Morphometric Analysis of the Hip as the Basis for Reverse Engineering Miroslav TRAJANOVIĆ, Milica TUFEGDŽIĆ, Stojanka ARSIĆ, Dragana ILIĆ University of Nis, Faculty of Mechanical Engineering, Aleksandra Medvedeva 14, 18000 Nis, Serbia, Machine-electrotechnical school, Cirila i Metodija 26, 37000 Krusevac, Serbia University of Nis, Faculty of Medicine, Blvd. dr Zorana Djindjica 81, 18000 Nis, Serbia Clinical Centre Nis, Center for Radiology, Blvd. dr Zorana Djindjica 48, 18000 Nis, Serbia

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Abstract— One of the crucial steps in the process of reverse of the , which represents a very complex engineering of bone is the definition of anatomical morphological entity resulting from the fusion of three landmarks that are best suited for process reengineering. separate : , and pubic bone. In order to Access is via the morphometric analysis of the given bone. accomplish this task we used the first steps of This paper presents a morphometric analysis of the hip methodology which is already presented in [6,7,8,13]. bone, so as the selection of anatomical landmarks. Input data were obtained with Toshiba MSCT scanner Aquillion 64, This methodology was conducted through several and then they were converted to a polygonal model, which is steps: an initial model for remodeling in the CAD program, where  Data acquisition and pre-processing, a set of anatomical landmarks is defined. Defined set of  Formation of polygonal model, healing and anatomical landmarks is used to determine the reference smoothing of bone, geometric entities of higher order and can be used to obtain  Separation of the three main parts of hip bone (three surface models of the hip bone. bones), Keywords— morphometric analysis, reverse engineering, hip  Identification and selection of the anatomical- bone, RGEs, CAD morphological landmarks needed to build RE model.

I. INTRODUCTION II. ANATOMICAL AND MORPHOLOGICAL In everyday orthopedic praxis, many applications CHARACTERISTICS OF THE HIP BONE require the existence of high-quality 3D models of bones. The hip bone (lat. os coxae) is a paired, massive bone, Examples of such applications are: medical-diagnosis, irregularly shaped, which resembles a plane propeller or therapy and treatments, rehabilitation (post-operative windmill winch (Figure 1). It consists of three parts: 1. analysis), computer assisted surgical training and ilium (os illi); 2. (os pubis); and 3. ischium (os simulation - planning and explaining complex surgical ischii). On the outer side of its middle part (Figure 1) is a operations (pre-operative researches), customized implant deep . A large aperture, the obturator foramen design (functional implants such as spine, hip and knee is below acetabulum (foramen obturatum). implants) and implant fabrication using rapid prototyping The main parts of the hip bone and its anatomical techniques (in the fields of prosthetics and implantation), landmarks are shown at Fig. 1. design and development of medical devices and instrumentation, design and manufacturing biocompatible and bioactive implants and tissue engineering, teaching purposes [1,2,3,4,5]. For these applications, 3D models of bones are obtained by reverse engineering (RE) methods, [1]. Today RE and medical image-based modeling technologies allow construction of 3D virtual models of anatomical structures of human body based on anatomical information from scanning data such as CT, MRI, and laser (or structured light) scanning. The paper presents a methodology of morphometric analysis of the hip bone (lat.os coxae) as the basis for reverse engineering, with the aim of defining anatomic landmarks and reference geometric entities (RGEs) that can be further used for generation of 3D surface model of Fig. 1 Pelvic bone [9] the hip bone in CAD software. The definition of accurate landmarks on hip bone has been a formidable task. The reason for this is complexity

107 The acetabulum consists of a central, non-articular part, which is a groove (sulcus supraacetabularis). The acetabular fossa (fossa acetabuli) which is completely acetabulum is a significant part of the hip joint (art. coxae) filled with adipose tissue and blood vessels of the hip joint. and the head of the femur (caput femoris) enters inside it. The articulated part of acetabulum represents lunate articular surface (facies lunata). III. DATA ACQUISITION AND PREPROCCESING The ilium is divisible into two parts, the body (corpus Point of clouds are the input for RE data processing, so ossis ilii) and the ala (ala ossis ilii). The body builds the at the first stage of the modeling we have collected input acetabular roof. The ala has two surfaces (external and data, from female pelvic bone, with Toshiba MSCT internal) and three borders (superior, anterior and scanner Aquillion 64. CT scan was separated from the CT posterior). The external surface (facies glutea) is crossed slices, performed in resolution of 0.5 mm and stored in the in at three parts with three lines - the posterior (linea form of DICOM format. These 2D slice images were glutea posterior), anterior (linea glutea anterior), and reconstructed in 3D polygonal model, written in STL inferior (linea glutea inferior) gluteal lines. The fields (STereoLitography) format through two basic steps: between these lines define the attachment sides to the image segmentation and region of interest segregation. gluteal (buttocks) muscles. The internal surface has two This is the basic data structure for CAD modeling. portions: the (fossa iliaca - FoI) and sacroiliaca surface (facies sacropelvica), which includes articular IV. MORPHOMETRIC ANALYSIS OF THE HIP BONE surface - auricular surface (facies auricularis - FA), so Importing STL data in CAD system represents the called from its resemblance in shape to the ear and the next step in modeling process. After cleaning and iliac tuberosity (tuberositas iliaca). This articular surface removing all unnecessary additional entities, polygonal articulates with a similar surface on the side of the model is created. This model must be healed, tessellated, and forms sacroiliac joint. Below the iliac fossa is the optimized and smoothed with the aim to meet the arcuate line (linea arcuata). The superior border is requirements from the end-use model. Model is suitable represented by the crest (crista iliaca - CRI). The for further processing, so the next step is determination of following anatomical landmarks at the anterior border of Referential Geometrical Entities (RGEs) on initial model ala are: the anterior superior iliac spine (spina iliaca at all three bones, which correspond to the anatomical anterior superior - SIAS) which can be palpated under the landmarks, according to anatomical and morphological skin and the anterior inferior iliac spine (spina iliaca characteristics anterior inferior - SIAI). Between these iliac spines there A. Determination of Referential Geometrical Entities is incisure (incisura iliaca anterior). At the posterior (RGEs) on initial model border of ala there are noticed the posterior superior iliac spine (spina iliaca posterior superior - SIPS) and the The procedure of identification and definition of posterior inferior iliac spine (spina iliaca posterior inferior anatomical landmarks is based on result of morphometric - SIPI). There is incisure (incisura iliaca posterior) analysis. Anatomical landmarks are defined for a given between these spines. bone only once, and are important as references for other The pubis is divisible into three parts: a body (corpus geometrical features. ossis pubis), a superior (ramus superior ossis pubis) and 1) Acetabulum an inferior ramus (ramus inferior ossis pubis). At the At the acetabular rim (limbus acetabuli - LA) twenty- internal surface there is articular, symphyseal surface two points are selected. Connecting these points gives the (facies symphysialis - FS) which articulates with a similar approximation for the LA. Based on the measured surface of the pubis at the opposite side, forming pubic distance from the surface which limits the LA to selected symphysis (symphysis pubica). The following anatomical points in LA, we have chosen the farthest three points and landmarks are noticed at the superior ramus: the oblique one nearest point at the LA, which are used to determine groove (pecten ossis pubis), the obturator crest (crista the two planes. By setting the plane though three the most orburatoria), the iliopectineal eminence (eminentia distant points, where the projection of the center at the iliopubica - EI), which serves to indicate the point of given plane is selected for the center of the circle, is junction of the ilium and pubis, and obtained the first approximation for LA (represented by (tuberculum pubicum - TP). the yellow circle at Figure 2). The mean value of the The ischium (os ischii) consists of a body (corpus projection distance between the points and the center ossis ischii) and ramus (ramus ossis ischii). The body projection on that plane gives the radius of 26.583 mm. constitutes a back third of the acetabulum, while the By setting the plane though three points - the farthest, ramus joins the inferior ramus of the pubis. Together they the nearest and center of the area that covers acetabulum, build ramus iscioopubicus which limits large hole from when the projection of the center of the area is chosen for the bottom side. This hole is called the obturator foramen the center of the circle, the second approximation for LA (foramen orburatum - FO). At the posterior border of this is obtained (represented by the pink circle at Figure 2). bone are noticed the following landmarks: greater sciatic The mean value of the projection distance between the notch (incisura ishiadica major - IMa), lesser sciatic notch points and the projection center to the given plane now (incisura ishiadica minor- IMi), the tuberosity of the gives the radius of 26.855 mm. By comparing these values ischium (tuber ischiadicum - TI) and the with the distance from the surface that limits FA to the (spina ischiadica). selected points in 3D (mean value from 26.962mm), we The acetabulum consists of the acetabular fossa (fossa have concluded that the second approximation is better acetabuli - FA), the lunate articular surface (facies lunata - because it shows significantly lower deviations. FL), the acetabular notch (incisura acetabuli - IA) and the acetabular rim (limbus s. margo acetabuli - LA), above

108 Fig. 4 The approximation and measurements at TI Fig. 2 The approximation for LA 4) The illium In the acetabular fossa is made the approximation of the articular area in the acetabulum floor (facies lunata - At this bone are defined the following anatomical FL), shown at Figure 3. The center of this area will be landmarks: anterior superior iliac spine (spina iliaca used later for defining the axis of rotation for the planes of anterior superior - SIAS), anterior inferior iliac spine intersection at the hip bone. (spina iliaca anterior inferior - SIAI), posterior superior iliac spine (spina iliaca posterior superior - SIPS) and 2) Pubis posterior inferior iliac spine (spina iliaca posterior inferior At the pubic bone we have defined points which - SIPI). The coordinates of these anatomical landmarks on determine articular symphyseal surface of pubis (facies the left and right hip bone may be used to determine symphysialis - FS). Area bounded by curve obtained by pelvic measurements, e.g. pelvic width, pelvic height and connecting these points represents an approximation for pelvic depth, end for the estimation of hip center in FS. The approximations for FS and FL are presented at frontal, sagital and transverse planes, [10], as well as for Figure 3. determination of the anatomical and technical frames [11], and pelvic anatomical coordinate system, [12].

V. CONCLUSIONS Morphometric analysis which is presented here includes the definition and determination of anatomical landmarks which represent RGEs and are essential for reverse engineering process of bones. The results that are generated by this method directly depend on the quality of landmarks which are chosen with the aim to provide an optimal and adequate coverage of anatomical and morphological characteristics of the hip bone and have the same locations on each bone. These, so called, true landmarks can be also used for definition of pseudo- landmarks (constructive points) or mathematical landmarks (extreme points), for determination of RGEs of higher order (curves, surfaces and solids) and their sub entities (vertices, faces and edges). ACKNOWLEDGMENT This paper is part of project III41017 Virtual human Fig. 3 The approximations for FL and FS osteoarticular system and its application in preclinical and 3) Ischium clinical practice, funded by the Ministry of Education, Science and Technological development of Republic of At the ischium body is defined the area that represents Serbia, for the period of 2011-2014. (tuber ischiadicum TI), by constructing the boundary line through border points on TI. After REFERENCES measuring the distance of these points on this boundary [1] L.C. Hieu , J.V. Sloten, L.T. Hung, L. Khanh, S.Soe, N. line that limits the TI surface, the farthest and the nearest Zlatov, , L.T.Phuoc and P.D. Trung, Medical Reverse point were chosen (Figure 4). These two points and the Engineering Applications and Methods, 2ND International center of TI determine a plane which can be used for the Conference on Innovations, Recent Trends and Challenges intersections on the upper part of ischium body. in Mechatronics, Mechanical Engineering and New High-

109 Tech Products Development, MECAHITECH'10, ECCOMAS Special Interest Conference M. Papadrakakis, Bucharest, 23-24 September 2010, M. Kojic, V. Papadopoulos (eds.) Rhodes, Greece, 22–24 [2] Nagarjan Tukuru, Shivalinge Gowda KP, Syed Mansoor June 2009 Ahmed and S Badami, Rapid Prototype Technique in [8] 132. M. Stojkovic, M. Trajanovic , N. Vitkovic, J. Medical Field, Research J. Pharm. and Tech. 1(4): Oct.- Milovanovic, S. Аrsic, M. Mitkovic, Referential Dec. 2008. geometrical entities for reverse modeling of geometry of [3] Milos Stojkovic, Jelena Milovanovic, Nikola Vitkovic, femur, Computational Vision and Medical Image Miroslav Trajanovic, Nenad Grujovic, Vladimir Processing - VipIMАGE 2009, Porto, Portugal, 14.-16. Milivojevic, Slobodan Milisavljevic, Stanko Mrvic, October 2009 Reverse modeling and solid free-form fabrication of [9] Marieb N. E., Wilhelm B. P., Mallatt J., Human Anatomy, sternum implant, Australasian Physical & Engineering Sixth Edition Media Update, 2010Pearson education, Inc., Sciences in Medicine: Volume 33, Issue 3 (2010), Page San Francisco, Copyright© 2012 243-250, DOI: 10.1007/s13246-010-0029-1 [10] Renata Noce Kirkwood, Elsie G. Culham, Patric Costigan, [4] Nikola Korunović, Miroslav Trajanović, Jelena Radiografic and non-invasive determination of the hip Milovanović, Miloš Stojković, Nikola Vitković, Bone joint centre location: effect on hip joints movements, modelling for structural analysis using FEM, Proceedings ELSEVIER, Clinical Biomechanics, Volume 14, Issue 4, of The International conference Mechanical Engineering in May 1999, Pages 227–235, Copyright © 1999 Elsevier XXI Century, Niš, 2010, pp 205- 208 Science Ltd. [5] Nikola Vitković, Miroslav Trajanović, Jelena [11] A Cappozzo, F Catani, U Della Croce, A Leardini, Milovanović, Nikola Korunović, Stojanka Arsić, Dragana Position and orientation in space of bones during Ilić, The geometrical models of the human femur and its movements: anatomical frame definition and usage in application for preoperative planning in determination, ELSEVIER, Clinical Biomechanics, orthopedics, ICIST 2011, 1st International Conference on Volume 10, Issue 4, June 1995, Pages 171–178, Copyright Internet Society Technology and Management, Kopaonik © 1995 Published by Elsevier Ltd. 2011, Serbia [12] Reginaldo Kisho Fukuchi, Claudiane Arakaki, Maria [6] Trajanović, M., Tufegdžić, M., Arsić, S., Veselinović, M., Isabel Veras Orselli, Marcos Duarte, Evaluation of Vitković, N., Reverse engineering of the human fibula, alternative mechical markers for pelvic coordinate system, 11th International Scientific Conference MMA 2012 - Journal of Biomechanics, Volume 43, Issue 3 , Pages 592- Advanced Production Technologies, Novi Sad, 2012, pp 594, 10 February 2010 527-530 [13] Vidosav Majstorovic, Miroslav Trajanovic, Nikola [7] Miroslav D. Trajanovic, Nikola M. Vitkovic, Milos S. Vitkovic, Milos Stojkovic, Reverse engineering of human Stojkovic, Miodrag T. Manic, Stojanka D. Arsic,The bones by using method of anatomical features, CIRP morphological approach to geometrical modelling of the Annals - Manufacturing Technology, Available online 22 distal femur, SEECCM 2009, 2nd South-East European April 2013, http://dx.doi.org/10.1016/j.cirp.2013.03.081 Conference on Computational Mechanics An IACM-

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