Twenty-three femurs (one plastic bone and twenty-two cadaver bones) with both nonpathologic and pathologic cases were considered to validate a statistical shape model based technique for three-dimensional (3D) reconstruction of a patient-specific surface model from calibrated x-ray radiographs. The 3D reconstruction technique is based on an iterative nonrigid registration of the features extracted from a statistically instantiated 3D surface model to those interactively identified from the radiographs. The surface models reconstructed from the radiographs were compared to the associated ground truths derived either from a 3D CT-scan reconstruction method or from a 3D laser-scan reconstruction method and an average error distance of 0.95 mm were found. Compared to the existing works, our approach has the advantage of seamlessly handling both nonpathologic and pathologic cases even when the statistical shape model that we used was constructed from surface models of nonpathologic bones.
Femoroacetabular impingement (FAI) before or after Periacetabular Osteotomy (PAO) is surprisingly frequent and surgeons need to be aware of the risk preoperatively and be able to avoid it intraoperatively. In this paper we present a novel computer assisted planning and navigation system for PAO with impingement analysis and range of motion (ROM) optimization. Our system starts with a fully automatic detection of the acetabular rim, which allows for quantifying the acetabular morphology with parameters such as acetabular version, inclination and femoral head coverage ratio for a computer assisted diagnosis and planning. The planned situation was optimized with impingement simulation by balancing acetabuar coverage with ROM. Intra-operatively navigation was conducted until the optimized planning situation was achieved. Our experimental results demonstrated: 1) The fully automated acetabular rim detection was validated with accuracy 1.1 ± 0.7mm; 2) The optimized PAO planning improved ROM significantly compared to that without ROM optimization; 3) By comparing the pre-operatively planned situation and the intra-operatively achieved situation, sub-degree accuracy was achieved for all directions.
Modern computerized planning tools for periacetabular osteotomy (PAO) use either morphology-based or biomechanics-based methods. The latter relies on estimation of peak contact pressures and contact areas using either patient specific or constant thickness cartilage models. We performed a finite element analysis investigating the optimal reorientation of the acetabulum in PAO surgery based on simulated joint contact pressures and contact areas using patient specific cartilage model. Furthermore we investigated the influences of using patient specific cartilage model or constant thickness cartilage model on the biomechanical simulation results. Ten specimens with hip dysplasia were used in this study. Image data were available from CT arthrography studies. Bone models were reconstructed. Mesh models for the patient specific cartilage were defined and subsequently loaded under previously reported boundary and loading conditions. Peak contact pressures and contact areas were estimated in the original position. Afterwards we used a validated preoperative planning software to change the acetabular inclination by an increment of 5° and measured the lateral center edge angle (LCE) at each reorientation position. The position with the largest contact area and the lowest peak contact pressure was defined as the optimal position. In order to investigate the influence of using patient specific cartilage model or constant thickness cartilage model on the biomechanical simulation results, the same procedure was repeated with the same bone models but with a cartilage mesh of constant thickness. Comparison of the peak contact pressures and the contact areas between these two different cartilage models showed that good correlation between these two cartilage models for peak contact pressures (r = 0.634 ∈ [0.6, 0.8], p < 0.001) and contact areas (r = 0.872 > 0.8, p < 0.001). For both cartilage models, the largest contact areas and the lowest peak pressures were found at the same position. Our study is the first study comparing peak contact pressures and contact areas between patient specific and constant thickness cartilage models during PAO planning. Good correlation for these two models was detected. Computer assisted planning with FE modeling using constant thickness cartilage models might be a promising PAO planning tool when a conventional CT is available.
Annually 133.000 people world-wide get sick on malign melanoma, tendency increasing. The purpose of this study is the early diagnosis of malignant skin cancer. At the moment the dermatologists are screening for anomalies at the relevant lesion by examining the skin area with a microscope. To determine changes, another scan has to be taken in a follow-up session after a time period of about 15-20 weeks. Today's visual diagnostic decision is based on the pragmatic ABCD approach (Asymmetry, Border, Colour, and Diameter). However, there is no adequate and sound non-invasive way to find out, if a skin spot is either malign or benign. If the visual approach corroborates a suspicion of skin cancer, histology is needed to make explicit diagnosis. To avoid unnecessary surgeries (on false positive alarm) and to initiate necessary surgeries in early stages a new diagnostic screening approach is presented here. Based on the fact that malign melanoma have higher metabolism as well as increased blood flow, it has been conjectured that malign melanoma have slightly higher temperature compared to the healthy skin that can be measured by high resolution functional infrared imaging.
Periacetabular Osteotomy (PAO) is a joint preserving surgical intervention intended to increase femoral head coverage and thereby to improve stability in young patients with hip dysplasia. Previously, we developed a CT-based, computer-assisted program for PAO diagnosis and planning, which allows for quantifying the 3D acetabular morphology with parameters such as acetabular version, inclination, lateral center edge (LCE) angle and femoral head coverage ratio (CO). In order to verify the hypothesis that our morphology-based planning strategy can improve biomechanical characteristics of dysplastic hips, we developed a 3D finite element model based on patient-specific geometry to predict cartilage contact stress change before and after morphology-based planning. Our experimental results demonstrated that the morphology-based planning strategy could reduce cartilage contact pressures and at the same time increase contact areas. In conclusion, our computer-assisted system is an efficient tool for PAO planning.
Purpose: To evaluate a low-cost, inertial sensor-based surgical navigation solution for periacetabular osteotomy (PAO) surgery without the line of sight impediment. Methods: Two commercial inertial measurement units (IMU, Xsens Technologies, TheNetherlands), are attached to a patient's pelvis and to the acetabular fragment, respectively.Registration of the patient with a pre-operatively acquired computer model is done by recording the orientation of the patient's anterior pelvic plane (APP) using one IMU. A custom-designed device is used to record the orientation of the APP in the reference coordinate system of the IMU.After registration, the two sensors are mounted to the patient's pelvis and acetabular fragment, respectively. Once the initial position is recorded, the orientation is measured and displayed on a computer screen. A patient-specific computer model generated from a pre-operatively acquired computed tomography (CT) scan is used to visualize the updated orientation of the acetabular fragment.Results: Experiments with plastic bones (8 hip joints) performed in an operating room comparing a previously developed optical navigation system with our inertial-based navigation system showed no statistically significant difference on the measurement of acetabular component reorientation. In all eight hip joints the mean absolute difference was below four degrees. Conclusion:Using two commercially available inertial measurement units we show that it is possible to accurately measure the orientation (inclination and anteversion) of the acetabular fragment during PAO surgery and therefore to successfully eliminate the line of sight impediment that optical navigation systems have.
The choice of the treatment method affects the postinterventional axial deformations of the FP segment but does not influence the curvature behavior. While PTA results in a more flexible artery, stents restrict the arteries' shortening capabilities. Depending on the anatomical position of the stents, this axial stiffening of the arteries may lead to chronic kinking, which may cause occlusions and, consequently, affect the long-term success of the procedure.
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