poses, compared against a gold-standard fiducial calibration device. In addition, 3 natural femora and 3 natural tibiae were used to examine registration reliability and repeatability. Both manual fitting and intensity-based registration exhibited a mean absolute error of <1 mm in-plane. Overall, intensity-based registration of the femoral bone model revealed significantly higher translational and rotational errors than manual fitting, while no statistical differences (except for y-axis translation) were found for the tibial bone model. The repeatability of 108 intensity-based registrations showed mean in-plane standard deviations of 0.23-0.56 mm, but out-of-plane position repeatability was lower (mean SD: femur 7.98 mm, tibia 6.96 mm). SDs for rotations averaged 0.77-2.52°. While the algorithm registered some images extremely well, other images clearly required manual intervention. When the algorithm registered the bones repeatably, it was also accurate, suggesting an approach that includes manual intervention could become practical for efficient and accurate registration.
Collapse
Affiliation(s)
- Barbara Postolka
- ETH Zürich, Institute for Biomechanics, Leopold-Ruzicka-Weg 4, 8093 Zürich, Switzerland.
| | - Renate List
- ETH Zürich, Institute for Biomechanics, Leopold-Ruzicka-Weg 4, 8093 Zürich, Switzerland.
| | - Benedikt Thelen
- University of Berne, Institute for Surgical Technology & Biomechanics, Stauffacherstrasse 78, 3014 Bern, Switzerland.
| | - Pascal Schütz
- ETH Zürich, Institute for Biomechanics, Leopold-Ruzicka-Weg 4, 8093 Zürich, Switzerland.
| | - William R Taylor
- ETH Zürich, Institute for Biomechanics, Leopold-Ruzicka-Weg 4, 8093 Zürich, Switzerland.
| | - Guoyan Zheng
- University of Berne, Institute for Surgical Technology & Biomechanics, Stauffacherstrasse 78, 3014 Bern, Switzerland.
| |
Collapse
|
18
|
Lin CC, Zhang S, Hsu CY, Frahm J, Lu TW, Shih TF. Measuring three-dimensional tibiofemoral kinematics using dual-slice real-time magnetic resonance imaging. Med Phys 2019; 46:4588-4599. [PMID: 31408532 DOI: 10.1002/mp.13761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 07/20/2019] [Accepted: 08/07/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The purpose of this study is to propose and evaluate a slice-to-volume registration (SVR) method integrating an advanced dual-slice real-time magnetic resonance image (MRI) and three-dimensional (3D) MRI volume of the tibiofemoral joint for determining their 3D kinematics. METHODS The real-time and 3D MRI of the knee were collected from 12 healthy adults at 5 static flexion positions and during dynamic flexion/extension movement. The 3D positions and orientations of the femur and tibia were obtained by registering their volumetric models constructed from the 3D MRI to dual-slice real-time MRI using an optimization process. The proposed method was quantitatively evaluated for its performance in terms of the robustness and measurement accuracy, and compared to those of a single-slice SVR method. Its repeatability in measuring knee kinematics during flexion/extension movement was also determined. RESULTS In comparison to the single-slice SVR method, the dual-slice method was significantly superior, giving a successful registration rate > 95%, a bias less than 0.5 mm in translations and 0.6° in rotations and a precision <0.7 mm in translations and 0.9° in rotations for determining the 3D tibiofemoral poses. For repeatability of the dual-slice SVR in measuring tibiofemoral kinematics during dynamic flexion/extension, the means of the time-averaged standard deviations were <0.9° for joint angles and 0.5 mm for joint translations. CONCLUSION A dual-slice SVR method in conjunction with real-time MRI has been developed and evaluated for its performance in measuring 3D kinematics of the tibiofemoral joint in 12 young adults in terms of the accuracy, robustness, and repeatability. The proposed MRI-based 3D measurement method provides a noninvasive and ionizing radiation-free approach for 3D kinematic measurement of the tibiofemoral joint, which will be helpful for future academic and clinical applications.
Collapse
Affiliation(s)
- Cheng-Chung Lin
- Department of Electrical Engineering, Fu Jen Catholic University, New Taipei City, 24205, Taiwan
| | - Shuo Zhang
- Biomedizinische NMR Forschungs GmbH am Max-Planck-Institute für biophysikalische Chemie, Am Fassberg 11, 37070, Göttingen, Germany
| | - Chao-Yu Hsu
- Department of Radiology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, 10051, Taiwan
| | - Jens Frahm
- Biomedizinische NMR Forschungs GmbH am Max-Planck-Institute für biophysikalische Chemie, Am Fassberg 11, 37070, Göttingen, Germany
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, 10051, Taiwan.,Department of Orthopaedic Surgery, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan
| | - Ting-Fang Shih
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan.,Department of Medical Imaging, National Taiwan University Hospital, Taipei, 10051, Taiwan
| |
Collapse
|
19
|
Lu M, Lin CC, Lu TW, Wang SN, Wu CH. Effects of soft tissue artefacts on computed segmental and stifle kinematics in canine motion analysis. Vet Rec 2019; 186:66. [PMID: 31409754 DOI: 10.1136/vr.105352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/20/2019] [Accepted: 07/10/2019] [Indexed: 11/04/2022]
Abstract
Skin marker-based motion analysis has been widely used to evaluate the functional performance of canine gait and posture. However, the interference of soft tissues between markers and the underlying bones (soft tissue artefacts, STAs) may lead to errors in kinematics measurements. Currently, no optimal marker attachment sites and cluster compositions are recommended for canine gait analysis. The current study aims to evaluate cluster-level STAs and the effects of cluster compositions on the computed stifle kinematics. Ten mixed-breed healthy dogs affixed with 19 retroreflective markers on the thigh and shank were enrolled. During isolated stifle passive extension, the marker trajectories were acquired with a motion capture system, and the skeletal poses were determined by integrating fluoroscopic and CT images of the bones. The cluster-level STAs were assessed, and clusters were paired to calculate the stifle kinematics. A selection of cluster compositions was useful for deriving accurate sagittal and frontal plane stifle kinematics with flexion angles below 50 per cent of the range of motion. The findings contribute to improved knowledge of canine STAs and their influence on motion measurements. The marker composition with the smallest error in describing joint kinematics is recommended for future applications and study in dogs during dynamic gait assessment.
Collapse
Affiliation(s)
- Ming Lu
- Institute of Veterinary Clinical Science, National Taiwan University, Taipei, Taiwan
| | - Cheng-Chung Lin
- Department of Electrical Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Tung-Wu Lu
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Shi-Nuan Wang
- Institute of Veterinary Clinical Science, National Taiwan University, Taipei, Taiwan
| | - Ching-Ho Wu
- Institute of Veterinary Clinical Science, National Taiwan Univeristy, Taipei, Taiwan .,Department of Surgery, National Taiwan University Veterinary Hospital, Taipei, Taiwan
| |
Collapse
|
20
|
Lin CC, Chang CL, Lu M, Lu TW, Wu CH. Quantification of three-dimensional soft tissue artifacts in the canine hindlimb during passive stifle motion. BMC Vet Res 2018; 14:389. [PMID: 30522489 PMCID: PMC6284316 DOI: 10.1186/s12917-018-1714-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/23/2018] [Indexed: 11/20/2022] Open
Abstract
Background Three-dimensional joint kinematics during canine locomotion are commonly measured using skin marker-based stereophotogrammetry technologies. However, marker-related errors caused by the displacement of the skin surface relative to the underlying bones (i.e., soft tissue artifacts, STA) may affect the accuracy of the measurements and obscure clinically relevant information. Few studies have assessed STA in canine limbs during kinematic analysis. The magnitudes and patterns of the STA and their influence on kinematic analysis remain unclear. Therefore, the current study aims to quantify the in vivo STA of skin markers on the canine thigh and crus during passive joint motion. The stifle joints of ten dogs were passively extended while the skin markers were measured using a motion capture system, and skeletal kinematics were determined using a CT-to-fluoroscopic image registration method. Results The skin markers exhibited considerable STA relative to the underlying bones, with a peak amplitude of 27.4 mm for thigh markers and 28.7 mm for crus markers; however, the amplitudes and displacement directions at different attachment sites were inconsistent. The markers on the cranial thigh and lateral crus closer to the stifle joint had greater STA amplitudes in comparison to those of other markers. Most markers had STA with linear and quadratic patterns against the stifle flexion angles. These STA resulted in underestimated flexion angles but overestimated adduction and internal rotation when the stifle was flexed to greater than 90°. Conclusions Marker displacements relative to the underlying bones were prominent in the cranial aspect of the thigh and the proximal-lateral aspect of the crus. The calculated stifle kinematic variables were also affected by the STA. These findings can provide a reference for marker selection in canine motion analysis for similar motion tasks and clarify the relationship between STA patterns and stifle kinematics; the results may therefore contribute to the development of STA models and compensation techniques for canine motion analysis. Electronic supplementary material The online version of this article (10.1186/s12917-018-1714-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Cheng-Chung Lin
- Department of Electrical Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chia-Lin Chang
- Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Taipei City, Taiwan
| | - Ming Lu
- Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Taipei City, Taiwan
| | - Tung-Wu Lu
- Institute of Biomedical Engineering and Department of Orthopedic Surgery, School of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Ching-Ho Wu
- Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Taipei City, Taiwan.
| |
Collapse
|
21
|
Lin CC, Li JD, Lu TW, Kuo MY, Kuo CC, Hsu HC. A model-based tracking method for measuring 3D dynamic joint motion using an alternating biplane x-ray imaging system. Med Phys 2018; 45:3637-3649. [PMID: 29889983 DOI: 10.1002/mp.13042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/10/2018] [Accepted: 06/05/2018] [Indexed: 11/10/2022] Open
Abstract
PURPOSES To propose a new model-based tracking method for measuring three-dimensional (3D) dynamic joint kinematics using a clinical alternating biplane x-ray imaging system; and to quantify in vitro its errors in measuring ankle and knee motions at different motion speeds. METHODS A new model-based tracking method based on motion component partition and interpolation (MCPI) was developed for measuring 3D dynamic joint kinematics based on a clinical alternating biplane x-ray imaging system. Two detectors of the biplane imaging system placed perpendicular to each other were operated to collect alternating fluoroscopic images of the targeted joint during tasks. The CT data of the joint were also acquired for the reconstruction of volumetric and surface models of each of the associated bones. The CT-based models of the bones were first registered to the alternating images using a model-to-single-plane fluoroscopic image registration method, and the resulting bone poses were then refined using a two-level optimization with motion component partition and model vertex trajectory interpolation. The MCPI method was evaluated in vitro for measurement errors for an ankle and a knee specimen moving at different speeds against a standard reference provided by a highly accurate motion capture system. The positional and rotational errors of the measured bone poses were quantified in terms of the bias, precision, and root-mean-squared errors (RMSE), as well as the mean target registration error (mTRE), a final mTRE less than 2.5 mm indicating a successful registration. RESULTS The new method was found to have RMSE of bone pose measurements of less than 0.18 mm for translations and 0.72° for rotations for the ankle, and 0.33 mm and 0.74° for the knee with a high successful registration rate (>97%), and did not appear to be affected by joint motion speeds. Given the same alternating fluoroscopic images, the MCPI method outperformed the typical biplane analysis method assuming zero time offset between the two fluoroscopic views. The differences in performance between the methods were increased with increased joint motion speed. With the accurate bone pose data, the new method enabled talocrural, subtalar, and tibiofemoral kinematics measurements with submillimeter and subdegree accuracy, except for an RMSE of 1.04° for the internal/external rotation of the talocrural joint. CONCLUSIONS A new model-based tracking method based on MCPI has been developed for measuring dynamic joint motions using an alternating biplane x-ray imaging system widely available in medical centers. The MCPI method has been demonstrated in vitro to be highly accurate in determining the 3D kinematics of the bones of both the ankle joint complex and the knee. The current results suggest that the MCPI method would be an effective approach for measuring in vivo 3D kinematics of dynamic joint motion in a clinical setting equipped with an alternating biplane x-ray imaging system.
Collapse
Affiliation(s)
- Cheng-Chung Lin
- Department of Electrical Engineering, Fu Jen Catholic University, New Taipei City, 24205, Taiwan
| | - Jia-Da Li
- Institute of Biomedical Engineering, National Taiwan University, Taipei, 10051, Taiwan
| | - Tung-Wu Lu
- Institute of Biomedical Engineering, National Taiwan University, Taipei, 10051, Taiwan
- Department of Orthopaedic Surgery, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan
| | - Mei-Ying Kuo
- Department of Physical Therapy, China Medical University, Taichung, 40402, Taiwan
| | - Chien-Chung Kuo
- Department of Orthopaedic Surgery, China Medical University Hospital, Taichung, 40447, Taiwan
| | - Horng-Chaung Hsu
- Department of Orthopaedic Surgery, China Medical University Hospital, Taichung, 40447, Taiwan
| |
Collapse
|
22
|
Kono K, Tomita T, Futai K, Yamazaki T, Tanaka S, Yoshikawa H, Sugamoto K. In vivo three-dimensional kinematics of normal knees during different high-flexion activities. Bone Joint J 2018; 100-B:50-55. [PMID: 29305450 PMCID: PMC5842511 DOI: 10.1302/0301-620x.100b1.bjj-2017-0553.r2] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Aims In Asia and the Middle-East, people often flex their knees deeply
in order to perform activities of daily living. The purpose of this
study was to investigate the 3D kinematics of normal knees during
high-flexion activities. Our hypothesis was that the femorotibial
rotation, varus-valgus angle, translations, and kinematic pathway
of normal knees during high-flexion activities, varied according
to activity. Materials and Methods We investigated the in vivo kinematics of eight
normal knees in four male volunteers (mean age 41.8 years; 37 to
53) using 2D and 3D registration technique, and modelled the knees
with a computer aided design program. Each subject squatted, kneeled,
and sat cross-legged. We evaluated the femoral rotation and varus-valgus
angle relative to the tibia and anteroposterior translation of the
medial and lateral side, using the transepicodylar axis as our femoral
reference relative to the perpendicular projection on to the tibial
plateau. This method evaluates the femur medially from what has
elsewhere been described as the extension facet centre, and differs
from the method classically applied. Results During squatting and kneeling, the knees displayed femoral external
rotation. When sitting cross-legged, femurs displayed internal rotation
from 10° to 100°. From 100°, femoral external rotation was observed.
No significant difference in varus-valgus angle was seen between
squatting and kneeling, whereas a varus position was observed from
140° when sitting cross-legged. The measure kinematic pathway using
our methodology found during squatting a medial pivoting pattern
from 0° to 40° and bicondylar rollback from 40° to 150°. During
kneeling, a medial pivot pattern was evident. When sitting cross-legged,
a lateral pivot pattern was seen from 0° to 100°, and a medial pivot
pattern beyond 100°. Conclusion The kinematics of normal knees during high flexion are variable
according to activity. Nevertheless, our study was limited to a
small number of male patients using a different technique to report
the kinematics than previous publications. Accordingly, caution
should be observed in generalizing our findings. Cite this article: Bone Joint J 2018;100-B:50–5.
Collapse
Affiliation(s)
- K Kono
- Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan and Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - T Tomita
- Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - K Futai
- Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - T Yamazaki
- Saitama Institute of Technology, 1690 Fusaiji, Fukaya, Saitama 369-0293, Japan
| | - S Tanaka
- Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - H Yoshikawa
- Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - K Sugamoto
- Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| |
Collapse
|
23
|
Li JD, Lu TW, Lin CC, Kuo MY, Hsu HC, Shen WC. Soft tissue artefacts of skin markers on the lower limb during cycling: Effects of joint angles and pedal resistance. J Biomech 2017; 62:27-38. [PMID: 28410738 DOI: 10.1016/j.jbiomech.2017.03.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/20/2017] [Accepted: 03/24/2017] [Indexed: 10/19/2022]
Abstract
Soft tissue artefacts (STA) are a major error source in skin marker-based measurement of human movement, and are difficult to eliminate non-invasively. The current study quantified in vivo the STA of skin markers on the thigh and shank during cycling, and studied the effects of knee angles and pedal resistance by using integrated 3D fluoroscopy and stereophotogrammetry. Fifteen young healthy adults performed stationary cycling with and without pedal resistance, while the marker data were measured using a motion capture system, and the motions of the femur and tibia/fibula were recorded using a bi-plane fluoroscopy-to-CT registration method. The STAs with respect to crank and knee angles over the pedaling cycle, as well as the within-cycle variations, were obtained and compared between resistance conditions. The thigh markers showed greater STA than the shank ones, the latter varying linearly with adjacent joint angles, the former non-linearly with greater within-cycle variability. Both STA magnitudes and within-cycle variability were significantly affected by pedal resistance (p<0.05). The STAs appeared to be composed of one component providing the stable and consistent STA patterns and another causing their variations. Mid-segment markers experienced smaller STA ranges than those closer to a joint, but tended to have greater variations primarily associated with pedal resistance and muscle contractions. The current data will be helpful for a better choice of marker positions for data collection, and for developing methods to compensate for both stable and variation components of the STA.
Collapse
Affiliation(s)
- Jia-Da Li
- Institute of Biomedical Engineering, National Taiwan University, Taiwan, ROC
| | - Tung-Wu Lu
- Institute of Biomedical Engineering, National Taiwan University, Taiwan, ROC; Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taiwan, ROC.
| | - Cheng-Chung Lin
- Institute of Biomedical Engineering, National Taiwan University, Taiwan, ROC; Department of Electrical Engineering, Fu Jen Catholic University, Taiwan, ROC
| | - Mei-Ying Kuo
- Department of Physical Therapy, China Medical University, Taiwan, ROC
| | - Horng-Chaung Hsu
- Department of Orthopaedics, China Medical University, Taiwan, ROC; Department of Orthopaedic Surgery, School of Medicine, China Medical University, Taiwan, ROC
| | - Wu-Chung Shen
- Department of Radiology, China Medical University Hospital, Taichung, Taiwan, ROC; Department of Biomedical Imaging and Radiological Science, College of Health Care, China Medical University, Taichung, Taiwan, ROC
| |
Collapse
|
24
|
Ghafurian S, Hacihaliloglu I, Metaxas DN, Tan V, Li K. A computationally efficient 3D/2D registration method based on image gradient direction probability density function. Neurocomputing 2017. [DOI: 10.1016/j.neucom.2016.07.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
25
|
Berger M, Müller K, Aichert A, Unberath M, Thies J, Choi JH, Fahrig R, Maier A. Marker-free motion correction in weight-bearing cone-beam CT of the knee joint. Med Phys 2016; 43:1235-48. [PMID: 26936708 DOI: 10.1118/1.4941012] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To allow for a purely image-based motion estimation and compensation in weight-bearing cone-beam computed tomography of the knee joint. METHODS Weight-bearing imaging of the knee joint in a standing position poses additional requirements for the image reconstruction algorithm. In contrast to supine scans, patient motion needs to be estimated and compensated. The authors propose a method that is based on 2D/3D registration of left and right femur and tibia segmented from a prior, motion-free reconstruction acquired in supine position. Each segmented bone is first roughly aligned to the motion-corrupted reconstruction of a scan in standing or squatting position. Subsequently, a rigid 2D/3D registration is performed for each bone to each of K projection images, estimating 6 × 4 × K motion parameters. The motion of individual bones is combined into global motion fields using thin-plate-spline extrapolation. These can be incorporated into a motion-compensated reconstruction in the backprojection step. The authors performed visual and quantitative comparisons between a state-of-the-art marker-based (MB) method and two variants of the proposed method using gradient correlation (GC) and normalized gradient information (NGI) as similarity measure for the 2D/3D registration. RESULTS The authors evaluated their method on four acquisitions under different squatting positions of the same patient. All methods showed substantial improvement in image quality compared to the uncorrected reconstructions. Compared to NGI and MB, the GC method showed increased streaking artifacts due to misregistrations in lateral projection images. NGI and MB showed comparable image quality at the bone regions. Because the markers are attached to the skin, the MB method performed better at the surface of the legs where the authors observed slight streaking of the NGI and GC methods. For a quantitative evaluation, the authors computed the universal quality index (UQI) for all bone regions with respect to the motion-free reconstruction. The authors quantitative evaluation over regions around the bones yielded a mean UQI of 18.4 for no correction, 53.3 and 56.1 for the proposed method using GC and NGI, respectively, and 53.7 for the MB reference approach. In contrast to the authors registration-based corrections, the MB reference method caused slight nonrigid deformations at bone outlines when compared to a motion-free reference scan. CONCLUSIONS The authors showed that their method based on the NGI similarity measure yields reconstruction quality close to the MB reference method. In contrast to the MB method, the proposed method does not require any preparation prior to the examination which will improve the clinical workflow and patient comfort. Further, the authors found that the MB method causes small, nonrigid deformations at the bone outline which indicates that markers may not accurately reflect the internal motion close to the knee joint. Therefore, the authors believe that the proposed method is a promising alternative to MB motion management.
Collapse
Affiliation(s)
- M Berger
- Pattern Recognition Lab, Friedrich-Alexander-University Erlangen-Nuremberg, 91058 Erlangen, Germany
| | - K Müller
- Radiological Sciences Laboratory, Stanford University, Stanford, California 94305
| | - A Aichert
- Pattern Recognition Lab, Friedrich-Alexander-University Erlangen-Nuremberg, 91058 Erlangen, Germany
| | - M Unberath
- Pattern Recognition Lab, Friedrich-Alexander-University Erlangen-Nuremberg, 91058 Erlangen, Germany
| | - J Thies
- Computer Graphics Lab, Friedrich-Alexander-University Erlangen-Nuremberg, 91058 Erlangen, Germany
| | - J-H Choi
- Radiological Sciences Laboratory, Stanford University, Stanford, California 94305
| | - R Fahrig
- Radiological Sciences Laboratory, Stanford University, Stanford, California 94305
| | - A Maier
- Pattern Recognition Lab, Friedrich-Alexander-University Erlangen-Nuremberg, 91058 Erlangen, Germany
| |
Collapse
|
26
|
Abstract
The purpose of anterior cruciate ligament (ACL) reconstruction is to restore the native stability of the knee joint and to prevent further injury to meniscus and cartilage, yet studies have suggested that joint laxity remains prevalent in varying degrees after ACL reconstruction. Imaging can provide measurements of translational and rotational motions of the tibiofemoral joint that may be too small to detect in routine physical examinations. Various imaging modalities, including fluoroscopy, computed tomography (CT), and magnetic resonance imaging (MRI), have emerged as powerful methods in measuring the minute details involved in joint biomechanics. While each technique has its own strengths and limitations, they have all enhanced our understanding of the knee joint under various stresses and movements. Acquiring the knowledge of the complex and dynamic motions of the knee after surgery would help lead to improved surgical techniques and better patient outcomes.
Collapse
Affiliation(s)
- Keiko Amano
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Qi Li
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
- West China Hospital, Orthopaedic Department, Sichuan University, Sichuan Province, China
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
| |
Collapse
|
27
|
Effects of soft tissue artifacts on differentiating kinematic differences between natural and replaced knee joints during functional activity. Gait Posture 2016; 46:154-60. [PMID: 27131194 DOI: 10.1016/j.gaitpost.2016.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 12/06/2015] [Accepted: 03/08/2016] [Indexed: 02/02/2023]
Abstract
Functional performance of total knee replacement (TKR) is often assessed using skin marker-based stereophotogrammetry, which can be affected by soft tissue artifacts (STA). The current study aimed to compare the STA and their effects on the kinematics of the knee between twelve patients with TKR and twelve healthy controls during sit-to-stand, and to assess the effects of STA on the statistical between-group comparisons. Each subject performed the sit-to-stand task while motions of the skin markers and the knees were measured by a motion capture system integrated with a three-dimensional fluoroscopy technique. The bone motions measured by the three-dimensional fluoroscopy were taken as the gold standard, with respect to which the STA of the markers were obtained. The STA were found to affect the calculated segmental poses and knee kinematics between the groups differently. The STA resulted in artefactual posterior displacements of the knee joint center, with magnitudes significantly greater in TKR than controls (p<0.01). The STA-induced knee external rotations in TKR were smaller than those in controls with mean differences of 2.3-3.0°. These between-group differences in the STA effects on knee kinematics in turn concealed the true between-group differences in the anterior-posterior translation and internal/external rotation of knee while leading to false significant between-group differences in the abduction/adduction and proximal-distal translation.
Collapse
|
28
|
Gaussian mixture models based 2D–3D registration of bone shapes for orthopedic surgery planning. Med Biol Eng Comput 2016; 54:1727-1740. [DOI: 10.1007/s11517-016-1460-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
|
29
|
Li JS, Tsai TY, Wang S, Li P, Kwon YM, Freiberg A, Rubash HE, Li G. Prediction of in vivo knee joint kinematics using a combined dual fluoroscopy imaging and statistical shape modeling technique. J Biomech Eng 2015; 136:124503. [PMID: 25320846 DOI: 10.1115/1.4028819] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 10/16/2014] [Indexed: 11/08/2022]
Abstract
Using computed tomography (CT) or magnetic resonance (MR) images to construct 3D knee models has been widely used in biomedical engineering research. Statistical shape modeling (SSM) method is an alternative way to provide a fast, cost-efficient, and subject-specific knee modeling technique. This study was aimed to evaluate the feasibility of using a combined dual-fluoroscopic imaging system (DFIS) and SSM method to investigate in vivo knee kinematics. Three subjects were studied during a treadmill walking. The data were compared with the kinematics obtained using a CT-based modeling technique. Geometric root-mean-square (RMS) errors between the knee models constructed using the SSM and CT-based modeling techniques were 1.16 mm and 1.40 mm for the femur and tibia, respectively. For the kinematics of the knee during the treadmill gait, the SSM model can predict the knee kinematics with RMS errors within 3.3 deg for rotation and within 2.4 mm for translation throughout the stance phase of the gait cycle compared with those obtained using the CT-based knee models. The data indicated that the combined DFIS and SSM technique could be used for quick evaluation of knee joint kinematics.
Collapse
|
30
|
Direct assessment of 3D foot bone kinematics using biplanar X-ray fluoroscopy and an automatic model registration method. J Foot Ankle Res 2015; 8:21. [PMID: 26085843 PMCID: PMC4470042 DOI: 10.1186/s13047-015-0079-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 06/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quantifying detailed 3-dimensional (3D) kinematics of the foot in contact with the ground during locomotion is crucial for understanding the biomechanical functions of the complex musculoskeletal structure of the foot. Biplanar X-ray fluoroscopic systems and model-based registration techniques have recently been employed to capture and visualise 3D foot bone movements in vivo, but such techniques have generally been performed manually. In the present study, we developed an automatic model-registration method with biplanar fluoroscopy for accurate measurement of 3D movements of the skeletal foot. METHODS Three-dimensional surface models of foot bones were generated prior to motion measurement based on computed tomography. The bone models generated were then registered to biplanar fluoroscopic images in a frame-by-frame manner using an optimisation technique, to maximise similarity measures between occluding contours of the bone surface models with edge-enhanced fluoroscopic images, while avoiding mutual penetration of bones. A template-matching method was also introduced to estimate the amount of bone translation and rotation prior to automatic registration. RESULTS We analysed 3D skeletal movements of a cadaver foot mobilized by a robotic gait simulator. The 3D kinematics of the calcaneus, talus, navicular and cuboid in the stance phase of the gait were successfully reconstructed and quantified using the proposed model-registration method. The accuracy of bone registration was evaluated as 0.27 ± 0.19 mm and 0.24 ± 0.19° (mean ± standard deviation) in translation and rotation, respectively, under static conditions, and 0.36 ± 0.19 mm and 0.42 ± 0.30° in translation and rotation, respectively, under dynamic conditions. CONCLUSIONS The measurement was confirmed to be sufficiently accurate for actual analysis of foot kinematics. The proposed method may serve as an effective tool for understanding the biomechanical function of the human foot during locomotion.
Collapse
|
31
|
Feng Y, Tsai TY, Li JS, Wang S, Hu H, Zhang C, Rubash HE, Li G. Motion of the femoral condyles in flexion and extension during a continuous lunge. J Orthop Res 2015; 33:591-7. [PMID: 25641056 DOI: 10.1002/jor.22826] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 01/07/2015] [Indexed: 02/04/2023]
Abstract
Numerous studies have reported on in-vivo posterior femoral condyle translations during various activities of the knee. However, no data has been reported on the knee motion during a continuous flexion-extension cycle. Further, few studies have investigated the gender variations on the knee kinematics. This study quantitatively determined femoral condylar motion of 10 male and 10 female knees during a continuous weightbearing flexion-extension cycle using two-dimensional to three-dimensional fluoroscopic tracking technique. The knees were CT-scanned to create three-dimensional models of the tibia and femur. Continuous images of each subject were taken using a single-fluoroscopic imaging system. The knee kinematics were measured along the motion path using geometric center axis of the femur. The results indicated that statistical differences between the flexion and extension motions were only found in internal-external tibial rotation and lateral femoral condylar motion at the middle range of flexion angles. At low flexion angles, male knees have greater external tibial rotation and more posteriorly positioned medial femoral condyle than females. The knee did not show a specific pivoting type of rotation with flexion. Axial rotation center varied from lateral to medial compartments of the knee. These data could provide useful information for understanding physiological motion of normal knees.
Collapse
Affiliation(s)
- Yong Feng
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China; Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, Massachusetts, 02114
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Hsu CP, Lin SC, Shih KS, Huang CH, Lee CH. Predicting 3D pose in partially overlapped X-ray images of knee prostheses using model-based Roentgen stereophotogrammetric analysis (RSA). Med Biol Eng Comput 2014; 52:1061-71. [PMID: 25293422 DOI: 10.1007/s11517-014-1206-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 09/23/2014] [Indexed: 11/30/2022]
Abstract
After total knee replacement, the model-based Roentgen stereophotogrammetric analysis (RSA) technique has been used to monitor the status of prosthetic wear, misalignment, and even failure. However, the overlap of the prosthetic outlines inevitably increases errors in the estimation of prosthetic poses due to the limited amount of available outlines. In the literature, quite a few studies have investigated the problems induced by the overlapped outlines, and manual adjustment is still the mainstream. This study proposes two methods to automate the image processing of overlapped outlines prior to the pose registration of prosthetic models. The outline-separated method defines the intersected points and segments the overlapped outlines. The feature-recognized method uses the point and line features of the remaining outlines to initiate registration. Overlap percentage is defined as the ratio of overlapped to non-overlapped outlines. The simulated images with five overlapping percentages are used to evaluate the robustness and accuracy of the proposed methods. Compared with non-overlapped images, overlapped images reduce the number of outlines available for model-based RSA calculation. The maximum and root mean square errors for a prosthetic outline are 0.35 and 0.04 mm, respectively. The mean translation and rotation errors are 0.11 mm and 0.18°, respectively. The errors of the model-based RSA results are increased when the overlap percentage is beyond about 9%. In conclusion, both outline-separated and feature-recognized methods can be seamlessly integrated to automate the calculation of rough registration. This can significantly increase the clinical practicability of the model-based RSA technique.
Collapse
Affiliation(s)
- Chi-Pin Hsu
- Institute of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan, ROC
| | | | | | | | | |
Collapse
|
33
|
Lin CC, Lu TW, Wang TM, Hsu CY, Hsu SJ, Shih TF. In vivo three-dimensional intervertebral kinematics of the subaxial cervical spine during seated axial rotation and lateral bending via a fluoroscopy-to-CT registration approach. J Biomech 2014; 47:3310-7. [PMID: 25218506 DOI: 10.1016/j.jbiomech.2014.08.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 08/07/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
Abstract
Accurate measurement of the coupled intervertebral motions is helpful for understanding the etiology and diagnosis of relevant diseases, and for assessing the subsequent treatment. No study has reported the in vivo, dynamic and three-dimensional (3D) intervertebral motion of the cervical spine during active axial rotation (AR) and lateral bending (LB) in the sitting position. The current study fills the gap by measuring the coupled intervertebral motions of the subaxial cervical spine in ten asymptomatic young adults in an upright sitting position during active head LB and AR using a volumetric model-based 2D-to-3D registration method via biplane fluoroscopy. Subject-specific models of the individual vertebrae were derived from each subject's CT data and were registered to the fluoroscopic images for determining the 3D poses of the subaxial vertebrae that were used to obtain the intervertebral kinematics. The averaged ranges of motion to one side (ROM) during AR at C3/C4, C4/C5, C5/C6, and C6/C7 were 4.2°, 4.6°, 3.0° and 1.3°, respectively. The corresponding values were 6.4°, 5.2°, 6.1° and 6.1° during LB. Intervertebral LB (ILB) played an important role in both AR and LB tasks of the cervical spine, experiencing greater ROM than intervertebral AR (IAR) (ratio of coupled motion (IAR/ILB): 0.23-0.75 in LB, 0.34-0.95 in AR). Compared to the AR task, the ranges of ILB during the LB task were significantly greater at C5/6 (p=0.008) and C6/7 (p=0.001) but the range of IAR was significantly smaller at C4/5 (p=0.02), leading to significantly smaller ratios of coupled motions at C4/5 (p=0.0013), C5/6 (p<0.001) and C6/7 (p=0.0037). The observed coupling characteristics of the intervertebral kinematics were different from those in previous studies under discrete static conditions in a supine position without weight-bearing, suggesting that the testing conditions likely affect the kinematics of the subaxial cervical spine. While C1 and C2 were not included owing to technical limitations, the current results nonetheless provide baseline data of the intervertebral motion of the subaxial cervical spine in asymptomatic young subjects under physiological conditions, which may be helpful for further investigations into spine biomechanics.
Collapse
Affiliation(s)
- Cheng-Chung Lin
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, ROC
| | - Tung-Wu Lu
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, ROC; Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan, ROC.
| | - Ting-Ming Wang
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan, ROC; Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Chao-Yu Hsu
- Department of Radiology, School of Medicine, National Taiwan University, Taipei, Taiwan, ROC; Department of Medical Imaging, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan, ROC
| | - Shih-Jung Hsu
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, ROC
| | - Ting-Fang Shih
- Department of Radiology, School of Medicine, National Taiwan University, Taipei, Taiwan, ROC; Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan, ROC
| |
Collapse
|
34
|
Shih KS, Chien HL, Lu TW, Chang CF, Kuo CC. Gait changes in individuals with bilateral hallux valgus reduce first metatarsophalangeal loading but increase knee abductor moments. Gait Posture 2014; 40:38-42. [PMID: 24637011 DOI: 10.1016/j.gaitpost.2014.02.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 01/26/2014] [Accepted: 02/09/2014] [Indexed: 02/02/2023]
Abstract
Hallux valgus (HV), one of the most common foot pathologies in modern society, affects not only the foot itself, but also the other lower limb joints. The purpose of the study was to investigate the kinematic and kinetic changes in the lower limb joints in patients with bilateral HV during level walking. Twelve female patients with bilateral HV and 12 healthy female controls walked while three-dimensional kinematic and kinetic data were measured. Patients with HV were found to shift their center of pressure (COP) laterally away from the 1st metatarsophalangeal joint (MPJ), which helped unload the joint during late stance. The lateral shift of the COP in these patients was associated with the reduced toe-out angles of the foot as a result of increased internal rotation of the hip. However, this strategy increased the abductor moments at the knee, an index closely correlated with the medial load at the knee and a predictor of the onset and progression of medial OA. Early treatment of HV may be helpful not only for reducing foot pain and deformity, but also for preventing the potentially harmful loading at the knee, especially in those at risk of medial knee OA.
Collapse
Affiliation(s)
- Kao-Shang Shih
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, ROC; Department of Orthopedic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, ROC
| | - Hui-Lien Chien
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, ROC
| | - Tung-Wu Lu
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, ROC; Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan, ROC.
| | - Chu-Fen Chang
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, ROC; Department of Physical Therapy, Tzu-Chi University, Hua-Lien, Taiwan, ROC
| | - Chien-Chung Kuo
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, ROC; Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan, ROC
| |
Collapse
|
35
|
Hsin-Chen Chen, Chia-Hsing Wu, Chien-Kuo Wang, Chii-Jeng Lin, Yung-Nien Sun. A Joint-Constraint Model-Based System for Reconstructing Total Knee Motion. IEEE Trans Biomed Eng 2014; 61:171-81. [DOI: 10.1109/tbme.2013.2278780] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
36
|
Baka N, Kaptein BL, Giphart JE, Staring M, de Bruijne M, Lelieveldt BPF, Valstar E. Evaluation of automated statistical shape model based knee kinematics from biplane fluoroscopy. J Biomech 2013; 47:122-9. [PMID: 24207131 DOI: 10.1016/j.jbiomech.2013.09.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 09/25/2013] [Accepted: 09/26/2013] [Indexed: 11/18/2022]
Abstract
State-of-the-art fluoroscopic knee kinematic analysis methods require the patient-specific bone shapes segmented from CT or MRI. Substituting the patient-specific bone shapes with personalizable models, such as statistical shape models (SSM), could eliminate the CT/MRI acquisitions, and thereby decrease costs and radiation dose (when eliminating CT). SSM based kinematics, however, have not yet been evaluated on clinically relevant joint motion parameters. Therefore, in this work the applicability of SSMs for computing knee kinematics from biplane fluoroscopic sequences was explored. Kinematic precision with an edge based automated bone tracking method using SSMs was evaluated on 6 cadaveric and 10 in-vivo fluoroscopic sequences. The SSMs of the femur and the tibia-fibula were created using 61 training datasets. Kinematic precision was determined for medial-lateral tibial shift, anterior-posterior tibial drawer, joint distraction-contraction, flexion, tibial rotation and adduction. The relationship between kinematic precision and bone shape accuracy was also investigated. The SSM based kinematics resulted in sub-millimeter (0.48-0.81mm) and approximately 1° (0.69-0.99°) median precision on the cadaveric knees compared to bone-marker-based kinematics. The precision on the in-vivo datasets was comparable to that of the cadaveric sequences when evaluated with a semi-automatic reference method. These results are promising, though further work is necessary to reach the accuracy of CT-based kinematics. We also demonstrated that a better shape reconstruction accuracy does not automatically imply a better kinematic precision. This result suggests that the ability of accurately fitting the edges in the fluoroscopic sequences has a larger role in determining the kinematic precision than that of the overall 3D shape accuracy.
Collapse
Affiliation(s)
- Nora Baka
- Biomechanics and Imaging Group, Department of Orthopedic Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
| | - Bart L Kaptein
- Biomechanics and Imaging Group, Department of Orthopedic Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
| | - J Erik Giphart
- Department of Bio-Medical Engineering, Steadman Philippon Research Institute, Vail, USA
| | - Marius Staring
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marleen de Bruijne
- Departments of Medical Informatics and Radiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Computer Science, University of Copenhagen, Denmark
| | | | - Edward Valstar
- Biomechanics and Imaging Group, Department of Orthopedic Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, The Netherlands
| |
Collapse
|
37
|
Lin CC, Lu TW, Shih TF, Tsai TY, Wang TM, Hsu SJ. Intervertebral anticollision constraints improve out-of-plane translation accuracy of a single-plane fluoroscopy-to-CT registration method for measuring spinal motion. Med Phys 2013; 40:031912. [PMID: 23464327 DOI: 10.1118/1.4792309] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The study aimed to propose a new single-plane fluoroscopy-to-CT registration method integrated with intervertebral anticollision constraints for measuring three-dimensional (3D) intervertebral kinematics of the spine; and to evaluate the performance of the method without anticollision and with three variations of the anticollision constraints via an in vitro experiment. METHODS The proposed fluoroscopy-to-CT registration approach, called the weighted edge-matching with anticollision (WEMAC) method, was based on the integration of geometrical anticollision constraints for adjacent vertebrae and the weighted edge-matching score (WEMS) method that matched the digitally reconstructed radiographs of the CT models of the vertebrae and the measured single-plane fluoroscopy images. Three variations of the anticollision constraints, namely, T-DOF, R-DOF, and A-DOF methods, were proposed. An in vitro experiment using four porcine cervical spines in different postures was performed to evaluate the performance of the WEMS and the WEMAC methods. RESULTS The WEMS method gave high precision and small bias in all components for both vertebral pose and intervertebral pose measurements, except for relatively large errors for the out-of-plane translation component. The WEMAC method successfully reduced the out-of-plane translation errors for intervertebral kinematic measurements while keeping the measurement accuracies for the other five degrees of freedom (DOF) more or less unaltered. The means (standard deviations) of the out-of-plane translational errors were less than -0.5 (0.6) and -0.3 (0.8) mm for the T-DOF method and the R-DOF method, respectively. CONCLUSIONS The proposed single-plane fluoroscopy-to-CT registration method reduced the out-of-plane translation errors for intervertebral kinematic measurements while keeping the measurement accuracies for the other five DOF more or less unaltered. With the submillimeter and subdegree accuracy, the WEMAC method was considered accurate for measuring 3D intervertebral kinematics during various functional activities for research and clinical applications.
Collapse
Affiliation(s)
- Cheng-Chung Lin
- Institute of Biomedical Engineering, National Taiwan University, Taiwan 10051, Republic of China
| | | | | | | | | | | |
Collapse
|
38
|
Lin CC, Zhang S, Frahm J, Lu TW, Hsu CY, Shih TF. A slice-to-volume registration method based on real-time magnetic resonance imaging for measuring three-dimensional kinematics of the knee. Med Phys 2013; 40:102302. [DOI: 10.1118/1.4820369] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Cheng-Chung Lin
- Institute of Biomedical Engineering, National Taiwan University, Taiwan 10051, Republic of China
| | | | | | | | | | | |
Collapse
|
39
|
Lin CC, Lu TW, Wang TM, Hsu CY, Shih TF. Comparisons of surface vs. volumetric model-based registration methods using single-plane vs. bi-plane fluoroscopy in measuring spinal kinematics. Med Eng Phys 2013; 36:267-74. [PMID: 24011956 DOI: 10.1016/j.medengphy.2013.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 06/27/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
Abstract
Several 2D-to-3D image registration methods are available for measuring 3D vertebral motion but their performance has not been evaluated under the same experimental protocol. In this study, four major types of fluoroscopy-to-CT registration methods, with different use of surface vs. volumetric models, and single-plane vs. bi-plane fluoroscopy, were evaluated: STS (surface, single-plane), VTS (volumetric, single-plane), STB (surface, bi-plane) and VTB (volumetric, bi-plane). Two similarity measures were used: 'Contour Difference' for STS and STB and 'Weighted Edge-Matching Score' for VTS and VTB. Two cadaveric porcine cervical spines positioned in a box filled with paraffin and embedded with four radiopaque markers were CT scanned to obtain vertebral models and marker coordinates, and imaged at ten static positions using bi-plane fluoroscopy for subsequent registrations using different methods. The registered vertebral poses were compared to the gold standard poses defined by the marker positions determined using CT and Roentgen stereophotogrammetry analysis. The VTB was found to have the highest precision (translation: 0.4mm; rotation: 0.3°), comparable with the VTS in rotations (0.3°), and the STB in translations (0.6mm). The STS had the lowest precision (translation: 4.1mm; rotation: 2.1°).
Collapse
Affiliation(s)
- Cheng-Chung Lin
- Institute of Biomedical Engineering, National Taiwan University, Taiwan, ROC
| | - Tung-Wu Lu
- Institute of Biomedical Engineering, National Taiwan University, Taiwan, ROC; Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taiwan, ROC.
| | - Ting-Ming Wang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taiwan, ROC
| | - Chao-Yu Hsu
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University Hospital Hsin-Chu Branch, Taiwan, ROC; Department of Radiology, College of Medicine, National Taiwan University, Taiwan, ROC
| | - Ting-Fang Shih
- Department of Radiology, College of Medicine, National Taiwan University, Taiwan, ROC; Department of Medical Imaging, National Taiwan University Hospital, Taiwan, ROC
| |
Collapse
|
40
|
Abe Y, Sato S, Kato K, Hyakumachi T, Yanagibashi Y, Ito M, Abumi K. A novel 3D guidance system using augmented reality for percutaneous vertebroplasty: technical note. J Neurosurg Spine 2013; 19:492-501. [PMID: 23952323 DOI: 10.3171/2013.7.spine12917] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Augmented reality (AR) is an imaging technology by which virtual objects are overlaid onto images of real objects captured in real time by a tracking camera. This study aimed to introduce a novel AR guidance system called virtual protractor with augmented reality (VIPAR) to visualize a needle trajectory in 3D space during percutaneous vertebroplasty (PVP). The AR system used for this study comprised a head-mount display (HMD) with a tracking camera and a marker sheet. An augmented scene was created by overlaying the preoperatively generated needle trajectory path onto a marker detected on the patient using AR software, thereby providing the surgeon with augmented views in real time through the HMD. The accuracy of the system was evaluated by using a computer-generated simulation model in a spine phantom and also evaluated clinically in 5 patients. In the 40 spine phantom trials, the error of the insertion angle (EIA), defined as the difference between the attempted angle and the insertion angle, was evaluated using 3D CT scanning. Computed tomography analysis of the 40 spine phantom trials showed that the EIA in the axial plane significantly improved when VIPAR was used compared with when it was not used (0.96° ± 0.61° vs 4.34° ± 2.36°, respectively). The same held true for EIA in the sagittal plane (0.61° ± 0.70° vs 2.55° ± 1.93°, respectively). In the clinical evaluation of the AR system, 5 patients with osteoporotic vertebral fractures underwent VIPAR-guided PVP from October 2011 to May 2012. The postoperative EIA was evaluated using CT. The clinical results of the 5 patients showed that the EIA in all 10 needle insertions was 2.09° ± 1.3° in the axial plane and 1.98° ± 1.8° in the sagittal plane. There was no pedicle breach or leakage of polymethylmethacrylate. VIPAR was successfully used to assist in needle insertion during PVP by providing the surgeon with an ideal insertion point and needle trajectory through the HMD. The findings indicate that AR guidance technology can become a useful assistive device during spine surgeries requiring percutaneous procedures.
Collapse
Affiliation(s)
- Yuichiro Abe
- Department of Orthopedic Surgery, Eniwa Hospital, Eniwa, Hokkaido
| | | | | | | | | | | | | |
Collapse
|
41
|
Chen CC, Lin CC, Lu TW, Chiang H, Chen YJ. Feasibility of differential quantification of 3D temporomandibular kinematics during various oral activities using a cone-beam computed tomography-based 3D fluoroscopic method. J Dent Sci 2013. [DOI: 10.1016/j.jds.2012.09.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
42
|
Teeter MG, Seslija P, Milner JS, Nikolov HN, Yuan X, Naudie DDR, Holdsworth DW. Quantification ofin vivoimplant wear in total knee replacement from dynamic single plane radiography. Phys Med Biol 2013; 58:2751-67. [DOI: 10.1088/0031-9155/58/9/2751] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
43
|
Tsai TY, Li JS, Wang S, Lin H, Malchau H, Li G, Rubash H, Kwon YM. A novel dual fluoroscopic imaging method for determination of THA kinematics: in-vitro and in-vivo study. J Biomech 2013; 46:1300-4. [PMID: 23497800 DOI: 10.1016/j.jbiomech.2013.02.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 02/08/2013] [Accepted: 02/11/2013] [Indexed: 11/28/2022]
Abstract
Accurate measurement of six-degrees-of-freedom in-vivo kinematics of the total hip arthroplasty (THA) is essential in gaining insights into in-vivo THA performance. The objective of this study was to validate a novel dual fluoroscopy imaging system (DFIS) for determination of the THA kinematics using both in-vitro and in-vivo approaches. The in-vitro validation utilized cadaveric hip specimens to compare the THA motion using the DFIS technique with those measured by a radiostereometric analysis (RSA). The differences between the DFIS technique and the RSA were within 0.33±0.81 mm (mean±SD) in translation and 0.45±0.65° in rotation during dynamic motion of the hips. In the in-vivo validation, the THA kinematics of two patients during a treadmill gait was assessed for the feasibility/repeatability of the DFIS technique in measurement of THA kinematics. The poses of the THAs during the treadmill gait was measured using the DFIS technique with the maximum standard deviation of 0.35 mm in translation and of 0.55° in rotation. This study demonstrated that the DFIS technique has comparable accuracy of the RSA and is highly repeatable for measurement of dynamic THA motion, suggesting that the DFIS is a promising tool in evaluating the in-vivo THA biomechanics during functional activities.
Collapse
Affiliation(s)
- Tsung-Yuan Tsai
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Tersi L, Barré A, Fantozzi S, Stagni R. In vitro quantification of the performance of model-based mono-planar and bi-planar fluoroscopy for 3D joint kinematics estimation. Med Biol Eng Comput 2012; 51:257-65. [DOI: 10.1007/s11517-012-0987-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 10/29/2012] [Indexed: 10/27/2022]
|
45
|
Seslija P, Teeter MG, Yuan X, Naudie DDR, Bourne RB, MacDonald SJ, Peters TM, Holdsworth DW. Measurement of joint kinematics using a conventional clinical single-perspective flat-panel radiography system. Med Phys 2012; 39:6090-103. [DOI: 10.1118/1.4752205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
46
|
Chen CC, Lin CC, Chen YJ, Hong SW, Lu TW. A method for measuring three-dimensional mandibular kinematics in vivo using single-plane fluoroscopy. Dentomaxillofac Radiol 2012; 42:95958184. [PMID: 22842637 DOI: 10.1259/dmfr/95958184] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Accurate measurement of the three-dimensional (3D) motion of the mandible in vivo is essential for relevant clinical applications. Existing techniques are either of limited accuracy or require the use of transoral devices that interfere with jaw movements. This study aimed to develop further an existing method for measuring 3D, in vivo mandibular kinematics using single-plane fluoroscopy; to determine the accuracy of the method; and to demonstrate its clinical applicability via measurements on a healthy subject during opening/closing and chewing movements. METHODS The proposed method was based on the registration of single-plane fluoroscopy images and 3D low-radiation cone beam CT data. It was validated using roentgen single-plane photogrammetric analysis at static positions and during opening/closing and chewing movements. RESULTS The method was found to have measurement errors of 0.1 ± 0.9 mm for all translations and 0.2° ± 0.6° for all rotations in static conditions, and of 1.0 ± 1.4 mm for all translations and 0.2° ± 0.7° for all rotations in dynamic conditions. CONCLUSIONS The proposed method is considered an accurate method for quantifying the 3D mandibular motion in vivo. Without relying on transoral devices, the method has advantages over existing methods, especially in the assessment of patients with missing or unstable teeth, making it useful for the research and clinical assessment of the temporomandibular joint and chewing function.
Collapse
Affiliation(s)
- C-C Chen
- School of Dentistry, National Taiwan University, Taipei City, Taiwan
| | | | | | | | | |
Collapse
|
47
|
Biomechanics of human movement and its clinical applications. Kaohsiung J Med Sci 2012; 28:S13-25. [PMID: 22301008 DOI: 10.1016/j.kjms.2011.08.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 07/07/2010] [Indexed: 11/21/2022] Open
Abstract
All life forms on earth, including humans, are constantly subjected to the universal force of gravitation, and thus to forces from within and surrounding the body. Through the study of the interaction of these forces and their effects, the form, function and motion of our bodies can be examined and the resulting knowledge applied to promote quality of life. Under gravity and other loads, and controlled by the nervous system, human movement is achieved through a complex and highly coordinated mechanical interaction between bones, muscles, ligaments and joints within the musculoskeletal system. Any injury to, or lesion in, any of the individual elements of the musculoskeletal system will change the mechanical interaction and cause degradation, instability or disability of movement. On the other hand, proper modification, manipulation and control of the mechanical environment can help prevent injury, correct abnormality, and speed healing and rehabilitation. Therefore, understanding the biomechanics and loading of each element during movement using motion analysis is helpful for studying disease etiology, making decisions about treatment, and evaluating treatment effects. In this article, the history and methodology of human movement biomechanics, and the theoretical and experimental methods developed for the study of human movement, are reviewed. Examples of motion analysis of various patient groups, prostheses and orthoses, and sports and exercises, are used to demonstrate the use of biomechanical and stereophotogrammetry-based human motion analysis studies to address clinical issues. It is suggested that further study of the biomechanics of human movement and its clinical applications will benefit from the integration of existing engineering techniques and the continuing development of new technology.
Collapse
|
48
|
Schairer WW, Haughom BD, Morse LJ, Li X, Ma CB. Magnetic resonance imaging evaluation of knee kinematics after anterior cruciate ligament reconstruction with anteromedial and transtibial femoral tunnel drilling techniques. Arthroscopy 2011; 27:1663-70. [PMID: 21958672 DOI: 10.1016/j.arthro.2011.06.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 05/20/2011] [Accepted: 06/24/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to use magnetic resonance (MR) imaging to evaluate the translational and rotational kinematics of anterior cruciate ligament (ACL) reconstructed knees with transtibial (TT) and anteromedial (AM) femoral tunnel drilling. METHODS ACL reconstruction was performed in 21 subjects: 12 with AM drilling (5 men and 7 women; mean age, 33 ± 9 years; imaged 18 ± 5 months after surgery) and 9 with TT drilling (5 men and 4 women; mean age, 32 ± 9 years; imaged 12 ± 8 months after surgery). Three-tesla MR imaging was obtained bilaterally at extension and 30° to 40° of flexion under simulated loading (125 N). MR images were segmented and kinematic calculations done with in-house MATLAB software (The MathWorks, Natick, MA). Translation and rotation of the tibia and the tibiofemoral contact area were measured. Statistical analysis treated reconstructed and contralateral knees as independent groups. Reconstructed groups were compared with analysis of covariance using contralateral knees as baseline. P < .05 indicated significance. RESULTS All kinematic measures in the AM group were similar to contralateral knees. The TT group showed significantly more total tibial rotation than contralateral knees (TT, 8.4° ± 3.9°; contralateral, 2.9° ± 6.8°) (P = .03), whereas the AM group did not (AM, 3.1° ± 5.6°; contralateral, 2.3° ± 5.4°) (P = .36). At knee extension, the tibia was more externally rotated in the TT group than in controls. Medial tibial translation was greater in the TT group than in controls. The AM group showed increased contact area in the lateral compartment compared with controls; no differences were seen in the TT group. CONCLUSIONS Using an MR-based approach, we found that knee kinematics were better restored with the AM femoral tunnel drilling ACL reconstruction than with the TT femoral tunnel drilling approach, which resulted in increased knee laxity. Our in vivo results support previous cadaveric and clinical studies that have found AM ACL reconstruction to restore anatomy and stability better than the TT approach. However, the clinical significance of increased contact area in the AM group remains unclear. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- William W Schairer
- School of Medicine, University of California, San Francisco, 94143-0728, USA
| | | | | | | | | |
Collapse
|
49
|
Zhu Z, Li G. An automatic 2D-3D image matching method for reproducing spatial knee joint positions using single or dual fluoroscopic images. Comput Methods Biomech Biomed Engin 2011; 15:1245-56. [PMID: 21806411 DOI: 10.1080/10255842.2011.597387] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Fluoroscopic image technique, using either a single image or dual images, has been widely applied to measure in vivo human knee joint kinematics. However, few studies have compared the advantages of using single and dual fluoroscopic images. Furthermore, due to the size limitation of the image intensifiers, it is possible that only a portion of the knee joint could be captured by the fluoroscopy during dynamic knee joint motion. In this paper, we presented a systematic evaluation of an automatic 2D-3D image matching method in reproducing spatial knee joint positions using either single or dual fluoroscopic image techniques. The data indicated that for the femur and tibia, their spatial positions could be determined with an accuracy and precision less than 0.2 mm in translation and less than 0.4° in orientation when dual fluoroscopic images were used. Using single fluoroscopic images, the method could produce satisfactory accuracy in joint positions in the imaging plane (in average up to 0.5 mm in translation and 1.3° in rotation), but large variations along the out-plane direction (in average up to 4.0 mm in translation and 2.2° in rotation). The precision of using single fluoroscopic images to determine the actual knee positions was worse than its accuracy obtained. The data also indicated that when using dual fluoroscopic image technique, if the knee joint outlines in one image were incomplete by 80%, the algorithm could still reproduce the joint positions with high precisions.
Collapse
Affiliation(s)
- Zhonglin Zhu
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | | |
Collapse
|
50
|
Tsai TY, Lu TW, Kuo MY, Lin CC. Effects of soft tissue artifacts on the calculated kinematics and kinetics of the knee during stair-ascent. J Biomech 2011; 44:1182-8. [PMID: 21296352 DOI: 10.1016/j.jbiomech.2011.01.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 01/10/2011] [Accepted: 01/10/2011] [Indexed: 11/27/2022]
Abstract
Biomechanics of the knee during stair-ascent has mostly been studied using skin-marker-based motion analysis techniques, but no study has reported a complete assessment of the soft tissue artifacts (STA) and their effects on the calculated joint center translation, angles and moments at the knee in normal subjects during this activity. This study aimed to bridge the gap. Twelve young adults walked up a three-step stair while data were acquired simultaneously from a three-dimensional motion capture system, a force plate and a dynamic fluoroscopy system. The "gold standards" of poses of the knee were obtained using a 3D fluoroscopy method. The STA of the markers on the thigh and shank were then calculated, together with their effects on the calculated joint center translations, angles and moments at the knee. The STA of the thigh markers were greater than those on the shank, leading to significantly underestimated flexion and extensor moments, but overestimated joint center translations during the first half of the stance phase. The results will be useful for a better understanding of the normal biomechanics of the knee during stair-ascent, as a baseline for future clinical applications and for developing a compensation method to correct for the effects of STA.
Collapse
Affiliation(s)
- Tsung-Yuan Tsai
- Institute of Biomedical Engineering, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei 100, Taiwan, ROC
| | | | | | | |
Collapse
|