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Implementation of digital stereo imaging for analysis of metaphyses and joints in skeletal collections.

The surface structure of the growing portion of bones, called the metaphysis, contains clues about the locomotor characteristics of various species. Present methods of capturing this anthropologically interesting surface are time-consuming and subject to human error. The research implements a digital stereo imaging technique for bone metaphyses and joints in skeletal collections. The corresponding points in two images collected from different angles are determined using an area-based correlation matching method. The depths of matched points are computed from the difference in location of the points in the two images. The paper presents a practical implementation of computer vision for anthropology using an 80286-based personal computer, a camera and a video digitiser. The stereo matching algorithm, a practical implementation of classical stereo imaging methods, takes less than 1 min and produces reasonable representations of mammal bones. The accuracy of the depth measurements ranged from 0.7 to 12 per cent for 45-150 cm object-camera distances. False matches occurred in approximately 6 per cent of the total matched points.

Animals↗

Pelvis and lower limb anatomical landmark calibration precision and its propagation to bone geometry and joint angles.

Human movement analysis using stereophotogrammetry is based on the reconstruction of the instantaneous laboratory position of selected bony anatomical landmarks (AL). For this purpose, knowledge of an AL's position in relevant bone-embedded frames is required. Because ALs are not points but relatively large and curved areas, their identification by palpation or other means is subject to both intra- and inter-examiner variability. In addition, the local position of ALs, as reconstructed using an ad hoc experimental procedure (AL calibration), is affected by photogrammetric errors. The intra- and inter-examiner precision with which local positions of pelvis and lower limb palpable bony ALs can be identified and reconstructed were experimentally assessed. Six examiners and two subjects participated in the study. Intra- and inter-examiner precision (RMS distance from the mean position) resulted in the range 6-21 mm and 13-25 mm, respectively. Propagation of the imprecision of ALs to the orientation of bone-embedded anatomical frames and to hip, knee and ankle joint angles was assessed. Results showed that this imprecision may cause distortion in joint angle against time functions to the extent that information relative to angular movements in the range of 10 degrees or lower may be concealed. Bone geometry parameters estimated using the same data showed that the relevant precision does not allow for reliable bone geometry description. These findings, together with those relative to skin movement artefacts reported elsewhere, assist the human movement analyst's consciousness of the possible limitations involved in 3D movement analysis using stereophotogrammetry and call for improvements of the relevant experimental protocols.

Biomedical Engineering↗

Implementation and application of real-time motion analysis based on passive markers.

A method for real-time motion analysis based on passive markers is presented. An opto-electronic automatic motion analyser was used as hardware platform and the real-time operation was based on the interfacing between two levels of the system architecture. True real-time acquisition, processing and representation of two-dimensional and three-dimensional kinematics data were implemented through a newly conceived data acquisition procedure and high speed optimisation of the kinematics data processing. The method allows one to operate the motion analysis system in real-time; even when the data elaboration unit is required to perform other processing functions, the only consequence is a decrease in system sampling rate. The maximum number of processed and plotted markers in three dimensions at the highest system sampling rate (100 Hz) turned out to be suitable for the implementation of analytical and visual kinematics biofeedback. An example of the achievable level of complexity in terms of marker disposition model and graphic representation is reported by describing a demonstration of the real-time representation of human face movements. A clinical application of the method for patient position definition and control at radiotherapy units is presented.

Biomechanical Phenomena↗

Measurement of upper extremity orientation by video stereometry system.

In the attempt to gain a broader understanding of the causal relationships behind work-related symptoms of pain in the human shoulder, monitoring of arm position is crucial. Different methods have been used with varying accuracy. A video-based stereometry system, using infra-red light and reflecting markers for motion analysis, has been introduced for measurements in the fields of ergonomics, biomechanics and sports medicine. The purpose of this study is to investigate the sources of error in using this system for posture registration of the upper limb. Measurements are performed on a calibration fixture, on a mechanical model of the upper limb and on a subject with an exoskeleton. Particular, attention is given to inconsistencies and relative errors due to the finite geometrical precision with which the markers are positioned in the calibration fixture and on the studied objects, the limited capability to align the objects relative to the coordinate system of the calibration fixture and the errors connected to angular measurements using protractors etc. It is concluded that the system makes a valuable addition to existing instruments for non-contact posture measurement, and produces position data with an adequate accuracy in normal handling.

Arm↗

The three-dimensional microstructure of intramural lymphatics in the canine large intestine.

The three-dimensional microstructure of the intramural lymphatics of canine large intestine was clarified micrographically. After direct injection of India ink into the colon wall, we prepared 2 less than 3cm full-thickness transparent specimens of the opened colon wall and transparent sections. Lymph vessels were distinguished from blood vessels by intraarterial injection of cinnabar ink. A stereomicroscope was used for observation, and stereograms were reproduced. Lymph vessel networks were present in the shallow and deep layers of the lamina propria mucosae and the deep layer of the submucosa. The lymph vessel networks in the lamina propria mucosae were present immediately beneath the blood capillary networks. The thickest lymph vessels and the densest network appeared in the submucosa. From the submucosa, some of the lymph vessels existed immediately to merge into the collecting trunks and other lymph vessels which compose a minor pathway existed along lymph vessels in the muscular layer and finally merged into the collecting trunks in the subserosa.

Animals↗

Development of quantitative analysis method for stereotactic brain image: assessment of reduced accumulation in extent and severity using anatomical segmentation.

Through visual assessment by three-dimensional (3D) brain image analysis methods using stereotactic brain coordinates system, such as three-dimensional stereotactic surface projections and statistical parametric mapping, it is difficult to quantitatively assess anatomical information and the range of extent of an abnormal region. In this study, we devised a method to quantitatively assess local abnormal findings by segmenting a brain map according to anatomical structure. Through quantitative local abnormality assessment using this method, we studied the characteristics of distribution of reduced blood flow in cases with dementia of the Alzheimer type (DAT). Using twenty-five cases with DAT (mean age, 68.9 years old), all of whom were diagnosed as probable Alzheimer's disease based on NINCDS-ADRDA, we collected I-123 iodoamphetamine SPECT data. A 3D brain map using the 3D-SSP program was compared with the data of 20 cases in the control group, who age-matched the subject cases. To study local abnormalities on the 3D images, we divided the whole brain into 24 segments based on anatomical classification. We assessed the extent of an abnormal region in each segment (rate of the coordinates with a Z-value that exceeds the threshold value, in all coordinates within a segment), and severity (average Z-value of the coordinates with a Z-value that exceeds the threshold value). This method clarified orientation and expansion of reduced accumulation, through classifying stereotactic brain coordinates according to the anatomical structure. This method was considered useful for quantitatively grasping distribution abnormalities in the brain and changes in abnormality distribution.

Aged↗

[Kinematic analysis before and after bicondylar resurfacing knee arthroplasty].

Knee joint motion appears as a hinge movement around the flexion-extension axis. Corresponding to the rolling-sliding mechanism and alternative models of knee joint kinematics, an instant center pathway must be expected. The current photogrammetric investigation aimed to analyze these pathways when assessed in the sagittal plane in patients with preoperative varus or valgus deformity. A total of 40 patients either with varus or valgus deformity (20 in each group) were examined before and 6 months after implantation of PFC-SIGMA prostheses. Apart from the influence of knee joint deformity, a so-called soft tissue ratio was investigated. Therefore, the relation of thigh and femur as well as lower limb and tibia diameters was calculated and combined in one value. The investigation unit consisted of a standardized chair with passive knee joint movement (90-0 degrees flexion) supported by an electric motor. The position of predefined skin markers was assessed by digital camera with online transmission to a PC. The instant center pathway was then evaluated applying the Reuleaux technique based on the changes of skin marker positions. Results showed the following characteristics: small values of soft tissue ratio were represented by round or oval courses of the pathway whereas increasing ratios led to triangular and slightly increased dimensions of the courses. Varus deformity was primarily combined with an increase of the pathway's dimension and in contrast, valgus deformity showed decreased pathways. In each case, dimensions normalized after prosthesis implantation. The instant center pathway of knee joint motion showed for both patient groups characteristic phenomena. They were clearly associated with constitutional and clinical features of each patient.

Aged↗

[What effect does the hydroxyapatite coating have in cementless knee arthroplasty?].

The goal of this study was to compare the migration of noncemented diffusion sintered titanium fibermesh-coated tibial components with (HA group) and without (non-HA group) additional hydroxyapatite coating. For this purpose digital radiostereometry (DIRSA) was used to compare the migration after 2 and 9 years for the two groups. After 2 years the mean maximum subsidence of the HA-coated components (0.24+/-0.18 mm) was about one-half of the mean maximum subsidence of the non-HA-coated group (0.55+/-0.55 mm). After 9 years the maximum subsidence of the HA-coated components was still smaller, but not as pronounced as before. The same trend was also found for the endpoint maximum total point motion (MTPM). After 2 years the mean MTPM of the HA-coated components was 0.66+/-0.38 mm and of the non-HA group 0.73+/-0.50 mm. After 9 years the mean MTPM for the HA-coated components was 0.54+/-0.15 mm and for the non-HA-coated components 0.74+/-0.20 mm. None of the HA-coated tibial components but one of the non-HA group had to be revised and exchanged due to aseptic loosening.

Aged↗

[The accuracy of palpation from orientation points for the navigated implantation of knee prostheses].

AIMS: Cinematic and pointing procedures are used for non-image based navigated implantation during total knee replacement. Pointing procedures require an exact knowledge of the landmarks. In this anatomical study, landmarks are defined and repeatedly referenced. Precision and reproducibility are evaluated by means of an inter- and an intra-observer study. The axes of the femur and tibia are calculated using the landmarks. MATERIAL AND METHODS: The specific landmarks of 30 femurs and 27 tibias were palpated by three surgeons and digitised by means of a photogrammetric system, as used intra-operatively. The recorded data were statistically evaluated. RESULTS: The specific landmarks can be referenced with great precision. The vectors that influence the implant position show a mean femoral deviation of 0.9 mm and a mean tibial deviation of 1.0 mm. The repeating accuracy of every observer was 1.5 mm femoral and 1.0 mm tibial. The calculated long axes at the femur and tibia thus reach a precision of 0.1 degrees (min.-max.: 0-0.9 degrees) at the femur and 0.2 degrees (.0-1.1 degrees) at the tibia. The short axes at the distal femur and proximal tibia exhibit an average deviation of from 0.7 degrees to 1.9 degrees (0-11.3 degrees). CONCLUSION: Long axes (mechanical axes) can be determined exactly but the precision of the short axes (rotational axes) is unsatisfactory, although palpation of landmarks was accurate. Therefore, palpation of more than one rotational axis at the femur and tibia is mandatory and should be visualized on the monitor during surgery.

Arthroplasty, Replacement, Knee↗

[Single-image roentgen analysis for the measurement of hip endoprosthesis migration].

A method to determine migration of hip endoprostheses is described. Migration is measured by means of standard AP radiographs and therefore can also be evaluated in retrospective studies. Measurement is conducted in X-ray studies displayed on a computer screen. Enhancement of bony structures by application of filters is available. The developed software can be used with common commercially available computers and X-ray scanners, and does not require special hardware. Several methods to determine accuracy are described. The accuracy of the described method is about 1 mm (95% confidence limit), which compares favourably with other methods, but is less accurate than roentgen stereophotogrammetry. For other methods, accuracy was not determined adequately. Two years after implantation, revision within the first 10 years of follow-up can be predicted with a sensitivity and specificity of more than 80%.

Acetabulum↗

[Measuring the surface of the back. Value in diagnosis of spinal diseases].

X-ray study to verify clinical findings in patients with scoliosis and other deformities of the spine is associated with considerable radiation exposure as well as a variety of other problems, particularly as regards assessing disease progression. Hence, in the course of the past few years a number of alternative, supplementary spinal diagnostic procedures have been developed which are based on analysis of the surface of the back: Moiré topography, photogrammetry/raster stereometry, opTRImetric system, ISIS system, video raster stereometry (formetrics), ultrasound-guided spine analysis (Zebris) and ultrasound topometry. To assess the effectiveness of screening, diagnosis, and progression of scoliosis the formetric system of video raster stereometry and the Zebris system for ultrasound-guided spine analysis were tested. It was shown that the results of screening tests, diagnostic study, and progression evaluation of scoliosis and sagittal deformities were exact enough using these systems. Furthermore, the ultrasound-guided Zebris system offers the option of dynamic analysis of spinal movement. Limitations in measurement precision were found in obese patients, asymmetric muscle surfaces, and in patients who had undergone surgery, although in the latter group progression could be reliably monitored if the radiological angle was known. We can assume that surface analysis procedures will gain in importance clinically and in practice.

Adolescent↗

[Functional rasterstereographic images. A new method for biomechanical analysis of skeletal geometry].

Video rasterstereography has been developed for optical back shape measurement and for biomechanical analysis of spinal and pelvic geometry. Analysis of one single measurement permits 3-dimensional reconstruction of the back surface and calculation of shape parameters including pelvis tilt and torsion. In addition, estimates of the lateral deviation of the spinal midline and of vertebral rotation are provided. Its extended analytic potential makes rasterstereography a very appropriate tool for functional examinations. The term "functional examinations" refers in this context to biomechanical analysis of functional movements of the spine and pelvis caused by quasi-continuous changes of posture, if these can be observed as changes in back shape. Two examples are given to illustrate the aim and performance of functional examinations. Shoe elevation is used to correct leg-length discrepancy and is therefore prescribed for prevention and correction of scoliosis produced by pelvic obliquity. In a previous study it was shown that simulating leg-length discrepancy by raising a foot causes the pelvis to perform a torsional movement about the transverse axis. In effect, this movement reduces to some extent the effect of shoe elevation; thus a larger elevation might give better results. 42 scoliotic patients underwent functional examination. Leg-length discrepancies were simulated in 7 steps, and the resulting back shape was analysed by rasterstereography. The measurements were corrected for pelvic torsion. This method provided satisfactory correspondence with radiographically recorded leg-length discrepancies, i.e. 0.7 mm +/- 11.2 mm. One specific advantage of this procedure is that it covers aspects relating to spinal lateral deviation and vertebral rotation. It is concluded, however, that the 7 measurements used are hardly sufficient for this application and that better results are therefore to be expected from extended series. Kyphosis and lordosis clearly depend on posture. This is confirmed in a functional examination where these angles are measured under voluntary changes of posture. In forward bending, the trunk straightens and kyphosis and lordosis angles decrease. The reverse case applies to backward bending. If this effect is taken into quantitative consideration, an improved accuracy of measurements is obtained by reference to a standardised, mathematically defined posture. The resulting rms-error of kyphosis/lordosis measurement is then reduced from 3.10 degrees/2.95 degrees to 1.65 degrees/1.40 degrees. These figures open up new applications in the follow-up of kyphotic and lordotic deformities.

Biomechanical Phenomena↗

Methodological concerns using intra-cortical pins to measure tibiofemoral kinematics.

The complexity of human tibiofemoral joint motion is now better understood with the advancement of new methodologies to measure tibiofemoral kinematics in vivo. Marker clusters anchored to stainless steel bone pins inserted directly into the femur and tibia provide the most sensitive and accurate means for directly measuring skeletal tibiofemoral joint motion. Despite its invasiveness, this technique has been successful, although complications have been reported with the femoral pin and its insertion site. The purpose of this technical report is twofold: to review the difficulties with the femoral pin and its insertion site from a historical perspective, and to identify the load force required from biological tissue to permanently deform the pin. In addition, proposals in the advancement of this method are discussed in the context of reducing impingement with the femoral pin and the Iliotibial band. Because stainless steel exhibits plastic behaviour with no sharp yield point, Apex self-drilling/self-tapping bone pins underwent incremental loading on an Instron materials testing machine. Loads were transmitted perpendicular to the pin with the threads partially exposed and fully secured in vice. Since the accuracy of our combined stereophotogrammetry and Optoelectric motion analysis was less than 0.4 mm, it was decided that plastic deformation occurred after deflections of 0.4 mm. With exposed threads, deflections larger than 0.4 mm were observed at 150 N and 100 N when loads were applied at 15 mm and 20 mm from the vice (representative of where the tissue came in contact with the pin). Loads greater than 200 N produced deflections less than 0.2 mm when threads were fully inserted. The 90 Hz resonant frequency for the marker cluster-bone pin complex is beyond the spectrum of human movement and can be lowpass filtered. To reduce impingement and pin bending, one solution may be to implant pins with a shorter threaded section. By completely penetrating the bone, only the smooth surface of the pin is exposed which is more resistant to bending. Otherwise pins with larger diameters and longer longitudinal incisions about the femoral insertion site are an alternative. Lengthening the longitudinal incisions about the insertion site, and correctly aligning and inserting the femoral pin between the Iliotibial band and quadriceps tendon may diminish impingement. Performing dynamic open chain flexion and extension movements while on the operating table may aid in aligning the pin at the incision site. This may stretch the IT band and quadriceps tendon and may guide the femoral pin into a more optimal position prior to it being inserted into the cortex of the bone.

Biomechanical Phenomena↗

Accuracy and initial stability of open- and closed-wedge high tibial osteotomy: a cadaveric RSA study.

We analyzed the difference in angle-correction accuracy and initial stability between open-wedge (OWO) and closed-wedge tibial valgus osteotomy (CWO). Five fresh-frozen pairs of human cadaver lower limbs were used; their bone mineral density (BMD) was measured with DEXA and a planned 7 degrees valgus osteotomy was performed, either with an open (right knees) or closed (left knees) technique. All knees for osteotomy were fixed with a rigid locked plate. In OWO, tricalcium phosphate (TCP) wedges were inserted. The knees were subjected to an increasing cyclic axial load until failure, while measuring the relative displacement of the bony segments with roentgen stereophotogrammetric analysis. The mean postoperative valgus correction angle was 9.5 degrees +/-2.8 degrees for CWO (over-correction of 2.5 degrees ) and 6.2 degrees +/-2.0 degrees for OWO (under-correction of 0.8 degrees ) (P =0.08). The data of displacement under load bearing showed no significant differences in rotations and translations in any direction. No significant correlation between BMD and the moment of failure was found (P =0.27). This study has shown that both methods gave an acceptable correction with a high variation of postoperative correction angles. There was a tendency for over-correction in the CWO group but no significant difference was found. There was no difference in initial stability between CWO and OWO with a rigid locked-plate fixation.

Bone Plates↗

Cortical bone resorption in osteoporosis.

A study was made of 110 women: 35 healthy premenopausal, 40 healthy postmenopausal, and 35 women diagnosed as having postmenopausal osteoporosis. The postmenopausal women had similar ages and years since menopause (YSM). In all of the women, total bone mass was evaluated by dual-energy X-ray absorptiometry and metacarpal morphometry was evaluated by radiogrammetry on the second metacarpal of the nondominant hand, performed by computed radiography. An external metacarpal diameter of >/=7.4 mm was required as proof of having developed an adequate peak bone mass. The endosteal diameter, which is indicative of bone resorption in both groups of postmenopausal women, obtained in the postmenopausal groups was subtracted from the endosteal diameter obtained in the premenopausal group and the resulting figure was divided by the years since menopause to calculate the rate of cortical bone resorption/year for each group. The endosteal diameters values differed in the three groups studied (P < 0.0001): 3.2 +/- 0.7 mm in the healthy premenopausal women; 3.9 +/- 0.6 mm in the healthy postmenopausal women; and 4.7 +/- 0.5 mm in the osteoporotic postmenopausal women. The rate of cortical bone resorption was 0.068 +/- 0.002 mm/YSM (years since menopause) in the osteoporotic postmenopausal women and 0.033 +/- 0.003 mm/YSM in the healthy postmenopausal women (P < 0. 0001). These figures reflect the importance of bone resorption, as opposed to deficient bone formation, as a cause of osteoporosis.

Absorptiometry, Photon↗

The influence of cement viscosity on the early migration of a tapered polished femoral stem.

It is unclear whether it is best to use high-viscosity or low-viscosity cement for fixation of total hip replacement (THR) femoral components. This study examines the influence of cement viscosity on the migration of the Exeter femoral component using roentgen stereophotogrammetric analysis (RSA). Simplex, CMW1 and CMW3 G cements were examined in a total of 46 patients over a 12-month period. The overall pattern of migration for all cohorts was one of subsidence and rotation into valgus. There was no significant difference in any aspect of migration between the groups. In vitro studies demonstrate that low-viscosity cement forms a more stable bone-cement interface. Several groups have examined the in vivo effect of cement viscosity on stem longevity with conflicting results. For a polished, tapered implant that is designed to subside, cement viscosity does not influence the 1-year migration, and it is therefore unlikely to affect long-term outcome.

Aged↗