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Lou E. Answer to the Letter to the Editor of F. Xiao, et al. concerning "Reliability and accuracy of scoliotic parameters on using a wireless handheld 3D ultrasound for children with adolescent idiopathic scoliosis: a pilot study" by Nguyen TNN, et al. (Eur Spine J [2024]; doi:10.1007/s00586-024-08445-w). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08468-3. [PMID: 39198287 DOI: 10.1007/s00586-024-08468-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 08/28/2024] [Indexed: 09/01/2024]
Affiliation(s)
- Edmond Lou
- Department of Electrical and Computer Engineering, University of Alberta, Donadeo ICE 11-263, 9211-116 Street NW, Edmonton, AB, T6G 1H9, Canada.
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Nguyen TNN, Le LH, Emery DJ, Stampe K, Hryniuk Southon S, Lou E. Reliability and accuracy of scoliotic parameters on using a wireless handheld 3D ultrasound for children with adolescent idiopathic scoliosis: a pilot study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08445-w. [PMID: 39129033 DOI: 10.1007/s00586-024-08445-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/02/2024] [Accepted: 08/05/2024] [Indexed: 08/13/2024]
Abstract
PURPOSE To report the accuracy and reliability of Cobb angle (CA), axial vertebral rotation (AVR), kyphotic and lordotic angles (KA and LA) measurements on using a new 3D ultrasound (US) system. METHODS Forty participants (34 F, 6 M, aged 14.0 ± 2.3 years) were recruited. The first 20 participants were scanned by the validated US system and the new US system. The other 20 participants were scanned with the new US system only. Two raters (R1 and R2) performed the measurements: R1 has 10 years of experience in radiology but is new in ultrasound scoliosis, while R2 has 30 years of scoliosis experience. All US images were measured twice by R1, and once by R2. Forty posteroanterior and 30 lateral standing radiographs were obtained and measured once by R1. Statistical analysis consisted of mean absolute difference (MAD), intraclass correlation coefficient (ICC (2,1)), and Bland-Altman plots. RESULTS R1 showed excellent intra-rater and inter-rater reliability for US measurements with ICCs(2,1) ≥ 0.91. The inter-method reliability was good between the two US systems for all parameters with ICCs(2,1) ≥ 0.85 and maximum MAD of 3.4°. The new US showed good reliability and accuracy compared to radiographs for CA, AVR and KA with ICCs(2,1) ≥ 0.81 and maximum MAD of 5.8°, but poor results for LA with ICCs(2,1) of 0.27-0.35 and MADs of 14.0°-15.4°. CONCLUSION The new 3D US system showed good reliability and accuracy for CA, AVR and KA measurements, but a large measurement discrepancy on LA. A new measurement method for US LA may need to investigate.
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Affiliation(s)
| | - Lawrence H Le
- University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Derek J Emery
- University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Kyle Stampe
- University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | | | - Edmond Lou
- University of Alberta, Edmonton, AB, T6G 2R3, Canada.
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Huo X, Li H, Shao K. Automatic Vertebral Rotation Angle Measurement of 3D Vertebrae Based on an Improved Transformer Network. ENTROPY (BASEL, SWITZERLAND) 2024; 26:97. [PMID: 38392353 DOI: 10.3390/e26020097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024]
Abstract
The measurement of vertebral rotation angles serves as a crucial parameter in spinal assessments, particularly in understanding conditions such as idiopathic scoliosis. Historically, these angles were calculated from 2D CT images. However, such 2D techniques fail to comprehensively capture the intricate three-dimensional deformities inherent in spinal curvatures. To overcome the limitations of manual measurements and 2D imaging, we introduce an entirely automated approach for quantifying vertebral rotation angles using a three-dimensional vertebral model. Our method involves refining a point cloud segmentation network based on a transformer architecture. This enhanced network segments the three-dimensional vertebral point cloud, allowing for accurate measurement of vertebral rotation angles. In contrast to conventional network methodologies, our approach exhibits notable improvements in segmenting vertebral datasets. To validate our approach, we compare our automated measurements with angles derived from prevalent manual labeling techniques. The analysis, conducted through Bland-Altman plots and the corresponding intraclass correlation coefficient results, indicates significant agreement between our automated measurement method and manual measurements. The observed high intraclass correlation coefficients (ranging from 0.980 to 0.993) further underscore the reliability of our automated measurement process. Consequently, our proposed method demonstrates substantial potential for clinical applications, showcasing its capacity to provide accurate and efficient vertebral rotation angle measurements.
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Affiliation(s)
- Xing Huo
- School of Mathematics, Hefei University of Technology, Hefei 230601, China
| | - Hao Li
- School of Mathematics, Hefei University of Technology, Hefei 230601, China
| | - Kun Shao
- School of Software, Hefei University of Technology, Hefei 230601, China
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Lee TY, Yang D, Lai KK, Castelein RM, Schlosser TPC, Chu W, Lam T, Zheng Y. Three-dimensional ultrasonography could be a potential non-ionizing tool to evaluate vertebral rotation of subjects with adolescent idiopathic scoliosis. JOR Spine 2023; 6:e1259. [PMID: 37780820 PMCID: PMC10540829 DOI: 10.1002/jsp2.1259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/07/2023] [Accepted: 04/25/2023] [Indexed: 10/03/2023] Open
Abstract
Background Three-dimensional (3D) ultrasonography is nonionizing and has been demonstrated to be a reliable tool for scoliosis assessment, including coronal and sagittal curvatures. It shows a great potential for axial vertebral rotation (AVR) evaluation, yet its validity and reliability need to be further demonstrated. Materials and Methods Twenty patients with adolescent idiopathic scoliosis (AIS) (coronal Cobb: 26.6 ± 9.1°) received 3D ultrasound scan for twice, 10 were scanned by the same operator, and the other 10 by different operators. EOS Bi-planar x-rays and 3D scan were conducted on another 29 patients on the same day. Two experienced 3D ultrasonographic researchers, with different experiences on AVR measurement, evaluated the 3D ultrasonographic AVR of the 29 patients (55 curves; coronal Cobb angle: 26.9 ± 11.3°). The gold standard AVR was determined from the 3D reconstruction of coronal and sagittal EOS radiographs. Intra-class correlation coefficients (ICCs), mean absolute difference (MAD), standard error measurements (SEM), and Bland-Altman's bias were reported to evaluate the intra-operator and inter-operator/rater reliabilities of 3D ultrasonography. The reliability of 3D ultrasonographic AVR measurements was further validated using inter-method with that of EOS. Results ICCs for intra-operator and inter-operator/rater reliability assessment were all greater than 0.95. MAD, SEM, and bias for the 3D ultrasonographic AVRs were no more than 2.2°, 2.0°, and 0.5°, respectively. AVRs between both modalities were strongly correlated (R 2 = 0.901) and not significantly different (p = 0.205). Bland-Altman plot also shows that the bias was less than 1°, with no proportional bias between the difference and mean of expected and radiographic Cobb angles. Conclusion This study demonstrates that 3D ultrasonography is valid and reliable to evaluate AVR in AIS patients. 3D ultrasonography can be a potential tool for screening and following up subjects with AIS and evaluating the effectiveness of nonsurgical treatments.
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Affiliation(s)
- Tin Yan Lee
- Department of Biomedical EngineeringThe Hong Kong Polytechnic UniversityHong KongHong Kong
- Research Institute for Smart AgeingThe Hong Kong Polytechnic UniversityHong KongHong Kong
| | - De Yang
- Department of Biomedical EngineeringThe Hong Kong Polytechnic UniversityHong KongHong Kong
| | - Kelly Ka‐Lee Lai
- Department of Biomedical EngineeringThe Hong Kong Polytechnic UniversityHong KongHong Kong
| | - Rene M. Castelein
- Department of Orthopaedic SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Tom P. C. Schlosser
- Department of Orthopaedic SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Winnie Chu
- Department of Imaging and Interventional RadiologyThe Chinese University of Hong KongHong Kong SARChina
| | - Tsz‐Ping Lam
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong KongHong KongHong Kong
| | - Yong‐Ping Zheng
- Department of Biomedical EngineeringThe Hong Kong Polytechnic UniversityHong KongHong Kong
- Research Institute for Smart AgeingThe Hong Kong Polytechnic UniversityHong KongHong Kong
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Jiang W, Xie Q, Qin Y, Ye X, Wang X, Zheng Y. A novel method for spine ultrasound and X-ray radiograph registration. ULTRASONICS 2023; 133:107018. [PMID: 37163859 DOI: 10.1016/j.ultras.2023.107018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/12/2023]
Abstract
Ultrasound is a promising imaging method for scoliosis evaluation because it is radiation free and provide real-time images. However, it cannot provide bony details because ultrasound cannot penetrate the bony structure. Therefore, registration of real-time ultrasound images with the previous X-ray radiograph can help physicians understand the spinal deformity of patients. In this study, an improved free-from deformation registration method based on mutual registration and hierarchical adaptive grid (MRHA-FFD) was developed. The method first performed registration grid preprocessing and then optimized control points and conducted mutual registration. Finally, a Blur-aware Attention Network was adopted for image deblurring. The performance of each step was verified by ablation experiments. Comparison experiment between the proposed method and traditional registration methods was also conducted. The qualitative and quantitative results suggested that MRHA-FFD is a promising approach for registering spine ultrasound image and X-ray radiograph.
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Affiliation(s)
- Weiwei Jiang
- College of Computer Science & Technology, Zhejiang University of Technology, 310023 Hangzhou, China.
| | - Qiaolin Xie
- College of Computer Science & Technology, Zhejiang University of Technology, 310023 Hangzhou, China
| | - Yingyu Qin
- College of Computer Science & Technology, Zhejiang University of Technology, 310023 Hangzhou, China
| | - Xiaojun Ye
- Department of Ultrasound, Hangzhou Women's Hospital, 310023 Hangzhou, China
| | - Xiaoyan Wang
- College of Computer Science & Technology, Zhejiang University of Technology, 310023 Hangzhou, China
| | - Yongping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Huang Q, Luo H, Yang C, Li J, Deng Q, Liu P, Fu M, Li L, Li X. Anatomical prior based vertebra modelling for reappearance of human spines. Neurocomputing 2022. [DOI: 10.1016/j.neucom.2022.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Effatparvar M, Sobczak S. Application of ultrasound in spine kinematic determination: A systemic review. J Med Ultrasound 2022; 30:6-10. [PMID: 35465585 PMCID: PMC9030350 DOI: 10.4103/jmu.jmu_200_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/15/2021] [Accepted: 01/10/2022] [Indexed: 11/04/2022] Open
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Seidel CP, Gilday SE, Jain VV, Sturm PF. How much does depth matter? Magnetically controlled growing rod distraction directly influenced by rod tissue depth. Spine Deform 2022; 10:177-182. [PMID: 34570308 DOI: 10.1007/s43390-021-00399-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Magnetically controlled growing rod (MCGR) for the treatment of early-onset scoliosis (EOS) is a relatively innovative technique. MCGR benefits over traditional growing rods are known but limitations and complications are being revealed. The purpose of this study was to examine the importance of tissue depth on rod lengthening. METHODS A single-institution retrospective review of 72 MCGR patients was performed. Ultrasound measured rod distraction. Differences in programmed and actual distraction, and complications were recorded. Tissue depths and achieved length were averaged and used to construct a regression to account for variability. RESULTS Percentage of std and offset orientation rod lengthening relative to the programmed distraction was inversely proportional to rod depth (std R = 0.50, p = 0.002) (offset R = 0.60, p < 0.001). Expected std rod lengthening achieved decreased by 1.46%/mm depth. Expected offset rod lengthening achieved decreased by 1.68%/mm depth. 28 pts (38.9%) sustained complications. Age, sex, BMI, standard tissue depth, and/or offset tissue depth had no predictive ability with respect to complications sustained (overall model R = 0.31, p = 0.36). CONCLUSION In a series of EOS surgical patients treated with MCGRs, the relationship between percentage of programmed lengthening achieved as well as total lengthening was inversely proportional to tissue depth of the rod. There was a trend towards increasing frequency of complications recorded with decreasing tissue depth though this was not significant. These data can help with surgical planning during MCGR placement.
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Affiliation(s)
| | - Sarah E Gilday
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Viral V Jain
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Peter F Sturm
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
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Forbes A, Cantin V, Develle Y, Dubé Y, Bertrand-Grenier A, Ménard-Lebel C, Sobczak S. Musculoskeletal ultrasound for 3D bone modeling: A preliminary study applied to lumbar vertebra. J Back Musculoskelet Rehabil 2021; 34:937-950. [PMID: 34092595 DOI: 10.3233/bmr-200259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is no non-invasive in vivo method to assess intervertebral kinematics. Current kinematics models are based on in vitro bone reconstructions from computed tomography (CT)-scan imaging, fluoroscopy and MRIs, which are either expensive or deleterious for human tissues. Musculoskeletal ultrasound is an accessible, easy to use and cost-effective device that allows high-resolution, real-time imaging of bone structure. OBJECTIVE The aim of this preliminary study was to compare the concordance of 3D bone modeling of lumbar vertebrae between CT-scan and ultrasound imaging and to study the intra and inter-reliability of distances measured on 3D ultrasound bone models. METHODS CT-scan, ultrasound, and in situ data of five lumbar vertebrae from the same human specimen were used. All vertebrae were scanned by tomography and a new musculoskeletal ultrasound procedure. Then, 3D bone modeling was created from both CT-scan and ultrasound image data set. Distances between anatomical bones landmarks were measured on the 3D models and compared to in situ measurements.
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Affiliation(s)
- A Forbes
- Chaire de Recherche en Anatomie Fonctionnelle, Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada.,Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada
| | - V Cantin
- Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada.,Département des Sciences de L'activité Physique, Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada
| | - Y Develle
- Chaire de Recherche en Anatomie Fonctionnelle, Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada
| | - Y Dubé
- Département de Génie Mécanique, Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada
| | - A Bertrand-Grenier
- Département de Chimie, Biochimie et Physique, Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada.,CIUSSS de la Mauricie-et-du-Centre-du-Québec, Centre Hospitalier Affilié Universitaire Régional, Trois-Rivières, QC G8Z 3R9, Canada
| | - C Ménard-Lebel
- Chaire de Recherche en Anatomie Fonctionnelle, Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada.,Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada
| | - S Sobczak
- Chaire de Recherche en Anatomie Fonctionnelle, Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada.,Département D'anatomie, Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada.,Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, Trois-Rivières (QC) Canada, G8Z 4M3, Canada
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Huo X, Cui G, Tan J, Shao K. Automatic measurement of axial vertebral rotation in 3D vertebral models. Biomed Phys Eng Express 2021; 7. [PMID: 34598167 DOI: 10.1088/2057-1976/ac2c55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/01/2021] [Indexed: 11/11/2022]
Abstract
Axial Vertebral Rotation (AVR) is a significant indicator of adolescent idiopathic scoliosis (AIS). A host of methods are provided to measure AVR on coronal plane radiographs or 3D vertebral model. This paper provides a method of automatic AVR measurement in 3D vertebral model that is based on point cloud segmentation neural network and the tip of the spinous process searching algorithm. An improved PointNet using multi-input and attention mechanism named Multi-Input PointNet is proposed, which can segment the upper and lower endplates of the vertebral model accurately to determine the transverse plane of vertebral model. An algorithm is developed to search the tip of the spinous process according to the special structure of vertebrae. AVR angle is measured automatically using the midline of vertebral model and projection ofy-axis on the transverse plane of vertebral model based on points obtained above. We compare automatic measurement results with manual measurement results on different vertebral models. The experiment shows that automatic results can achieve accuracy of manual measurement results and the correlation coefficient of them is 0.986, proving our automatic AVR measurement method performs well.
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Affiliation(s)
- Xing Huo
- Hefei University of Technology, Hefei, Anhui, People's Republic of China
| | - Guangpeng Cui
- Hefei University of Technology, Hefei, Anhui, People's Republic of China
| | - Jieqing Tan
- Hefei University of Technology, Hefei, Anhui, People's Republic of China
| | - Kun Shao
- Hefei University of Technology, Hefei, Anhui, People's Republic of China
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Yang D, Lee T, Lai K, Wong Y, Wong L, Yang J, Lam T, Castelein R, Cheng J, Zheng Y. A novel classification method for mild adolescent idiopathic scoliosis using 3D ultrasound imaging. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lv P, Chen J, Dong L, Wang L, Deng Y, Li K, Huang X, Zhang C. Evaluation of Scoliosis With a Commercially Available Ultrasound System. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:29-36. [PMID: 31190407 DOI: 10.1002/jum.15068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/10/2019] [Accepted: 05/19/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Currently, radiography with measurement of the Cobb angle is still considered the reference standard for diagnosing scoliosis. However, the ionizing radiation hazard is drawing wide attention. Can 3-dimensional (3D) ultrasound (US) be an alternative modality for diagnosing and monitoring patients with scoliosis? The aim of our study was to assess the reliability and validity of 3D US imaging in the evaluation of scoliosis. METHODS A commercially available ultrasound system with a magnetic tracking system was selected for long-distance 3D US imaging. Straight phantoms and curved phantoms were scanned with the imaging system to evaluate the stability of the system for curvature measurements. Eight healthy adult volunteers and 28 patients with scoliosis were recruited for long-distance 3D US imaging. The intraclass correlation coefficient was used to test the reproducibility of the interobserver and intraobserver measurements for both the healthy adults and patients with scoliosis. A linear regression analysis and Bland-Altman plot were used to analyze the correlation and to determine the extent of agreement between the angles measured on US images and the Cobb angles measured on conventional radiographs. RESULTS The 28 patients with scoliosis included 10 male and 18 female patients aged 8 to 37 years (mean age ± SD, 17.7 ± 1.4 years; body mass index, <25 kg/m2 ). In the phantom study, there was no statistically significant difference between the angles measured by the 3D US imaging system and those measured by an angle gauge (P > 0.05). In the clinical study, there was very good interobserver and intraobserver reliability (intraclass correlation coefficients, >0.90) for the US imaging system, with a high correlation (r2 = 0.92) and agreement between the US and radiographic methods. CONCLUSIONS The long-distance 3D US imaging system offers a viable modality for diagnosing and monitoring scoliosis without radiation.
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Affiliation(s)
- Pin Lv
- Departments of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingyuan Chen
- Departments of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lujie Dong
- Departments of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Wang
- Departments of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Youbin Deng
- Departments of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaiyan Li
- Departments of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolin Huang
- Departments of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao Zhang
- Departments of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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A semi-automatic 3D ultrasound reconstruction method to assess the true severity of adolescent idiopathic scoliosis. Med Biol Eng Comput 2019; 57:2115-2128. [PMID: 31367838 DOI: 10.1007/s11517-019-02015-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 07/15/2019] [Indexed: 01/08/2023]
Abstract
Adolescent idiopathic scoliosis (AIS) is a three-dimensional (3D) spinal deformity. Current practice uses the Cobb method to measure spinal severity on postero-anterior (PA) radiographs. This method may underestimate spinal deformity and exposes patients to ionizing radiation, increasing the risk of cancer. This paper reports a new 3D ultrasound method using the voxel-based reconstruction technique with bilinear interpolation to reconstruct a 3D spinal image and measure true spinal curvature on the plane of maximal curvature (PMC). Axial vertebral rotation (AVR) was measured on the 3D image and utilized to estimate the PMC. In vitro phantom experiments and in vivo clinical study were conducted to evaluate reconstruction accuracy and measurement reliability. The in vitro study showed a high accuracy of the reconstruction of vertebrae with the mean absolute difference (MAD) < 3 mm. The in vitro and in vivo measurements of AVR were reliable (> 0.90). The in vivo study also showed high intra- and inter-rater reliabilities of the PA and PMC Cobb angle measurements with ICC values > 0.90 and MADs within the clinical accepted tolerances. The PMC Cobb angles were up to 7° greater than their corresponding PA Cobb angles. This method demonstrated a non-ionizing radiation method to assess the actual severity of AIS. Graphical abstract Adolescent idiopathic scoliosis (AIS) is a lateral curvature of spine with vertebral rotation. Using the Cobb method to measure spinal severity on postero-anterior (PA) radiographs may under estimate its severity.
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Lee TTY, Cheung JCW, Law SY, To MKT, Cheung JPY, Zheng YP. Analysis of sagittal profile of spine using 3D ultrasound imaging: a phantom study and preliminary subject test. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2019. [DOI: 10.1080/21681163.2019.1566025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Timothy Tin-Yan Lee
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, China
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, China
| | - Siu-Yu Law
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, China
| | - Michael Kai Tsun To
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, China
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Intra- and Interrater Reliability of Cobb Angle Measurements on the Plane of Maximum Curvature Using Ultrasound Imaging Method. Spine Deform 2019; 7:18-26. [PMID: 30587314 DOI: 10.1016/j.jspd.2018.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 06/21/2018] [Accepted: 06/23/2018] [Indexed: 11/20/2022]
Abstract
STUDY DESIGN Retrospective reliability study. OBJECTIVES To investigate the intra- and interrater reliability of Cobb angle measurements on the plane of maximum curvature (PMC) using ultrasound (US) images on children with adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA Cobb angle measurement on posteroanterior (PA) radiographs is the gold standard to assess curve severity. However, the PA Cobb angle does not reflect the true three-dimensional deformity. METHODS One hundred one children with AIS (87 F; 14 M) (age: 13.7 ± 1.7 years) were recruited and 157 curves were recorded by clinicians on radiographs. Three raters, R1, R2, and R3 with 0, 4, and 20+ years of experience, respectively, measured the PA Cobb, vertebral axial rotation (VAR), PMC Cobb, and PMC orientations on US images. The true PMC orientations were determined using 3D reconstructions on the PA and lateral EOS radiographs. The reliability of R1 measurements on PMC orientations were validated using intermethod (US vs. EOS measurements) with the intraclass correlation coefficients (ICCs). Inter- and intrarater reliabilities, standard error measurements, and Bland-Altman's bias were used to report the PMC Cobb and VAR measurements. RESULTS Intermethod, inter-, and intrarater ICC(2,1) values for all reliability assessments were greater than 0.9. The mean absolute differences and the standard error measurements for both PMC Cobb and VAR were less than 4° and 0.5°, respectively. The PMC orientation was strongly correlated (r2 = 0.88) between both measurement modalities. There appeared to be a positive association between the difference of PMC and PA Cobb when the PA Cobb and the maximum VAR were greater than 30° and 14°, respectively. CONCLUSION The PMC Cobb and VAR can be measured reliably on US images. Future studies should validate the PMC Cobb angle and to include a wider Cobb angle range on participants.
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Zheng R, Hill D, Hedden D, Mahood J, Moreau M, Southon S, Lou E. Factors influencing spinal curvature measurements on ultrasound images for children with adolescent idiopathic scoliosis (AIS). PLoS One 2018; 13:e0198792. [PMID: 29912905 PMCID: PMC6005491 DOI: 10.1371/journal.pone.0198792] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/27/2018] [Indexed: 01/26/2023] Open
Abstract
The measurements of spinal curvatures using the ultrasound (US) imaging method on children with scoliosis have been comparable with radiography. However, factors influencing the reliability and accuracy of US measurement have not been studied. The purpose of this study is to investigate the effects of curve features and patients' demographics on US measurements and to determine which factors influence the reliability and accuracy. Two hundred children with scoliosis were recruited and scanned with US by one experienced operator and three trainees. One experienced rater measured the proxy Cobb angles from US images twice one week apart and compared the results with clinical radiographic records. The correlation and accuracy between the US and radiographic measurements were subdivided by different curve severities, curve types, subjects' weight status and US acquisition experiences. A total of 326 and 313 curves were recognized from radiographs and US images, respectively. The mean Cobb angles of the 13 missing curves were 17.4±7.4° and 11 at the thoracic region. Among the 16 curves showing large discrepancy (≥6°) between US and radiographic measurements, 7 were main thoracic and 6 were lumbar curves. Twelve had axial vertebral rotation (AVR) greater than 8°. The US scans performed by the experienced operator showed fewer large discrepancy curves, smaller difference and higher correlation than the scans from the trainees (3%, 1.7±1.5°, 0.95 vs 6%, 2.4±1.8°, 0.90). Only 4% missing and 5% large discrepancy curves were demonstrated for US measurements in comparison to radiography. The missing curves were mainly caused by small severity and in the upper spinal region. There was a higher chance of the large discrepancy curves in the main thoracic and lumbar regions with AVR>8°. A skilled operator acquired better US images and led to more accurate measurements especially for those subjects with larger curvatures, AVR and body mass index (BMI).
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Affiliation(s)
- Rui Zheng
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Doug Hill
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Douglas Hedden
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - James Mahood
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Marc Moreau
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah Southon
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Edmond Lou
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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Ng SY, Bettany-Saltikov J. Imaging in the Diagnosis and Monitoring of Children with Idiopathic Scoliosis. Open Orthop J 2017; 11:1500-1520. [PMID: 29399226 PMCID: PMC5759132 DOI: 10.2174/1874325001711011500] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/10/2017] [Accepted: 09/11/2017] [Indexed: 11/22/2022] Open
Abstract
The paper reviews the current imaging methods in the diagnosis and monitoring of patients with adolescent idiopathic scoliosis. Radiography is generally used in the initial diagnosis of the condition. Postero-anterior erect full spine radiograph is generally prescribed, and is supplemented by lateral full spine radiograph when indicated. To reduce the radiation hazard, only the area of interest should be exposed, and follow-up radiographs should be taken with as few projections as possible. When available, EOS® stereoradiography should be used. The radiation of the microdose protocol is 45 times less than that of the conventional radiography. Surface topography offers another approach to monitoring changes of curvatures in AIS patients. Recently, 3D ultrasound has been found to be able to measure the Cobb angle accurately. Yet, it is still in the early developmental stages. The inherent intrinsic and external limitations of the imaging system need to be resolved before it can be widely used clinically. For AIS patients with atypical presentation, computed tomography (CT) and/or magnetic resonance imaging (MRI) may be required to assess for any underlying pathology. As CT is associated with a high radiation dose, it is playing a diminishing role in the management of scoliosis, and is replaced by MRI, which is also used for pre-operative planning of scoliosis. The different imaging methods have their limitations. The EOS® stereoradiography is expensive and is not commonly available. The surface topography does not enable measurement of Cobb angle, particularly when the patient is in-brace. The 3D ultrasound scanning has inherent intrinsic technical limitation and cannot be used in all subjects. Radiography, however, enables diagnosis and monitoring of the adolescent idiopathic scoliosis (AIS). It is thus the gold standard in the evaluation and management of scoliosis curves.
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Affiliation(s)
- Shu-Yan Ng
- Wanchai Chiropractic Clinic, 11/fl China Hong Kong Tower, 8 Hennessy Road, Wanchai, Hong Kong
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He C, To MKT, Cheung JPY, Cheung KMC, Chan CK, Jiang WW, Zhou GQ, Lai KKL, Zheng YP, Wong MS. An effective assessment method of spinal flexibility to predict the initial in-orthosis correction on the patients with adolescent idiopathic scoliosis (AIS). PLoS One 2017; 12:e0190141. [PMID: 29267389 PMCID: PMC5739463 DOI: 10.1371/journal.pone.0190141] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/10/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Spinal flexibility is an essential parameter for clinical decision making on the patients with adolescent idiopathic scoliosis (AIS). Various methods are proposed to assess spinal flexibility, but which assessment method is more effective to predict the effect of orthotic treatment is unclear. OBJECTIVE To investigate an effective assessment method of spinal flexibility to predict the initial in-orthosis correction, among the supine, prone, sitting with lateral bending and prone with lateral bending positions. METHODS Thirty-five patients with AIS (mean Cobb angle: 28° ± 7°; mean age: 12 ± 2 years; Risser sign: 0-2) were recruited. Before orthosis fitting, spinal flexibility was assessed by an ultrasound system in 4 positions (apart from standing) including supine, prone, sitting with lateral bending and prone with lateral bending. After orthosis fitting, the initial in-orthosis correction was routinely assessed by whole spine standing radiograph. Comparisons and correlation analyses were performed between the spinal flexibility in the 4 positions and the initial in-orthosis correction. RESULTS The mean in-orthosis correction was 41% while the mean curve correction (spinal flexibility) in the 4 studied positions were 40% (supine), 42% (prone), 127% (prone with lateral bending) and 143% (sitting with lateral bending). The correlation coefficients between initial in-orthosis correction and curve correction (spinal flexibility) in the 4 studied positions were r = 0.66 (supine), r = 0.75 (prone), r = 0.03 (prone with lateral bending) and r = 0.04 (sitting with lateral bending). CONCLUSIONS The spinal flexibility in the prone position is the closest to and most correlated with the initial in-orthosis correction among the 4 studied positions. Thus, the prone position could be an effective method to predict the initial effect of orthotic treatment on the patients with AIS.
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Affiliation(s)
- Chen He
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Michael Kai-Tsun To
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Jason Pui-Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kenneth Man-Chee Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Chi-Kwan Chan
- Department of Prosthetics and Orthotics, The Duchess of Kent Children's Hospital, Sandy Bay, Hong Kong
| | - Wei-Wei Jiang
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
- College of Computer Science and Technology, Xihu District, Hangzhou, Zhejiang Province, China
| | - Guang-Quan Zhou
- State Key laboratory of Biological Science and Medical Engineering, Southeast University, Xuanwu District, Nanjing, Jiangsu Province, China
| | - Kelly Ka-Lee Lai
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Yong-Ping Zheng
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Man-Sang Wong
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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