Percutaneous MR-guided interventions using an optical Moiré Phase tracking system: Initial results.

The aim of this study was the development and evaluation of a real-time guidance support using optical Moiré Phase Tracking (MPT) for magnetic resonance (MR) guided percutaneous interventions. A gradient echo sequence, capable of real-time position updates by the MPT system, was modified to enable needle guidance based on four rigidly attached MPT markers at the back of a needle. Two perpendicular imaging planes were automatically aligned along the calibrated needle and centered at its tip. For user guidance, additional information about the needle trajectory and the tip to target distance were added as image overlay. Both, images and guiding information were displayed on the in-room monitor to facilitate MR guided interventions. The guidance support was evaluated by four experienced interventional radiologists and four novices targeting rubber O-rings embedded in a custom-made phantom on a 3T wide-bore MRI system (80 punctures). The skin to target time, user error, system error and total error were analyzed. The mean skin to target time was 146s±68s with no statistically significant difference between experts and novices. A low mean user error (0.91mm±0.43mm), system error (0.53mm±0.27mm) and total error (0.99mm±0.47mm) was reached in all directions. No statistically significant difference in user error, system error and total error could be found between experts and novices. The presented tracking and image guidance system combined with the user interface offers continuous and interactive control of the imaging plane while puncturing in the magnet enabling accurate real-time feedback for both, experienced and non-experienced users.

Reduced hamstring strength increases anterior cruciate ligament loading during anticipated sidestep cutting.

BACKGROUND: Dynamic knee stability is considered a critical factor in reducing anterior cruciate ligament loads. While the relationships between hamstring force production and anterior cruciate ligament loading are well known in vitro, the influence of hamstring strength to anterior cruciate ligament loading during athletic maneuvers remains unknown. Therefore, the purpose of this study was to determine the influence of hamstring strength on anterior cruciate ligament loading during anticipated sidestep cut. METHODS: Seventeen recreationally active females were recruited to perform sidestep cutting maneuvers pre/post an acute hamstring strength reduction protocol. Kinematics and kinetics were calculated during the cut and a musculoskeletal model was used to estimate muscle, joint, and anterior cruciate ligament loads. Dependent t-tests were conducted to investigate differences between the two cutting conditions. FINDINGS: Anterior cruciate ligament loading increased by 36% due to reduced hamstring strength. This was mostly due to a 44% increase in sagittal plane loading and a 24% increase in frontal plane loading. Post strength reduction sidestep cuts were also performed with decreased anterior tibiofemoral shear force, an outcome that would theoretically reduce anterior cruciate ligament loading. However, the overall decrease in hamstring force production coupled with a more axial hamstring line of action yielded a net increase in anterior cruciate ligament loading. INTERPRETATION: These results suggest that decreased hamstring strength significantly increases anterior cruciate ligament loading during anticipated sidestep cutting. Additionally, these results support the premise that preseason screening programs should monitor hamstring strength to identify female athletes with potential deficits and increased injury risk.

Anticipatory effects on anterior cruciate ligament loading during sidestep cutting.

BACKGROUND: A key to understanding potential anterior cruciate ligament injury mechanisms is to determine joint loading characteristics associated with an injury-causing event. However, direct measurement of anterior cruciate ligament loading during athletic tasks is invasive. Thus, previous research has been unable to study the association between neuromuscular variables and anterior cruciate ligament loading. Therefore, the purpose of this study was to determine the influence of movement anticipation on anterior cruciate ligament loading using a musculoskeletal modeling approach. METHODS: Twenty healthy recreationally active females were recruited to perform anticipated and unanticipated sidestep cutting. Three-dimensional kinematics and kinetics of the right leg were calculated. Muscle, joint and anterior cruciate ligament forces were then estimated using a musculoskeletal model. Dependent t-tests were conducted to investigate differences between the two cutting conditions. FINDINGS: ACL loading significantly increased during unanticipated sidestep cutting (p<0.05). This increase was primarily due to a significant increase in the sagittal plane ACL loading, which contributed 62% of the total loading. Frontal plane ACL loading contributed 26% and transverse plane ACL loading contributed 12%. INTERPRETATION: These results suggest that anterior cruciate ligament loading resulted from a multifaceted interaction of the sagittal plane shear forces (i.e., quadriceps, hamstrings, and tibiofemoral), as well as the frontal and transverse plane knee moments. Additionally, the results of this study confirm the hypothesis in the current literature that unanticipated movements such as sidestep cutting increase anterior cruciate ligament loading.

Effect of patellofemoral pain on strength and mechanics after an exhaustive run.

PURPOSE: To investigate the effects of an exhaustive run on trunk and lower extremity strength and mechanics in patients with and without patellofemoral pain (PFP), we hypothesized that strength would decrease and mechanics would change after the exhaustive run. METHODS: Nineteen subjects with PFP and 19 controls participated (10 men and 9 women per group). Lower extremity and trunk mechanics during running, body mass-normalized strength, and pain assessments before and after an exhaustive run were quantified. A repeated-measures ANOVA was used to assess group differences and exhaustion-related changes (P < 0.05), with t-test post hoc analyses performed when significant interactions were identified (P < 0.0125). RESULTS: Pain significantly increased with the exhaustive run in the PFP group (P = 0.021). Hip strength was reduced after the exhaustive run, more so in those with PFP (abduction: before = 0.384 ± 0.08, after = 0.314 ± 0.08, P < 0.001; external rotation: before = 0.113 ± 0.02, after = 0.090 ± 0.02, P < 0.001). Persons with PFP also demonstrated increased knee flexion (before = 41.6° ± 5.5°, after = 46.9° ± 7.5°, P < 0.001), hip flexion (before = 30.4° ± 6.8°, after = 42.5° ± 9.7°, P < 0.001), and anterior pelvic tilt (before = 7.2° ± 5.1°, after = 13.3° ± 6.7°, P = 0.001) after the exhaustive run compared to controls. Trunk flexion increased in both PFP (before = 13.09° ± 6.2°, after = 16.31° ± 5.3°, P < 0.001) and control (before = 1393° ± 4.7°, after = 15.99° ± 5.9°, P < 0.001) groups. Hip extension (before = -2.09 ± 0.49 N · m · kg(-1), after = -2.49 ± 0.54 N · m · kg(-1), P = 0.002) moments increased only in subjects with PFP. CONCLUSIONS: Exhaustive running results in reduced hip strength in subjects with PFP; however, this did not result in changes to hip internal rotation or adduction kinematics. Kinematic and kinetic changes after the exhaustive run are more indicative of compensatory changes to reduce pain. Increasing trunk flexion during running might provide pain relief during running; however, reducing anterior pelvic tilt may also warrant attention during treatment.

Measurement and correction of microscopic head motion during magnetic resonance imaging of the brain.

Magnetic resonance imaging (MRI) is a widely used method for non-invasive study of the structure and function of the human brain. Increasing magnetic field strengths enable higher resolution imaging; however, long scan times and high motion sensitivity mean that image quality is often limited by the involuntary motion of the subject. Prospective motion correction is a technique that addresses this problem by tracking head motion and continuously updating the imaging pulse sequence, locking the imaging volume position and orientation relative to the moving brain. The accuracy and precision of current MR-compatible tracking systems and navigator methods allows the quantification and correction of large-scale motion, but not the correction of very small involuntary movements in six degrees of freedom. In this work, we present an MR-compatible tracking system comprising a single camera and a single 15 mm marker that provides tracking precision in the order of 10 m and 0.01 degrees. We show preliminary results, which indicate that when used for prospective motion correction, the system enables improvement in image quality at both 3 T and 7 T, even in experienced and cooperative subjects trained to remain motionless during imaging. We also report direct observation and quantification of the mechanical ballistocardiogram (BCG) during simultaneous MR imaging. This is particularly apparent in the head-feet direction, with a peak-to-peak displacement of 140 m.

Prospective motion correction for magnetic resonance spectroscopy using single camera Retro-Grate reflector optical tracking.

PURPOSE: To introduce and evaluate a method of prospective motion correction for localized proton magnetic resonance spectroscopy (1H-MRS) using a single-camera optical tracking system. MATERIALS AND METHODS: Five healthy participants were scanned at 3T using a point-resolved spectroscopic sequence (PRESS) with a motion-tracking module and phase navigator. Head motion in six degrees was tracked with a Retro-Grate Reflector (RGR) tracking system and target via a mirror mounted inside the bore. Participants performed a series of three predetermined motion patterns during scanning. RESULTS: Left-right rotation (Rz) (average 12°) resulted in an increase in the total choline to total creatine ratio (Cho/Cr) of +14.6 ± 1.5% (P = 0.0009) for scans without correction, but no change for scans with correction (+1.1 ± 1.5%; P = 0.76). Spectra with uncorrected Z-translations showed large lipid peaks (skull) with changes in Cho/Cr of -13.2 ± 1.6% (P = 0.02, no motion correction) and -2.2 ± 2.4% (P = 0.51) with correction enabled. There were no significant changes in the ratios of N-acetylaspartate, glutamate+glutamine, or myo-inositol to creatine compared to baseline scans for all experiments. CONCLUSION: Prospective motion correction for 1H-MRS, using single-camera RGR tracking, can reduce spectral artifacts and quantitation errors in Cho/Cr ratios due to head motion and promises improved spectral quality and reproducibility.

Validation of a single camera three-dimensional motion tracking system.

The ability to analyze human movement is an essential tool of biomechanical analysis for both sport and clinical applications. Traditional 3D motion capture technology limits the feasibility of large scale data collections and therefore the ability to address clinical questions. Ideally, the measurement system/protocol should be non-invasive, mobile, generate nearly instantaneous feedback to the clinician and athlete, and be relatively inexpensive. The retro-grate reflector (RGR) is a new technology that allows for three-dimensional motion capture using a single camera. Previous studies have shown that orientation and position information recorded by the RGR system has high measurement precision and is strongly correlated with a traditional multi-camera system across a series of static poses. The technology has since been refined to record moving pose information from multiple RGR targets at sampling rates adequate for assessment of athletic movements. The purpose of this study was to compare motion data for a standard athletic movement recorded simultaneously with the RGR and multi-camera (Motion Analysis Eagle) systems. Nine subjects performed three single-leg land-and-cut maneuvers. Thigh and shank three-dimensional kinematics were collected with the RGR and Eagle camera systems simultaneously at 100Hz. Results showed a strong agreement between the two systems in all three planes, which demonstrates the ability of the RGR system to record moving pose information from multiple RGR targets at a sampling rate adequate for assessment of human movement and supports the ability to use the RGR technology as a valid 3D motion capture system.