In clinical routine, lower limb analysis relies on conventional X-ray (2D view) or computerised tomography (CT) Scan (lying position). However, these methods do not allow 3D analysis in standing position. The aim of this study is to propose a fast and accurate 3D-reconstruction-method based on parametric models and statistical inferences from biplanar X-rays with clinical measurements' (CM) assessment in standing position for a clinical routine use. For the reproducibility study, the 95% CI was under 2.7° for all lower limbs' angular measurements except for tibial torsion, femoral torsion and tibiofemoral rotation ( < 5°). The 95% CI were under 2.5 mm for lower limbs' lengths and 1.5 to 3° for the pelvis' CM. Comparisons between X-rays and CT-scan based 3D shapes in vitro showed mean differences of 1.0 mm (95% CI = 2.4 mm). Comparisons of 2D lower limbs' and 3D pelvis' CM between standing 'Shifted-Feet' and 'Non-Shifted-Feet' position showed means differences of 0.0 to 1.4°. Significant differences were found only for pelvic obliquity and rotation. The reconstruction time was about 5 min.
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AbstractRib cage 3D reconstruction is an important prerequisite for thoracic spine modelling, particularly for studies of the deformed thorax in adolescent idiopathic scoliosis. This study proposes a new method for rib cage 3D reconstruction from biplanar radiographs, using a statistical parametric model approach.Simplified parametric models were defined at the hierarchical levels of rib cage surface, rib midline and rib surface, and applied on a database of 86 trunks. The resulting parameter database served to statistical models learning which were used to quickly provide a first estimate of the reconstruction from identifications on both radiographs. This solution was then refined by manual adjustments in order to improve the matching between model and image. Accuracy was assessed by comparison with 29 rib cages from CT scans in terms of geometrical parameter differences and in terms of line-to-line error distance between the rib midlines. Intra and inter-observer reproducibility were determined regarding 20 scoliotic patients.The first estimate (mean reconstruction time of 2'30) was sufficient to extract the main rib cage global parameters with a 95% confidence interval lower than 7%, 8%, 2% and 4° for rib cage volume, antero-posterior and lateral maximal diameters and maximal rib hump, respectively. The mean error distance was 5.4 mm (max 35mm) down to 3.6 mm (max 24 mm) after the manual adjustment step (+3'30).The proposed method will improve developments of rib cage finite element modeling and evaluation of clinical outcomes.
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