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David M, Devantéry K, Nauche B, Chagnon M, Keezer M, Gaudreault N, Bureau NJ, Cloutier G. Ultrasound elastography of back muscle biomechanical properties: a systematic review and meta-analysis of current methods. Insights Imaging 2024; 15:206. [PMID: 39143409 PMCID: PMC11324641 DOI: 10.1186/s13244-024-01785-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/23/2024] [Indexed: 08/16/2024] Open
Abstract
OBJECTIVES To report the current elastography methods used to quantify back muscles' biomechanical characteristics in patients with musculoskeletal disorders (MSKd) and inform on their reliability, validity, and responsiveness. METHODS MEDLINE, Embase, CINAHL, Cochrane library and grey literature were consulted. Predefined criteria allowed for study selection and data extraction. The quality of evidence was rated using the COSMIN tool. Data were meta-analyzed in terms of pooled intraclass correlation coefficient (pICC) for reliability and pooled standardized mean difference (pSMD) for validity and responsiveness. Heterogeneity was assessed. RESULTS Seventy-nine studies were included in the meta-analysis (total number of participants N = 3178). Three elastography methods were identified: strain imaging (SI; number of cohorts M = 26), shear wave imaging (SWI; M = 50), and vibration sonoelastography (VSE; M = 3). Strain imaging and SWI studies reported good reliability measurement properties (pICC > 0.70) and a medium pSMD (0.58 for SI and 0.60 for SWI; p ≤ 0.020) in discriminating MSKd from controls' condition (validity). Strain imaging studies reported a medium pSMD (0.64; p = 0.005) in detecting within-group changes over time, whereas SWI pSMD was very high (1.24; p = 0.005). Only SWI reported significant but small pSMD (0.30; p = 0.003) in detecting between-group changes over time. The small number of VSE studies could not be meta-analyzed. Heterogeneity was high (I-squared > 90%; p < 0.001). CONCLUSIONS Elastography presents good reliability results and a medium pSMD in discriminating MSKd from control conditions. Responsiveness data suggest detectable changes within groups over time using SI and SWI, calling for long-term longitudinal studies. Assessing changes between groups over time using elastography still needs to be proven. Highly significant heterogeneity limits meta-analytic results. CRITICAL RELEVANCE STATEMENT While still in its early-stage exploration phase, musculoskeletal ultrasound elastography may reliably quantify back muscles' biomechanics in asymptomatic individuals, moderately discriminate back musculoskeletal disorders and detect biomechanical changes over time in these conditions, calling for long-term longitudinal studies. KEY POINTS Ultrasound elastography is reviewed for back pain and related musculoskeletal disorder assessments. Growing literature supports good reproducibility, some validity and responsiveness. Back muscle elastography considers assumptions calling for standardized protocols.
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Affiliation(s)
- Mercedes David
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montreal, QC, H2L 2W5, Canada
- Institute of Biomedical Engineering, University of Montreal, Montreal, QC, H3C 3J7, Canada
| | | | | | - Miguel Chagnon
- Department of Mathematics and Statistics, University of Montreal, Montreal, QC, H2C 3J7, Canada
| | - Mark Keezer
- University of Montreal Hospital, Montreal, QC, H3X 0C1, Canada
- Department of Neurology, University of Montreal, Montreal, QC, H2C 3J7, Canada
| | | | - Nathalie J Bureau
- University of Montreal Hospital, Montreal, QC, H3X 0C1, Canada
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Montreal, QC, H3C 3J7, Canada
| | - Guy Cloutier
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montreal, QC, H2L 2W5, Canada.
- Institute of Biomedical Engineering, University of Montreal, Montreal, QC, H3C 3J7, Canada.
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Montreal, QC, H3C 3J7, Canada.
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Experimental verification of a two-dimensional respiratory motion compensation system with ultrasound tracking technique in radiation therapy. Phys Med 2018; 49:11-18. [PMID: 29866336 DOI: 10.1016/j.ejmp.2018.04.393] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/11/2018] [Accepted: 04/17/2018] [Indexed: 12/17/2022] Open
Abstract
This study proposed respiratory motion compensation system (RMCS) combined with an ultrasound image tracking algorithm (UITA) to compensate for respiration-induced tumor motion during radiotherapy, and to address the problem of inaccurate radiation dose delivery caused by respiratory movement. This study used an ultrasound imaging system to monitor respiratory movements combined with the proposed UITA and RMCS for tracking and compensation of the respiratory motion. Respiratory motion compensation was performed using prerecorded human respiratory motion signals and also sinusoidal signals. A linear accelerator was used to deliver radiation doses to GAFchromic EBT3 dosimetry film, and the conformity index (CI), root-mean-square error, compensation rate (CR), and planning target volume (PTV) were used to evaluate the tracking and compensation performance of the proposed system. Human respiratory pattern signals were captured using the UITA and compensated by the RMCS, which yielded CR values of 34-78%. In addition, the maximum coronal area of the PTV ranged from 85.53 mm2 to 351.11 mm2 (uncompensated), which reduced to from 17.72 mm2 to 66.17 mm2 after compensation, with an area reduction ratio of up to 90%. In real-time monitoring of the respiration compensation state, the CI values for 85% and 90% isodose areas increased to 0.7 and 0.68, respectively. The proposed UITA and RMCS can reduce the movement of the tracked target relative to the LINAC in radiation therapy, thereby reducing the required size of the PTV margin and increasing the effect of the radiation dose received by the treatment target.
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Ting LL, Chuang HC, Kuo CC, Jian LA, Huang MY, Liao AH, Tien DC, Jeng SC, Chiou JF. Tracking and compensation of respiration pattern by an automatic compensation system. Med Phys 2017; 44:2077-2095. [DOI: 10.1002/mp.12239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 03/08/2017] [Accepted: 03/19/2017] [Indexed: 11/07/2022] Open
Affiliation(s)
- Lai-Lei Ting
- Department of Radiation Oncology; Taipei Medical University Hospital; No. 252, Wu-Hsing St. Taipei 11031 Taiwan
| | - Ho-Chiao Chuang
- Department of Mechanical Engineering; National Taipei University of Technology; No. 1, Sec. 3, Chung-Hsiao E. Rd. Taipei 10608 Taiwan
| | - Chia-Chun Kuo
- Department of Radiation Oncology; Taipei Medical University Hospital; No. 252, Wu-Hsing St. Taipei 11031 Taiwan
| | - Li-An Jian
- Department of Mechanical Engineering; National Taipei University of Technology; No. 1, Sec. 3, Chung-Hsiao E. Rd. Taipei 10608 Taiwan
| | - Ming-Yuan Huang
- Department of Emergency Medicine; Mackay Memorial Hospital; Taipei 10449 Taiwan
| | - Ai-Ho Liao
- Graduate Institute of Biomedical Engineering; National Taiwan University of Science and Technology; Taipei 10607 Taiwan
| | - Der-Chi Tien
- Department of Mechanical Engineering; National Taipei University of Technology; No. 1, Sec. 3, Chung-Hsiao E. Rd. Taipei 10608 Taiwan
| | - Shiu-Chen Jeng
- Department of Radiation Oncology; Taipei Medical University Hospital; No. 252, Wu-Hsing St. Taipei 11031 Taiwan
- School of Dentistry; College of Oral Medicine; Taipei Medical University; No. 250, Wu-Hsing St. Taipei 11031 Taiwan
| | - Jeng-Fong Chiou
- Department of Radiation Oncology; Taipei Medical University Hospital; No. 252, Wu-Hsing St. Taipei 11031 Taiwan
- Department of Radiology; School of Medicine; College of Medicine; Taipei Medical University; No. 250, Wu-Hsing St. Taipei 11031 Taiwan
- Taipei Cancer Center; Taipei Medical University; No. 252, Wu Hsing Street Taipei City 110 Taiwan
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Kuo CC, Chuang HC, Teng KT, Hsu HY, Tien DC, Wu CJ, Jeng SC, Chiou JF. An autotuning respiration compensation system based on ultrasound image tracking. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2016; 24:875-892. [PMID: 27612051 DOI: 10.3233/xst-160598] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The purpose of this study was to develop an ultrasound image tracking algorithm (UITA) for extracting the exact displacement of internal organs caused by respiratory motion. The program can track organ displacements in real time, and analyze the displacement signals associated with organ displacements via a respiration compensating system (RCS). The ultrasound imaging system is noninvasive and has a high spatial resolution and a high frame rate (around 32 frames/s), which reduces the radiation doses that patients receive during computed tomography and X-ray observations. This allows for the continuous noninvasive observation and compensation of organ displacements simultaneously during a radiation therapy session.This study designed a UITA for tracking the motion of a specific target, such as the human diaphragm. Simulated diaphragm motion driven by a respiration simulation system was observed with an ultrasound imaging system, and then the induced diaphragm displacements were calculated by our proposed UITA. These signals were used to adjust the gain of the RCS so that the amplitudes of the compensation signals were close to the target movements. The inclination angle of the ultrasound probe with respect to the surface of the abdomen affects the results of ultrasound image displacement tracking. Therefore, the displacement of the phantom was verified by a LINAC with different inclination-angle settings of the ultrasound probe. The experimental results indicate that the best inclination angle of the ultrasound probe is 40 degrees, since this results in the target displacement of the ultrasound images being close to the actual target motion. The displacement signals of the tracking phantom and the opposing displacement signals created by the RCS were compared to assess the positioning accuracy of our proposed ultrasound image tracking technique combined with the RCS.When the ultrasound probe was inclined by 40 degrees in simulated respiration experiments using sine waves, the correlation between the target displacement on the ultrasound images and the actual target displacement was around 97%, and all of the compensation rates exceeded 94% after activating the RCS. Furthermore, the diaphragm movements on the ultrasound images of three patients could be captured by our image tracking technique. The test results show that our algorithm could achieve precise point locking and tracking functions on the diaphragm. This study has demonstrated the feasibility of the proposed ultrasound image tracking technique combined with the RCS for compensating for organ displacements caused by respiratory motion.This study has shown that the proposed ultrasound image tracking technique combined with the RCS can provide real-time compensation of respiratory motion during radiation therapy, without increasing the overall treatment time. In addition, the system has modest space requirements and is easy to operate.
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Affiliation(s)
- Chia-Chun Kuo
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ho-Chiao Chuang
- Department of Mechanical Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Kuan-Ting Teng
- Department of Mechanical Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Hsiao-Yu Hsu
- Department of Mechanical Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Der-Chi Tien
- Department of Mechanical Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Chih-Jen Wu
- Division of Nephrology, Mackay Memorial Hospital and Medicine, Mackay Medical College, Taipei, Taiwan
- Graduate Institute of Medical Sciences and Department of Pharmacology, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Shiu-Chen Jeng
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei, Taiwan
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jeng-Fong Chiou
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Cancer Center, Taipei Medical University Hospital, Taipei City, Taiwan
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