3D Coordinates Of Markers Research Articles

A New Method for Quantifying 3D Skeletal Morphology in Living Subjects Using Low‐Dose Stereo Radiographs

Accurate and repeatable assessments of three‐dimensional (3D) skeletal morphology are critical to interpretations of vertebrate functional anatomy. In skeletal specimens, these goals can be accomplished using in‐silico models derived from 3D laser scan, photogrammetry, or computed tomography (CT) data. Assessments of skeletal morphology in living subjects, especially humans, are more challenging and are often either cost‐prohibitive (e.g., magnetic resonance) or expose subjects to high doses of ionizing radiation (e.g., CT). Here, we present a new, open‐source method for assessing 3D skeletal morphology using ultra‐low dose biplanar radiographs. Biplanar radiographs were obtained using an EOS Imaging System (EOS Imaging, Inc., Paris, France). A custom‐built calibration frame with radiopaque markers was scanned using this system on multiple days in multiple positions inside the scanning space. We quantified the 3D coordinates of markers by placing landmarks at the center of each marker in both anterior‐posterior and lateral radiographs. Landmark data for each scan were collected independently by two observers to determine inter‐observer error. 3D coordinates of landmarks in each scan differed by <1 mm between observers, suggesting strong repeatability in assessing morphology of living subjects. To assess distortion in EOS images, we constructed a second calibration device, a flat plate with radiopaque markers at the corners of three squares with 10 cm, 20 cm, and 30 cm sides, respectively, surrounding an origin point. The calibration plate was scanned with the origin point at the center of the scan area and the sides of the squares parallel to the detectors. We identified distortion at the edges of EOS images which could significantly impact measurements on skeletal features near the margins of the scan area (i.e., hips, pelvis, lower limbs) and developed a method to mathematically correct for resulting distortion in landmark data. Finally, we demonstrate this method using measurements of iliac blade and spinous process orientation in a sample of living human participants. This method will be applicable to studies of multiple human cohorts, including symptomatic and asymptomatic groups, as well as to other biplanar radiograph platforms and study organisms.

Improved artificial neural networks for 3D body posture and lumbosacral moment predictions during manual material handling activities

Body posture measurement approaches, required in biomechanical models to assess risk of musculoskeletal injuries, are usually costly and/or impractical for use in real workplaces. Therefore, we recently developed three artificial neural networks (ANNs), based on measured posture data on several individuals, to predict whole body 3D posture (coordinates of 15 markers located on body’s main joints), segmental orientations (Euler angles of 14 body segments), and lumbosacral (L5-S1) moments during static manual material handling (MMH) activities (ANNPosture, ANNAngle, and ANNMoment, respectively). These ANNs require worker's body height, body weight (only for ANNMoment), hand-load 3D position, and its mass as inputs to accurately predict 3D marker coordinates (RMSE = 7.0 cm), segmental orientations (RMSE = 29.9°) and L5-S1 moments (RMSE = 16.5 N.m) for various static MMH activities. The current work aims to further improve the accuracy of these ANNs by performing outlier elimination and data normalization (as effective tools to improve the accuracy of ANNs) as well as by introducing participant’s knee flexion angle (i.e., lifting technique: stoop, semi-squat, and full-squat) and body weight as new inputs into these ANNs. Results indicate that the RMSE of the new ANNPosture, ANNAngle, and ANNMoment reduced by, respectively, ∼43%, 10%, and 29% (from 7.0 cm, 29.9°, and 16.5 Nm in the original ANNs to, respectively, 4.0 cm, 27.0°, and 11.8 Nm). Such significant improvements in the predictive power of our ANNs further confirm their effectiveness as alternative posture-prediction approaches requiring minimal in vivo data collection in real workplaces.

Effects of seat height on muscular pattern and interlimb coordination in cycling

Effects of seat height on muscular pattern and interlimb coordination in cycling

3D displacement measurement model for health monitoring of structures using a motion capture system

Unlike 1D or 2D displacement measurement sensors, a motion capture system (MCS) can determine the movement of markers in any direction precisely. In addition, an MCS can overcome the limitations of the sampling frequency in 3D measurements by terrestrial laser scanning (TLS) and global positioning system (GPS). This paper presents a method to measure three dimensional (3D) structural displacements using a motion capture system (MCS) with a high accuracy and sampling rate. The MCS measures 2D coordinates of a number of markers with multiple cameras; these measurements are then used to calculate the 3D coordinates of markers. Therefore, unlike previous 1D or 2D displacement measurement sensors, the MCS can determine precisely the movement of markers in any direction. In addition, since the MCS cameras can monitor several markers, measurement points are increased by the addition of more markers. The effectiveness of the proposed model was tested by comparing the displacements measured in a free vibration experiment of a 3-story structure with a height of 2.1m using both the MCS and laser displacement sensors.

Mechanics of the Mitral Valve Strut Chordae Insertion Region

Interest in developing durable mitral valve repair methods is growing, underscoring the need to better understand the native mitral valve mechanics. In this study, the authors investigate the dynamic deformation of the mitral valve strut chordae-to-anterior leaflet transition zone using a novel stretch mapping method and report the complex mechanics of this region for the first time. Eight structurally normal porcine mitral valves were studied in a pulsatile left heart simulator under physiological hemodynamic conditions -120 mm peak transvalvular pressure, 5 l/min cardiac output at 70 bpm. The chordal insertion region was marked with a structured array of 31 miniature markers, and their motions throughout the cardiac cycle were tracked using two high speed cameras. 3D marker coordinates were calculated using direct linear transformation, and a second order continuous surface was fit to the marker cloud at each time frame. Average areal stretch, principal stretch magnitudes and directions, and stretch rates were computed, and temporal changes in each parameter were mapped over the insertion region. Stretch distribution was heterogeneous over the entire strut chordae insertion region, with the highest magnitudes along the edges of the chordal insertion region and the least along the axis of the strut chordae. At early systole, radial stretch was predominant, but by mid systole, significant stretch was observed in both radial and circumferential directions. The compressive stretches measured during systole indicate a strong coupling between the two principal directions, explaining the small magnitude of the systolic areal stretch. This study for the first time provides the dynamic kinematics of the strut chordae insertion region in the functioning mitral valve. A heterogeneous stretch pattern was measured, with the mechanics of this region governed by the complex underlying collagen architecture. The insertion region seemed to be under stretch during both systole and diastole, indicating a transfer of forces from the leaflets to the chordae and vice versa throughout the cardiac cycle, and demonstrating its role in optimal valve function.

SU-FF-T-147: Intra Fractional Motion in Clinical IMRT Prostate Treatments, Warrants the Use of Faster Treatment Techniques

Purpose: To estimate intrafracional motion of the prostate in a routine clinical setting and its impact on margin reduction and treatment time. Method and Materials: External beam treatment for cancer of the prostate using an IMRT technique was evaluated. Fifteen patients underwent a marker match procedure ensuring correct positioning at time of treatment. For all fields intra‐treatment images were obtained, yielding 5 to 7 images per fraction. IMRT was delivered using a dynamic sliding window technique. The obtained images were processed to remove IMRT information. The markers were detected in the image using an automated methodology. Every image was timestamped and chronologically adjacent images were backprojected to yield 3D marker coordinates. Allowing to calculate the position of the prostate during the treatment delivery at specific time instances. Using a Poisson model for the probability of movement we can determine the maximal allowable time frame within which to perform this treament. Results: The maximal treament time measured was 1460s, the shortest lasted 343s. The times were measured starting from the last image in the marker‐match procedure and includes the decision and adjustment process. Depending on the elapsed time we noticed an increase in positional confidence level from 5.8mm to 7.6mm. The delivery of the fields are of the order of 250s. Conclusion: We note a significant increase in probability of prostate movement in our treaments as time elapses. This limits the amount of margin reduction possible. There are two strategies possible to reduce this time. 1) Increase the marker match speed, or 2) increase the delivery speed. A good candidate to do this is the use of a volumetric Arc technique (VMAT) which is implemented in our department with RapidArc™. The latter is able to deliver the same or even better dose distribution in under 2 minutes (8 patients).

Effect of Strut Chordae Transection on Mitral Valve Leaflet Biomechanics

Strut chordae transection (SCT) has been recommended as a surgical treatment for mitral regurgitation (MR) arising from ischemic heart disease. However, little is known about the contribution of anterior strut chordae to leaflet tissue mechanics. In this study, experimental measurements of mitral valve deformation under quasi-static pressure loading were performed on isolated pig hearts before and after transecting both strut chordae. Biplane video images of markers placed on the anterior leaflet surface were used to reconstruct the 3D position of the markers. The 2D nonhomogeneous deformations in the anterior leaflet were calculated by least squares fit to the 3D marker coordinates in successive pressure loading states. Results show that the anterior leaflet undergoes large, anisotropic and nonhomogeneous deformation, with a significant radial stretch gradient and smaller, uniform circumferential stretch. Following chordal transection, the radial deformation decreases. A gradient in the circumferential stretch is observed as an increase from the annulus toward the coaptation line. Without the support provided by the strut chordae, the center portion of the anterior leaflet experienced a substantial change in shape in response to the systolic pressure, altering the load-bearing mechanism in the valvular structure. The shift of the deformation distribution suggests that additional strain energy is absorbed by the circumferentially oriented collagen fibers following SCT and may result in long-term tissue remodeling. This study provides detailed biomechanical data for interpreting the results of previous investigations of SCT, as well as for exploring a greater understanding of how SCT affects MR through computational modeling.

Annular Height-to-Commissural Width Ratio of Annulolasty Rings In Vivo

A "saddle-shaped" mitral annulus with an optimal ratio between annular height and commissural diameter may reduce leaflet and chordal stress and is purported to be conserved across mammalian species. Whether annuloplasty rings maintain this relationship is unknown. Twenty-three adult sheep underwent implantation of radiopaque markers on the left ventricle and mitral annulus. Eight animals underwent implantation of a Carpentier-Edwards Physio ring, 7 underwent a Medtronic Duran flexible ring, and 8 served as controls. Animals were studied with biplane videofluoroscopy 7 to 10 days postoperatively. Annular height and commissural width (CW) were determined from 3D marker coordinates, and annular height:CW ratio (AHWCR) was calculated. Annular height was similar in Control and Duran animals but significantly lower in the Physio group at end diastole (8.4+/-3.8, 6.7+/-2.3, and 3.4+/-0.6 mm, respectively, for Control, Duran, and Physio; ANOVA=0.005) and at end systole (14.5+/-6.2, 10.5+/-5.5, and 5.8+/-2.5 mm, respectively, for Control, Duran, and Physio; ANOVA=0.004). Both ring groups reduced CW significantly relative to Control. AHCWR did not differ between Control and Duran but was lower in Physio (23+/-11%, 24+/-7%, and 12+/-2% at end diastole and 42+/-17%, 37+/-17%, and 21+/-10% at end systole, respectively, for Control, Duran, and Physio, respectively; ANOVA <0.05 for both). Mitral annular height and AHWCR of the native valve were unchanged by a Duran ring, whereas the Physio ring led to a lower AHWCR. Theoretically, such a flexible annuloplasty ring may provide better leaflet stress distribution by maintaining normal AHWCR.

Subvalvular Repair

Residual or recurrent mitral regurgitation frequently occurs after mitral ring annuloplasty repair for ischemic mitral regurgitation (IMR), because annuloplasty primarily addresses annular dilatation. We describe a subvalvular repair technique addressing posterior papillary muscle (PPM) displacement. Ten sheep had radiopaque markers placed on the left ventricle (LV) and mitral apparatus. A suture was anchored at the right fibrous trigone, passed through the PPM tip and LV wall, and exteriorized through a tourniquet (STRING-1). A second suture was anchored transmurally in the high septum (anterobasal LV wall) and passed through the PPM and LV wall (STRING-2). Reversible posterolateral ischemia was induced by temporarily occluding the proximal circumflex artery. Under open chest conditions, 3D marker coordinates were obtained with biplane videofluoroscopy at baseline and during acute ischemia before and after tightening of each STRING using transesophageal echocardiography to grade IMR. IMR decreased (mean+/-SEM, 2.0+/-0.1 to 1.2+/-0.1; P<0.05) when STRING-1 was tightened, did not change after tightening STRING-2 (2.3+/-0.1 to 2.3+/-0.1), and decreased after tightening both sutures (STRING-1+2, 2.3+/-0.2 to 1.3+/-0.2; P<0.05). STRING-1 and STRING-1+2 (STRING-1, 1.7+/-0.4 mm; STRING-2, 0.7+/-0.5 mm; STRING-1+2, 1.5+/-0.3 mm; P<0.05) resulted in significant PPM basal repositioning. Tightening of any STRING sutures did not affect anterior mitral leaflet excursion. Basal repositioning of the PPM with STRING-1 reduced acute IMR without concomitant annular reduction. This technique may be a useful adjunct if residual IMR is likely after undersized ring annuloplasty.

Kinematical models to reduce the effect of skin artifacts on marker-based human motion estimation

The estimation of the skeletal motion obtained from marker-based motion capture systems is known to be affected by significant bias caused by skin movement artifacts, which affects joint center and rotation axis estimation. Among different techniques proposed in the literature, that based on rigid body model, still the most used by commercial motion capture systems, can smooth only part of the above effects without eliminating their main components. In order to sensibly improve the accuracy of the motion estimation, a novel technique, named local motion estimation (LME), is proposed. This rests on a recently described approach that, using virtual humans and extended Kalman filters, estimates the kinematical variables directly from 2D measurements without requiring the 3D marker reconstruction. In this paper, we show how such method can be extended to include the computation of the local marker displacement due to skin artifacts. The 3D marker coordinates, expressed in the corresponding local reference coordinate frames, are inserted into the state vector of the filter and their dynamics is automatically estimated, with adequate accuracy, without assuming any particular deformation function. Simulated experiments of lower limb motion, involving systematic mislocations (5, 10, 20 mm) and random errors of the marker coordinates and joint center locations (±5, ±10, ±15 mm), have shown that artifact motion can be substantially decoupled from the global skeletal motion with an effective increase of the accuracy wrt standard techniques. In particular, the comparison between the nominal kinematical variables and the one recovered from markers attached to the skin surface proved LME to be sensibly superior (50% in the worse condition) to the methods imposing marker-bone rigidity. In conclusion, while requiring further validation on real movement data, we argue that the proposed method can constitute an appropriate approach toward the improvement of the human motion estimation.

Edge-to-Edge Mitral Repair

Edge-to-edge approximation of the mitral valve leaflets (Alfieri procedure) is a novel surgical treatment for patients with ischemic mitral regurgitation (IMR). Long-term durability may be limited if abnormal mitral leaflet stresses result from this procedure. The aim of the current study was to measure Alfieri stitch tension (F(A)) and to explore its geometric determinants in an ovine model of acute IMR as a reflection of the mitral leaflet stresses imposed by the procedure. Eight sheep were studied immediately after surgical placement of (1) a force transducer interposed between sutures approximating the central leaflet edges and (2) radiopaque markers around the mitral annulus and leaflet edges. Computer-aided analysis of videofluorograms was used to obtained 3D marker coordinates. Simultaneous measurements of F(A), septal-lateral annular dimension (L(S-L)), leaflet edge separation (L(SEP)), anterior (L(AL)) and posterior (L(PL)) leaflet length, and hemodynamic variables were obtained at baseline (CTL) and during acute IMR (circumflex artery occlusion). F(A) was significantly elevated throughout the cardiac cycle during IMR compared with CTL, with maximum F(A) in diastole (0.26+/-0.05 versus 0.46+/-0.08 N, CTL versus IMR; P<0.05). Multivariable analysis revealed L(S-L) as the single independent predictor of maximum F(A) (P<0.001). Positive linear correlations were shown between values of F(A) and L(AL) and L(PL) (dependent variables). These experimental data demonstrate higher F(A) during IMR and cyclic changes in F(A) closely paralleling changes in L(S-L), eg, being greatest in diastole when the annulus is largest. Increased F(A) during IMR is probably indicative of successful therapeutic intent, but higher diastolic leaflet stresses resulting from persistent or progressive mitral annular dilatation may adversely affect repair durability. This indirectly implies that concomitant mitral ring annuloplasty should be added to the Alfieri repair.

Edge-to-Edge Mitral Repair

Background Edge-to-edge approximation of the mitral valve leaflets (Alfieri procedure) is a novel surgical treatment for patients with ischemic mitral regurgitation (IMR). Long-term durability may be limited if abnormal mitral leaflet stresses result from this procedure. The aim of the current study was to measure Alfieri stitch tension (F A ) and to explore its geometric determinants in an ovine model of acute IMR as a reflection of the mitral leaflet stresses imposed by the procedure. Methods and Results Eight sheep were studied immediately after surgical placement of (1) a force transducer interposed between sutures approximating the central leaflet edges and (2) radiopaque markers around the mitral annulus and leaflet edges. Computer-aided analysis of videofluorograms was used to obtained 3D marker coordinates. Simultaneous measurements of F A , septal-lateral annular dimension (L S-L ), leaflet edge separation (L SEP ), anterior (L AL ) and posterior (L PL ) leaflet length, and hemodynamic variables were obtained at baseline (CTL) and during acute IMR (circumflex artery occlusion). F A was significantly elevated throughout the cardiac cycle during IMR compared with CTL, with maximum F A in diastole (0.26±0.05 versus 0.46±0.08 N, CTL versus IMR; P &lt;0.05). Multivariable analysis revealed L S-L as the single independent predictor of maximum F A ( P &lt;0.001). Positive linear correlations were shown between values of F A and L AL and L PL (dependent variables). Conclusions These experimental data demonstrate higher F A during IMR and cyclic changes in F A closely paralleling changes in L S-L , eg, being greatest in diastole when the annulus is largest. Increased F A during IMR is probably indicative of successful therapeutic intent, but higher diastolic leaflet stresses resulting from persistent or progressive mitral annular dilatation may adversely affect repair durability. This indirectly implies that concomitant mitral ring annuloplasty should be added to the Alfieri repair.

Coordinate-free analysis of mitral valve dynamics in normal and ischemic hearts.

The purpose of this investigation was to study mitral valve 3D geometry and dynamics by using a coordinate-free system in normal and ischemic hearts to gain mechanistic insight into normal valve function, valve dysfunction during ischemic mitral regurgitation (IMR), and the treatment effects of ring annuloplasty. Radiopaque markers were implanted in sheep: 9 in the ventricle, 1 on each papillary tip, 8 around the mitral annulus, and 1 on each leaflet edge midpoint. One group served as a control (n=7); all others underwent flexible Tailor partial (n=5) or Duran complete (n=6) ring annuloplasty. After an 8+/-2-day recovery, 3D marker coordinates were measured with biplane videofluoroscopy before and during posterolateral left ventricular ischemia, and MR was assessed by color Doppler echocardiography. Papillary to annular distances remained constant throughout the cardiac cycle in normal hearts, during ischemia, and after ring annuloplasty with either type of ring. Papillary to leaflet edge distances similarly remained constant throughout ejection. During ischemia, however, the absolute distances from the papillary tips to the annulus changed in a manner consistent with leaflet tethering, and IMR was observed. In contrast, during ischemia in either ring group, those distances did not change from preischemia, and no IMR was observed. This analysis uncovered a simple pattern of relatively constant intracardiac distances that describes the 3D geometry and dynamics of the papillary tips and leaflet edges from the dynamic mitral annulus. Ischemia perturbed the papillary-annular distances, and IMR occurred. Either type of ring annuloplasty prevented such changes, preserved papillary-annular distances, and prevented IMR.

Coordinate-Free Analysis of Mitral Valve Dynamics in Normal and Ischemic Hearts

Background —The purpose of this investigation was to study mitral valve 3D geometry and dynamics by using a coordinate-free system in normal and ischemic hearts to gain mechanistic insight into normal valve function, valve dysfunction during ischemic mitral regurgitation (IMR), and the treatment effects of ring annuloplasty. Methods and Results —Radiopaque markers were implanted in sheep: 9 in the ventricle, 1 on each papillary tip, 8 around the mitral annulus, and 1 on each leaflet edge midpoint. One group served as a control (n=7); all others underwent flexible Tailor partial (n=5) or Duran complete (n=6) ring annuloplasty. After an 8±2-day recovery, 3D marker coordinates were measured with biplane videofluoroscopy before and during posterolateral left ventricular ischemia, and MR was assessed by color Doppler echocardiography. Papillary to annular distances remained constant throughout the cardiac cycle in normal hearts, during ischemia, and after ring annuloplasty with either type of ring. Papillary to leaflet edge distances similarly remained constant throughout ejection. During ischemia, however, the absolute distances from the papillary tips to the annulus changed in a manner consistent with leaflet tethering, and IMR was observed. In contrast, during ischemia in either ring group, those distances did not change from preischemia, and no IMR was observed. Conclusions —This analysis uncovered a simple pattern of relatively constant intracardiac distances that describes the 3D geometry and dynamics of the papillary tips and leaflet edges from the dynamic mitral annulus. Ischemia perturbed the papillary-annular distances, and IMR occurred. Either type of ring annuloplasty prevented such changes, preserved papillary-annular distances, and prevented IMR.

Deformational Dynamics of the Aortic Root

Background —Current surgical methods for treating aortic valve and aortic root pathology vary widely, and the basis for selecting one repair or replacement alternative over another continues to evolve. More precise knowledge of the interaction between normal aortic root dynamics and aortic valve mechanics may clarify the implications of various surgical procedures on long-term valve function and durability. Methods and Results —To investigate the role of aortic root dynamics on valve function, we studied the deformation modes of the left, right, and noncoronary aortic root regions during isovolumic contraction, ejection, isovolumic relaxation, and diastole. Radiopaque markers were implanted at the top of the 3 commissures (sinotubular ridge) and at the annular base of the 3 sinuses in 6 adult sheep. After a 1-week recovery, ECG and left ventricular and aortic pressures were recorded in conscious, sedated animals, and the 3D marker coordinates were computed from biplane videofluorograms (60 Hz). Left ventricular preload, contractility, and afterload were independently manipulated to assess the effects of changing hemodynamics on aortic root 3D dynamic deformation. The ovine aortic root undergoes complex, asymmetric deformations during the various phases of the cardiac cycle, including aortoventricular and sinotubular junction strain and aortic root elongation, compression, shear, and torsional deformation. These deformations were not homogeneous among the left, right, and noncoronary regions. Furthermore, changes in left ventricular volume, pressure, and contractility affected the degree of deformation in a nonuniform manner in the 3 regions studied, and these effects varied during isovolumic contraction, ejection, isovolumic relaxation, and diastole. Conclusions —These complex 3D aortic root deformations probably minimize aortic cusp stresses by creating optimal cusp loading conditions and minimizing transvalvular turbulence. Aortic valve repair techniques or methods of replacement using unstented autograft, allograft, or xenograft tissue valves that best preserve this normal pattern of aortic root dynamics should translate into a lower risk of long-term cusp deterioration.

Deformational dynamics of the aortic root: modes and physiologic determinants.

Current surgical methods for treating aortic valve and aortic root pathology vary widely, and the basis for selecting one repair or replacement alternative over another continues to evolve. More precise knowledge of the interaction between normal aortic root dynamics and aortic valve mechanics may clarify the implications of various surgical procedures on long-term valve function and durability. To investigate the role of aortic root dynamics on valve function, we studied the deformation modes of the left, right, and noncoronary aortic root regions during isovolumic contraction, ejection, isovolumic relaxation, and diastole. Radiopaque markers were implanted at the top of the 3 commissures (sinotubular ridge) and at the annular base of the 3 sinuses in 6 adult sheep. After a 1-week recovery, ECG and left ventricular and aortic pressures were recorded in conscious, sedated animals, and the 3D marker coordinates were computed from biplane videofluorograms (60 Hz). Left ventricular preload, contractility, and afterload were independently manipulated to assess the effects of changing hemodynamics on aortic root 3D dynamic deformation. The ovine aortic root undergoes complex, asymmetric deformations during the various phases of the cardiac cycle, including aortoventricular and sinotubular junction strain and aortic root elongation, compression, shear, and torsional deformation. These deformations were not homogeneous among the left, right, and noncoronary regions. Furthermore, changes in left ventricular volume, pressure, and contractility affected the degree of deformation in a nonuniform manner in the 3 regions studied, and these effects varied during isovolumic contraction, ejection, isovolumic relaxation, and diastole. These complex 3D aortic root deformations probably minimize aortic cusp stresses by creating optimal cusp loading conditions and minimizing transvalvular turbulence. Aortic valve repair techniques or methods of replacement using unstented autograft, allograft, or xenograft tissue valves that best preserve this normal pattern of aortic root dynamics should translate into a lower risk of long-term cusp deterioration.