The accuracy and repeatability of an automatic 2D–3D fluoroscopic image-model registration technique for determining shoulder joint kinematics

doi:10.1016/j.medengphy.2011.12.021

Medical Engineering & Physics

Volume 34, Issue 9, November 2012, Pages 1303-1309

https://doi.org/10.1016/j.medengphy.2011.12.021 Get rights and content

Abstract

Fluoroscopic imaging, using single plane or dual plane images, has grown in popularity to measure dynamic in vivo human shoulder joint kinematics. However, no study has quantified the difference in spatial positional accuracy between single and dual plane image-model registration applied to the shoulder joint. In this paper, an automatic 2D–3D image-model registration technique was validated for accuracy and repeatability with single and dual plane fluoroscopic images. Accuracy was assessed in a cadaver model, kinematics found using the automatic registration technique were compared to those found using radiostereometric analysis. The in vivo repeatability of the automatic registration technique was assessed during the dynamic abduction motion of four human subjects. The in vitro data indicated that the error in spatial positional accuracy of the humerus and the scapula was less than 0.30 mm in translation and less than 0.58° in rotation using dual plane images. Single plane accuracy was satisfactory for in-plane motion variables, but out-of-plane motion variables on average were approximately 8 times less accurate. The in vivo test indicated that the repeatability of the automatic 2D–3D image-model registration was 0.50 mm in translation and 1.04° in rotation using dual images. For a single plane technique, the repeatability was 3.31 mm in translation and 2.46° in rotation for measuring shoulder joint kinematics. The data demonstrate that accurate and repeatable shoulder joint kinematics can be obtained using dual plane fluoroscopic images with an automatic 2D–3D image-model registration technique; and that out-of-plane motion variables are less accurate than in-plane motion variables using a single plane technique.

Introduction

The accurate determination of human shoulder joint kinematics is important for understanding shoulder joint pathology and evaluating the surgical treatment of shoulder joint diseases. Numerous prior studies have used various techniques to measure in vivo shoulder kinematics, such as electromagnetic tracking [1], [2], [3], [4], [5], magnetic resonance (MR) imaging [6], [7], [8], [9], [10], radiostereometric analysis (RSA) [11], [12], [13], and optical motion tracking [14], [15], [16], [17], [18]. However, measuring the motion of the scapula and humerus with sub-millimeter levels of accuracy in six-degrees-of-freedom (6DOF) is still a challenging issue in biomedical engineering [19], [20], [21].

Fluoroscopic image-model registration, using a single image or dual images, has increasingly been used to determine in vivo human shoulder joint motions [20], [22], [23], [24], [25], [26], [27]. The critical step in these techniques is the 2D–3D image registration procedure that aligns a 3D-bone model to those of the captured fluoroscopic single image or dual images, of the corresponding target bone. The accuracy of using these techniques has been reported for studying artificial joints [26], [28], [29], and the joints of the knee [30], [31], [32], [33], [34], shoulder [19], [21], [23], ankle [35] and spine [36]. Prior study has shown that the application of the dual plane image-model registration technique is technically challenging [19], [21], [30], [31], single image plane registration is widely in use to determine joint positions in space [22], [23], [28], [34]. However, no study has directly compared the accuracy of using single versus dual fluoroscopic image-model registration techniques to determine in vivo shoulder kinematics.

Recently, an automatic 2D–3D image matching method has been developed and validated for its application to investigate human knee joint kinematics using fluoroscopic images [29], [33]. In this paper, we assess the accuracy and repeatability of using single and dual fluoroscopic images to study the shoulder joint kinematics in 6DOF using an automatic 2D–3D image-model registration technique adapted to the geometry of the shoulder. The accuracy and repeatability of this method in the determination of shoulder joint positions in space was evaluated through a series of in vitro and in vivo tests. The shoulder joint positions reproduced by the automatic 2D–3D image matching method were compared to the positions determined from RSA, taken as the gold standard for position in this study. The repeatability of using this technique to measure in vivo shoulder joint kinematics was demonstrated using four human subjects. Lastly, the optimization performance of the matching algorithm's convergence was assessed in an idealized testing environment, such to avoid systematic error and bias.

Section snippets

2D–3D image matching method

The experimental setup of a dual fluoroscopic image system (DFIS) has been extensively presented in previous studies [19], [26], [27], [31], [32], [33], [35], [36]. In summary, a common imaging zone (approximately 6.5 L in volume) is formed by two fluoroscopes (BV Pulsera^®, Philips, Bothell, WA) for stereophotogrammetric analysis (Fig. 1a). The distance between the fluoroscopic intensifier (295 mm in diameter) and the X-ray source is 982 mm. Within a DFIS, a subject can freely move his/her

In vitro testing DFIS to RSA

Using dual fluoroscopic images, a maximum error of 0.16 ± 0.06 mm in translation and 0.58 ± 0.99° in rotation for the humerus was found comparing automatic registration with DFIS to the gold standard RSA (Table 1). Similarly, for the scapula, a maximum error of 0.30 ± 0.04 mm in translation and 0.36 ± 0.13° in rotation was determined. For image-model registration of the humerus using a single fluoroscopic image (F1), the maximum in-plane translational error was 0.26 ± 0.09 mm and 0.60 ± 1.50° in rotation,

Discussion

In this study, we examined the accuracy and repeatability of an automatic 2D–3D image-model registration method using both single and pairs of fluoroscopic images in determining the 6DOF spatial positions of the shoulder joint. The data indicated that for the humerus and scapula, the error in the spatial positions found using a DFIS compared to RSA, was less than 0.30 mm in translation and 0.58° in rotation for all 6DOF. When using a single fluoroscopic image registration technique, the in-plane

Conflict of interest statement

The authors of this manuscript have nothing to disclose that would bias our work.

Acknowledgements

This study was partially supported by the Harvard Shoulder Service at the Massachusetts General Hospital, a grant from National Program on Key Basic Research Project (2011CB707701) and a grant from National Key Technologies R & D Program of China (2011BAF01B03).

References (44)

P.W. McClure et al.
Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo
J Shoulder Elbow Surg
(2001)
J.D. Borstad et al.
Comparison of scapular kinematics between elevation and lowering of the arm in the scapular plane
Clin Biomech (Bristol, Avon)
(2002)
D.D. Ebaugh et al.
Three-dimensional scapulothoracic motion during active and passive arm elevation
Clin Biomech (Bristol, Avon)
(2005)
J. Crosbie et al.
Scapulohumeral rhythm and associated spinal motion
Clin Biomech (Bristol, Avon)
(2008)
F. Fayad et al.
Three-dimensional scapular kinematics and scapulohumeral rhythm in patients with glenohumeral osteoarthritis or frozen shoulder
J Biomech
(2008)
H. Graichen et al.
Glenohumeral translation during active and passive elevation of the shoulder—a 3D open-MRI study
J Biomech
(2000)
P.W. de Bruin et al.
Image-based RSA. Roentgen stereophotogrammetric analysis based on 2D–3D image registration
J Biomech
(2008)
D.F. Massimini et al.
Non-invasive determination of coupled motion of the scapula and humerus—an in vitro validation
J Biomech
(2011)
M.J. Bey et al.
Measuring dynamic in vivo glenohumeral joint kinematics: technique and preliminary results
J Biomech
(2008)
Y. Kon et al.
The influence of handheld weight on the scapulohumeral rhythm
J Shoulder Elbow Surg
(2008)

N. Nishinaka et al.

Determination of in vivo glenohumeral translation using fluoroscopy and shape-matching techniques

J Shoulder Elbow Surg

(2008)

M.J. Bey et al.

In vivo measurement of subacromial space width during shoulder elevation: technique and preliminary results in patients following unilateral rotator cuff repair

Clin Biomech (Bristol, Avon)

(2007)

P.J. Boyer et al.

In vivo articular cartilage contact at the glenohumeral joint: preliminary report

J Orthop Sci

(2008)

G. Li et al.

Validation of a non-invasive fluoroscopic imaging technique for the measurement of dynamic knee joint motion

J Biomech

(2008)

L. Wan et al.

Determination of in vivo articular cartilage contact areas of human talocrural joint under weightbearing conditions

Osteoarthritis Cartilage

(2006)

W.J. Anderst et al.

A technique to measure three-dimensional in vivo rotation of fused and adjacent lumbar vertebrae

Spine J

(2008)

H.A. Vrooman et al.

Fast and accurate automated measurements in digitized stereophotogrammetric radiographs

J Biomech

(1998)

E.R. Valstar et al.

Digital automated RSA compared to manually operated RSA

J Biomech

(2000)

A.E. Kedgley et al.

Comparative accuracy of radiostereometric and optical tracking systems

J Biomech

(2009)

R.C. Rhoad et al.

A new in vivo technique for three-dimensional shoulder kinematics analysis

Skeletal Radiol

(1998)

H. Graichen et al.

Magnetic resonance-based motion analysis of the shoulder during elevation

Clin Orthop Relat Res

(2000)

D.K. Hodge et al.

Dynamic MR imaging and stress testing in glenohumeral instability: comparison with normal shoulders and clinical/surgical findings

J Magn Reson Imaging

(2001)

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Citation Excerpt :
Therefore, there is not a direct relationship between voxel values of the radiography images and 2D projections of MRI. Glenohumeral (GH) kinematic measurement accuracy using CT-based 2D-3D registration has been studied (Bey et al., 2006; Giphart et al., 2012; Massimini et al., 2011; Zhu et al., 2012). However, validation of GH kinematic accuracy using MRI–based registration has never been done, to our knowledge.
Biplane 2D-3D registration approaches have been used for measuring 3D, in vivo glenohumeral (GH) joint kinematics. Computed tomography (CT) has become the gold standard for reconstructing 3D bone models, as it provides high geometric accuracy and similar tissue contrast to video-radiography. Alternatively, magnetic resonance imaging (MRI) would not expose subjects to radiation and provides the ability to add cartilage and other soft tissues to the models. However, the accuracy of MRI-based 2D-3D registration for quantifying glenohumeral kinematics is unknown. We developed an automatic 2D-3D registration program that works with both CT- and MRI-based image volumes for quantifying joint motions. The purpose of this study was to use the proposed 2D-3D auto-registration algorithm to describe the humerus and scapula tracking accuracy of CT- and MRI-based registration relative to radiostereometric analysis (RSA) during dynamic biplanar video-radiography. The GH kinematic accuracy (RMS error) was 0.6–1.0 mm and 0.6–2.2° for the CT-based registration and 1.4–2.2 mm and 1.2–2.6° for MRI-based registration. Higher kinematic accuracy of CT-based registration was expected as MRI provides lower spatial resolution and bone contrast as compared to CT and suffers from spatial distortions. However, the MRI-based registration is within an acceptable accuracy for many clinical research questions.

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¹: Digital Medical Engineering Laboratory, C249, School of Medicine, Tsinghua University, Beijing 100084, China. Tel.: +86 10 62783631; fax: +86 10 62794377.

²: Department of Mechanical Engineering, MIT, 77 Massachusetts Avenue, Cambridge, MA 02139, USA. Tel.: +1 617 643 7279.

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