Kinematic Assessment of Real-time Motion Acquisition of the Human Peripheral joints by Dynamic Computer Tomography 

The prevalence and consequences of musculoskeletal pathologies is predicted to rise due to the increase in the global population age. These pathologies represented a leading cause of disability in four of the six world health organization regions in 2017. Understanding the complexity of these pathologies and improving the results of therapeutic interventions remains a challenge. Combining intra-articular kinematics with detailed analysis of joint morphology can provide useful insight and help therapeutic decision making.

Advances in imaging techniques and the subsequent quantitative analysis are being exploited for the management of MSK disorders. 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. This research focuses on creating a framework for the study of musculoskeletal (MSK) structures by means of 4-dimensional Computed Tomography (4D-CT) imaging during real-time motion

Wide beam CT scanners allow to acquire 3D radiographic images from a moving anatomic area over lengths of up to 16 cm in what is known as 4D-CT. This novel approach
provides 1) high resolution 3D images with (2) high temporal resolution over (3) a large volume and offers the opportunity to investigate the function of skeletal structures during real time movement. Image segmentation and registration approaches 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.

"Our workflow enables routine kinematic analysis of joints using dynamic musculoskeletal CT images"

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) Analyzing 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.

Musculoskeletal conditions account for the greatest proportion of lost productivity in the workplace, knowledge gained from this frame work will be helpful in early diagnosis and improved treatment with an over all effect on productivity. Tools developed from this research will impact accurate quantitative analysis in large imaging studies and will enable breakthroughs in the development and validation of new therapeutic interventions and preventive strategies for MSK diseases. Medical software providers, manufacturers of medical devices and prosthesis, and service providers in the field of patient-specific instrument manufacturing and surgical planning also stand to benefit from the knowledge and tools derived from this research.