Michael P. Zeleznik

A Versatile Functional–Anatomic Image Fusion Method for Volume Data Sets

We describe and validate a volumetric three-dimensional registration method, and compare it to our previously validated two-dimensional/three-dimensional method. CT/MRI and SPECT data from 14 patients were interactively fused using a polynomial warping technique. Registration accuracy was confirmed visually and by a nonsignificant F value from multivariate analysis of the transformed landmarks, a significant difference of the squared sum of intensity differences between the transformed/untransformed and the reference volume both at the 0.05 (p > 0.05) confidence level and an average 31% improvement of the correlation coefficient and cross correlation. For the two-dimensional/three-dimensional method, ROI center-to-center distance ranged from 1.42 to 11.32 mm (for liver) with an average of 6.13 mm ± 3.09 mm. The average ROI overlap was 92.51% with a 95% confidence interval of 90.20–96.88%. The new method is superior because it operates on the true three-dimensional volume. Both methods give good registration results, take 10 to 30 min, and require anatomic knowledge.

Evaluation of a Semiautomatic 3D Fusion Technique Applied to Molecular Imaging and MRI Brain/Frame Volume Data Sets

A generally applicable 3D fusion method was evaluated using molecular imaging and MRI volumetric data sets from 15 brain tumor patients with stereotactic frames attached to their skull. Point pairs, placed on the frame only, were chosen, polynomial warping coefficients were generated to map voxels from one coordinate space to the other. The MRI frame was considered the reference structure and the standard for “correct” registration. An ANOVA test (p > 0.05) confirmed the point pair choice to be consistent. The 95% confidence interval for the t-test showed the measured distance difference between the registered volumes was within one MRI voxel. A further experiment was conducted to independently evaluate the brain registration based on testing for consistency of randomly selected interior/exterior points. A t-test result (p < 0.05) showed that the consistency (i.e., both interior or both exterior) before and after volume registration were significantly different. This fusion method may be a viable alternative when other methods fail.

Using PET/CT Bone Scan Dynamic Data to Evaluate Tibia Remodeling When a Taylor Spatial Frame Is Used: Short and Longer Term Differences.

Eighteen consecutive patients, treated with a Taylor Spatial Frame for complex tibia conditions, gave their informed consent to undergo Na18F− PET/CT bone scans. We present a Patlak-like analysis utilizing an approximated blood time-activity curve eliminating the need for blood aliquots. Additionally, standardized uptake values (SUV) derived from dynamic acquisitions were compared to this Patlak-like approach. Spherical volumes of interest (VOIs) were drawn to include broken bone, other (normal) bone, and muscle. The SUVm(t) (m = max, mean) and a series of slopes were computed as (SUVm(t i) − SUVm(t j))/(t i − t j), for pairs of time values t i and t j. A Patlak-like analysis was performed for the same time values by computing ((VOIp(t i)/VOIe(t i))−(VOIp(t j)/VOIe(t j)))/(t i − t j), where p = broken bone, other bone, and muscle and e = expected activity in a VOI. Paired comparisons between Patlak-like and SUVm slopes showed good agreement by both linear regression and correlation coefficient analysis (r = 84%, r s = 78%-SUVmax, r = 92%, and r s = 91%-SUVmean), suggesting static scans could substitute for dynamic studies. Patlak-like slope differences of 0.1 min−1 or greater between examinations and SUVmax differences of ~5 usually indicated good remodeling progress, while negative Patlak-like slope differences of −0.06 min−1 usually indicated poor remodeling progress in this cohort.

Validation of a 3D CT method for measurement of linear wear of acetabular cups

Background We evaluated the accuracy and repeatability of a 3D method for polyethylene acetabular cup wear measurements using computed tomography (CT). We propose that the method be used for clinical in vivo assessment of wear in acetabular cups. Material and methods Ultra-high molecular weight polyethylene cups with a titanium mesh molded on the outside were subjected to wear using a hip simulator. Before and after wear, they were (1) imaged with a CT scanner using a phantom model device, (2) measured using a coordinate measurement machine (CMM), and (3) weighed. CMM was used as the reference method for measurement of femoral head penetration into the cup and for comparison with CT, and gravimetric measurements were used as a reference for both CT and CMM. Femoral head penetration and wear vector angle were studied. The head diameters were also measured with both CMM and CT. The repeatability of the method proposed was evaluated with two repeated measurements using different positions of the phantom in the CT scanner. Results The accuracy of the 3D CT method for evaluation of linear wear was 0.51 mm and the repeatability was 0.39 mm. Repeatability for wear vector angle was 17°. Interpretation This study of metal-meshed hip-simulated acetabular cups shows that CT has the capacity for reliable measurement of linear wear of acetabular cups at a clinically relevant level of accuracy.

Motion analysis of total cervical disc replacements using computed tomography: Preliminary experience with nine patients and a model

Background Cervical total disc replacement (CTDR) is an alternative to anterior fusion. Therefore, it is desirable to have an accurate in vivo measurement of prosthetic kinematics and assessment of implant stability relative to the adjacent vertebrae. Purpose To devise an in vivo CT-based method to analyze the kinematics of cervical total disc replacements (CTDR), specifically of two prosthetic components between two CT scans obtained under different conditions. Material and Methods Nine patients with CTDR were scanned in flexion and extension of the cervical spine using a clinical CT scanner with a routine low-dose protocol. The flexion and extension CT volume data were spatially registered, and the prosthetic kinematics of two prosthetic components, an upper and a lower, was calculated and expressed in Euler angles and orthogonal linear translations relative to the upper component. For accuracy analysis, a cervical spine model incorporating the same disc replacement as used in the patients was also scanned and processed in the same manner. Results Analysis of both the model and patients showed good repeatability, i.e. within 2 standard deviations of the mean using the 95% limits of agreement with no overlapping confidence intervals. The accuracy analysis showed that the median error was close to zero. Conclusion The mobility of the cervical spine after total disc replacement can be effectively measured in vivo using CT. This method requires an appropriate patient positioning and scan parameters to achieve suitable image quality.

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.

In vivo and ex vivo measurement of polyethylene wear in total hip arthroplasty: Comparison of measurements using a CT algorithm, a coordinate-measuring machine, and a micrometer

Background — Determination of the amount of wear in a polyethylene liner following total hip arthroplasty (THA) is important for both the clinical care of individual patients and the development of new types of liners. Patients and methods — We measured in vivo wear of the polyethylene liner using computed tomography (CT) (obtained in the course of regular clinical care) and compared it to coordinate-measuring machine (CMM) readings. Also, changes in liner thickness of the same retrieved polyethylene liner were measured using a micrometer, and were compared to CT and CMM measurements. The distance between the centers of the acetabular cup and femoral head component was measured in 3D CT, using a semi-automatic analysis method. CMM readings were performed on each acetabular liner and data were analyzed using 3D computer-aided design software. Micrometer readings compared the thickest and thinnest regions of the liner. We analyzed 10 THA CTs and retrievals that met minimal requirements for CT slice thickness and explanted cup condition. Results — For the 10 cups, the mean difference between the CT readings and the CMM readings was -0.09 (–0.38 to 0.20) mm. This difference was not statistically significant (p = 0.6). Between CT and micrometer, the mean difference was 0.11 (–0.33 to 0.55) mm. This difference was not statistically significant (p = 0.6). Interpretation — Our results show that CT imaging is ready to be used as a tool in clinical wear measurement of polyethylene liners used in THA.

Model studies on segmental movement in lumbar spine using a semi-automated program for volume fusion.

Objective: To validate a new non-invasive CT method for measuring segmental translations in lumbar spine in a phantom using plastic vertebrae with tantalum markers and human vertebrae. Material and Methods: One hundred and four CT volumes were acquired of a phantom incorporating three lumbar vertebrae. Lumbar segmental translation was simulated by altering the position of one vertebra in all three cardinal axes between acquisitions. The CT volumes were combined into 64 case pairs, simulating lumbar segmental movement of up to 3 mm between acquisitions. The relative movement between the vertebrae was evaluated visually and numerically using a volume fusion image post-processing tool. Results were correlated to direct measurements of the phantom. Results: On visual inspection, translation of at least 1 mm or more could be safely detected and correlated with separation between the vertebrae in three dimensions. There were no significant differences between plastic and human vertebrae. Numerically, the accuracy limit for all the CT measurements of the 3D segmental translations was 0.56 mm (median: 0.12; range: −0.76 to +0.49 mm). The accuracy for the sagittal axis was 0.45 mm (median: 0.10; range: −0.46 to +0.62 mm); the accuracy for the coronal axis was 0.46 mm (median: 0.09; range: −0.66 to +0.69 mm); and the accuracy for the axial axis was 0.45 mm (median: 0.05; range: −0.72 to + 0.62 mm). The repeatability, calculated over 10 cases, was 0.35 mm (median: 0.16; range: −0.26 to +0.30 mm). Conclusion: The accuracy of this non-invasive method is better than that of current routine methods for detecting segmental movements. The method allows both visual and numerical evaluation of such movements. Further studies are needed to validate this method in patients.

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.

PACS Data Base Design

A PACS database must manage three different types of data; structured data in the form of patient/exam identification information, and unstructured data in the form of text and images. Queries based on the content of text documents as well as the content of images must be suported, in addition to those based on standard, well structured keys such as name, age and sex. We model the PACS database as three logically distinct databases, each supporting one of these data types, with mapping structures relating all three. Several design issues which have a bearing, both on these models and on physical implemtations, are discussed. Because image database systems are the least understood at this time, most of the paper focusses on the them. We briefly discuss current trends in structured and text databases, without discussing commercial systems, and then present some current methods of implementing image database systems.