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Determination of the Human Spine Curve Based on Laser Triangulation Primož Poredoš1*,Dušan Čelan2, Janez Možina1 and Matija Jezeršek1

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Determination of the Human Spine Curve Based on Laser Triangulation Primož Poredoš1*,Dušan Čelan2, Janez Možina1 and Matija Jezeršek1 Poredoš et al. BMC Medical Imaging (2015) 15:2 DOI 10.1186/s12880-015-0044-5 RESEARCH ARTICLE Open Access Determination of the human spine curve based on laser triangulation Primož Poredoš1*,Dušan Čelan2, Janez Možina1 and Matija Jezeršek1 Abstract Background: The main objective of the present method was to automatically obtain a spatial curve of the thoracic and lumbar spine based on a 3D shape measurement of a human torso with developed scoliosis. Manual determination of the spine curve, which was based on palpation of the thoracic and lumbar spinous processes, was found to be an appropriate way to validate the method. Therefore a new, noninvasive, optical 3D method for human torso evaluation in medical practice is introduced. Methods: Twenty-four patients with confirmed clinical diagnosis of scoliosis were scanned using a specially developed 3D laser profilometer. The measuring principle of the system is based on laser triangulation with one- laser-plane illumination. The measurement took approximately 10 seconds at 700 mm of the longitudinal translation along the back. The single point measurement accuracy was 0.1 mm. Computer analysis of the measured surface returned two 3D curves. The first curve was determined by manual marking (manual curve), and the second was determined by detecting surface curvature extremes (automatic curve). The manual and automatic curve comparison was given as the root mean square deviation (RMSD) for each patient. The intra-operator study involved assessing 20 successive measurements of the same person, and the inter-operator study involved assessing measurements from 8 operators. Results: The results obtained for the 24 patients showed that the typical RMSD between the manual and automatic curve was 5.0 mm in the frontal plane and 1.0 mm in the sagittal plane, which is a good result compared with palpatory accuracy (9.8 mm). The intra-operator repeatability of the presented method in the frontal and sagittal planes was 0.45 mm and 0.06 mm, respectively. The inter-operator repeatability assessment shows that that the presented method is invariant to the operator of the computer program with the presented method. Conclusions: The main novelty of the presented paper is the development of a new, non-contact method that provides a quick, precise and non-invasive way to determine the spatial spine curve for patients with developed scoliosis and the validation of the presented method using the palpation of the spinous processes, where no harmful ionizing radiation is present. Keywords: Laser profilometry, 3D, Back shape analysis, Scoliosis, Spatial spine curve, Cubic splines Background the vertebrae and its surrounding tissue, including infec- Human upright posture analysis is of key importance in tions, injuries, tumors, bone changes that develop with medicine because incorrect posture may be a reason for age such as spinal stenosis, herniated disks and conditions a vast number of pathological conditions [1]. An ana- such as ankylosing spondylitis and scoliosis [3]. Because tomical expression of the so-called double »S« shaped identified pathological curvatures of the spine are a conse- sagittal curvatures is one of the measures for a correct quence of the aforementioned problems, clinicians prefer body posture in clinical assessment [2]. A number of obtaining a quantitative assessment of human posture problems can change the structure of the spine or damage using one of the numerous measuring methods. Body posture can be assessed using methods that de- * Correspondence: [email protected] termine the internal deformity of the torso or assess 1University of Ljubljana, Faculty of Mechanical Engineering, Aškerčeva 6, 1000 Ljubljana, Slovenia the external shape of the torso. The internal deformity Full list of author information is available at the end of the article © 2015 Poredoš et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Poredoš et al. BMC Medical Imaging (2015) 15:2 Page 2 of 11 assessment can be performed using radiographic imaging the spatial spine curves were obtained from the set of methods, such as magnetic resonance imaging (MRI) and middle control points of each vertebral body on the X-ray radiography, or ultrasound-based imaging methods such images was performed by Devedžić et al. [22]. Ranavolo as medical ultrasonography. However, the main limita- et al. [23] determined the sagittal spine curve, which was tions of the MRI imaging methods are their high costs obtained by calculating the coordinates of the vertebral and low availability [4], whereas the radiographic imaging centroids from the lateral radiographs. Centroids were de- method is known to be harmful to patients due to its cu- fined as the intersections of the diagonal lines on each ver- mulative effect of ionizing radiation [5]. The major draw- tebra. They discovered that the sagittal spine shape can be backs of the medical ultrasonography method are linked determined by 5th-order polynomial interpolation. to speckle noise [6] and its relative dependence on a The trunk surface topography, which was acquired skilled operator [7]. The external shape of the torso can using a laser triangulation imaging system to predict the be determined using several methods, most commonly scoliosis curve type using support vector machines, was mechanical methods such as the DeBrunner kyphometer analyzed by Assi et al. [24]. The spatial spinal curve ex- [8], »Flexicurve ruler« [9], Gravity goniometer or in- traction was a polygonal line located along the commonly clinometer [10] and Myrin inclinometer [11]. Optical named back valley, which is one of the most visible fea- methodssuchasrasterstereography[12],Moirétopog- tures of the trunk external surface. Seoud et al. [16] used raphy [13] and laser triangulation imaging [14] are also the same system to determine the spatial spine curve by used. The main drawback of mechanical methods is the applying the section extraction approach to the 3D torso lack of automated processes such as data storing, pro- shape. The curve on the back that joins the vertebral cessing and visualization. prominence was represented by cubic splines that were To avoid all of the aforementioned disadvantages, nu- equally spaced along the curve by 100 points. Another in- merous efforts have been focused on the development of teresting approach, in which the spatial spine curves were an alternative optical 3D imaging method that has a low determined using the volume decomposition routine, was cost and high speed and is accurate [15]. One of the presented by Ajemba et al. [25]. In this routine, a regular most important objectives of optical metrology in recent set of cross sections of the torso was obtained, and the years has been to replace evaluations that are based on centroid line of the trunk was computed. The cross sec- radiography [16]. The second important objective is the tion sets and centroid lines were interdependent. The final possibility of acquiring, storing, processing and visualiz- centroid line was computed interactively, considering the ing the measured 3D data [17]. Therefore, over the last inclination of the torso. 2 decades, many 3D imaging systems and methods for There is occasionally a need to use two independent analyzing human torsos with developed scoliosis have imaging systems, one to acquire the internal torso de- been established. formity and the other to acquire the external shape of Scoliosis is an abnormal 3D curvature of the vertebral the torso. Jaremko et al. [26] used the laser triangulation column accompanied by asymmetry and deformities of system for 3D torso surface acquisition and postero- the external surface of the trunk [18]. It involves elem- anterior X-ray imaging simultaneously. Data from both ental deformities in the three main anatomical planes: systems were combined to yield a superimposed 3D torso lateral curvature in the frontal plane, anteroposterior spine model. The determination of spatial spine curve was (lordotic and kyphotic) deviation in the sagittal plane, performed by visual estimation based on the selection of and vertebral axial rotation in the transverse plane [19,14]. the best spinous process locations, which were character- In modern clinical practice, X-ray acquisition is recom- ized by bumps and dips on the back surface. The range of mended every 6 months until the patient reaches the age spine curve lateral deviation between the spinous process at which growth stops [20]. The demand for an accurate levels T12-L4, based on 48 scans, was 9.1 mm ± 4.9 mm. and reliable clinical evaluation of the spatial spine curve in Validation of the raster stereographic imaging method scoliosis is hardly new because there are many studies of using the radiographic imaging method was investigated spine curve determination based on the internal torso de- by Hackenberg et al. [12]. Raster stereographic and radio- formity assessment and the external shape of the torso graphic frontal spine curves were compared by best-fit assessment. superimposition. They found that accuracy of raster ster- The identification of spatial spine curve classification eography, based on 25 patients and measured using root- patterns of the scoliosis spinal deformity was studied by mean-square differences, was 5.0 mm. Hong [21]. A 3D spine model was constructed based on A review of the literature shows that the spatial spine the frontal and sagittal X-ray images. The spatial spine curve can be determined by both internal deformity curves were extracted from the 3D Bezier curves with 17 torso assessment and external torso shape assessment. uniformed segments and 18 nodes that were superim- However, to the best of the authors’ knowledge, there are posed over the X-ray images.
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