Jens A. Richolt

Femoral Morphology Due to Impingement Influences the Range of Motion in Slipped Capital Femoral Epiphysis

Femoroacetabular impingement due to metaphyseal prominence is associated with the slippage in patients with slipped capital femoral epiphysis (SCFE), but it is unclear whether the changes in femoral metaphysis morphology are associated with range of motion (ROM) changes or type of impingement. We asked whether the femoral head-neck junction morphology influences ROM analysis and type of impingement in addition to the slip angle and the acetabular version. We analyzed in 31 patients with SCFE the relationship between the proximal femoral morphology and limitation in ROM due to impingement based on simulated ROM of preoperative CT data. The ROM was analyzed in relation to degree of slippage, femoral metaphysis morphology, acetabular version, and pathomechanical terms of “impaction” and “inclusion.” The ROM in the affected hips was comparable to that in the unaffected hips for mild slippage and decreased for slippage of more than 30°. The limitation correlated with changes in the metaphysic morphology and changed acetabular version. Decreased head-neck offset in hips with slip angles between 30° and 50° had restricted ROM to nearly the same degree as in severe SCFE. Therefore, in addition to the slip angle, the femoral metaphysis morphology should be used as criteria for reconstructive surgery.

Affine adaptive filtering of CT data

A novel method for resampling and enhancing image data using multidimensional adaptive filters is presented. The underlying issue that this paper addresses is segmentation of image structures that are close in size to the voxel geometry. Adaptive filtering is used to reduce both the effects of partial volume averaging by resampling the data to a lattice with higher sample density and to reduce the image noise level. Resampling is achieved by constructing filter sets that have subpixel offsets relative to the original sampling lattice. The filters are also frequency corrected for ansisotropic voxel dimensions. The shift and the voxel dimensions are described by an affine transform and provides a model for tuning the filter frequency functions. The method has been evaluated on CT data where the voxels are in general non cubic. The in-plane resolution in CT image volumes is often higher by a factor of 3-10 than the through-plane resolution. The method clearly shows an improvement over conventional resampling techniques such as cubic spline interpolation and sinc interpolation.

Three-dimensional analysis of the proximal femur in patients with slipped capital femoral epiphysis based on computed tomography.

A three-dimensional (3D) analysis based on computed tomography was performed to study the 3D geometry of the proximal femur in cases of slipped capital femoral epiphysis (SCFE). For this purpose, new interactive software was developed to analyze hip joint geometry using 3D models without pelvis tilting and projected errors. Twenty-two patients, 8 girls and 14 boys, with a total of 30 slipped capital femoral epiphyses, were reviewed. In the affected hips, we observed a reduced femoral anteversion of 7.0° (vs. 12.7°) and a reduced femoral shaft neck angle of 134.2° (vs. 141.0°). In response to these results, we suggest that an SCFE is associated with reduced femoral anteversion and a reduced femoral shaft neck angle.

AnatomyBrowser: a Novel Approach to Visualization and Integration of Medical Information

In this article, we present a novel technique for visualization of three-dimensional (3D) surface models, as well as its implementation in a system called AnatomyBrowser. Using our approach, visualization of 3D surface models is performed in two separate steps: a pre-rendering step, in which the models are rendered and saved in a special format, and an actual display step, in which the final result of rendering is generated using information from the prerendering step. Whereas prerendering requires high-end graphics hardware, the final image generation and display can be implemented efficiently in software. Moreover, our current implementation of AnatomyBrowser interface uses the Java programming language and can therefore be readily run on a wide range of systems, including low-end computers with no special graphics hardware. In addition to visualization of 3D models and 2D slices, AnatomyBrowser provides a rich set of annotation and cross-referencing capabilities. We demonstrate several possible applications for AnatomyBrowser, including interactive anatomy atlases, surgery planning, and assistance in segmentation.

Tensor Controlled Local Structure Enhancement of CT Images for Bone Segmentation

This paper addresses the problem of segmenting bone from Computed Tomography (CT) data. In clinical practice, identification of bone is done by thresholding, a method which is simple and fast. Unfortunately, thresholding alone has significant limitations. In particular, segmentation of thin bone structures and of joint spaces is problematic. This problem is particularly severe for thin bones such as in the skull (the paranasal sinus and around the orbit). Another area where current techniques often fail is automatic, reliable and robust identification of individual bones, which requires precise separation of the joint spaces. This paper presents a novel solution to these problems based on three-dimensional filtering techniques. Improvement of the segmentation results in more accurate 3D models for the purpose of surgical planning and intraoperative navigation.

Development of the acetabulum in patients with slipped capital femoral epiphysis: a three-dimensional analysis based on computed tomography.

Orientation and shape of the acetabulum were determined by the use of three-dimensional reconstruction of computed tomography (CT) data sets in 22 patients with a total of 30 slipped capital femoral epiphyses. We developed an interactive three-dimensional software program to measure the anteversion and inclination of the acetabulum without projectional and pelvis-tilting errors. Furthermore, we determined the height, width, depth, volume, and surface of the acetabulum as parameters describing the acetabular shape. Comparison of the affected side with the contralateral unaffected hip showed no significant differences for acetabular orientation and shape. The relationship between the degree of the slip and the acetabular orientation was calculated. No correlation was found. Based on the results of this study, we conclude that the slipping of the capital femoral epiphysis has no influence on acetabular development.

Planning and Evaluation of Reorienting Osteotomies of the Proximal Femur in Cases of SCFE Using Virtual Three-Dimensional Models

Slipped Capital Femoral Epiphysis (SCFE) is a disease affecting the geometry of adolescent hips. Evaluation of the slippage as well planning of correction surgeries is a major three-dimensional problem. Therefore, the current clinical approach, which is based on biplanar plain radiographs, is not satisfying.

Impingement simulation of the hip in SCFE using 3D models.

OBJECTIVE Affecting as it does the geometry of adolescent hips, slipped capital femoral epiphysis (SCFE) and its evaluation represent a major three-dimensional problem. The current methods of clinical assessment-geometric measurements of the femur on plain radiographs or on axial computed tomographic (CT) cross-sections-address only one of the two joint components. MATERIALS AND METHODS We have developed a system to simulate motion of hip joints with physiologic joint contact. In our system, CT-based computer models of the femur, pelvis, etc., are fitted with oriented bounding boxes (OBBs) and manipulated. Collision detection algorithms control the hip motion, which, in this virtual joint, is based on the surface geometry of the joint partners rather than on a predefined fixed rotation center. RESULTS An illustrative case is presented to show the advantages of the new biomechanical evaluation method over conventional radiological assessments for SCFE. The proposed system provides remarkably high speed, and the necessary data can be prepared in a reasonable time. CONCLUSION The range-of-motion assessment provides the surgeon with information about the site and the impact of nonphysiologic contact in the hip joint. The information thus obtained can be valuable for indication and planning of corrective surgery in cases of SCFE.

AnatomyBrowser: A Framework for Integration of Medical Information

In this paper we present AnatomyBrowser, a framework for integration of images and textual information in medical applications. AnatomyBrowser allows the user to combine 3D surface models of anatomical structures, their cross-sectional slices, and the text available on the structures, while providing a rich set of cross-referencing and annotation capabilities. The 3D models of the structures are generated fully automatically from the segmented slices. The software is platform independent, yet is capable of utilizing available graphics resources. Possible applications include interactive anatomy atlases, image guided surgery and model based segmentation. The program is available on-line at http://www.ai.mit.edu/projects/anatomy.browser.

Quantitative evaluation of angular measurements on plain radiographs in patients with slipped capital femoral epiphysis: a 3-dimensional analysis of computed tomography-based computer models of 46 femora.

Background: In cases of slipped capital femoral epiphyses (SCFE) findings on plain radiographs help to determine the further necessary course of action. In severe cases possible surgical procedures are commonly indicated and planned using angular measurements on plain radiographs to describe the extent and direction of the slip. The aim of this study was to quantify the amount of angular errors deriving from this method. Methods: Data and imaging of 23 consecutive patients with SCFE (31 affected and 15 unaffected femora) were included in this study. We determined shaft-neck/shaft-physis angles on antero-posterior and torsional angles on lateral radiographs in a clinical setting. As a reference we enabled similar angular measurements on CT-based three-dimensional computer models of the same femora bearing no projectional errors and malpositioning problems. Results: In average, shaft-neck- and shaft-physis-angles were overestimated (6.5° and 10.1°) on plain radiographs and neck torsion underestimated (−15.7°). In general the variability was high, especially for neck and physeal torsional measurements with standard deviations of +/−11.8° and +/−16.7°. Three out of four torsional measurements on affected femora were outside a +/−10° window of error, about every third outside a +/−20° window. Conclusion: Our results suggest to be careful when using plain radiographs as a source to determine the slippage extent in SCFE. Before using a plain radiograph to reject or indicate and plan a correction osteotomy in an individual case of SCFE the surgeon should reassure that radiographic method and patient positioning provide a reproducible and accurate depiction of the femoral geometry. Level of Evidence: Level II; 23 consecutive patients with SCFE in the senior authors practice; evaluation of the reliability of angular measurements on plain radiographs; CT based 3D computer models of the same femora as a reference.