In-vivo measurement of dynamic joint motion using high speed biplane radiography and CT: application to canine ACL deficiency

Dynamic assessment of three-dimensional (3D) skeletal kinematics is essential for understanding normal joint function as well as the effects of injury or disease. This paper presents a novel technique for measuring in-vivo skeletal kinematics that combines data collected from high-speed biplane radiography and static computed tomography (CT). The goals of the present study were to demonstrate that highly precise measurements can be obtained during dynamic movement studies employing high frame-rate biplane video-radiography, to develop a method for expressing joint kinematics in an anatomically relevant coordinate system and to demonstrate the application of this technique by calculating canine tibio-femoral kinematics during dynamic motion. The method consists of four components: the generation and acquisition of high frame rate biplane radiographs, identification and 3D tracking of implanted bone markers, CT-based coordinate system determination, and kinematic analysis routines for determining joint motion in anatomically based coordinates. Results from dynamic tracking of markers inserted in a phantom object showed the system bias was insignificant (-0.02 mm). The average precision in tracking implanted markers in-vivo was 0.064 mm for the distance between markers and 0.31 degree for the angles between markers. Across-trial standard deviations for tibio-femoral translations were similar for all three motion directions, averaging 0.14 mm (range 0.08 to 0.20 mm). Variability in tibio-femoral rotations was more dependent on rotation axis, with across-trial standard deviations averaging 1.71 degrees for flexion/extension, 0.90 degree for internal/external rotation, and 0.40 degree for varus/valgus rotation. Advantages of this technique over traditional motion analysis methods include the elimination of skin motion artifacts, improved tracking precision and the ability to present results in a consistent anatomical reference frame.     

The video technique developed for measuring epicardial strains on guinea pig's left ventricle

Single-plain video used for measurements of epicardial strains is a technique that yields minor interference with the studied mechanical properties of the ventricle. Due to its low temporal resolution, the existing technique is, however, not appropriate for small animals. We questioned whether the technique could be improved enough to cope with higher heart rates and miniaturization necessary for experiments on rats, mice and guinea pigs. Therefore, we developed a high-speed video system and used it for measuring epicardial strains in guinea pig hearts in situ with the open chest. The improvement was achieved in video hardware (camera: Dalsa D6-0256; framegraber: EPIX PIXCI D32) and software, the markers (glowing acrylate crystals; diameter approximately 0.15 mm) and illumination (UVA light, OSRAM L). Three markers were attached onto the epicardium in the equatorial region of the left ventricular free wall, 1.5 mm apart, with fibrin glue. From their coordinates, we calculated two-dimensional finite strains with end diastole as the reference point. The accuracy of the displacement measurement of the technique and the error introduced by approximate-visual estimation of the left ventricle coordinate system were evaluated. The accuracy of the displacement measurement was +/-1.6 microm and the temporal resolution was 2 ms. Error due to approximate coordinate system orientation was +/-3% of the strain amplitude. The typical amplitude of strains was -0.06, -0.11 and 0.04 in circumferential, axial direction and in-plane shear, respectively. The improvements enable us to perform physiologically relevant measurements of epicardial deformations on guinea pig heart.     

Three-dimensional kinematics of the human knee during walking.

Three-dimensional kinematics of the tibiofemoral joint were studied during normal walking. Target markers were fixed to tibia and femur by means of intra-cortical traction pins. Radiographs of the lower limb were obtained to compute the position of the target markers relative to internal anatomical structures. High-speed cine cameras were used to measure three-dimensional coordinates of the target markers in five subjects walking at a speed of 1.2 m s-1. Relative motion between tibia and femur was resolved according to a joint coordinate system (JCS). The measurements have identified that substantial angular and linear motions occur about and along each of the JCS axes during walking. The results do not, however, support the traditional view that the so-called 'screw home' mechanism of the knee joint operates during gait.     

A novel validation and calibration method for motion capture systems based on micro-triangulation

Motion capture systems are widely used to measure human kinematics. Nevertheless, users must consider system errors when evaluating their results. Most validation techniques for these systems are based on relative distance and displacement measurements. In contrast, our study aimed to analyse the absolute volume accuracy of optical motion capture systems by means of engineering surveying reference measurement of the marker coordinates (uncertainty: 0.75 mm). The method is exemplified on an 18 camera OptiTrack Flex13 motion capture system. The absolute accuracy was defined by the root mean square error (RMSE) between the coordinates measured by the camera system and by engineering surveying (micro-triangulation). The original RMSE of 1.82 mm due to scaling error was managed to be reduced to 0.77 mm while the correlation of errors to their distance from the origin reduced from 0.855 to 0.209. A simply feasible but less accurate absolute accuracy compensation method using tape measure on large distances was also tested, which resulted in similar scaling compensation compared to the surveying method or direct wand size compensation by a high precision 3D scanner. The presented validation methods can be less precise in some respects as compared to previous techniques, but they address an error type, which has not been and cannot be studied with the previous validation methods.     

Accuracy of an optical active-marker system to track the relative motion of rigid bodies

The measurement of relative motion between two moving bones is commonly accomplished for in vitro studies by attaching to each bone a series of either passive or active markers in a fixed orientation to create a rigid body (RB). This work determined the accuracy of motion between two RBs using an Optotrak optical motion capture system with active infrared LEDs. The stationary noise in the system was quantified by recording the apparent change in position with the RBs stationary and found to be 0.04 degrees and 0.03 mm. Incremental 10 degrees rotations and 10-mm translations were made using a more precise tool than the Optotrak. Increasing camera distance decreased the precision or increased the range of values observed for a set motion and increased the error in rotation or bias between the measured and actual rotation. The relative positions of the RBs with respect to the camera-viewing plane had a minimal effect on the kinematics and, therefore, for a given distance in the volume less than or close to the precalibrated camera distance, any motion was similarly reliable. For a typical operating set-up, a 10 degrees rotation showed a bias of 0.05 degrees and a 95% repeatability limit of 0.67 degrees. A 10-mm translation showed a bias of 0.03 mm and a 95% repeatability limit of 0.29 mm. To achieve a high level of accuracy it is important to keep the distance between the cameras and the markers near the distance the cameras are focused to during calibration.     

A new in vivo technique for determination of 3D kinematics and contact areas of the patello-femoral and tibio-femoral joint

Patello-femoral disorders are often caused by changes of patello-femoral and/or tibio-femoral kinematics. However, until now there has been no quantitative in vivo technique, that is able to obtain 3D kinematics and contact areas of all knee compartments simultaneously on a non-invasive basis. The aim of this study was therefore to develop and apply a technique which allows for determination of 3D kinematics and contact areas of the patello-femoral and tibio-femoral joint during different knee flexion angles and under neuromuscular activation patterns. One knee of each of the 10 healthy volunteers was examined in an open MR system under flexing isometric muscle activity at 30 degrees and 90 degrees. Three-dimensional kinematics and contact areas of the patello-femoral and tibio-femoral joints were analyzed by 3D image postprocessing. The reproducibility of the imaging technique yielded a coefficient of variation of 4.6% for patello-femoral, 4.7% for femoro-tibial displacement and 8.6% for contact areas. During knee flexion (30-90 degrees ), patella tilt (opened to medial) decreased (8.8+/-3.4 degrees vs. 4.6+/-3.1 degrees, p<0.05), while lateral patellar shift increased significantly (1.6+/-2.3mm vs. 3.4+/-3.0mm, p<0.05). Furthermore, a significant posterior translation and external rotation of the femur relative to the tibia was observed. Patello-femoral contact areas increased significantly in size (134+/-60mm(2) vs. 205+/-96 mm(2)) during knee flexion. This technique shows a high reproducibility and provides physiologic in vivo data of 3D kinematics and contact areas of the patello-femoral and the tibio-femoral joint during knee flexion. This allows for advanced in vivo diagnostics, and may help to improve therapy of patello-femoral disorders in the future.     

Accuracy map of an optical motion capture system with 42 or 21 cameras in a large measurement volume

Optical motion capture is commonly used in biomechanics to measure human kinematics. However, no studies have yet examined the accuracy of optical motion capture in a large capture volume (>100 m³), or how accuracy varies from the center to the extreme edges of the capture volume. This study measured the dynamic 3D errors of an optical motion capture system composed of 42 OptiTrack Prime 41 cameras (capture volume of 135 m³) by comparing the motion of a single marker to the motion reported by a ThorLabs linear motion stage. After spline interpolating the data, it was found that 97% of the capture area had error below 200 μm. When the same analysis was performed using only half (21) of the cameras, 91% of the capture area was below 200 μm of error. The only locations that exceeded this threshold were at the extreme edges of the capture area, and no location had a mean error exceeding 1 mm. When measuring human kinematics with skin-mounted markers, uncertainty of marker placement relative to underlying skeletal features and soft tissue artifact produce errors that are orders of magnitude larger than the errors attributed to the camera system itself. Therefore, the accuracy of this OptiTrack optical motion capture system was found to be more than sufficient for measuring full-body human kinematics with skin-mounted markers in a large capture volume (>100 m³).     

In-air versus underwater comparison of 3D reconstruction accuracy using action sport cameras

Action sport cameras (ASC) have achieved a large consensus for recreational purposes due to ongoing cost decrease, image resolution and frame rate increase, along with plug-and-play usability. Consequently, they have been recently considered for sport gesture studies and quantitative athletic performance evaluation. In this paper, we evaluated the potential of two ASCs (GoPro Hero3+) for in-air (laboratory) and underwater (swimming pool) three-dimensional (3D) motion analysis as a function of different camera setups involving the acquisition frequency, image resolution and field of view. This is motivated by the fact that in swimming, movement cycles are characterized by underwater and in-air phases what imposes the technical challenge of having a split volume configuration: an underwater measurement volume observed by underwater cameras and an in-air measurement volume observed by in-air cameras. The reconstruction of whole swimming cycles requires thus merging of simultaneous measurements acquired in both volumes. Characterizing and optimizing the instrumental errors of such a configuration makes mandatory the assessment of the instrumental errors of both volumes.In order to calibrate the camera stereo pair, black spherical markers placed on two calibration tools, used both in-air and underwater, and a two-step nonlinear optimization were exploited. The 3D reconstruction accuracy of testing markers and the repeatability of the estimated camera parameters accounted for system performance. For both environments, statistical tests were focused on the comparison of the different camera configurations. Then, each camera configuration was compared across the two environments. In all assessed resolutions, and in both environments, the reconstruction error (true distance between the two testing markers) was less than 3mm and the error related to the working volume diagonal was in the range of 1:2000 (3×1.3×1.5 m³) to 1:7000 (4.5×2.2×1.5 m³) in agreement with the literature. Statistically, the 3D accuracy obtained in the in-air environment was poorer (p<10⁻⁵) than the one in the underwater environment, across all the tested camera configurations. Related to the repeatability of the camera parameters, we found a very low variability in both environments (1.7% and 2.9%, in-air and underwater). This result encourage the use of ASC technology to perform quantitative reconstruction both in-air and underwater environments.     

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.     

Assessment of screw displacement axis accuracy and repeatability for joint kinematic description using an electromagnetic tracking device

Screw displacement axes (SDAs) have been employed to describe joint kinematics in biomechanical studies. Previous reports have investigated the accuracy of SDAs combining various motion analysis techniques and smoothing procedures. To our knowledge, no study has assessed SDA accuracy describing the relative movement between adjacent bodies with an electromagnetic tracking system. This is important, since in relative motion, neither body is fixed and consequently sensitivity to potential measurement errors from both bodies may be significant. Therefore, this study assessed the accuracy of SDAs for describing relative motion between two moving bodies. We analyzed numerical simulated data, and physical experimental data recorded using a precision jig and electromagnetic tracking device. The numerical simulations demonstrated SDA position accuracy (p=0.04) was superior for single compared to relative body motion, whereas orientation accuracy (p=0.2) was similar. Experimental data showed data-filtering (Butterworth filter) improved SDA position and orientation accuracies for rotation magnitudes smaller or equal to 5.0 degrees, with no effect at larger rotation magnitudes (p<0.05). This suggests that in absence of a filter, SDAs should only be calculated at rotations of greater than 5.0 degrees. For rotation magnitudes of 0.5 degrees (5.0 degrees ) about the SDA, SDA position and orientation error measurements determined from filtered experimental data were 3.75+/-0.30 mm (3.31+/-0.21 mm), and 1.10+/-0.04 degrees (1.04+/-0.03 degrees ), respectively. Experimental accuracy values describing the translation along and rotation about the SDA, were 0.06+/-0.00 mm and 0.09+/-0.01 degrees, respectively. These small errors establish the capability of SDAs to detect small translations, and rotations. In conclusion, application of SDAs should be a useful tool for describing relative motion in joint kinematic studies.     

A television/computer three-dimensional surface shape measurement system

An optical scanner is described which has been designed primarily for the measurement of human back shape. A projector and television camera were mounted together in a box which could rotate about a horizontal axis. The projector shone a horizontal plane of light, which was viewed at an angle from below by the television camera, linked directly to a minicomputer. The shape of the line of light formed by the plane as it fell on an object, together with a knowledge of the geometry of the system, enabled three-dimensional coordinates of points on the line to be calculated. A record of a surface shape was built up by scanning the object in about 2 s. Calibration of the system was achieved by scanning an object of known dimensions. Sets of algorithms are described which derive geometric parameters from the calibration scan and which sort surface shape coordinates, outline them and detect special markers from the surface shape scan. The accuracy of measurement exceeded the design aim of +/- 3 mm in each axis within a volume of 400 mm x 500 mm x 300 mm.     

In situ comparison of A-mode ultrasound tracking system and skin-mounted markers for measuring kinematics of the lower extremity

Skin-mounted marker based motion capture systems are widely used in measuring the movement of human joints. Kinematic measurements associated with skin-mounted markers are subject to soft tissue artifacts (STA), since the markers follow skin movement, thus generating errors when used to represent motions of underlying bone segments. We present a novel ultrasound tracking system that is capable of directly measuring tibial and femoral bone surfaces during dynamic motions, and subsequently measuring six-degree-of-freedom (6-DOF) tibiofemoral kinematics. The aim of this study is to quantitatively compare the accuracy of tibiofemoral kinematics estimated by the ultrasound tracking system and by a conventional skin-mounted marker based motion capture system in a cadaveric experimental scenario. Two typical tibiofemoral joint models (spherical and hinge models) were used to derive relevant kinematic outcomes. Intra-cortical bone pins equipped with optical markers were inserted in the tibial and femoral bones to serve as a reference to provide ground truth kinematics. The ultrasound tracking system resulted in lower kinematic errors than the skin-mounted markers (the ultrasound tracking system: maximum root-mean-square (RMS) error 3.44° for rotations and 4.88 mm for translations, skin-mounted markers with the spherical joint model: 6.32° and 6.26 mm, the hinge model: 6.38° and 6.52 mm). Our proposed ultrasound tracking system has the potential of measuring direct bone kinematics, thereby mitigating the influence and propagation of STA. Consequently, this technique could be considered as an alternative method for measuring 6-DOF tibiofemoral kinematics, which may be adopted in gait analysis and clinical practice.     

In vivo measurement of the dynamic 3-D kinematics of the ovine stifle joint

The ovine stifle joint is a promising animal model for investigation of joint mechanobiology. A method for in vivo measurement of dynamic 3-D kinematics of the ovine stifle joint is described (accuracy: 0.36 +/- 0.39 mm). Inter-subject variability in kinematics is greater than both intra-subject and inter-session variability. For future studies in which joint kinematics are measured prior to and following controlled orthopaedic interventions, pooling of data should be avoided and each subject should act as its own control.     

Evaluation of an electromagnetic position tracking device for measuring in vivo, dynamic joint kinematics

An electromagnetic position tracking device was evaluated to determine its static and dynamic accuracy and reliability for applications related to measuring in vivo joint kinematics. The device detected the position and orientation of small coiled sensors, maintained in an electromagnetic field. System output was measured against known translations or rotations throughout the measurement volume. Average translational errors during static testing were 0.1 +/- 0.04, 0.2 +/- 0.17, and 0.8 +/- 0.81 mm (mean+/-SD) for sensors 50, 300, and 550 mm away from the field generator, respectively. Average rotational errors were 0.4 +/- 0.31 degrees, 0.4 +/- 0.21 degrees, and 0.9 +/- 0.85 degrees (mean +/- SD) for sensors located at the same distances. Since we intended to use this system in an animal walking on a treadmill, we incrementally moved the sensors under various treadmill conditions. The effects of treadmill operation on translational accuracy were found to be negligible. The effects of dynamic motions on sensor-to-sensor distance were also assessed for future data collection in the animal. Sensor-to-sensor distance showed standard deviations of 2.6 mm and a range of 13 mm for the highest frequency tested (0.23 Hz). We conclude that this system is useful for static or slow dynamic motions, but is of limited use for obtaining gait kinematics at higher speeds.     

Non-homogeneous analysis of three-dimensional transmural finite deformation in canine ventricular myocardium

A new method has been developed for analyzing transmural distributions of finite deformation in canine ventricular myocardium without the need to assume that the strain in a finite volume of the wall is homogeneous. The three-dimensional nodal geometric parameters of bilinear-cubic or bilinear-quadratic finite elements are fitted by least squares to the measured coordinates of 12-18 radiopaque markers implanted in the left ventricular free wall. For six dog hearts, root-mean-squared errors in the fitted in-plane coordinates ranged from 0.079-0.556 mm in the end-diastolic reference state and 0.142-0.622 mm at end-systole. The corresponding error ranges in the radial coordinate were 0.042-0.264 mm at end-diastole and 0.106-0.279 mm at end-systole. Smoothly continuous transmural profiles of wall strain computed as the element deformed during the cardiac cycle from end-diastole to end-systole showed good agreement with the discrete results of conventional homogeneous analysis. Using the kinematics of a thick-walled incompressible cylinder, overall absolute errors due to the non-homogeneity of myocardial deformation were found to be reduced in the new analysis by 30-35% for typical experimental parameters. Overall relative errors were also reduced (from 23 to 20%). Since measurement errors in the reconstructed marker coordinates were spatially smoothed by the fitting procedure, noise in the computed deformations was also substantially attenuated, and transmural gradients of three-dimensional strain components could be obtained with improved accuracy. Hence physiological factors affected by transmural stress and strain distributions, such as myocardial blood flow, ischemia and hypertrophy, may be better understood.     

Soft-tissue artefact assessment during step-up using fluoroscopy and skin-mounted markers

When measuring knee kinematics with skin-mounted markers, soft tissue and structures surrounding the knee hide the actual underlying segment kinematics. Soft-tissue artefacts can be reduced when plate-mounted markers or marker trees are used instead of individual unconstrained mounted markers. The purpose of this study was to accurately quantify the soft-tissue artefacts and to compare two marker cluster fixation methods by using fluoroscopy of knee motion after total knee arthroplasty during a step-up task. Ten subjects participated 6 months after their total knee arthroplasty. The patients were randomised into (1) a plate-mounted marker group and (2) a strap-mounted marker group. Fluoroscopic data were collected during a step-up motion. A three-dimensional model fitting technique was used to reconstruct the in vivo 3-D positions of the markers and the implants representing the bones. The measurement errors associated with the thigh were generally larger (maximum translational error: 17mm; maximum rotational error 12 degrees ) than the measurement errors for the lower leg (maximum translational error: 11mm; maximum rotational error 10 degrees ). The strap-mounted group showed significant more translational errors than the plate-mounted group for both the shank (respectively, 3+/-2.2 and 0+/-2.0mm, p = 0.025) and the thigh (2+/-2.0 and 0+/-5.9mm, p = 0.031). The qualitative conclusions based on interpretation of the calculated estimates of effects within the longitudinal mixed-effects modelling evaluation of the data for the two groups (separately) were effectively identical. The soft-tissue artefacts across knee flexion angle could not be distinguished from zero for both groups. For all cases, recorded soft-tissue artefacts were less variable within subjects than between subjects. The large soft-tissue artefacts, when using clustered skin markers, irrespective of the fixation method, question the usefulness of parameters found with external movement registration and clinical interpretation of stair data in small patient groups.     

Systematic accuracy and precision analysis of video motion capturing systems--exemplified on the Vicon-460 system

With rising demand on highly accurate acquisition of small motion the use of video-based motion capturing becomes more and more popular. However, the performance of these systems strongly depends on a variety of influencing factors. A method was developed in order to systematically assess accuracy and precision of motion capturing systems with regard to influential system parameters. A calibration and measurement robot was designed to perform a repeatable dynamic calibration and to determine the resultant system accuracy and precision in a control volume investigating small motion magnitudes (180x180x150mm(3)). The procedure was exemplified on the Vicon-460 system. Following parameters were analyzed: Camera setup, calibration volume, marker size and lens filter application. Equipped with four cameras the Vicon-460 system provided an overall accuracy of 63+/-5mum and overall precision (noise level) of 15mum for the most favorable parameter setting. Arbitrary changes in camera arrangement revealed variations in mean accuracy between 76 and 129mum. The noise level normal to the cameras' projection plane was found higher compared to the other coordinate directions. Measurements including regions unaffected by the dynamic calibration reflected considerably lower accuracy (221+/-79mum). Lager marker diameters led to higher accuracy and precision. Accuracy dropped significantly when using an optical lens filter. This study revealed significant influence of the system environment on the performance of video-based motion capturing systems. With careful configuration, optical motion capturing provides a powerful measuring opportunity for the majority of biomechanical applications.     

A novel methodology to reproduce previously recorded six-degree of freedom kinematics on the same diarthrodial joint

The objective of this study was to develop a novel method to more accurately reproduce previously recorded 6-DOF kinematics of the tibia with respect to the femur using robotic technology. Furthermore, the effect of performing only a single or multiple registrations and the effect of robot joint configuration were investigated. A single registration consisted of registering the tibia and femur with respect to the robot at full extension and reproducing all kinematics while multiple registrations consisted of registering the bones at each flexion angle and reproducing only the kinematics of the corresponding flexion angle. Kinematics of the knee in response to an anterior (134 N) and combined internal/external (+/-10 N m) and varus/valgus (+/-5 N m) loads were collected at 0 degrees , 15 degrees , 30 degrees , 60 degrees , and 90 degrees of flexion. A six axes, serial-articulated robotic manipulator (PUMA Model 762) was calibrated and the working volume was reduced to improve the robot's accuracy. The effect of the robot joint configuration was determined by performing single and multiple registrations for three selected configurations. For each robot joint configuration, the accuracy in position of the reproduced kinematics improved after multiple registrations (0.7+/-0.3, 1.2+/-0.5, and 0.9+/-0.2 mm, respectively) when compared to only a single registration (1.3+/-0.9, 2.0+/-1.0, and 1.5+/-0.7 mm, respectively) (p<0.05). The accuracy in position of each robot joint configuration was unique as significant differences were detected between each of the configurations. These data demonstrate that the number of registrations and the robot joint configuration both affect the accuracy of the reproduced kinematics. Therefore, when using robotic technology to reproduce previously recorded kinematics, it may be necessary to perform these analyses for each individual robotic system and for each diarthrodial joint, as different joints will require the robot to be placed in different robot joint configurations.     

MRI vs CT-based 2D-3D auto-registration accuracy for quantifying shoulder motion using biplane video-radiography

Biplane 2D-3D registration approaches have been used for measuring 3D, in vivo glenohumeral (GH) joint kinematics. Computed tomography (CT) has become the gold standard for reconstructing 3D bone models, as it provides high geometric accuracy and similar tissue contrast to video-radiography. Alternatively, magnetic resonance imaging (MRI) would not expose subjects to radiation and provides the ability to add cartilage and other soft tissues to the models. However, the accuracy of MRI-based 2D-3D registration for quantifying glenohumeral kinematics is unknown. We developed an automatic 2D-3D registration program that works with both CT- and MRI-based image volumes for quantifying joint motions. The purpose of this study was to use the proposed 2D-3D auto-registration algorithm to describe the humerus and scapula tracking accuracy of CT- and MRI-based registration relative to radiostereometric analysis (RSA) during dynamic biplanar video-radiography. The GH kinematic accuracy (RMS error) was 0.6–1.0 mm and 0.6–2.2° for the CT-based registration and 1.4–2.2 mm and 1.2–2.6° for MRI-based registration. Higher kinematic accuracy of CT-based registration was expected as MRI provides lower spatial resolution and bone contrast as compared to CT and suffers from spatial distortions. However, the MRI-based registration is within an acceptable accuracy for many clinical research questions.