Stereoradiogrammetric technique for estimating alignment of the joints in the hand and wrist

A method and apparatus for quantitative measurement of the alignment and motion of the joints of the hand in three dimensions has been developed using stereoradiogrammetric principles. Alignment in planes of flexion-extension and radial-ulnar deviation can be determined to within 2.5°; rotation about the long axis of the metacarpals or phalanges is more difficult to determine, and can be measured to within 7°. Stereo views subtending angles in the range of 40° were found to optimize the total system accuracy.     

Trigonometric analysis of the mechanical axis deviation induced by telescopic intramedullary femoral lengthening nails

Femoral lengthening with intramedullary nails can create alterations in the mechanical axis of the limb. This is based on the relationship of the anatomic femur axis to the mechanical femur axis, which is typically 5-9 degrees valgus. We developed trigonometric formulas to calculate the predicted change, using the lengths of the tibia, femur, and whole limb; the amount of lengthening; and the angle between the anatomic and the mechanical axis of the femur. We recognized three patterns depending on whether the overall limb mechanical axis is lateral (valgus), medial (varus), or straight through the center of the knee. The varus and valgus patterns lead to similar formulas. When the mechanical axis goes directly through the center of the knee joint, the formula simplifies. These formulas could be incorporated into digital radiographic programs to predict the change in mechanical axis deviation that will develop from lengthening along the anatomic femur axis with an intramedullary lengthening nail.     

Evaluation of knee functional calibration with and without the effect of soft tissue artefact

Functional calibration methods were devised to improve repeatability and accuracy of the knee flexion–extension axis, which is used to define the medio-lateral axis of the femur coordinate system in gait analysis. Repeatability of functional calibration methods has been studied extensively in healthy individuals, but not accuracy in the absence of a benchmark knee axis. We captured bi-plane fluoroscopy data of the knee joint in 17 subjects with unilateral total knee arthroplasty during treadmill walking. The prosthesis provided a benchmark knee axis to evaluate the functional calibration methods. Stereo-photogrammetry data of thigh and shank marker clusters were captured simultaneously to investigate the effect of soft tissue artefact (STA). Three methods were tested, the Axis Transformation Technique (ATT) finds the best single fixed axis of rotation, 2DofKnee finds the axis that minimises knee varus–valgus and trajAJC finds the axis perpendicular to the trajectory, in the transverse plane of the femur, of a point located on the longitudinal axis of the tibia. Using fluoroscopy data, functional axes formed an angle of less than 2° in the transverse plane with the benchmark axis. True internal–external range of movement was correlated with decreased accuracy for ATT, while varus–valgus range of movement was correlated with decreased accuracy for 2DofKnee and trajAJC. STA had negative impact on accuracy and variability. Using stereo-photogrammetry data, the accuracy of 2DofKnee was 1.7°(SD: 5.1°), smaller than ATT 2.9°(SD: 5.1°) but not to trajAJC 1.7°(SD: 5.2°). Our results confirm that of previous studies, which utilised the femur condylar axis as reference.     

A method to quantify alteration of knee kinematics caused by changes of TKR positioning

Few in-vitro studies have investigated changes in kinematics caused by total knee replacement (TKR) implantation. The advent of surgical navigation systems allows implant position to be measured accurately and the effects of alteration of TKR position and alignment investigated. A test rig and protocol were developed to compare the kinematics of TKR-implanted knees for different femoral component positions. The TKR was implanted and the component positions documented using a navigation system. The quadriceps was tensed and the knees were flexed and extended manually. Torques and drawer forces were applied to the tibia during knee flexion–extension, while recording the kinematics with the navigation system. The implant was removed and replaced on an intramedullary fixation that allowed proximal–distal, and internal–external rotation of the femoral component without conducting a repeated arthrotomy on the knee. The implant was repositioned using the navigation system to reproduce the previously achieved normally navigated position and the kinematics were recorded again. The recorded kinematics of the knee were not significantly different between both normal implantation and intramedullary remounting for tibial internal–external rotation, varus–valgus angulation, or posterior drawer, at any angle of knee flexion examined. Anterior drawer was increased approximately 2.5 mm across the range 20–35° knee flexion (p<0.05), but was otherwise not significantly different. This method of navigating implant components and of moving them within the closed knee (thus avoiding artefactual effects of repeated soft tissue manipulations) can now be used to quantify the effect on kinematics of alteration of the position of the femoral component.     

Determining degree-day thresholds from field observations

 This paper compares several methods for determining degree-day (°D) threshold temperatures from field observations. Three of the methods use the mean developmental period temperature and simple equations to estimate: (1) the smallest standard deviation in °D, (2) the least standard deviation in days, and (3) a linear regression intercept. Two additional methods use iterations of cumulative °D and threshold temperatures to determine the smallest root mean square error (RMSE). One of the iteration methods uses a linear model and the other uses a single triangle °D calculation method. The method giving the best results was verified by comparing observed and predicted phenological periods using 7 years of kiwifruit data and 10 years of cherry tree data. In general, the iteration method using the single triangle method to calculate °D provided threshold temperatures with the smallest RMSE values. However, the iteration method using a linear °D model also worked well. Simply using a threshold of zero gave predictions that were nearly as good as those obtained using the other two methods. The smallest standard deviation in °D performed the worst. The least standard deviation in days and the regression methods did well sometimes; however, the threshold temperatures were sometimes negative, which does not support the idea that development rates are related to heat units. Received: 26 May 1998 / Accepted: 28 October 1998     

An MRI-based method to align the compressive loading axis for human cadaveric knees

There is a need to align the mechanical axis of the tibia with the axis of loading for studies involving tibiofemoral compression to interpret results and to ensure repeatability of loading within and among specimens. Therefore, the objectives of this study were (1) to develop a magnetic resonance imaging (MRI)-based alignment method for use with apparatuses applying tibiofemoral joint compression, (2) to demonstrate the usefulness of the method by aligning cadaveric knees in an apparatus that could apply tibiofemoral joint compression, and (3) to quantify the error associated with the alignment method. A four degree-of-freedom adjustable device was constructed to allow determination and alignment of the mechanical axis of the tibia of cadaveric knee joints with the axis of loading of an apparatus applying tibiofemoral joint compression. MRI was used to determine the locations of bony landmarks in three dimensions defining the mechanical axis of the tibia relative to an initial orientation of the four degree-of-freedom device. Adjustment values of the device were then computed and applied to the device to align the mechanical axis of the tibia with the axis of a compressive loading apparatus. To demonstrate the usefulness of the method, four cadaveric knees were aligned in the compressive loading apparatus. The vectors describing the mechanical axis of the tibia and the loading axis of the apparatus before and after adjustment of the four degree-of-freedom device were computed for each cadaveric knee. After adjustment of the four degree-of-freedom device, the mechanical axis of the tibia was collinear with the loading axis of the apparatus for each cadaveric knee. The errors in the adjustment values introduced by inaccuracies in the MR images were quantified using the Monte Carlo technique. The precisions in the translational and rotational adjustments were 1.20 mm and 0.90 deg respectively. The MR-based alignment method will allow consistent interpretation of results obtained during tibiofemoral compressive studies conducted using the apparatus described in this paper by providing a well-defined loading axis. The alignment method can also be adapted for use with other apparatuses applying tibiofemoral compression.     

Accuracy of real-time MR temperature mapping in the brain: A comparison of fast sequences

PurposeTo compare magnetic resonance (MR) thermometry based on the proton resonance frequency (PRF) method using a single shot echoplanar imaging (ss EPI) sequence to both of the standard sequences, gradient echo (GRE) and segmented echoplanar imaging (seg EPI) in the in vivo human brain, at 1.5T and 3T.Material and methodsRepetitive MR thermometry was performed on the brain of six volunteers using GRE, seg EPI, and ss EPI sequences on whole-body 1.5T and 3T clinical systems using comparable acquisition parameters. Phase stability and temperature data precision in the human head were determined over 12 min for the three sequences at both field strengths. An ex-vivo swine skeletal muscle model was used to evaluate temperature accuracy of the ss EPI sequence during heating by high intensity focused ultrasound (HIFU).ResultsIn-vivo examinations of brain revealed an average temperature precision of 0.37 °C/0.39 °C/0.16 °C at 3T for the GRE/seg EPI/ss EPI sequences. At 1.5T, a precision of 0.58 °C/0.63 °C/0.21 °C was achieved. In the ex-vivo swine model, a strong correlation of temperature data derived using ss EPI and GRE sequences was found with a temperature deviation <1 °C.ConclusionThe ss EPI sequence was the fastest and the most precise sequence for MR thermometry, with significantly higher accuracy compared to GRE.     

Elastic anisotropy of bone lamellae as a function of fibril orientation pattern

In this study, the homogenized anisotropic elastic properties of single bone lamellae are computed using a finite element unit cell method. The resulting stiffness tensor is utilized to calculate indentation moduli for multiple indentation directions in the lamella plane which are then related to nanoindentation experiments. The model accounts for different fibril orientation patterns in the lamellae—the twisted and orthogonal plywood pattern, a 5-sublayer pattern and an X-ray diffraction-based pattern. Three-dimensional sectional views of each pattern facilitate the comparison to transmission electron (TEM) images of real lamella cuts. The model results indicate, that the 5-sublayer- and the X-ray diffraction-based patterns cause the lamellae to have a stiffness maximum between 0° and 45° to the osteon axis. Their in-plane stiffness characteristics are qualitatively matching the experimental findings that report a higher stiffness in the osteon axis than in the circumferential direction. In contrast, lamellae owning the orthogonal or twisted plywood fibril orientation patterns have no preferred stiffness alignment. This work shows that the variety of fibril orientation patterns leads to qualitative and quantitative differences in the lamella elastic mechanical behavior. The study is a step toward a deeper understanding of the structure—mechanical function relationship of bone lamellae.     

Determination of heat-stable exotoxin of Bacillus thuringiensis by high-performance anion-exchange chromatography

A high-performance anion-exchange chromatography method for quantitative determination of heat-stable exotoxin in insecticide preparations and cultivation liquids is described. Heat-stable exotoxin-containing samples were chromatographed in a column packed with anion-exchange resin under gradient elution conditions, using HCl and NaCl solution, at 50°C. The calibration was linear in the exotoxin concentration range from 1 to 100 mg/ml. The sensitivity of the method allows one to determine 1 nmol and more of the heat-stable exotoxin in the applied sample, the relative standard deviation being not more than ±4%.     

In vivo tests of an improved method for functional location of the subtalar joint axis

The subtalar joint is important in frontal plane movement and posture of the hindfoot. Abnormal subtalar joint moments caused by muscle forces and the ground reaction force acting on the foot are thought to play a role in various foot deformities. Calculating joint moments typically requires knowledge of the location of the joint axis; however, location of the subtalar axis from measured movement is difficult because the talus cannot be tracked using skin-mounted markers. The accuracy of a novel technique for locating the subtalar axis was assessed in vivo using magnetic resonance imaging. The method was also tested with skin-mounted markers and video motion analysis. The technique involves applying forces to the foot that cause pure subtalar joint motion (with negligible talocrural joint motion), and then using helical axis decomposition of the resulting tibiocalcaneal motion. The resulting subtalar axis estimates differed by 6° on average from the true best-fit subtalar axes in the MRI tests. Motion was found to have been applied primarily about the subtalar joint with an average of only 3° of talocrural joint motion. The proposed method provides a potential means for obtaining subject-specific subtalar axis estimates which can then be used in inverse dynamic analyses and subject-specific musculoskeletal models.     

High-precision quality assurance of robotic couches with six degrees of freedom

A robotic couch capable of six degrees of freedom (6-DoF) of motion was introduced for state-of-the-art radiation therapy. Patient treatment requires precise quality assurance (QA) of 6-DoF. Unfortunately, conventional methods do not provide the requisite accuracy and precision. Therefore, we developed a high-precision automated QA system using a visual tracking system (VTS). The VTS comprises four motion-sensing cameras, a cube with infrared reflective markers. To acquire data in treatment room coordinates, a transformation matrix from VTS coordinates to treatment room coordinates was determined.The mean error and standard deviation of linear and rotational motions, as well as couch sagging were analyzed from continuously acquired images in the moving couch. The accuracy of VTS was 0.024 mm deviation for the sinusoidal motion, and the accuracy of the transformation matrix was 0.02 mm. In a cross-comparison, the difference between Laser Tracker (FARO) measurements was 0.14 ± 0.12 mm for translation and 0.032 ± 0.026° on average for yaw rotation. The new system provides QA of yaw, pitch and roll motion as well as sagging of the couch and sub-millimeter/degree accuracy together with precision.     

A new method for estimating joint parameters from motion data

Joint centers and axes of rotation (joint parameters) are central to all branches of movement analysis. In gait analysis, the standard protocol used to determine hip and knee joint parameters is prone to errors arising from palpation, anthropometric regression equations, and misplaced alignment devices. Several alternative methods have been proposed, but to date none have been shown to be accurate and reliable enough for use in the clinical setting. This article describes a new method for joint parameter estimation. The new method can be summarized as follows: (i) the motions of two adjacent segments spanning a single joint are tracked, (ii) the axis of rotation between every pair of observed segment configurations is computed, (iii) the most likely intersection of all axes (effective joint center) and most likely orientation of the axes (effective joint axis) is found. Initial validation of the method was conducted on a hinged mechanical analog and a single healthy adult subject. For the analog, the center was found to be within 3.8 mm of the geometric center and 2.0 degrees of the geometric axis (standard deviation). For the adult subject, hip centers varied on the order of 1-3 mm, knee centers by 3-9 mm, and knee axes by 2.0 degrees. The results suggest that the new method is an objective, precise, and practical alternative to the standard clinical approach.     

Quantification of trabecular spatial orientation from low-resolution images

No accepted methodology exists to assess trabecular bone orientation from clinical CT scans. The aim of this study was to test the hypothesis that the distribution of grey values in clinical CT images is related to the underlying trabecular architecture and that this distribution can be used to identify the principal directions and local anisotropy of trabecular bone. Fourteen trabecular bone samples were extracted from high-resolution (30 μm) micro-CT scans of seven human femoral heads. Trabecular orientations and local anisotropy were calculated using grey-level deviation (GLD), a novel method providing a measure of the three-dimensional distribution of image grey values. This was repeated for different image resolutions down to 300 μm and for volumes of interest (VOIs) ranging from 1 to 7 mm. Outcomes were compared with the principal mechanical directions and with mean intercept length (MIL) as calculated for the segmented 30-μm images. For the 30-μm images, GLD predicted the mechanical principal directions equally well as MIL. For the 300-μm images, which are resolutions that can be obtained in vivo using clinical CT, only a small increase (3°–6°) in the deviation from the mechanical orientations was found. VOIs of 5 mm resulted in a robust quantification of the orientation. We conclude that GLD can quantify structural bone parameters from low-resolution CT images.     

A new approach using the Pierce two-node model for different body parts

This paper presents a new approach, in applying the Pierce two-node model, to predict local skin temperatures of individual body parts with good accuracy. In this study, local skin temperature measurements at 24 sites on the bodies of 11 human subjects were carried out in a controlled environment under three different indoor conditions (i.e. neutral, warm and cold). The neutral condition measurements were used to adjust the local skin set-points in the model for each body part. Additional modifications to the calculation algorithm were introduced corresponding to different body parts. The local core set-points were then calculated, using a line search method, as the input values that allow the model to predict the skin temperatures with maximum deviation of ±0.1°C for the neutral condition. The model predictability was verified for the other two indoor conditions, and the results show that the modified model predicts local skin temperatures with average deviation of ±0.3°C.     

Upper limb joint angle measurement in occupational health

Usual human motion capture systems are designed to work in controlled laboratory conditions. For occupational health, instruments that can measure during normal daily life are essential, as the evaluation of the workers' movements is a key factor to reduce employee injury- and illness-related costs. In this paper, we present a method for joint angle measurement, combining inertial sensors (accelerometers and gyroscopes) and magnetic sensors. This method estimates wrist flexion, wrist lateral deviation, elbow flexion, elbow pronation, shoulder flexion, shoulder abduction and shoulder internal rotation. The algorithms avoid numerical integration of the signals, which allows for long-time estimations without angle estimation drift. The system has been tested both under laboratory and field conditions. Controlled laboratory tests show mean estimation errors between 0.06° and of 1.05°, and standard deviation between 2.18° and 9.20°. Field tests seem to confirm these results when no ferromagnetic materials are close to the measurement system.     

The mechanical consequences of dynamic frontal plane limb alignment for non-contact ACL injury

This study investigated the mechanical consequences of differences in dynamic frontal plane alignment of the support limb and the influence of anticipatory muscle activation at the hip and ankle on reducing the potential for non-contact ACL injury during single-limb landing. A frontal plane, three-link passive dynamic model was used to estimate an ACL non-contact injury threshold. This threshold was defined as the maximum axial force that the knee could sustain before the joint opened 8 degrees either medially or laterally, which was deemed sufficient to cause injury. The limb alignment and hip and ankle muscle contractions were varied to determine their effects on the ACL injury threshold. Valgus or varus alignment reduced the injury threshold compared to neutral alignment, but increasing the anticipatory contraction of hip abduction and adduction muscle groups increased the injury threshold. Increasing anticipatory ankle inversion/eversion muscle contraction had no effect. This study provides a mechanical rationale for the conclusion that a neutral limb alignment (compared to valgus or varus) during landing and increasing hip muscle contraction (abductors/adductors) prior to landing can reduce the possibility of ACL rupture through a valgus or varus opening mechanism.     

Simultaneous determination of the histamine H1-receptor antagonist ebastine and its two metabolites,carebastine and hydroxyebastine,in human plasma using high-performance liquid chromatography

Ebastine (CAS 90729-43-4) is an antiallergic agent which selectively and potently blocks histamine H₁-receptors in vivo. A simple and sensitive high-performance liquid chromatography (HPLC) method is described for the simultaneous determination of ebastine and its two oxidized metabolites, carebastine (CAS 90729-42-3) and hydroxyebastine (M–OH), in human plasma. After a pretreatment of plasma sample by solid-phase extraction, ebastine and its metabolites were analyzed on an HPLC system with ultraviolet detection at 254 nm. Chromatography was performed on a cyano column (250×4.0 mm I.D.) at 40 °C with the mobile phase of acetonitrile–methanol–0.012 M ammonium acetate buffer (20:30:48, v/v/v) at a flow rate of 1.2 ml/min. Accurate determinations were possible over the concentration range of 3–1000 ng/ml for the three compounds using 1 ml plasma samples. The intra- and inter-day assay accuracy of this method were within 100±15% of nominal values and the precision did not exceed 12.4% of relative standard deviation. The lower limits of quantitation were 3 ng/ml for ebastine and its metabolites in human plasma. This method was satisfactorily applied to the determination of ebastine and its two oxidized metabolites in human plasma after oral administration of ebastine.     

Evaluation of different methods for determining growing degree-day thresholds in apricot cultivars

The aim of this study was to examine different methods for determining growing degree-day (GDD) threshold temperatures for two phenological stages (full bloom and harvest) and select the optimal thresholds for a greater number of apricot (Prunus armeniaca L.) cultivars grown in the Belgrade region. A 10-year data series were used to conduct the study. Several commonly used methods to determine the threshold temperatures from field observation were evaluated: (1) the least standard deviation in GDD; (2) the least standard deviation in days; (3) the least coefficient of variation in GDD; (4) regression coefficient; (5) the least standard deviation in days with a mean temperature above the threshold; (6) the least coefficient of variation in days with a mean temperature above the threshold; and (7) the smallest root mean square error between the observed and predicted number of days. In addition, two methods for calculating daily GDD, and two methods for calculating daily mean air temperatures were tested to emphasize the differences that can arise by different interpretations of basic GDD equation. The best agreement with observations was attained by method (7). The lower threshold temperature obtained by this method differed among cultivars from −5.6 to −1.7°C for full bloom, and from −0.5 to 6.6°C for harvest. However, the “Null” method (lower threshold set to 0°C) and “Fixed Value” method (lower threshold set to −2°C for full bloom and to 3°C for harvest) gave very good results. The limitations of the widely used method (1) and methods (5) and (6), which generally performed worst, are discussed in the paper.     

Useability of an image based nagivation system in reconstruction of leg alignment in total knee arthroplasty - results of a propsective study]

Accurate leg alignment is one important factor for long term survival in total knee arthroplasty (TKA). The aim of this study was to determine the accuracy of a CT-based navigation system in restoration of the leg axis. 80 TKA (P.F.C.-Sigma--DePuy) were implanted either using a CT-based navigation-system or the conventional technique. There were no significant differences between the groups according to the preoperative leg deformity. Accuracy of implantation was determined on postoperative long-leg coronal and lateral x-rays. A postoperative leg axis between 3 degrees varus and 3 degrees valgus was obtained in 35/40 patients (88%) in the computer assisted and 28/40 patients (70%) in the conventional operated group. A higher precision in the sagittal plane was seen for the tibial (computer assisted: 3.9 +/- 2.2 vs. conventional TKA 1.3 +/- 5.8) and the femoral component (computer assisted: 3.5 +/- 2.3 vs. conventional TKA 6.9 +/- 3.6). The use of the CT-based VectorVision-System allows a significant improvement in the accuracy of implantation in TKA. The CT-based module has the advantage of a precise preoperative planning and a useful documentation and control tool for each important step. On the other hand there are additional costs and time consuming logistics.