Josh Tan

CT Based Three-Dimensional Measurement of Orbit and Eye Anthropometry

PURPOSE To measure eye and orbit anthropometric variation within the normal population by using CT images and to determine the effects of age and sex on eye and orbit anthropometry. Quantification of eye and orbit anthropometric variation within the normal population and between persons of different age and sex is important in the prediction and prevention of eye injury. METHODS A systematic method was developed to align head CT images three dimensionally and to measure ocular and orbital parameters in 39 subjects. Twenty-four measurements were collected along the orbital rim, to quantify the orbital aperture. Protrusions of the brow and the eye were measured, along with relative distances, to describe location of the eye within the orbit. RESULTS The orbit widened with age, and significant relations were identified between orbital aperture and eye location measurements, both of which varied significantly between the sexes. CONCLUSIONS The comprehensive set of measurements collected in this study provides three-dimensional information on orbit geometry, as well as placement of the eye within the orbit. These measurements and the methodology used will contribute to the development of finite element models of the orbit and eye for computational modeling purposes and may be useful in the design of eye protection equipment.

A Multi-Modality Image Data Collection Protocol for Full Body Finite Element Model Development

This study outlines a protocol for image data collection acquired from human volunteers. The data set will serve as the foundation of a consolidated effort to develop the next generation full-body Finite Element Analysis (FEA) models for injury prediction and prevention. The geometry of these models will be based off the anatomy of four individuals meeting extensive prescreening requirements and representing the 5th and 50th percentile female, and the 50th and 95th percentile male. Target values for anthropometry are determined by literature sources. Because of the relative strengths of various modalities commonly in use today in the clinical and engineering worlds, a multi-modality approach is outlined. This approach involves the use of Computed Tomography (CT), upright and closed-bore Magnetic Resonance Imaging (MRI), and external anthropometric measurements. CT data provide sub-millimeter resolution and slice thickness of the subjects in the supine and an approximately seated position. Closed-bore MRI complements CT data by providing high-resolution images with improved contrast between soft tissues. MRI pulse sequences that image fat-water interfaces out-of-phase are used to enhance contrast and facilitate segmenting organ and muscle boundaries. Upright MRI data complement closed-bore data by enabling quantification of morphological changes that occur when a subject is oriented upright with respect to gravity. The final component in this suite of image data is a set of external anthropometry (EA) measurements. EA measurements include three-dimensional point cloud acquisition of external bony landmarks as well as surface contours. These data serve as a valuable geometric validation tool for the assembled full-body FEA models. Protocol development results, including preliminary image data sets, in-plane resolution and slice thickness achieved for each modality, pulse sequence designs for MRI acquisition protocols, and custom positioning systems used in image acquisition are presented. The approach outlined in this study is expected to provide sufficient data to develop models in both the seated and standing posture. This suite of imaging and anthropometry data will serve as a strong foundation for the collaborative development of a group of fullbody FEA models for injury prediction in the coming years. A Multi-Modality Image Data Collection Protocol for Full Body Finite Element Model Development

Microcomputed Tomography Characterization of Shoulder Osseous Deformity After Brachial Plexus Birth Palsy: A Rat Model Study

BACKGROUND Shoulder deformities are common secondary sequelae associated with brachial plexus birth palsy. The aim of the present study was to characterize three-dimensional glenohumeral deformity associated with brachial plexus birth palsy with use of microcomputed tomography scanning in a recently developed animal model. METHODS Brachial plexus birth palsy was produced by a right-sided neurotomy of the C5 and C6 nerve roots in seven five-day-old Sprague-Dawley rats. Microcomputed tomography scanning was performed when the rats were four months of age. Glenoid size, version, and inclination; humeral head size; and acromion-glenoid distance were measured. Normal shoulders of age-matched rats (n = 9) served as controls. Statistical analysis was performed with use of the unpaired two-tailed Student t test. RESULTS There were significant increases in glenoid retroversion (-7.6° ± 4.9° compared with 3.6° ± 2.1°; p = 0.038) and glenoid inclination (38.7° ± 7.3° compared with 11.2° ± 1.9°; p = 0.015) in the shoulders with simulated brachial plexus birth palsy in comparison with the normal, control shoulders. The glenohumeral joints were more medialized in the joints with simulated brachial plexus birth palsy as reflected by the acromion-glenoid distance measurement; however, the difference was not significant (3.20 ± 0.51 compared with 2.40 ± 0.18 mm; p = 0.12). Although the mean humeral head height and width measurements, on the average, were smaller in the brachial plexus birth palsy shoulders as compared with the normal, control shoulders, only the measurement of humeral head height was significantly different between the two groups (4.25 ± 2.02 compared with 4.97 ± 0.11 mm [p = 0.008] and 3.56 ± 0.27 compared with 4.19 ± 0.17 mm [p = 0.056], respectively). CONCLUSIONS In this animal model, rats with simulated brachial plexus birth palsy developed gross architectural joint distortion characterized by increased glenoid retroversion and inclination. In addition, humeral heads tended to be smaller four months after simulated brachial plexus birth palsy.

Opportunistic Measurement of Skeletal Muscle Size and Muscle Attenuation on Computed Tomography Predicts 1-Year Mortality in Medicare Patients

BACKGROUND Opportunistic assessment of sarcopenia on CT examinations is becoming increasingly common. This study aimed to determine relationships between CT-measured skeletal muscle size and attenuation with 1-year risk of mortality in older adults enrolled in a Medicare Shared Savings Program (MSSP). METHODS Relationships between skeletal muscle metrics and all-cause mortality were determined in 436 participants (52% women, mean age 75 years) who had abdominopelvic CT examinations. On CT images, skeletal muscles were segmented at the level of L3 using two methods: (a) all muscles with a threshold of -29 to +150 Hounsfield units (HU), using a dedicated segmentation software, (b) left psoas muscle using a free-hand region of interest tool on a clinical workstation. Muscle cross-sectional area (CSA) and muscle attenuation were measured. Cox regression models were fit to determine the associations between muscle metrics and mortality, adjusting for age, sex, race, smoking status, cancer diagnosis, and Charlson comorbidity index. RESULTS Within 1 year of follow-up, 20.6% (90/436) participants died. In the fully-adjusted model, higher muscle index and muscle attenuation were associated with lower risk of mortality. A one-unit standard deviation (SD) increase was associated with a HR = 0.69 (95% CI = 0.49, 0.96; p = .03) for total muscle index, HR = 0.67 (95% CI = 0.49, 0.90; p < .01) for psoas muscle index, HR = 0.54 (95% CI = 0.40, 0.74; p < .01) for total muscle attenuation, and HR = 0.79 (95% CI = 0.66, 0.95; p = .01) for psoas muscle attenuation. CONCLUSION In older adults, higher skeletal muscle index and muscle attenuation on abdominopelvic CT examinations were associated with better survival, after adjusting for multiple risk factors.