Paul K. Commean

Volumetric measurement of renal cysts and parenchyma using MRI: phantoms and patients with polycystic kidney disease.

We have developed an MR method to measure the volumes of renal cysts and parenchyma in patients with polycystic kidney disease. Phantoms were designed to simulate polycystic kidneys. Four patients were recruited. MR scans were performed on the phantoms and patients. A stereology technique was applied for image segmentation and volume measurement. Volumetric measurement of renal cysts and parenchyma was accurate in phantom studies and reliable in both phantom and patient studies in these limited examples.

Facial surface scanner

An optical noncontact 3-D digitizing system developed to acquire, process, display, and replicate the surface of the human head is described. The modification of the digitizer to help plan and evaluate facial plastic surgery is discussed. The quality and accuracy of the images produced are examined, and some medically relevant results are considered.<<ETX>>

Improved Surgical Outcomes for Breast Cancer Patients Receiving Neoadjuvant Aromatase Inhibitor Therapy: Results from a Multicenter Phase II Trial

BACKGROUND Neoadjuvant aromatase inhibitor therapy has been reported to improve surgical outcomes for postmenopausal women with clinical stage II or III hormone receptor-positive breast cancer. A multicenter phase II clinical trial was conducted to investigate the value of this approach for US surgical practice. STUDY DESIGN One hundred fifteen postmenopausal women with >2 cm, estrogen receptor (ER) or progesterone receptor (PgR)-positive breast cancer were enrolled in a trial of 16 to 24 weeks of letrozole 2.5 mg daily before operation. RESULTS One hundred six patients were eligible for primary analysis, 96 underwent operations, 7 received chemotherapy after progressive disease, and 3 did not undergo an operation. Baseline surgical status was marginal for breast-conserving surgery (BCS) in 48 (45%), 47 were definitely ineligible for BCS (44%), and 11 were inoperable by standard mastectomy (10%). Overall Response Evaluation Criteria In Solid Tumors clinical response rate in the breast was 62%, with 12% experiencing progressive disease. Fifty percent underwent BCS, including 30 of 46 (65%) patients who were initially marginal for BCS and 15 of 39 (38%) patients who were initially ineligible for BCS. All 11 inoperable patients successfully underwent operations, including 3 (27%) who had BCS. Nineteen percent of patients undergoing mastectomy had a pathologic T1 tumor, suggesting that some highly responsive tumors were overtreated surgically. CONCLUSIONS Neoadjuvant aromatase inhibitor improves operability and facilitates BCS, but there was considerable variability in responsiveness. Better techniques to predict response, determine residual tumor burden before operation, and greater willingness to attempt BCS in responsive patients could additionally improve the rate of successful BCS.

Computer-Assisted 3D Reconstruction of Serial Sections of Cortical Bone to Determine the 3D Structure of Osteons

Abstract. The objective of this study was to create three-dimensional (3D) images for the histomorphological study of osteons. Medical imaging technology was used to register digitized 2D images of serial decalcified histological sections of bone, to segment the tissues of interest from the surrounding tissues, and to create 3D reconstructions from the segmented structures. Examination of the 3D reconstructions did not support suggestions in the literature that osteons have a spiraling organization. In contrast, the 3D reconstructions indicated that osteons have a complex pattern of organization that is dominated by branching. Examination of the reconstructions also suggested that osteons described in the literature as being dumbbell shaped are actually artifacts of the plane of sectioning. This study demonstrated the applicability of imaging and visualization technology developed for the 3D reconstruction of medical images to the reconstruction of digitized 2D images of serial sections of bone and additionally demonstrated the feasibility of using 3D reconstructions for the histomorphological study of osteons.

Interactive Separation of Segmented Bones in CT Volumes Using Graph Cut

We present a fast, interactive method for separating bones that have been collectively segmented from a CT volume. Given user-provided seed points, the method computes the separation as a multi-way cut on a weighted graph constructed from the binary, segmented volume. By properly designing and weighting the graph, we show that the resulting cut can accurately be placed at bone-interfaces using only a small number of seed points even when the data is noisy. The method has been implemented with an interactive graphical interface, and used to separate the 12 human foot bones in 10 CT volumes. The interactive tool produced compatible result with a ground-truth separation, generated by a completely manual labelling procedure, while reducing the human interaction time from a mean of 2.4 hours per volume in manual labelling down to approximately 18 minutes.

Accuracy and reliability testing of a portable soft tissue indentor

We have designed, built, and tested a portable indentor device that allows us to determine force/displacement (F/D) measurements on soft tissue in a clinical or research setting. The indentor system consists of a load cell mounted on a three-dimensional measurement device (Metrecom). The output of the load cell and the Metrecom are recorded and analyzed by software running on a notebook computer. The displacement calibration of the Metrecom gave an average error=0.005 mm [standard deviation (SD)=0.062)]. The force calibration of the load cell resulted in an average error=0.022 N (SD=0.049) and a linearity of 1.0062(R/sup 2/=0.9998). The indentor device was tested on six different human soft tissues by two different investigators. The interreliabilities and intrareliabilities were 0.99 [interclass correlation (ICC)] indicating that the results were repeatable by more than one investigator. F/D measurements from indentor testing on two materials were comparable to values measured using an Instron device (5.34 versus, 5.52 N/mm, and 0.98 versus 1.04 N/mm). The device was used to measure the soft tissue characteristics on the plantar surface of the foot of one subject. These data were used to calculate the effective Youngs modulus for the tissue using equations derived by Zheng et al. [1999] and indicated a wide range of values dependent upon the portion of the F/D curve used. All results indicate data from this portable indentor device are reliable, accurate, and sensitive enough to identify mechanical properties of human tissues.

Lower extremity residual limb slippage within the prosthesis

OBJECTIVE The ability to measure skin surface slippage relative to the internal wall of a lower extremity prosthesis under various loading conditions is important for evaluation of socket fit and function, and creation of finite element models. Skin surface three-dimensional (3D) shape measurements with tracking of fiducial displacements in situ under axial loading of the prosthesis have not previously been reported. Analysis of slippage within the prosthesis has been performed using a new experimental measurement method based on spiral x-ray computed tomography (SXCT) imaging. DESIGN Small lead markers were placed on the residuum of an adult with a below-knee amputation, and SXCT scans were obtained with the prosthesis in situ under two static axial loading conditions (44.5N and 178N). The 3D scan data were used to assess slippage with three methods: gross displacement of the tibia and distal end of the residuum; relative displacement of markers; and distance measurements between markers. RESULTS The markers affixed to the below-knee skin surface within the prosthesis were measured. The skin slipped from 2 to 6 mm relative to the internal prosthesis wall when an additional load of 133.5N was applied in the axial direction to the distal end of the prosthesis. The tibial remnant moved 10.0 mm distally relative to the prosthesis internal wall. CONCLUSION This method provides a feasible means for measuring residuum skin slippage relative to the prosthesis and skin deformation relative to tibia within an in situ prosthesis under load.

Quantification of facial surface change using a structured light scanner.

Three-dimensional surface changes that accompany facial surgical procedures were measured noninvasively and evaluated quantitatively. An optical three-dimensional surface scanner with 360-degree surface coverage of a subjects head and a subsecond data acquisition was used. The scanner employs six pairs of “white light” pattern projectors and digital TV cameras. A noncontact optical method to quantify facial surface morphology and objectively assess change resulting from reconstructive or cosmetic plastic surgery has been developed. This quantification technique was implemented and tested with the three-dimensional range scanner. This technique defines the entire surface of the head and face, as opposed to the conventional manual method of measuring surface points or facial landmarks. The method allows facial volume change assessment. The method was tested by repeatedly scanning a volunteer who was injected subcutaneously with known volumes of anesthetic solution. The measured and injected volumes were compared and showed little difference.

Anthropometric optical surface imaging system repeatability, precision, and validation

Disciplines using human body surface dimensions require accurate, repeatable measurements. This study presents a design for the analysis of repeatability, precision, and validation of a new anthropometric device. This model enables estimation of the proportion of the total variation attributable to each level of data collection. This model is applied to an analysis of repeatability, precision, and validation of the Cencit Imaging System, a new optical surface scanner. Twenty-seven facial landmarks were marked on 10 men and 10 women at two measurement sessions. Two images were scanned during each session, and each image was digitized twice. The Cencit Imaging System results were compared with a previously validated digitizer. The Cencit Imaging System was found to produce accurate, highly repeatable images. Much of the error in this study is attributable to human error in marking landmarks on the subjects. The new imaging system will prove useful in a variety of anthropometric applications.

Effect of Metatarsal Pad Placement on Plantar Pressure in People with Diabetes Mellitus and Peripheral Neuropathy

Background: Standard prevention and treatment strategies to decrease peak plantar pressure include a total contact insert with a metatarsal pad, but no clear guidelines exist to determine optimal placement of the pad with respect to the metatarsal head. The purpose of this study was to determine the effect of metatarsal pad location on peak plantar pressure in subjects with diabetes mellitus and peripheral neuropathy. Methods: Twenty subjects with diabetes mellitus, peripheral neuropathy, and a history of forefoot plantar ulcers were studied (12 men and eight women, mean age = 57 ± 9 years). CT determined the position of the metatarsal pad relative to metatarsal head and peak plantar pressures were measured on subjects in three footwear conditions: extra-depth shoes and a 1) total contact insert, 2) total contact insert and a proximal metatarsal pad, and 3) total contact insert and a distal metatarsal pad. The change in peak plantar pressure between shoe conditions was plotted and compared to metatarsal pad position relative to the second metatarsal head. Results: Compared to the total contact insert, all metatarsal pad placements between 6.1 mm to 10.6 mm proximal to the metatarsal head line resulted in a pressure reduction (average reduction = 32 ± 16%). Metatarsal pad placements between 1.8 mm distal and 6.1 mm proximal and between 10.6 mm proximal and 16.8 mm proximal to the metatarsal head line resulted in variable peak plantar pressure reduction (average reduction = 16 ± 21%). Peak plantar pressure increased when the metatarsal pad was located more than 1.8 mm distal to the metatarsal head line. Conclusions: Consistent peak plantar pressure reduction occurred when the metatarsal pad in this study was located between 6 to 11 mm proximal to the metatarsal head line. Pressure reduction lessened as the metatarsal pad moved outside of this range and actually increased if the pad was located too distal of this range. Computational models are needed to help predict optimal location of metatarsal pad with a variety of sizes, shapes, and material properties.