This PhD aims at creating a framework for the study of musculoskeletal (msk) structures by means of 4-dimensional Computed Tomography (CT) imaging during real-time motion. Advances in technology of CT such as wider beams and improved temporal resolutions have opened opportunities in diagnosis. Such technologies can be employed in the study of joints undergoing motion in real time. Knowledge gained from such kinematic analysis can be essential in diagnosis of joint pathologies as well as inform therapeutic decisions and the design of prosthesis.
Currently, data on intra-articular kinematics are obtained using 2D stereofluoroscopy which gives limited information of the kinematics in real time. This technique is also complex, expensive and requires a dedicated set-up. Externally fixed marker-sets have also been used to study joint kinematics, however these may not represent the real-time motion of the joints with most of these interventions being invasive. Most detailed intra-articular kinematic studies are therefore only performed in vitro, but with the major drawback being the applicability of these studies to live clinical situations.
The technical capabilities of wide beam CT scanners, which allow to dynamically investigate organs and structures by 3D radiographic images over a length up to 16 cm will be used in addressing the challenges of joint kinematics assessment. Image segmentation and registration techniques will be applied on the images to obtain quantitative metrics useful in understanding and diagnosing pathologies in MSK. Scan protocols for the acquisition of the images will be optimized to reduce the radiation dose while preserving image quality to ensure success of the image processing steps. To achieve this, preliminary experiments with a custom-made phantom as well as in vivo studies will be used to investigate scan parameters, that yield good results in the image processing steps.
The end applications of these studies include: a) Monitoring patellar and tibiofemoral movement in healthy as well as treated and non-treated pathological conditions; b) analysing joint kinematics before and after joint replacement, ligament reconstruction, or arthrodesis; c) Comparing in-vivo knee kinematics after dynamic intra-ligamentary stabilization of the anterior cruciate ligament (ACL) with knee kinematics after more traditional delayed ACL reconstruction procedures.
|||Four-dimensional CT as a valid approach to detect and quantify kinematic changes after selective ankle ligament sectioning. Scientific Reports, 9(1), Nature Publishing Group, 2019.|
|||Four-dimensional CT as a valid approach to detect and quantify kinematic changes after selective ankle ligament sectioning.. Scientific Reports, 9(1):1291-1300, Nature Publishing Group, 2019.|