B. Godbout

3D reconstruction of the spine from biplanar X-rays using parametric models based on transversal and longitudinal inferences

Reconstruction methods from biplanar X-rays provide 3D analysis of spinal deformities for patients in standing position with a low radiation dose. However, such methods require an important reconstruction time and there is a clinical need for fast and accurate techniques. This study proposes and evaluates a novel reconstruction method of the spine from biplanar X-rays. The approach uses parametric models based on longitudinal and transversal inferences. A first reconstruction level, dedicated to routine clinical use, allows to get a fast estimate (reconstruction time: 2 min 30 s) of the 3D reconstruction and accurate clinical measurements. The clinical measurements precision (evaluated on asymptomatic subjects, moderate and severe scolioses) was between 1.2 degrees and 5.6 degrees. For a more accurate 3D reconstruction (complex pathologies or research purposes), a second reconstruction level can be obtained within a reduced reconstruction time (10 min) with a fine adjustment of the 3D models. The mean shape accuracy in comparison with CT-scan was 1.0 mm. The 3D reconstruction method precision was 1.8mm for the vertebrae position and between 2.3 degrees and 3.9 degrees for the orientation. With a reduced reconstruction time, an improved accuracy and precision and a method proposing two reconstruction levels, this approach is efficient for both clinical routine uses and research purposes.

Reliability of a quantification imaging system using magnetic resonance images to measure cartilage thickness and volume in human normal and osteoarthritic knees

OBJECTIVE The aim of this study was to evaluate the reliability of a software tool that assesses knee cartilage volumes using magnetic resonance (MR) images. The objectives were to assess measurement reliability by: (1) determining the differences between readings of the same image made by the same reader 2 weeks apart (test-retest reliability), (2) determining the differences between the readings of the same image made by different readers (between-reader agreement), and (3) determining the differences between the cartilage volume readings obtained from two MR images of the same knee image acquired a few hours apart (patient positioning reliability). METHODS Forty-eight MR examinations of the knee from normal subjects, patients with different stages of symptomatic knee osteoarthritis (OA), and a subset of duplicate images were independently and blindly quantified by three readers using the imaging system. The following cartilage areas were analyzed to compute volumes: global cartilage, medial and lateral compartments, and medial and lateral femoral condyles. RESULTS Between-reader agreement of measurements was excellent, as shown by intra-class correlation (ICC) coefficients ranging from 0.958 to 0.997 for global cartilage (P<0.0001), 0.974 to 0.998 for the compartments (P<0.0001), and 0.943 to 0.999 for the condyles(P<0.0001). Test-retest reliability of within-reader data was also excellent, with Pearson correlation coefficients ranging from 0.978 to 0.999 (P<0.0001). Patient positioning reliability was also excellent, with Pearson correlation coefficients ranging from 0.978 to 0.999 (P<0.0001). CONCLUSIONS The results of this study establish the reliability of this MR imaging system. Test-retest reliability, between-reader agreement, and patient positioning reliability were all extremely high. This study represents a first step in the overall validation of an imaging system designed to follow progression of human knee OA.

Computer-aided method for quantification of cartilage thickness and volume changes using MRI: validation study using a synthetic model

The primary objective of this study was to develop a computer-aided method for the quantification of three-dimensional (3-D) cartilage changes over time in knees with osteoarthritis (OA). We introduced a local coordinate system (LCS) for the femoral and tibial cartilage boundaries that provides a standardized representation of cartilage geometry, thickness, and volume. The LCS can be registered in different data sets from the same patient so that results can be directly compared. Cartilage boundaries are segmented from 3-D magnetic resonance (MR) slices with a semi-automated method and transformed into offset-maps , defined by the LCS. Volumes and thickness are computed from these offset-maps. Further anatomical labeling allows focal volumes to be evaluated in predefined subregions. The accuracy of the automated behavior of the method was assessed, without any human intervention, using realistic, synthetic 3-D MR images of a human knee. The error in thickness evaluation is lower than 0.12 mm for the tibia and femur. Cartilage volumes in anatomical subregions show a coefficient of variation ranging from 0.11% to 0.32%. This method improves noninvasive 3-D analysis of cartilage thickness and volume and is well suited for in vivo follow-up clinical studies of OA knees.

Surface reconstruction from planar x-ray images using moving least squares

Planar radiographs still are the gold standard for the measurement of the skeletal weight-bearing shape and posture. In this paper, we propose to use an as-rigid-as-possible deformation approach based on moving least squares to obtain 3D personalized bone models from planar x-ray images. Our prototype implementation is capable of performing interactive rate shape editing. The biplane reconstructions of both femur and vertebrae show a good accuracy when compared to CT-scan.

Assessment of femur geometrical parameters using EOS™ imaging technology in patients with atypical femur fractures; preliminary results

Atypical femur fractures (AFF) arise in the subtrochanteric and diaphyseal regions. Because of this unique distribution, we hypothesized that patients with AFF demonstrate specific geometrical variations of their lower limb whereby baseline tensile forces applied to the lateral cortex are higher and might favor the appearance of these rare stress fractures, when exposed to bisphosphonates. Using the low irradiation 2D-3D X-ray scanner EOS™ imaging technology we aimed to characterize and compare femur geometric parameters between women who sustained bisphosphonate-associated AFF and those who had experienced similar duration of exposure to bisphosphonates but did not sustain fractures. Conditional logistic regression models were constructed to estimate the association between selected geometric parameters and the occurrence of AFF. We identified 16 Caucasian women with AFF and recruited 16 ethnicity-, sex-, age-, height- and cumulative bisphosphonate exposure-matched controls from local osteoporosis clinics. Compared to controls, those with AFF had more lateral femur bowing (-3.2° SD [3.4] versus -0.8° SD [1.9] p=0.02). In regression analysis, lateral femur bowing was associated with the risk of AFF (aOR 1.54; 95% CI 1.04-2.28, p=0.03). Women who sustained a subtrochanteric AFF demonstrated a lesser femoral neck shaft angle (varus geometry) than those with a fracture at a diaphyseal site (121.9 [3.6]° versus 127.6 [7.2]°, p=0.07), whereas femur bowing was more prominent in those with a diaphyseal fracture compared to those with a subtrochanteric fracture (-4.3 [3.2]° versus -0.9 [2.7]°, p=0.07). Our analyses support that subjects with AFF exhibit femoral geometry parameters that result in higher tensile mechanical load on the lateral femur. This may play a critical role in the pathogenesis of AFF and requires further evaluation in a larger size population.

Coupling 2D/3D registration method and statistical model to perform 3D reconstruction from partial x-rays images data

3D reconstructions of the spine from a frontal and sagittal radiographs is extremely challenging. The overlying features of soft tissues and air cavities interfere with image processing. It is also difficult to obtain information that is accurate enough to reconstruct complete 3D models. To overcome these problems, the proposed method efficiently combines the partial information contained in two images from a patient with a statistical 3D spine model generated from a database of scoliotic patients. The algorithm operates through two simultaneous iterating processes. The first one generates a personalized vertebra model using a 2D/3D registration process with bone boundaries extracted from radiographs, while the other one infers the position and the shape of other vertebrae from the current estimation of the registration process using a statistical 3D model. Experimental evaluations have shown good performances of the proposed approach in terms of accuracy and robustness when compared to CT-scan.

3D shape reconstruction of bone from two x-ray images using 2D/3D non-rigid registration based on moving least-squares deformation

Several studies based on biplanar radiography technologies are foreseen as great systems for 3D-reconstruction applications for medical diagnoses. This paper proposes a non-rigid registration method to estimate a 3D personalized shape of bone models from two planar x-ray images using an as-rigid-as-possible deformation approach based on a moving least-squares optimization method. Based on interactive deformation methods, the proposed technique has the ability to let a user improve readily and with simplicity a 3D reconstruction which is an important step in clinical applications. Experimental evaluations of six anatomical femur specimens demonstrate good performances of the proposed approach in terms of accuracy and robustness when compared to CT-scan.

Fast 3D reconstruction of the spine from biplanar radiography: a diagnosis tool for routine scoliosis diagnosis and research in biomechanics

Reconstruction methods from biplanar radiography allow a 3D clinical analysis, for patients in standing position, with a low radiation dose. This low-dose and postural imaging modality is thus very interesting for scoliosis clinical diagnosis and research in biomechanics. Nevertheless, such applications require both accurate and fast 3D reconstruction methods. Fast approaches, based on statistical models (Pomero et al. 2004; Gille et al. 2007), allow to obtain an estimate of the spinal 3D reconstruction within 14min. However, this remains too tedious to be used in a clinical routine. The purpose of this study is to propose and evaluate a novel semi-automated 3D reconstruction method of the spine from biplanar radiography. This method relies on a parametric model of the spine using statistical inferences and automatic registration methods based on image processing. Two reconstruction levels are proposed: a first reconstruction level (‘Fast Spine’), providing a fast estimate of the 3D reconstruction and accurate clinical measurements, dedicated to a routine clinical use, and a more accurate second reconstruction level (‘Full Spine’) for applications in biomechanical research.

3D Elastic Registration of Vessel Lumen from IVUS Data on Biplane Angiography

Accurate reconstructions of vessels are important in the understanding of blood flow anomalies. We present a new elastic registration method to reconstruct the lumen of the femoral artery by fusion of Intravascular Ultrasound data and biplane angiography. The catheter path and pullback parameters are found by minimizing width discrepancy in the back-projections without the need for explicit catheter segmentation. Preliminary results on real subjects are promising and show the convergence of the algorithm.

Comparative study of scoliotic spines using a fast 3D reconstruction method from biplanar X-rays

Biplanar X-ray based methods allow the 3D reconstruction of a skeleton in a standing position with a low radiation dose compared with a CT-scan. With the development of biplanar radiography in a clinical routine use, fast and accurate reconstruction methods have been proposed, in particular for 3D reconstruction of the spine (Humbert et al.), with clinical measurements dedicated to diagnosis of scoliosis. Such fast methods allow us to carry out studies including numerous subjects, with various pathologies. Few comparative studies analysing scoliosis and its influence on conventional clinical parameters are proposed in literature. The purpose of this study is first to present and evaluate the fast reconstruction method proposed by Humbert et al. Then, the method will be used to perform a comparison of clinical measurements between different categories of idiopathic scoliosis. This study aims to verify the consistency of clinical measurements obtained from the 3D reconstruction methods in relation to literature, to evaluate the scoliosis influence on clinical measurements and finally to give normality indices to guide clinicians in their clinical diagnosis.