Lotta Olivecrona

Assessing Wear of the Acetabular Cup Using Computed Tomography: an ex vivo Study

Purpose: To validate a clinically useful method for measuring acetabular cup wear using computed tomography (CT). Material and Methods: Eight uncemented acetabular cups were scanned twice ex vivo using CT. The linear penetration depth of the femoral component head into the cup and the thickness of the remaining polyethylene liner were measured in the CT volumes using dedicated software. Two independent examiners twice assessed each volume. The CT measurements were compared to direct measurements using a coordinate measuring device and micrometer measurements. Results: Accuracy of wear measurements expressed as penetration depth was ±0.6 and ±1.0 mm for the two examiners, respectively, with no significant differences between examiners, trials, and CT scans. Accuracy of measurements of remaining polyethylene was ±1.3 and ±1.0 mm, respectively, for the two examiners. Systematic differences between examiners were found, but no significant differences between trials and CT scans. These differences were due to different interpretations of metal artifacts in the volumes. Conclusion: The proposed CT method for evaluating wear as head penetration depth allows for reliable wear detection at a clinically relevant level. Measurements of remaining polyethylene on CT volumes are not as reliable as wear measurements owing to metal artifacts.

A new technique for diagnosis of acetabular cup loosening using computed tomography: preliminary experience in 10 patients.

Background and purpose Considerable migration of the acetabular cup is required for diagnosis of loosening by conventional radiography. We have developed a new clinically applicable method for assessment of cup loosening using computed tomography (CT). Patients and methods 10 patients scheduled for revision hip replacement due to suspected wear or loosening were scanned twice with CT under torsion loading of the prosthesis. Two independent examiners assessed each patient with respect to motion of the acetabular cup relative to the pelvis using CT volume registration. The CT measurements were compared to findings at revision surgery. Results The method was applicable in 8 of the 10 patients. 1 patient had a severe tremor. In 1 patient, surgery revealed that the hip was ankylotic due to massive ectopic bone formation. This left 8 patients that could be evaluated. 4 cups were loose at surgery, and 3 of these cups could be seen to be mobile by CT. 4 cups that were stable on revision were accurately diagnosed as not being mobile by CT. Movements of less than 1 millimeter between bone and prosthesis could not be distinguished from errors in CT acquisition and volume registration. There was good agreement between the two observers. Interpretation Movement of loose acetabular cups during torsion loading could be detected using CT volume registration. It was sensitive to cup movement in 3 out of 4 cases of loose cups. The method was specific and yielded no false positive results.

Standard orientation of the pelvis: validation on a model and ten patients:

Purpose: To validate an image post‐processing method for re‐orienting the pelvis in CT volumes to a standardized orientation in a model and in 10 patients. Material and Methods: Twenty‐four CT volumes of a pelvic model and 10 pairs of postoperative total hip arthroplasty (THA) patient CT scans were rotated to a defined pelvic standard orientation and the rotation was recorded. For precision, a test‐retest procedure was used. For accuracy, three exactly represented coordinate points were used. For clinical application, the standard orientation was used for calculating the direction of acetabular cup migration from a previous model study. Results: Precision of pelvic standard orientation, calculated as maximal directional error, was better than 1° in the model study and better than 1.5° in the patient study. Accuracy, expressed as angle between ideal and measured coordinate axes, was 0.1° for x, y, z axes. No measurable systematic errors were found. When applied to acetabular cup migration in the model, standardization of pelvic orientation had no significant effect on the measurements. Conclusion: Reorienting the pelvis during image post‐processing was shown to be accurate. It enables measurements relative to the pelvis and minimizes the dependency of patient positioning.

A new computed tomography-based radiographic method to detect early loosening of total wrist implants

Background: Diagnosis of loosening of total wrist implants is usually late using routine radiographs. Switching modality to computed tomography (CT) should aid in early diagnosis. Purpose: To propose and evaluate the accuracy of a new CT method for assessing loosening of the carpal component in total wrist arthroplasty. Material and Methods: A protocol encompassing volume registration of paired CT scans of patients with unexplained pain in a prosthetically replaced wrist (used in clinical routine) is presented. Scans are acquired as a dynamic examination under torsional load. Using volume registration, the carpal component of the prosthesis is brought into spatial alignment. After registration, prosthetic loosening is diagnosed by a shift in position of the bones relative to the prosthesis. This study is a preclinical validation of this method using a human cadaverous arm with a cemented total wrist implant and tantalum markers. Seven CT scans of the arm were acquired. The scans were combined into 21 pairs of CT volumes. The carpal component was registered in each scan pair, and the residual mismatch of the surrounding tantalum markers and bone was analyzed both visually and numerically. Results: The detection limit for prosthetic movement was less than 1 mm. Conclusion: The results of this study demonstrate that CT volume registration holds promise to improve detection of movement of the carpal component at an earlier stage than is obtainable with plain radiography.

Clinical application of a semiautomatic 3d fusion tool where automatic fusion techniques are difficult to use

The purpose of this paper is to demonstrate the clinical advantages of using semiautomatic volume registration where automatic registration is problematic due to large deformations, small bone anatomy, or extraneous structures. Examples are drawn from clinical cases of MRI/PET breast studies, CT angiography/SPECT cardiac studies, and total wrist arthroplasty. These types of studies should be contrasted with those involving the head, thorax, and pelvis where there is much less deformation and the existence of (some) large bones facilitates automatic matching.

Clinical Applications from Head to Toe Using a Semiautomatic 3D Inter/Intramodality Fusion Technique

Automated image registration techniques, particularly between modalities which clearly display anatomy and especially within the head, have become commonplace. Meanwhile advances in molecular imaging and the need to perform registration in other areas of body has driven the development of nonrigid and semiautomatic 3D volume fusion methods. This paper will focus on this latter class of 3D volume registration methods for a variety of clinical applications.