1
|
Wijetunga CG, Roebert J, Hiscock RJ, Bedi HS, Roshan-Zamir S, Wang O, Fraval A, Tate J, Eden M, Rotstein AH. Defining Reference Values for the Normal Adult Lisfranc Joint Using Weightbearing Computed Tomography. J Foot Ankle Surg 2023; 62:382-387. [PMID: 36335050 DOI: 10.1053/j.jfas.2022.09.008] [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: 07/28/2020] [Revised: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022]
Abstract
The uninjured contralateral feet of consecutive patients undergoing cone-beam weightbearing computed tomography for acute Lisfranc injury between July 2017 and October 2019 were retrospectively analyzed. Of these, any cases with history or radiological evidence of trauma to the Lisfranc interval were excluded. The area of the non-weightbearing (NWBA) and weightbearing (WBA) Lisfranc joint was calculated (in mm2) using a novel technique. Area difference (AD) was calculated as WBA-NWBA. Area ratio (AR) was calculated as WBA/NWBA. A subset of cases was double-measured by 2 technologists to evaluate inter- and intraobserver variability. A total of 91 patients aged 15 to 74 years were included in the study. The measurement technique was reproducible with excellent intraobserver correlation (intraclass correlation coefficient [ICC]: 0.998, 95% confidence interval [CI]: 0.996-0.999) and high interobserver correlation (ICC: 0.964, CI: 0.939-0.979). The median NWBA was 83 (range 52-171) and median WBA was 86 (range 52-171). Median AD was 1 mm2 (range -3 to 10) and median AR was 1.01 (range 0.96-1.11). No significant difference was identified in AD or AR when adjusted for age, gender, patient-weight or weight put through the foot. Both AD and AR distributions were highly skewed toward 0 and 1, respectively. Based on 95% CI, normal reference range for AD is -1 to 7 mm2 and for AR is 0.98 to 1.09. Absolute area of the Lisfranc joint is highly variable between individuals. The Lisfranc joint is rigid with little to no physiologic widening in most subjects. The normal upper limit of widening of the Lisfranc area on weightbearing was 9%. Differences in age, sex, patient-weight or weight put through the foot were not significantly associated with the extent of joint widening.
Collapse
Affiliation(s)
- Chatura Gihan Wijetunga
- Radiologist and MSK Imaging Fellow, Victoria House Medical Imaging, South Yarra, Victoria, Australia.
| | - Justin Roebert
- Musculoskeletal Radiologist, Victoria House Medical Imaging, South Yarra, Victoria, Australia
| | - Richard John Hiscock
- Biostatistician, Mercy Perinatal, University of Melbourne, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Harvinder S Bedi
- Orthopaedic Surgeon, St Vincent's Private Hospital East Melbourne, East Melbourne, Victoria, Australia
| | - Sasha Roshan-Zamir
- Orthopaedic Surgeon, St Vincent's Private Hospital East Melbourne, East Melbourne, Victoria, Australia
| | - Otis Wang
- Orthopaedic Surgeon, St Vincent's Private Hospital East Melbourne, East Melbourne, Victoria, Australia
| | - Andrew Fraval
- Orthopaedic Registrar, Western Health Orthopaedic Department, Western Hospital, Footscray, Victoria, Australia
| | - Julie Tate
- Radiographer, Victoria House Medical Imaging, South Yarra, Victoria, Australia
| | - Maggie Eden
- Radiographer, Victoria House Medical Imaging, South Yarra, Victoria, Australia
| | - Andrew H Rotstein
- Musculoskeletal Radiologist, Victoria House Medical Imaging, South Yarra, Victoria, Australia
| |
Collapse
|
2
|
Meyers MC, Sterling JC. Lisfranc injury: Prevalence and maintaining a high index of suspicion for optimal evaluation. PHYSICIAN SPORTSMED 2022; 50:507-514. [PMID: 34429021 DOI: 10.1080/00913847.2021.1969218] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To quantify the long-term prevalence of game-related Lisfranc trauma in college football on artificial turf and natural grass. METHODS 32 universities were evaluated over 10 competitive seasons across all Football Bowl Subdivision (FBS) conferences. Outcomes of interest included injury severity, injury category, primary type of injury, player and skill position, injury mechanism and situation, elective imaging and surgical procedures, and field conditions. Injury incidence rates (IIR) were calculated using injuries per 10 games = (number of injuries) number of games) × 10. RESULTS Of the 1577 games documented, 783 games (49.7%) were played on a 3-layer artificial turf (≥9.0 lbs/ft2) infill system versus 794 games (50.3%) played on natural grass. In sum, 78 Lisfranc cases were documented with 34 (43.6%) occurring on artificial turf, and 44 (56.4%) on natural grass. MANOVAs indicated significant main effects by injury category (F3,74 = 6.439; P = .001), and injury mechanism (F5,72 = 3.372; P = .009) observed between surfaces, but not by injury severity (F2,75 = 0.720; P = .490), primary type of injury (F4,73 = 0.772; P = .547), overall player (F2,75 = 0.219; P = .804) and skill positions (F8,69 = 0.850; P = .563), injury situation (F10,67 = 1.030; P = .428), elective imaging and surgical procedures (F3,74 = 0.515; P = .673), or field conditions (F2,75 = 0.375; P = .688). Post hoc analyses indicated significantly greater incidences (P < .05) of Lisfranc trauma on natural grass attributed to shoe:surface interaction during noncontact play, and during no contact, foot rotation or planting. Ligament tears (n = 8; 57.1%), with minimal cases of subluxation/dislocations (n = 4; 28.6%) and fractures (n = 2; 14.3%) comprised grade 3 cases across both surfaces. CONCLUSION In regards to Lisfranc trauma, a 3-layer, heavyweight artificial infill surface is as safe or safer than natural grass. The findings of this study may be generalizable only to this level of football competition.
Collapse
Affiliation(s)
- Michael C Meyers
- Human Performance Laboratory, Department of Human Performance and Sport Studies, Idaho State University, Pocatello, ID. USA
| | - James C Sterling
- Baylor, Scott & White, Sports and Physical Medicine Center, Dallas, TX, USA
| |
Collapse
|
3
|
Lalwani R, Kotgirwar S, Athavale SA. Support system of Lisfranc joint complex: An anatomical investigation with an evolutionary perspective. Foot Ankle Surg 2022; 28:1089-1093. [PMID: 35339373 DOI: 10.1016/j.fas.2022.03.004] [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: 01/14/2022] [Revised: 02/18/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The anatomical arrangement of the Lisfranc joint between the midfoot and forefoot is complex and not just critical for bipedal gait but also for prevention, management, and rehabilitation of injuries in this region. MATERIAL AND METHODS In forty adult cadaveric lower limbs, the Lisfranc mortise, the ligaments and supports were observed and noted. RESULTS The structural arrangement that accords stability to the joint has osseous, ligamentous, and tendinous components. A bony mortise, which is deep medially, disrupts the linearity of the joint line. An extensive Lisfranc ligament with confluent interosseous and plantar parts was observed. Tibialis posterior, peroneus Longus and Lisfranc ligament exhibit a unique anatomical arrangement that supports the joint inferiorly. CONCLUSION The study documents a unique lattice of tendons and ligament offering dynamic support to the joint. Demands of assumption of erect posture and bipedal walking in humans like adduction of the first ray of the foot, maintenance of longitudinal and transverse arches of the foot and ability stiffen midfoot for efficient forefoot take-off are well reflected in the joint structure and supports.
Collapse
Affiliation(s)
- Rekha Lalwani
- Department of Anatomy, All India Institute of Medical Sciences, Bhopal, M.P., India.
| | - Sheetal Kotgirwar
- Department of Anatomy, All India Institute of Medical Sciences, Bhopal, M.P., India
| | | |
Collapse
|
4
|
Sripanich Y, Steadman J, Krähenbühl N, Rungprai C, Saltzman CL, Lenz AL, Barg A. Anatomy and biomechanics of the Lisfranc ligamentous complex: A systematic literature review. J Biomech 2021; 119:110287. [PMID: 33639336 DOI: 10.1016/j.jbiomech.2021.110287] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 12/21/2020] [Accepted: 01/23/2021] [Indexed: 12/15/2022]
Abstract
Lisfranc injuries are challenging to treat and can have a detrimental effect on active individuals. Over the past decade researchers have investigated methods for the reconstruction of the Lisfranc ligamentous complex (LLC) to preserve its functional stability and mobility. To aid in this innovation, this study presents the current understanding of the anatomical and biomechanical characteristics of the LLC through a systematic review. Three medical databases (PubMed, Scopus, and Embase) were searched from inception through July 2019. Original studies investigating the anatomy and/or biomechanical properties of the LLC were considered for inclusion. Data recorded from each study included: number of cadavers, number of feet, gender, laterality, age, type of specimen, measurement methods, reported ligamentous bundles, ligament origins and insertions, geometric characteristics, and biomechanical properties of the LLC. The Quality Appraisal for Cadaveric Studies (QUACS) scale was used to assess the methodologic quality of included articles. Eight cadaveric studies investigating the LLC were included out of 1204 screened articles. Most articles described the LLC as three distinct structures: the dorsal- (DLL), interosseous- (ILL), and plantar- (PLL) Lisfranc Ligaments. The ILL had the largest thickness and insertional area of osseous attachment. Biomechanically, the ILL also had the highest stiffness and resistance to load prior to failure when loaded parallel to its fiber orientation. Current knowledge of the anatomical and biomechanical properties of the LLC are presented and highlight its significant role of stabilizing the tarsometatarsal articulation. Appreciating the biomechanical characteristics of the ILL may improve clinical insight in managing LLC injuries.
Collapse
Affiliation(s)
- Yantarat Sripanich
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok 10400, Thailand
| | - Jesse Steadman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Nicola Krähenbühl
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Chamnanni Rungprai
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok 10400, Thailand
| | - Charles L Saltzman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Amy L Lenz
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Hamburg, Martinistrasse 52, 20246 Hamburg, Germany.
| |
Collapse
|
5
|
DeLuca MK, Walrod B, Boucher LC. Ultrasound as a Diagnostic Tool in the Assessment of Lisfranc Joint Injuries. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:579-587. [PMID: 31617236 DOI: 10.1002/jum.15138] [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: 05/10/2019] [Accepted: 09/08/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Ligamentous Lisfranc injuries are frequently overlooked because of subtle clinical presentations and diagnostic difficulties. The dorsal Lisfranc ligament (DLL) is easily visualized with ultrasound (US), which can provide quick, cost-effective diagnoses of disorders but is not considered standard clinical practice. This study sought to compare DLL measurement accuracy between US and cadaveric dissection. METHODS Ultrasound images of 22 embalmed cadaveric feet were obtained with an M-Turbo US machine and a 6-13-MHz linear array (FUJIFILM SonoSite, Inc, Bothell, WA). Images were measured in the US unit and again with ImageJ software (National Institutes of Health, Bethesda, MD). Specimens were dissected, and DLL morphologic characteristics were recorded. RESULTS Twenty-two specimens were scanned, however 4 were excluded, leaving a sample of 11 male and 7 female cadaveric specimens (mean age ± SD, 80.3 ± 14.03 years). The DLL length differences between SonoSite (8.39 ± 1.27 mm) and ImageJ (8.25 ± 1.84 mm) were not significant (P > .05). Both US DLL measurements significantly differed from the gross dissection measurement (10.8 ± 1.85 mm; P < .001). The morphologic characteristics of the DLL at dissection were consistent. Overall, 70% to 80% of the ligament length was represented by US compared to dissection. The dorsal joint space did not differ significantly between SonoSite (2.19 ± 0.49 mm) and ImageJ (2.05 ± 0.52; P > .05). Both US measurements were also significantly larger than dissection measurements (1.04 ± 0.24; P < .001). Intraclass correlation coefficients indicated good reliability for the DLL length (0.835) and moderate reliability for the dorsal joint space (0.714). CONCLUSIONS The DLL is underrepresented but easily distinguished by US, demonstrating its utility in Lisfranc injury diagnosis. Thus, we propose a 4-component assessment involving US, which may provide more rapid, cost-effective diagnoses of subtle Lisfranc injuries.
Collapse
Affiliation(s)
- Meridith K DeLuca
- Division of Anatomy, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Bryant Walrod
- Department of Family Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Laura C Boucher
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| |
Collapse
|
6
|
Sripanich Y, Weinberg MW, Krähenbühl N, Rungprai C, Mills MK, Saltzman CL, Barg A. Imaging in Lisfranc injury: a systematic literature review. Skeletal Radiol 2020; 49:31-53. [PMID: 31368007 DOI: 10.1007/s00256-019-03282-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/30/2019] [Accepted: 07/08/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To systematically review current diagnostic imaging options for assessment of the Lisfranc joint. MATERIALS AND METHODS PubMed and ScienceDirect were systematically searched. Thirty articles were subdivided by imaging modality: conventional radiography (17 articles), ultrasonography (six articles), computed tomography (CT) (four articles), and magnetic resonance imaging (MRI) (11 articles). Some articles discussed multiple modalities. The following data were extracted: imaging modality, measurement methods, participant number, sensitivity, specificity, and measurement technique accuracy. Methodological quality was assessed by the QUADAS-2 tool. RESULTS Conventional radiography commonly assesses Lisfranc injuries by evaluating the distance between either the first and second metatarsal base (M1-M2) or the medial cuneiform and second metatarsal base (C1-M2) and the congruence between each metatarsal base and its connecting tarsal bone. For ultrasonography, C1-M2 distance and dorsal Lisfranc ligament (DLL) length and thickness are evaluated. CT clarifies tarsometatarsal (TMT) joint alignment and occult fractures obscured on radiographs. Most MRI studies assessed Lisfranc ligament integrity. Overall, included studies show low bias for all domains except patient selection and are applicable to daily practice. CONCLUSIONS While conventional radiography can demonstrate frank diastasis at the TMT joints; applying weightbearing can improve the viewer's capacity to detect subtle Lisfranc injury by radiography. Although ultrasonography can evaluate the DLL, its accuracy for diagnosing Lisfranc instability remains unproven. CT is more beneficial than radiography for detecting non-displaced fractures and minimal osseous subluxation. MRI is clearly the best for detecting ligament abnormalities; however, its utility for detecting subtle Lisfranc instability needs further investigation. Overall, the available studies' methodological quality was satisfactory.
Collapse
Affiliation(s)
- Yantarat Sripanich
- Department of Orthopedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Maxwell W Weinberg
- Department of Orthopedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Nicola Krähenbühl
- Department of Orthopedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Chamnanni Rungprai
- Department of Orthopedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok, 10400, Thailand
| | - Megan K Mills
- Department of Radiology and Imaging Sciences, University of Utah, 30 N. 1900 E. #1A071, Salt Lake City, UT, 84132, USA
| | - Charles L Saltzman
- Department of Orthopedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Alexej Barg
- Department of Orthopedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
| |
Collapse
|
7
|
Ryba D, Ibrahim N, Choi J, Vardaxis V. Evaluation of dorsal Lisfranc ligament deformation with load using ultrasound imaging. Foot (Edinb) 2016; 26:30-5. [PMID: 26802947 DOI: 10.1016/j.foot.2015.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/20/2015] [Accepted: 10/29/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Research findings have linked dorsal Lisfranc ligament (dLL) rupture to complete Lisfranc ligament complex rupture; identifying deformation characteristics of the dorsal Lisfranc ligament alone may be helpful in diagnosing complete ligament rupture. The goal of the present study was to assess the deformation characteristics of the asymptomatic dLL using physiologically relevant stress/loads in a clinical setting and to discern normative dLL parameters. METHODS Unilateral dLL measurements were taken from 50 healthy volunteers, using sonographic imaging under three different stress/load conditions. Stress/load was applied using the individuals' bodyweight (low-seated; medium-bilaterally equal weight bearing in standing; and high-single leg standing). Digital images of the dLL captured using ultrasound were visualized to determine the dLL length. One-way repeated measures ANOVA was used to assess changes in the dLL length with load. RESULTS The average dLL elongation, as percent resting length change, was 8.76% between seated and single leg standing positions. Most of the dLL elongation (6.26%) occurred between seated and bilateral standing. CONCLUSIONS The deformation and role of the dorsal Lisfranc ligament can be observed using sonographic imaging resulting from physiological loading in the clinical setting. CLINICAL RELEVANCE These deformation parameters can be used to generate normative data for diagnostic purposes.
Collapse
Affiliation(s)
- Dalton Ryba
- College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, IA, United States
| | - Nooreen Ibrahim
- College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, IA, United States
| | - Jim Choi
- Iowa Radiology PC, West Des Moines, IA, United States
| | - Vassilios Vardaxis
- College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, IA, United States; Department of Physical Therapy, Des Moines University, Des Moines, IA, United States.
| |
Collapse
|
8
|
Singh V, Elamvazuthi I, Jeoti V, George J, Swain A, Kumar D. Impacting clinical evaluation of anterior talofibular ligament injuries through analysis of ultrasound images. Biomed Eng Online 2016; 15:13. [PMID: 26838596 PMCID: PMC4736278 DOI: 10.1186/s12938-016-0129-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 01/21/2016] [Indexed: 12/03/2022] Open
Abstract
Background Anterior talofibular ligament (ATFL) is considered as the weakest ankle ligament that is most prone to injuries. Ultrasound imaging with its portable, non-invasive and non-ionizing radiation nature is increasingly being used for ATFL diagnosis. However, diagnosis of ATFL injuries requires its segmentation from ultrasound images that is a challenging task due to the existence of homogeneous intensity regions, homogeneous textures and low contrast regions in ultrasound images. To address these issues, this research has developed an efficient ATFL segmentation framework that would contribute to accurate and efficient diagnosis of ATFL injuries for clinical evaluation. Methods The developed framework comprises of five computational steps to segment the ATFL ligament region. Initially, region of interest is selected from the original image, which is followed by the adaptive histogram equalization to enhance the contrast level of the ultrasound image. The enhanced contrast image is further optimized by the particle swarm optimization algorithm. Thereafter, the optimized image is processed by the Chan–Vese method to extract the ATFL region through curve evolution; then the resultant image smoothed by morphological operation. The algorithm is tested on 25 subjects’ datasets and the corresponding performance metrics are evaluated to demonstrate its clinical applicability. Results The performance of the developed framework is evaluated based on various measurement metrics. It was found that estimated computational performance of the developed framework is 12 times faster than existing Chan–Vese method. Furthermore, the developed framework yielded the average sensitivity of 98.3 %, specificity of 96.6 % and accuracy of 96.8 % as compared to the manual segmentation. In addition, the obtained distance using Hausdorff is 14.2 pixels and similarity index by Jaccard is 91 %, which are indicating the enhanced performance whilst segmented area of ATFL region obtained from five normal (average Pixels—16,345.09), five tear (average Pixels—14,940.96) and five thickened (average Pixels—12,179.20) subjects’ datasets show good performance of developed framework to be used in clinical practices. Conclusions On the basis of obtained results, the developed framework is computationally more efficient and more accurate with lowest rate of coefficient of variation (less than 5 %) that indicates the highest clinical significance of this research in the assessment of ATFL injuries.
Collapse
Affiliation(s)
- Vedpal Singh
- Centre for Intelligent Signal and Imaging Research (CISIR), Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Bandar Seri Iskandar, 32610, Perak Darul Ridzuan, Malaysia.
| | - Irraivan Elamvazuthi
- Centre for Intelligent Signal and Imaging Research (CISIR), Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Bandar Seri Iskandar, 32610, Perak Darul Ridzuan, Malaysia.
| | - Varun Jeoti
- Centre for Intelligent Signal and Imaging Research (CISIR), Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Bandar Seri Iskandar, 32610, Perak Darul Ridzuan, Malaysia.
| | - John George
- Research Imaging Centre, University of Malaya, Kuala Lumpur, 50603, Malaysia.
| | - Akshya Swain
- Department of Electrical and Computer Engineering, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Dileep Kumar
- Centre for Intelligent Signal and Imaging Research (CISIR), Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Bandar Seri Iskandar, 32610, Perak Darul Ridzuan, Malaysia.
| |
Collapse
|