Koutras Christos, Shayestehpour Hamed, Pérez Jesús, Wong Christian, Rasmussen John, Tournier Maxime, Nesme Matthieu, Otaduy Miguel A
Department of Computer Science, Universidad Rey Juan Carlos, Madrid, Spain.
Department of Materials and Production, Aalborg University, Aalborg, Denmark.
Front Bioeng Biotechnol. 2022 Jul 19;10:945461. doi: 10.3389/fbioe.2022.945461. eCollection 2022.
The use of patient-specific biomechanical models offers many opportunities in the treatment of adolescent idiopathic scoliosis, such as the design of personalized braces. The first step in the development of these patient-specific models is to fit the geometry of the torso skeleton to the patient's anatomy. However, existing methods rely on high-quality imaging data. The exposure to radiation of these methods limits their applicability for regular monitoring of patients. We present a method to fit personalized models of the torso skeleton that takes as input biplanar low-dose radiographs. The method morphs a template to fit annotated points on visible portions of the spine, and it relies on a default biomechanical model of the torso for regularization and robust fitting of hardly visible parts of the torso skeleton, such as the rib cage. The proposed method provides an accurate and robust solution to obtain personalized models of the torso skeleton, which can be adopted as part of regular management of scoliosis patients. We have evaluated the method on ten young patients who participated in our study. We have analyzed and compared clinical metrics on the spine and the full torso skeleton, and we have found that the accuracy of the method is at least comparable to other methods that require more demanding imaging methods, while it offers superior robustness to artifacts such as interpenetration of ribs. Normal-dose X-rays were available for one of the patients, and for the other nine we acquired low-dose X-rays, allowing us to validate that the accuracy of the method persisted under less invasive imaging modalities.
使用针对患者的生物力学模型在青少年特发性脊柱侧弯的治疗中提供了许多机会，例如个性化支具的设计。开发这些针对患者的模型的第一步是使躯干骨骼的几何形状与患者的解剖结构相匹配。然而，现有方法依赖于高质量的成像数据。这些方法的辐射暴露限制了它们在患者常规监测中的适用性。我们提出了一种方法，该方法以双平面低剂量X线片为输入来拟合躯干骨骼的个性化模型。该方法使一个模板变形以拟合脊柱可见部分上的标注点，并且它依赖于躯干的默认生物力学模型来对躯干骨骼几乎不可见的部分（例如胸廓）进行正则化和稳健拟合。所提出的方法为获得躯干骨骼的个性化模型提供了一种准确且稳健的解决方案，该模型可作为脊柱侧弯患者常规管理的一部分被采用。我们在参与我们研究的十名年轻患者身上评估了该方法。我们分析并比较了脊柱和整个躯干骨骼的临床指标，并且我们发现该方法的准确性至少与其他需要更苛刻成像方法的方法相当，同时它对肋骨相互穿透等伪影具有更高的稳健性。其中一名患者有正常剂量的X线片，对于其他九名患者我们获取了低剂量X线片，这使我们能够验证该方法在侵入性较小的成像方式下仍然保持准确性。
