Difference between palpation and optoelectronics recording of scapular motion

The aim of this study is to determine the errors of scapular localisation due to skin relative to bone motion with an optoelectronic tracking system. We compared three-dimensional (3D) scapular positions obtained with skin markers to those obtained through palpation of three scapular anatomical landmarks. The scapular kinematics of nine subjects were collected. Static positions of the scapula were recorded with the right arm elevated at 0°, 40°, 80°, 120° and 160° in the sagittal plane. Palpation and subsequent digitisation of anatomical landmarks on scapula and thorax were done at the same positions. Scapular 3D orientation was also computed during 10 repeated movements of arm elevation between 0° and 180°. Significant differences in scapular kinematics were seen between static positions and palpation when considering anterior/posterior tilt and upward/downward rotation at angles over 120° of humeral elevation and only at 120° for internal/external rotation. There was no significant difference between positions computed during static positions and during the movement for the three scapular orientations. A rotation correction model is presented in order to reduce the errors between static position and palpation measurement.     

A new method for motion capture of the scapula using an optoelectronic tracking device: a feasibility study

Optoelectronic tracking systems are rarely used in 3D studies examining shoulder movements including the scapula. Among the reasons is the important slippage of skin markers with respect to scapula. Methods using electromagnetic tracking devices are validated and frequently applied. Thus, the aim of this study was to develop a new method for in vivo optoelectronic scapular capture dealing with the accepted accuracy issues of validated methods.

Eleven arm positions in three anatomical planes were examined using five subjects in static mode. The method was based on local optimisation, and recalculation procedures were made using a set of five scapular surface markers.

The scapular rotations derived from the recalculation-based method yielded RMS errors comparable with the frequently used electromagnetic scapular methods (RMS up to 12.6° for 150° arm elevation). The results indicate that the present method can be used under careful considerations for 3D kinematical studies examining different shoulder movements.     

Cluster-based upper body marker models for three-dimensional kinematic analysis: Comparison with an anatomical model and reliability analysis

Quantifying angular joint kinematics of the upper body is a useful method for assessing upper limb function. Joint angles are commonly obtained via motion capture, tracking markers placed on anatomical landmarks. This method is associated with limitations including administrative burden, soft tissue artifacts, and intra- and inter-tester variability. An alternative method involves the tracking of rigid marker clusters affixed to body segments, calibrated relative to anatomical landmarks or known joint angles. The accuracy and reliability of applying this cluster method to the upper body has, however, not been comprehensively explored. Our objective was to compare three different upper body cluster models with an anatomical model, with respect to joint angles and reliability. Non-disabled participants performed two standardized functional upper limb tasks with anatomical and cluster markers applied concurrently. Joint angle curves obtained via the marker clusters with three different calibration methods were compared to those from an anatomical model, and between-session reliability was assessed for all models. The cluster models produced joint angle curves which were comparable to and highly correlated with those from the anatomical model, but exhibited notable offsets and differences in sensitivity for some degrees of freedom. Between-session reliability was comparable between all models, and good for most degrees of freedom. Overall, the cluster models produced reliable joint angles that, however, cannot be used interchangeably with anatomical model outputs to calculate kinematic metrics. Cluster models appear to be an adequate, and possibly advantageous alternative to anatomical models when the objective is to assess trends in movement behavior.     

A method to perform spinal motion analysis from functional X-ray images

Identifying spinal instability is an important aim for proper surgical treatment. Analysis of functional X-ray images delivers measurements of the range of motion (RoM) and the center of rotation (CoR). In today's practice, CoR determination is often omitted, due to the lack of accurate methods. The aim of this work was to investigate the accuracy of a new analysis software (FXA?) based on an in vitro experiment.Six bovine spinal specimens (L3-4) were mounted in a robot (KR125, Kuka). CoRs were predefined by locking the robot actuator tool center point to the estimated position of the physiologic CoR and taking a baseline X-ray. Specimens were deflected to various RoM_preset flexion/extension angles about the CoR_preset. Lateral functional radiographs were acquired and specimen movements were recorded using an optical motion tracking system (Optotrak Certus). RoM and CoR errors were calculated from presets for both methods. Prior to the experiment, the FXA? software was verified with artificially generated images.For the artificial images, FXA? yielded a mean RoM-error of 0.01±0.03° (bias±standard deviation). In the experiment, RoM-error of the FXA?-software (deviation from presets) was 0.04±0.13°, and 0.10±0.16° for the Optotrak, respectively. Both correlated with 0.998 (p<0.001). For RoM<1.0°, FXA? determined CoR positions with a bias>20 mm. This bias progressively decreased from RoM=1° (bias=6.0 mm) to RoM=9° (bias<1.5 mm).Under the assumption that CoR location variances <5 mm are clinically irrelevant on the lumbar spine, the FXA? method can accurately determine CoRs for RoMs>1°. Utilizing FXA?, polysegmental RoMs, CoRs and implant migration measurements could be performed in daily practice.     

Development and validation of ultrasound speckle tracking to quantify tendon displacement

Ultrasound can be used to study tendon movement. However, measurement of tendon movement is mostly based on manual tracking of anatomical landmarks such as the musculo-tendinous junction, limiting the applicability to a small number of muscle-tendon units. The aim of this study was to quantify tendon displacement without anatomical landmarks using a speckle tracking algorithm optimized for tendons in long B-mode image sequences. A dedicated two-dimensional multi-kernel block-matching scheme with subpixel motion estimation was devised to handle large displacements over long sequences. The accuracy of the tracking on porcine tendons was evaluated during different displacements and velocities. Subsequently, the accuracy of tracking the flexor digitorum superficialis (FDS) of a human cadaver hand was evaluated. Finally, the in-vivo accuracy of the tendon tracking was determined by measuring the movement of the FDS at the wrist level. For the porcine experiment and the human cadaver arm experiment tracking errors were, on average, 0.08 and 0.05 mm, respectively (1.3% and 1.0%). For the in-vivo experiment the tracking error was, on average, 0.3 mm (1.6%). This study demonstrated that our dedicated speckle tracking can quantify tendon displacement at different physiological velocities without anatomical landmarks with high accuracy. The technique allows tracking over large displacements and in a wider range of tendons than by using anatomical landmarks.     

A videofluoroscopy-based tracking algorithm for quantifying the time course of human intervertebral displacements

The motions of individual intervertebral joints can affect spine motion, injury risk, deterioration, pain, treatment strategies, and clinical outcomes. Since standard kinematic methods do not provide precise time-course details about individual vertebrae and intervertebral motions, information that could be useful for scientific advancement and clinical assessment, we developed an iterative template matching algorithm to obtain this data from videofluoroscopy images. To assess the bias of our approach, vertebrae in an intact porcine spine were tracked and compared to the motions of high-contrast markers. To estimate precision under clinical conditions, motions of three human cervical spines were tracked independently ten times and vertebral and intervertebral motions associated with individual trials were compared to corresponding averages. Both tests produced errors in intervertebral angular and shear displacements no greater than 0.4° and 0.055 mm, respectively. When applied to two patient cases, aberrant intervertebral motions in the cervical spine were typically found to correlate with patient-specific anatomical features such as disc height loss and osteophytes. The case studies suggest that intervertebral kinematic time-course data could have value in clinical assessments, lead to broader understanding of how specific anatomical features influence joint motions, and in due course inform clinical treatments.     

Capturing data from three-dimensional surfaces using fuzzy landmarks

Anatomical landmarks are defined as biologically meaningful loci that can be unambiguously defined and repeatedly located with a high degree of accuracy and precision. The neurocranial surface is characteristically void of such loci. We define a new class of landmarks, termed fuzzy landmarks, that will allow us to represent the form of the neurocranium. A fuzzy landmark represents the position of a biological structure that is precisely delineated, but occupies an area that is larger than a single point in the observer's reference system. In this study, we present a test case in which the cranial bosses are evaluated as fuzzy landmarks. Five fuzzy landmarks (the cranial bosses) and three traditional landmarks were placed repeatedly by a single observer on three-dimensional (3D) computed tomography (CT) surface reconstructions of pediatric dry skulls and skulls of pediatric patients, and directly on four of the same dry skulls using a 3Space digitizer. Thirty landmark digitizing trials from CT scans show an average error of 1.15 mm local to each fuzzy landmark, while the average error for the last ten trials was 0.75 mm, suggesting a learning curve. Data collected with the 3Space digitizer was comparable. Measurement error of fuzzy landmarks is larger than that of traditional landmarks, but is acceptable, especially since fuzzy landmarks allow inclusion of areas that would otherwise go unsampled. The information obtained is valuable in growth studies, clinical evaluation, and volume measurements. Our method of fuzzy landmarking is not limited to cranial bosses, and can be applied to any other anatomical features with fuzzy boundaries. Am J Phys Anthropol 107:113–124, 1998. © 1998 Wiley-Liss, Inc.     

Lesion Explorer: A Video-guided,Standardized Protocol for Accurate and Reliable MRI-derived Volumetrics in Alzheimer's Disease and Normal Elderly

Obtaining in vivo human brain tissue volumetrics from MRI is often complicated by various technical and biological issues. These challenges are exacerbated when significant brain atrophy and age-related white matter changes (e.g. Leukoaraiosis) are present. Lesion Explorer (LE) is an accurate and reliable neuroimaging pipeline specifically developed to address such issues commonly observed on MRI of Alzheimer''s disease and normal elderly. The pipeline is a complex set of semi-automatic procedures which has been previously validated in a series of internal and external reliability tests^1,2. However, LE''s accuracy and reliability is highly dependent on properly trained manual operators to execute commands, identify distinct anatomical landmarks, and manually edit/verify various computer-generated segmentation outputs.LE can be divided into 3 main components, each requiring a set of commands and manual operations: 1) Brain-Sizer, 2) SABRE, and 3) Lesion-Seg. Brain-Sizer''s manual operations involve editing of the automatic skull-stripped total intracranial vault (TIV) extraction mask, designation of ventricular cerebrospinal fluid (vCSF), and removal of subtentorial structures. The SABRE component requires checking of image alignment along the anterior and posterior commissure (ACPC) plane, and identification of several anatomical landmarks required for regional parcellation. Finally, the Lesion-Seg component involves manual checking of the automatic lesion segmentation of subcortical hyperintensities (SH) for false positive errors.While on-site training of the LE pipeline is preferable, readily available visual teaching tools with interactive training images are a viable alternative. Developed to ensure a high degree of accuracy and reliability, the following is a step-by-step, video-guided, standardized protocol for LE''s manual procedures.     

Detection of the hip center in computer-assisted surgery: An in vitro assessment study

The HKA i.e. the angle between the hip, knee and ankle centers is a clinical parameter widely used in orthopedic surgery. It can be intraoperatively assessed with computer-assisted surgery navigation systems by computing the 3D location of these joint centers. The hip center is computed using functional methods but is defined by the experts as the anatomical center of the femoral head. The aim of this in vitro study is therefore to assess, first, the accuracy of these functional methods for the determination of the HKA and, second, their reproducibility. We have analyzed on six cadaveric lower limbs the accuracy and the reproducibility of functional methods and their impact on the HKA values. The anatomical hip center has been used as the reference value. The reproducibility is 5.2 mm for the determination of the functional hip centers. The average impact on the HKA is 1.2° (4° max). Despite a lack of reproducibility of the functional methods, the impact on the HKA is limited. The accuracy of the functional methods on the HKA can therefore be enough for some clinical applications.     

Spinal shape changes resulting from scoliotic spine surgical instrumentation expressed as intervertebral rotations and centers of rotation

This paper reports the changes in spinal shape resulting from scoliotic spine surgical instrumentation expressed as intervertebral rotations and centers of rotation. The objective is to test the hypothesis that the type of spinal instrumentation system (Cotrel-Dubousset versus Colorado) does not influence these motion parameters. Intervertebral rotations and centers of rotation of the scoliotic spines were computed from the pre- and post-operative radiographs of 82 patients undergoing spinal correction. The three-dimensional (3D) reconstruction of six anatomical landmarks was achieved for each of the thoracic and lumbar vertebrae. A least-squares approach based on singular value decomposition was used to calculate the rigid body transformation parameters. Average centers of rotation for all intervertebral levels are located in the neural canal at the mid-sagittal plane and approximately at the superior endplate level of the inferior vertebra. Intervertebral rotations have components in all planes: 6.7 degrees (frontal), 5.5 degrees (sagittal) and 4.5 degrees (transverse) RMS for all intervertebral levels. Nearly all intervertebral rotations and centers of rotation are not significantly different for the two instrumentation systems. Various intervertebral rotations and 3D reconstruction errors were simulated on a theoretical model of a lumbar functional unit to assess the proposed method. Intervertebral rotation errors were 1.7 degrees when simulating 3D errors of 3mm on the position of the landmarks. Maximum errors for the position of centers of rotation were below 1cm in the case of intervertebral rotations larger than 2.5 degrees (most cases), but were larger (38 mm) for small intervertebral rotations (<1 degrees ). The type of instrumentation system did not influence intervertebral rotations and centers of rotation. These results provide valuable data for the development and validation of simulation models for surgical instrumentation of idiopathic scoliosis.     

Development of a patient-specific anatomical foot model from structured light scan data

The use of anatomically accurate finite element (FE) models of the human foot in research studies has increased rapidly in recent years. Uses for FE foot models include advancing knowledge of orthotic design, shoe design, ankle–foot orthoses, pathomechanics, locomotion, plantar pressure, tissue mechanics, plantar fasciitis, joint stress and surgical interventions. Similar applications but for clinical use on a per-patient basis would also be on the rise if it were not for the high costs associated with developing patient-specific anatomical foot models. High costs arise primarily from the expense and challenges of acquiring anatomical data via magnetic resonance imaging (MRI) or computed tomography (CT) and reconstructing the three-dimensional models. The proposed solution morphs detailed anatomy from skin surface geometry and anatomical landmarks of a generic foot model (developed from CT or MRI) to surface geometry and anatomical landmarks acquired from an inexpensive structured light scan of a foot. The method yields a patient-specific anatomical foot model at a fraction of the cost of standard methods. Average error for bone surfaces was 2.53 mm for the six experiments completed. Highest accuracy occurred in the mid-foot and lowest in the forefoot due to the small, irregular bones of the toes. The method must be validated in the intended application to determine if the resulting errors are acceptable.     

Validation of imaging-based quantification of glenohumeral joint kinematics using an unmodified clinical biplane fluoroscopy system

Model-based tracking, using CT and biplane fluoroscopy, allows highly accurate quantification of glenohumeral motion and changes in the subacromial space. Previous investigators have used custom-built biplane fluoroscopes designed specifically for kinematic applications, which are available at few institutions and require FDA approval prior to clinical use. The aim of this study was to demonstrate the utility of an off-the-shelf clinical biplane fluoroscope for kinematic applications by validating model-based tracking for measurement of glenohumeral motion using an unmodified clinical system. Biplane images of each shoulder of a cadaver torso were acquired at various joint positions and during simulated movements along anatomical planes of motion. The pose of each humerus and scapula was determined using model-based tracking and compared to a bead-based gold standard. Error due to a temporal-offset between corresponding biplane images, characteristic of clinical biplane systems, was determined by comparison of measured and known relative position of 2 bead clusters of a phantom that was imaged while moved throughout the fluoroscopy image volume. Model-based tracking had global kinematic mean absolute errors of 0.27 mm and 0.29° (static), and 0.22–0.32 mm and 0.12–0.45° (dynamic). Glenohumeral mean absolute errors were 0.39 mm and 0.45° (static), and 0.36–0.42 mm and 0.41–0.48° (dynamic). The temporal-offset was predicted to add errors of 0.06–0.85 mm and 0.05–0.28° for cadaveric trials for the speeds examined. For defined speeds, sub-millimeter and sub-degree kinematic accuracy and precision were achieved using an unmodified clinical biplane fluoroscope for quantification of glenohumeral motion.     

MRI development and validation of two new predictive methods of glenohumeral joint centre location identification and comparison with established techniques

Identification of the centre of the glenohumeral joint (GHJ) is essential for three-dimensional (3D) upper limb motion analysis. A number of convenient, yet un-validated methods are routinely used to estimate the GHJ location in preference to the International Society of Biomechanics (ISB) recommended methods. The current study developed a new regression model, and simple 3D offset method for GHJ location estimation, employing easy to administer measures, and compared the estimates with the known GHJ location measured with magnetic resonance imaging (MRI). The accuracy and reliability of the new regression and simple 3D offset techniques were compared with six established predictive methods. Twenty subjects wore a 3D motion analysis marker set that was also visible in MRI. Immediately following imaging, they underwent 3D motion analysis acquisition. The GHJ and anatomical landmark positions of 15 participants were used to determine the new regression and simple 3D generic offset methods. These were compared for accuracy with six established methods using 10 subject's data. A cross validation on 5 participants not used for regression model development was also performed. Finally, 10 participants underwent a further two MRI's and subsequent 3D motion analysis analyses for inter-tester and intra-tester reliability quantification. When compared with any of the other established methods, our newly developed regression model found an average GHJ location closer to the actual MRI location, having an GHJ location error of 13±2 mm, and had significantly lower inter-tester reliability error, 6±4 mm (p<0.01).     

CT-based semi-automatic quantification of vertebral fracture restoration

Minimally invasive surgeries aiming to restore fractured vertebral body are increasing; therefore, our goals were to create a 3D vertebra reconstruction process and design clinical indices to assess the vertebral restoration in terms of heights, angles and volumes. Based on computed tomography (CT)-scan of the vertebral spine, a 3D reconstruction method as well as relevant clinical indices were developed. First, a vertebra initial solution requiring 5 min of manual adjustments is built. Then an image processing algorithm places this solution in the CT-scan images volume to adjust the model's nodes. On the vertebral body's anterior and posterior parts, nine robust heights, volume and endplate angle measurement methods were developed. These parameters were evaluated by reproducibility and accuracy studies. The vertebral body reconstruction accuracy was 1.0 mm; heights and volume accuracy were, respectively, 1.2 and 179 mm³. In conclusion, a 3D vertebra reconstruction process requiring little user time was proposed as well as 3D clinical indices assessing fractured and restored vertebra.     

Comparative assessment of bone pose estimation using Point Cluster Technique and OpenSim

Estimating the position of the bones from optical motion capture data is a challenge associated with human movement analysis. Bone pose estimation techniques such as the Point Cluster Technique (PCT) and simulations of movement through software packages such as OpenSim are used to minimize soft tissue artifact and estimate skeletal position; however, using different methods for analysis may produce differing kinematic results which could lead to differences in clinical interpretation such as a misclassification of normal or pathological gait. This study evaluated the differences present in knee joint kinematics as a result of calculating joint angles using various techniques. We calculated knee joint kinematics from experimental gait data using the standard PCT, the least squares approach in OpenSim applied to experimental marker data, and the least squares approach in OpenSim applied to the results of the PCT algorithm. Maximum and resultant RMS differences in knee angles were calculated between all techniques. We observed differences in flexion/extension, varus/valgus, and internal/external rotation angles between all approaches. The largest differences were between the PCT results and all results calculated using OpenSim. The RMS differences averaged nearly 5° for flexion/extension angles with maximum differences exceeding 15°. Average RMS differences were relatively small (< 1.08°) between results calculated within OpenSim, suggesting that the choice of marker weighting is not critical to the results of the least squares inverse kinematics calculations. The largest difference between techniques appeared to be a constant offset between the PCT and all OpenSim results, which may be due to differences in the definition of anatomical reference frames, scaling of musculoskeletal models, and/or placement of virtual markers within OpenSim. Different methods for data analysis can produce largely different kinematic results, which could lead to the misclassification of normal or pathological gait. Improved techniques to allow non-uniform scaling of generic models to more accurately reflect subject-specific bone geometries and anatomical reference frames may reduce differences between bone pose estimation techniques and allow for comparison across gait analysis platforms.     

Automatic localization of anatomical landmarks on the back surface and construction of a body-fixed coordinate system

A method for automatic measurement of anatomical landmarks on the back surface is presented. The landmarks correspond to the verteba prominens, the dimples of the posterior superior iliac spines and the sacrum point (beginning of rima ani), which are characterized by distinct surface curvature. The surface curvatures are calculated from rasterstereographic surface measurements. The procedure of isolating a region of interest for each landmark (surface segmentation) and the calculation of the landmark coordinates are described in detail. The accuracy of landmark localization was tested with serial rasterstereographs of 28 patients (with moderate idiopathic scoliosis). From the results the intrinsic accuracy of the method is estimated to be little more than 1 mm (depending on the sampling density of the surface measurement). Therefore, the landmarks may well be used for the objective definition of a body-fixed reference coordinate system. The accuracy is, however, dependent on the specific landmark and a minor influence of posture variations is observed.     

A New Method for the Analysis of Soft Tissues with Data Acquired under Field Conditions

Analyzing soft-tissue structures is particularly challenging due to the lack of homologous landmarks that can be reliably identified across time and specimens. This is particularly true when data are to be collected under field conditions. Here, we present a method that combines photogrammetric techniques and geometric morphometrics methods (GMM) to quantify soft tissues for their subsequent volumetric analysis. We combine previously developed methods for landmark data acquisition and processing with a custom program for volumetric computations. Photogrammetric methods are a particularly powerful tool for field studies as they allow for image acquisition with minimal equipment requirements and for the acquisition of the spatial coordinates of points (anatomical landmarks or others) from these images. For our method, a limited number of homologous landmarks, i.e., points that can be found on any specimen independent of space and time, and further distinctive points, which may vary over time, space and subject, are identified on two-dimensional photographs and their three-dimensional coordinates estimated using photogrammetric methods. The three-dimensional configurations are oriented by the spatial principal components (PCs) of the homologous points. Crucially, this last step orients the configuration such that x and y-information (PC1 and PC2 coordinates) constitute an anatomically-defined plane with the z-values (PC3 coordinate) in the direction of interest for volume computation. The z-coordinates are then used to estimate the volume of the tissue. We validate our method using a physical, geometric model of known dimensions and physical (wax) models designed to approximate perineal swellings in female macaques. To demonstrate the usefulness and potential of our method, we use it to estimate the volumes of Barbary macaque sexual swellings recorded in the field with video images. By analyzing both the artificial data and real monkey swellings, we validate our method''s accuracy and illustrate its potential for application in important areas of biological research.     

A novel functional calibration method for real-time elbow joint angles estimation with magnetic-inertial sensors

Magnetic-inertial measurement units (MIMUs) are often used to measure the joint angles between two body segments. To obtain anatomically meaningful joint angles, each MIMU must be computationally aligned (i.e., calibrated) with the anatomical rotation axes. In this paper, a novel four-step functional calibration method is presented for the elbow joint, which relies on a two-degrees-of-freedom elbow model. In each step, subjects are asked to perform a simple task involving either one-dimensional motions around some anatomical axes or a static posture. The proposed method was implemented on a fully portable wearable system, which, after calibration, was capable of estimating the elbow joint angles in real time. Fifteen subjects participated in a multi-session experiment that was designed to assess accuracy, repeatability and robustness of the proposed method. When compared against an optical motion capture system (OMCS), the proposed wearable system showed an accuracy of about 4° along each degree of freedom. The proposed calibration method was tested against different MIMU mountings, multiple repetitions and non-strict observance of the calibration protocol and proved to be robust against these factors. Compared to previous works, the proposed method does not require the wearer to maintain specific arm postures while performing the calibration motions, and therefore it is more robust and better suited for real-world applications.