An Evaluation of the Reliability of Manual Landmark Identification on 3D Segmented Wrists.

BACKGROUND: Three-dimensional (3D) preoperative planning is increasingly used in orthopaedic surgery. Two-dimensional (2D) characterization of distal radial deformities remains inaccurate, and 3D planning requires a reliable reference frame at the wrist. We aim to evaluate the reliability of the determination of anatomical points placed manually on 3D models of the radius to determine which of those points allow reliable morphometric measurements. METHODS: Twenty-three radial scans were reconstructed in 3D. Five operators specialized in the upper limb manually positioned 8 anatomical points on each model. One of the operators repeated the operation 6 times. The anatomical points were based on previously published 3D models used for radial inclination and dorsopalmar tilt measurements. The repeatability and reproducibility of the measurements derived using this manual landmarking were calculated using different measurement methods based on the identified points. An error of ≤2° was considered clinically acceptable. RESULTS: This study of intraobserver and interobserver variability of the anatomic points allowed us to determine the least variable and most accurately defined points. The middle of the ulnar border of the radius, the radial styloid, and the midpoint of the ulnar incisura of the radius were the least variable. The palmar and dorsal ends of the ridge delineating the scaphoid and lunate facets were the most variable. Only 1 of the radial inclination measurement methods was clinically acceptable; the others had a repeatability and reproducibility limit of >2°, making those measurements clinically unacceptable. CONCLUSIONS: The use of isolated points seems insufficient for the development of a wrist reference frame, especially for the purpose of measuring dorsopalmar tilt. If one concurs that an error of 2° is unacceptable for all distal radial measurements, then clinicians should avoid using 3D landmarked points, due to their unreliability, except for radial inclination measured using the radial styloid and the midpoint of the ulnar edge of the radius. A characterization of the wrist using 3D shapes that fit the articular surface of the radius should be considered. LEVEL OF EVIDENCE: Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Volumetric and Simultaneous Photoacoustic and Ultrasound Imaging With a Conventional Linear Array in a Multiview Scanning Scheme.

Volumetric, multimodal imaging with precise spatial and temporal coregistration can provide valuable and complementary information for diagnosis and monitoring. Considerable research has sought to combine 3-D photoacoustic (PA) and ultrasound (US) imaging in clinically translatable configurations; however, technical compromises currently result in poor image quality either for PA or ultrasonic modes. This work aims to provide translatable, high-quality, simultaneously coregistered dual-mode PA/US 3-D tomography. Volumetric imaging based on a synthetic aperture approach was implemented by interlacing PA and US acquisitions during a rotate-translate scan with a 5-MHz linear array (12 angles and 30-mm translation to image a 21-mm diameter, 19 mm long cylindrical volume within 21 s). For coregistration, an original calibration method using a specifically designed thread phantom was developed to estimate six geometrical parameters and one temporal offset through global optimization of the reconstructed sharpness and superposition of calibration phantom structures. Phantom design and cost function metrics were selected based on analysis of a numerical phantom and resulted in a high estimation accuracy for the seven parameters. Experimental estimations validated the calibration repeatability. The estimated parameters were used for the bimodal reconstruction of additional phantoms with either identical or distinct spatial distributions of US and PA contrasts. The superposition distance of the two modes was within < 10% of the acoustic wavelength, and a wavelength-order uniform spatial resolution was obtained. This dual-mode PA/US tomography should contribute to more sensitive and robust detection and follow-up of biological changes or the monitoring of slower-kinetic phenomena in living systems such as the accumulation of nanoagents.