Добірка наукової літератури з теми "Low-Dose biplanar X-Rays"

The aim of this paper is to describe a protocol that simulates the spinal surgery undergone by adolescents with idiopathic scoliosis (AIS) by using a 3D-printed spine model. Patients with AIS underwent pre- and postoperative bi-planar low-dose X-rays from which a numerical 3D model of their spine was generated. The preoperative numerical spine model was subsequently 3D printed to virtually reproduce the spine surgery. Special consideration was given to the printing materials for the 3D-printed elements in order to reflect the radiopaque and mechanical properties of typical bones most accurately. Two patients with AIS were recruited and operated. During the virtual surgery, both pre- and postoperative images of the 3D-printed spine model were acquired. The proposed 3D-printing workflow used to create a realistic 3D-printed spine suitable for virtual surgery appears to be feasible and reliable. This method could be used for virtual-reality scoliosis surgery training incorporating 3D-printed models, and to test surgical instruments and implants.

Introduction:Patients with adolescent idiopathic scoliosis frequently receive X-ray imaging at diagnosis and subsequent follow monitoring. To achieve the ALARA concept of radiation dose, a biplanar low-dose X-ray system (BLDS) has been proposed. The aim of the study is to gather evidence on safety, accuracy and overall effectiveness of a BLDS compared with CT scanning, in a pediatric population, in order to support the final decision on possible acquisition of such innovative diagnostic system.Methods:The new method Decision-oriented HTA (DoHTA) was applied to carefully assess the diagnostic technology. It was developed starting from the EUnetHTA Core Model® integrated with the analytic hierarchy process in order to identify all the relevant assessment aspects of the technology involved, identified from scientific literature, experts’ judgments and specific context analysis of Bambino Gesù Children's Hospital. A weight was associated to each assessment element and the alternatives’ ranking was defined.Results:This innovative system provides orthopedic images in standing or sitting position, being able to examine the spine and lower limbs under normal weight-bearing conditions. This system is recommended for particular clinical indications as scoliosis and other congenital deformities of the spine. It is able to acquire simultaneous posteroanterior and lateral images in a single scan without vertical distortion and with lower radiation exposure than CT scanning. 2D images acquired can be combined to obtain a 3D reconstruction scanning based on a semi-automated statistical model.Conclusions:The major advantages of BLDS are the relatively low dose of radiation and the possibility of obtaining a 3D reconstruction of the bones. Our preliminary results show that data on the clinical effectiveness are limited but the technical advancements of BLDS appear promising in terms of patient management and patient health outcomes associated with its use.

Background and purpose: The low radiation biplanar X-ray imager (EOS imaging, Paris, France) scans patients in a weight-bearing position, provides calibrated images, and limits radiation, an asset for serial radiostereometric analysis (RSA) studies. RSA in vivo precision values have not been published for this type of imaging system, thus the goal of this study was to assess the precision of RSA in vivo utilizing a low radiation biplanar imager.Patients and methods: At a mean of 5 years post-surgery (range 1.4–7.5 years), 15 total knee arthroplasty (TKA) participants (mean age 67 years at the time of imaging, 12 female, 3 male) with RSA markers implanted during index surgery were scanned twice at the same visit in the EOS imager. Precision of marker-based analysis was calculated by comparing the position of the implant relative to the underlying bone between the 2 examinations.Results: The 95% limit of precision was 0.11, 0.04, and 0.15 mm along the x, y, and z axes, respectively and 0.15°, 0.20°, and 0.14° around the same axes.Conclusion: This precision study has shown an in vivo RSA precision of ≤ 0.15 mm and ≤ 0.20°, well within published uniplanar values for conventional arthroplasty RSA, with the added benefit of weight-bearing imaging, a lower radiation dose, and without the need for a reference object during the scan.

The 3D concept is extremely important in clinical studies of human body. Accurate 3D models of bony structures are currently required in clinical routine for diagnosis, patient follow-up, surgical planning, computer assisted surgery and biomechanical applications. However, 3D conventional medical imaging techniques such as computed tomography (CT) scan and magnetic resonance imaging (MRI) have serious limitations such as using in non-weight-bearing positions, costs and high radiation dose(for CT). Therefore, 3D reconstruction methods from biplanar X-ray images have been taken into consideration as reliable alternative methods in order to achieve accurate 3D models with low dose radiation in weight-bearing positions. Different methods have been offered for 3D reconstruction from X-ray images using photogrammetry which should be assessed. In this paper, after demonstrating the principles of 3D reconstruction from X-ray images, different existing methods of 3D reconstruction of bony structures from radiographs are classified and evaluated with various metrics and their advantages and disadvantages are mentioned. Finally, a comparison has been done on the presented methods with respect to several metrics such as accuracy, reconstruction time and their applications. With regards to the research, each method has several advantages and disadvantages which should be considered for a specific application.

Photogrammetry can have great impact on the success of medical processes for diagnosis, treatment and surgeries. Precise 3D models which can be achieved by photogrammetry improve considerably the results of orthopedic surgeries and processes. Usual 3D imaging techniques, computed tomography (CT) and magnetic resonance imaging (MRI), have some limitations such as being used only in non-weight-bearing positions, costs and high radiation dose(for CT) and limitations of MRI for patients with ferromagnetic implants or objects in their bodies. 3D reconstruction of bony structures from biplanar X-ray images is a reliable and accepted alternative for achieving accurate 3D information with low dose radiation in weight-bearing positions. The information can be obtained from multi-view radiographs by using photogrammetry. The primary step for 3D reconstruction of human bone structure from medical X-ray images is calibration which is done by applying principles of photogrammetry. After the calibration step, 3D reconstruction can be done using efficient methods with different levels of automation. Because of the different nature of X-ray images from optical images, there are distinct challenges in medical applications for calibration step of stereoradiography. In this paper, after demonstrating the general steps and principles of 3D reconstruction from X-ray images, a comparison will be done on calibration methods for 3D reconstruction from radiographs and they are assessed from photogrammetry point of view by considering various metrics such as their camera models, calibration objects, accuracy, availability, patient-friendly and cost.

L’architecture de la main et du poignet est un ensemble complexe d’articulations permettant la réalisation efficace de l’ensemble des gestes de la vie quotidienne.La précision des mouvements et la transmission des forces effectrices nécessitent une congruence articulaire optimale et une cohésion osseuse assurées par un système ligamentaire organisé.Tout traumatisme engendrant un écart articulaire (fracture) ou une perte de la cohésion osseuse (rupture ligamentaire) risque de produire des mouvements pathologiques au sein de ces articulations. Il apparaît alors des douleurs, une diminution des amplitudes de mouvements et une altération de la fonction globale. La connaissance des mécanismes physiopathologiques conduisant à ces troubles est essentielle à plusieurs niveaux : premièrement, dans un cadre diagnostic, pour pouvoir identifier une éventuelle lésion, même partielle, et la traiter ; deuxièmement, dans un cadre d’amélioration de la connaissance globale de la cinématique physiologique et pathologique de la main et du poignet ; et enfin, dans un cadre d’innovation afin de proposer de nouvelles solutions (implants) à des problèmes non résolus.La conception de modèles géométriques et biomécaniques personnalisés dans le contexte général de l’étude des articulations humaines permet de répondre à ce type de questions. Dans un travail préliminaire, lié à mon master recherche et à la thèse de Stan Durand, des essais biomécaniques ont été réalisés sur pièces anatomiques pour analyser l’effet d’un implant spécifique sur le comportement cinématique du poignet et concevoir une méthode de modélisation personnalisée de la main et du poignet par l’acquisition de radiographies biplanes faibles doses.Dans la continuité de ce projet, ce travail de thèse présente plusieurs objectifs.Le premier objectif est de valider notre méthode de modélisation de la main et du poignet personnalisée chez le vivant, en comparant cette méthode à la technique de référence de segmentation scannographique.Le deuxième objectif est d’appliquer cette méthode pour constituer un corridor de déplacement physiologique de certains os d’intérêt du carpe (scaphoïde, lunatum, triquétrum), entre deux positions de référence (poignet en position neutre ou poing fermé) parmi une population de volontaires indemnes de lésions ligamentaires. Ce corridor de normalité est utile pour comparer les déplacements physiologiques et pathologiques en pratique clinique.Le troisième objectif est de comparer les données de cinématiques carpiennes de patients atteints de lésions ligamentaires infra radiologique à ce corridor de normalité. Le but est d’évaluer les capacités diagnostic du modèle personnalisé. En analysant les données pré et post opératoire, une étude de faisabilité permet en outre d’investiguer le champ du suivi objectif de la restauration chirurgicale par suture ou réancrage ligamentaire.La finalité générale d’une telle étude est donc l’utilisation de modèles géométriques, cinématiques et biomécaniques de la main et du poignet dans le but d’évaluer la cinématique normale et pathologique (diagnostic) et d’analyser des implants chirurgicaux actuels afin de proposer des axes d’amélioration
The architecture of the hand and wrist is a complex set of articulations enabling the efficient execution of all the gestures of daily life.Precision of movement and transmission of effector forces require optimal joint congruence and bone cohesion ensured by an organized ligament system.Any trauma resulting in articular step off (fracture) or loss of bone cohesion (ligament rupture) is likely to produce pathological kinematics within these joints. The result is pain, decrease range of motion and impaired overall function. Knowledge of the pathophysiological mechanisms leading to these disorders is essential on several levels: firstly, in a diagnostic context, to be able to identify and treat any injury, even a partial one. Secondly, to improve overall knowledge of the physiological and pathological kinematics of the hand and wrist. And lastly, as part of an innovation drive to propose new solutions (implants) to unresolved problems.The design of customized geometric and biomechanical models in the general context of the study of human joints provides answers to these types of questions. In preliminary work, linked to my Master's research and Stan Durand's thesis, biomechanical tests were carried out on anatomical parts to analyze the effect of a specific implant on the kinematic behavior of the wrist, and to design a method for personalized modeling of the hand and wrist using low-dose biplane X-rays.Following on from this project, this thesis has several objectives.The first objective is to validate our method of personalized hand and wrist modeling in living subjects, by comparing it with the reference technique of TDM segmentation.Secondly, we will apply this method to create a corridor of physiological displacement of certain carpal bones of interest (scaphoid, lunate, triquetrum), between two reference positions (wrist in neutral position or closed fist) among a population of volunteers free of ligament lesions. This corridor of normality is useful for comparing physiological and pathological displacements in clinical practice.Indeed, the third objective is to compare carpal kinematic data from patients with infra-radiological ligament lesions with this corridor of normality. The aim is to assess the diagnostic capabilities of the customized model. By analyzing pre- and post-operative data, a feasibility study will also investigate the field of objective follow-up of surgical restoration by suture or ligament re-anchoring.The aim of such a study is therefore to use geometric, kinematic and biomechanical models of the hand and wrist to assess normal and pathological kinematics (diagnosis), and to analyze current surgical implants in order to propose areas for improvement