颈椎体内运动的生物力学研究

由于技术水平的限制,传统的体外生物力学研究方法无法完全模拟人体内真实环境。颈椎体内运动的生物力学研究利用先进的影像技术和检测方法,能够直接观测体内颈椎的运动状态,所获得的数据更接近真实情况,对临床具有重要的参考价值和指导意义。介绍颈椎体内运动的生物力学研究方法、发展过程及目前颈椎体内运动的研究现状,分析颈椎融合手术和颈椎间盘置换术后颈椎运动的改变以及手术对邻近节段的影响,并对今后的发展方向进行探讨。     

慢性非特异性腰痛腰椎屈伸生物力学特征研究进展

慢性非特异性腰痛(nonspecific chronic low back pain, NSCLBP)是一种常见疾病,已经引起了广泛关注,但发病机制尚不明确。 近年来,借助相关设备研究 NSCLBP 发生发展的生物力学机制越来越受到重视。 本文以腰椎核心功能屈伸运动为重点,综述国内外关于 NSCLBP 腰椎屈伸生物力学特征的研究进展,通过对具体研究方法及观察指标的深入探讨及总结展望,发现患者运动学、动力学、表面肌电等参数存在异常征象,为探索 NSCLBP 发病机制及其科学防治开拓思路。     

下肢运动信息采集与运动仿真

目的 建立人体下肢3D模型与生物力学模型,进行运动学和动力学分析,搭建下肢控制平台为主动式下肢假肢和人体下肢助行器的控制研究提供理论依据。方法 利用VICON人体三维运动捕捉系统采集平地行走人体下肢髋、膝、踝运动信息。利用Solidworks建立人体下肢3D模型,进行下肢运动学分析。基于Matlab中Simulink的机械仿真模块（SimMechanics）建立人体下肢模型,进行动力学分析,产生运动信号。基于Quanser半实物仿真平台搭建控制模型,接收SimMechanics产生的运动控制信号,实现对双下肢运动平台的控制。结果 利用运动学分析得到各个关节的速度和加速度信号,利用动力学仿真得到各个关节的力矩信号,对建立的人体双下肢模型进行模拟仿真,通过仿真验证了模型的合理性,利用输出的信号对双下肢运动平台进行控制实现了平地行走功能。结论 建立的平台可以进行人体下肢运动学、动力学和控制方法的研究,为主动式假肢和人体下肢助行器的控制提供借鉴作用。     

Quantitative Imaging Biomarkers: The Application of Advanced Image Processing and Analysis to Clinical and Preclinical Decision Making

The importance of medical imaging for clinical decision making has been steadily increasing over the last four decades. Recently, there has also been an emphasis on medical imaging for preclinical decision making, i.e., for use in pharamaceutical and medical device development. There is also a drive towards quantification of imaging findings by using quantitative imaging biomarkers, which can improve sensitivity, specificity, accuracy and reproducibility of imaged characteristics used for diagnostic and therapeutic decisions. An important component of the discovery, characterization, validation and application of quantitative imaging biomarkers is the extraction of information and meaning from images through image processing and subsequent analysis. However, many advanced image processing and analysis methods are not applied directly to questions of clinical interest, i.e., for diagnostic and therapeutic decision making, which is a consideration that should be closely linked to the development of such algorithms. This article is meant to address these concerns. First, quantitative imaging biomarkers are introduced by providing definitions and concepts. Then, potential applications of advanced image processing and analysis to areas of quantitative imaging biomarker research are described; specifically, research into osteoarthritis (OA), Alzheimer's disease (AD) and cancer is presented. Then, challenges in quantitative imaging biomarker research are discussed. Finally, a conceptual framework for integrating clinical and preclinical considerations into the development of quantitative imaging biomarkers and their computer-assisted methods of extraction is presented.     

3D spinal motion analysis during staircase walking using an ambulatory inertial and magnetic sensing system

Previous research on spinal motion during walking has been restricted to the level walking condition in a gait lab although staircase walking (i.e., stair ascent and descent) exhibits unique biomechanical characteristics. A major difficulty in spinal motion capture during staircase walking is the in-the-lab limitation of measurement techniques. The purpose of this article is twofold: (i) to present an ambulatory spinal motion measurement system based on inertial and magnetic sensors (IMSs) to overcome this limitation and (ii) to demonstrate its application to 3D spinal motion analysis during staircase walking to fill a gap in the spinal kinematics literature. The proposed system is comprised of three tri-axial IMSs on the pelvis/spine measuring 3D angular motions of the pelvis, lumbar spine and thoracic spine and two uni-axial gyroscopes on the shanks providing gait cycle information. The proposed system was employed in comparing the spinal motion during the staircase walking to that of the level walking with respect to the motion pattern, variability, and range of motion (ROM). The test results showed clear differences in spinal motion between the level walking and staircase walking conditions, particularly in regards to the motion pattern and ROM of the flexion/extension and lateral bending of the spine.     

The strategies to regulate and to modulate the propulsive forces during gait initiation in lower limb amputees

We used the framework of motor program adaptability to examine how unilateral above-knee (AK) or below-knee (BK) amputee subjects organize the global and local biomechanical processes of generation of the propulsive forces during gait initiation to overcome the segmental and neuro-muscular asymmetry. The organization of the global biomechanical process refers to the kinematics behavior of the couple center of foot pressure (CoP) and center of mass (CoM); the organization of the local biomechanical process refers to the propulsive forces generated by the prosthetic or intact limb during the anticipatory postural adjustment phase and the step execution phase. Specifically, we examined: i) the strategy to regulate the progression velocity, i.e., to maintain it comparably when the leading limb changed from the prosthetic limb to the intact limb; and ii) the strategy to modulate the progression velocity, i.e., to increase it when gait was initiated with the prosthetic limb vs. intact limb. The kinematics of the CoM and CoP in the amputees showed the same global biomechanical organization that is typically observed in able-bodied subjects, i.e., the production of the forward disequilibrium torque was obtained by a backward shift of the CoP, followed by a forward acceleration of the CoM. However, gait initiation was achieved by using a different local strategy depending on which limb was used to initiate the step. For the regulation of the CoM progression velocity, when the gait was initiated with the intact limb, the slope of the progression velocity during the anticipatory postural adjustment phase (APA) was steeper and lasted longer, the step execution duration was shorter, and the variation of the CoM speed was lower. In other words, to regulate the speed of progression, the amputee subjects controlled the spatial and temporal parameters of the propulsive forces. In the modulation of the CoM progression velocity, when the gait was initiated with the intact limb, the amputees controlled only the intensity of the propulsive forces during both the APA and step execution phases. In contrast, when the gait was initiated with the prosthetic limb, the modulation resulted mainly from the propulsive forces generated during the step execution phase. These different strategies are discussed in terms of the subjects capacity to adapt the motor program for gait initiation to new constraints.An erratum to this article can be found at     

Integration of SimSET photon history generator in GATE for efficient Monte Carlo simulations of pinhole SPECT

The authors developed and validated an efficient Monte Carlo simulation (MCS) workflow to facilitate small animal pinhole SPECT imaging research. This workflow seamlessly integrates two existing MCS tools: simulation system for emission tomography (SimSET) and GEANT4 application for emission tomography (GATE). Specifically, we retained the strength of GATE in describing complex collimator/detector configurations to meet the anticipated needs for studying advanced pinhole collimation (e.g., multipinhole) geometry, while inserting the fast SimSET photon history generator (PHG) to circumvent the relatively slow GEANT4 MCS code used by GATE in simulating photon interactions inside voxelized phantoms. For validation, data generated from this new SimSET-GATE workflow were compared with those from GATE-only simulations as well as experimental measurements obtained using a commercial small animal pinhole SPECT system. Our results showed excellent agreement (e.g., in system point response functions and energy spectra) between SimSET-GATE and GATE-only simulations, and, more importantly, a significant computational speedup (up to approximately 10-fold) provided by the new workflow. Satisfactory agreement between MCS results and experimental data were also observed. In conclusion, the authors have successfully integrated SimSET photon history generator in GATE for fast and realistic pinhole SPECT simulations, which can facilitate research in, for example, the development and application of quantitative pinhole and multipinhole SPECT for small animal imaging. This integrated simulation tool can also be adapted for studying other preclinical and clinical SPECT techniques.     

Development of state estimation explains improvements in sensorimotor performance across childhood

Previous developmental research examining sensorimotor control of the arm in school-age children has demonstrated age-related improvements in movement kinematics. However, the mechanisms that underlie these age-related improvements are still unclear. This study hypothesized that changes in sensorimotor performance across childhood can be attributed, in part, to the development of state estimation, defined as estimates computed by the central nervous system, which specify both current and future hand positions and velocities (i.e., hand "state"). Two behavioral experiments were conducted, in which 6- to 12-year-old children and young adults executed goal-directed arm movements. Results from Experiment 1 revealed that young children (i.e., ～6-8 years) have less precise proprioceptive feedback for static (i.e., stationary) hand state estimation compared with older children (i.e., ～10-12 years), resulting in increased variability of target-directed reaching movements. Experiment 2 demonstrated that young children rely on delayed and unreliable state estimates during the execution of goal-directed hand movements (i.e., dynamic state estimation), resulting in both increased movement errors and directional variability. Collectively, these results suggest that improvements in sensorimotor behavior across childhood can be attributed, at least partially, to the development of both static and dynamic state estimation.     

Diagnostic imaging over the last 50 years: research and development in medical imaging science and technology

Over the last 50 years, diagnostic imaging has grown from a state of infancy to a high level of maturity. Many new imaging modalities have been developed. However, modern medical imaging includes not only image production but also image processing, computer-aided diagnosis (CAD), image recording and storage, and image transmission, most of which are included in a picture archiving and communication system (PACS). The content of this paper includes a short review of research and development in medical imaging science and technology, which covers (a) diagnostic imaging in the 1950s, (b) the importance of image quality and diagnostic performance, (c) MTF, Wiener spectrum, NEQ and DQE, (d) ROC analysis, (e) analogue imaging systems, (f) digital imaging systems, (g) image processing, (h) computer-aided diagnosis, (i) PACS, (j) 3D imaging and (k) future directions. Although some of the modalities are already very sophisticated, further improvements will be made in image quality for MRI, ultrasound and molecular imaging. The infrastructure of PACS is likely to be improved further in terms of its reliability, speed and capacity. However, CAD is currently still in its infancy, and is likely to be a subject of research for a long time.     

Neuroimaging insights into the pathophysiology of sleep disorders

Neuroimaging methods can be used to investigate whether sleep disorders are associated with specific changes in brain structure or regional activity. However, it is still unclear how these new data might improve our understanding of the pathophysiology underlying adult sleep disorders. Here we review functional brain imaging findings in major intrinsic sleep disorders (i.e., idiopathic insomnia, narcolepsy, and obstructive sleep apnea) and in abnormal motor behavior during sleep (i.e., periodic limb movement disorder and REM sleep behavior disorder). The studies reviewed include neuroanatomical assessments (voxel-based morphometry, magnetic resonance spectroscopy), metabolic/functional investigations (positron emission tomography, single photon emission computed tomography, functional magnetic resonance imaging), and ligand marker measurements. Based on the current state of the research, we suggest that brain imaging is a useful approach to assess the structural and functional correlates of sleep impairments as well as better understand the cerebral consequences of various therapeutic approaches. Modem neuroimaging techniques therefore provide a valuable tool to gain insight into possible pathophysiological mechanisms of sleep disorders in adult humans.     

A Semi-automated Approach to Improve the Efficiency of Medical Imaging Segmentation for Haptic Rendering

The Sensimmer platform represents our ongoing research on simultaneous haptics and graphics rendering of 3D models. For simulation of medical and surgical procedures using Sensimmer, 3D models must be obtained from medical imaging data, such as magnetic resonance imaging (MRI) or computed tomography (CT). Image segmentation techniques are used to determine the anatomies of interest from the images. 3D models are obtained from segmentation and their triangle reduction is required for graphics and haptics rendering. This paper focuses on creating 3D models by automating the segmentation of CT images based on the pixel contrast for integrating the interface between Sensimmer and medical imaging devices, using the volumetric approach, Hough transform method, and manual centering method. Hence, automating the process has reduced the segmentation time by 56.35% while maintaining the same accuracy of the output at ±2 voxels.     

Anniversary paper: evaluation of medical imaging systems

Medical imaging used to be primarily within the domain of radiology, but with the advent of virtual pathology slides and telemedicine, imaging technology is expanding in the healthcare enterprise. As new imaging technologies are developed, they must be evaluated to assess the impact and benefit on patient care. The authors review the hierarchical model of the efficacy of diagnostic imaging systems by Fryback and Thornbury [Med. Decis. Making 11, 88-94 (1991)] as a guiding principle for system evaluation. Evaluation of medical imaging systems encompasses everything from the hardware and software used to acquire, store, and transmit images to the presentation of images to the interpreting clinician. Evaluation of medical imaging systems can take many forms, from the purely technical (e.g., patient dose measurement) to the increasingly complex (e.g., determining whether a new imaging method saves lives and benefits society). Evaluation methodologies cover a broad range, from receiver operating characteristic (ROC) techniques that measure diagnostic accuracy to timing studies that measure image-interpretation workflow efficiency. The authors review briefly the history of the development of evaluation methodologies and review ROC methodology as well as other types of evaluation methods. They discuss unique challenges in system evaluation that face the imaging community today and opportunities for future advances.     

Similar muscles contribute to horizontal and vertical acceleration of center of mass in forward and backward walking: implications for neural control

Leg kinematics during backward walking (BW) are very similar to the time-reversed kinematics during forward walking (FW). This suggests that the underlying muscle activation pattern could originate from a simple time reversal, as well. Experimental electromyography studies have confirmed that this is the case for some muscles. Furthermore, it has been hypothesized that muscles showing a time reversal should also exhibit a reversal in function [from accelerating the body center of mass (COM) to decelerating]. However, this has not yet been verified in simulation studies. In the present study, forward simulations were used to study the effects of muscles on the acceleration of COM in FW and BW. We found that a reversal in function was indeed present in the muscle control of the horizontal movement of COM (e.g., tibialis anterior and gastrocnemius). In contrast, muscles' antigravity contributions maintained their function for both directions of movement. An important outcome of the present study is therefore that similar muscles can be used to achieve opposite functional demands at the level of control of the COM when walking direction is reversed. However, some muscles showed direction-specific contributions (i.e., dorsiflexors). We concluded that the changes in muscle contributions imply that a simple time reversal would be insufficient to produce BW from FW. We therefore propose that BW utilizes extra elements, presumably supraspinal, in addition to a common spinal drive. These additions are needed for propulsion and require a partial reconfiguration of lower level common networks.     

Effects of point configuration on the accuracy in 3D reconstruction from biplane images

Two or more angiograms are being used frequently in medical imaging to reconstruct locations in three-dimensional (3D) space, e.g., for reconstruction of 3D vascular trees, implanted electrodes, or patient positioning. A number of techniques have been proposed for this task. In this simulation study, we investigate the effect of the shape of the configuration of the points in 3D (the "cloud" of points) on reconstruction errors for one of these techniques developed in our laboratory. Five types of configurations (a ball, an elongated ellipsoid (cigar), flattened ball (pancake), flattened cigar, and a flattened ball with a single distant point) are used in the evaluations. For each shape, 100 random configurations were generated, with point coordinates chosen from Gaussian distributions having a covariance matrix corresponding to the desired shape. The 3D data were projected into the image planes using a known imaging geometry. Gaussian distributed errors were introduced in the x and y coordinates of these projected points. Gaussian distributed errors were also introduced into the gantry information used to calculate the initial imaging geometry. The imaging geometries and 3D positions were iteratively refined using the enhanced-Metz-Fencil technique. The image data were also used to evaluate the feasible R-t solution volume. The 3D errors between the calculated and true positions were determined. The effects of the shape of the configuration, the number of points, the initial geometry error, and the input image error were evaluated. The results for the number of points, initial geometry error, and image error are in agreement with previously reported results, i.e., increasing the number of points and reducing initial geometry and/or image error, improves the accuracy of the reconstructed data. The shape of the 3D configuration of points also affects the error of reconstructed 3D configuration; specifically, errors decrease as the "volume" of the 3D configuration increases, as would be intuitively expected, and shapes with larger spread, such as spherical shapes, yield more accurate reconstructions. These results are in agreement with an analysis of the solution volume of feasible geometries and could be used to guide selection of points for reconstruction of 3D configurations from two views.     

Towards a theory of a solution space for the biplane imaging geometry problem

Biplane angiographic imaging is a primary method for visual and quantitative assessment of the vasculature. In order to reliably reconstruct the three-dimensional (3D) position, orientation, and shape of the vessel structure, a key problem is to determine the rotation matrix R and the translation vector t which relate the two coordinate systems. This so-called Imaging Geometry Determination problem is well studied in the medical imaging and computer vision communities and a number of interesting approaches have been reported. Each such technique determines a solution which yields 3D vasculature reconstructions with errors comparable to other techniques. From the literature, we see that different techniques with different optimization strategies yield reconstructions with equivalent errors. We have investigated this behavior, and it appears that the error in the input data leads to this equivalence effectively yielding what we call the solution space of feasible geometries, i.e., geometries which could be solutions given the error or uncertainty in the input image data. In this paper, we lay the theoretical framework for this concept of a solution space of feasible geometries using simple schematic constructions, deriving the underlying mathematical relationships, presenting implementation details, and discussing implications and applications of the proposed idea. Because the solution space of feasible geometries encompasses equivalent solutions given the input error, the solution space approach can be used to evaluate the precision of calculated geometries or 3D data based on known or estimated uncertainties in the input image data. We also use the solution space approach to calculate an imaging geometry, i.e., a solution.     

Molecular imaging and the unification of multilevel mechanisms and data in medical physics

Molecular imaging (MI) constitutes a recently developed approach of imaging, where modalities and agents have been reinvented and used in novel combinations in order to expose and measure biologic processes occurring at molecular and cellular levels. It is an approach that bridges the gap between modalities acquiring data from high (e.g., computed tomography, magnetic resonance imaging, and positron-emitting isotopes) and low (e.g., PCR, microarrays) levels of a biological organization. While data integration methodologies will lead to improved diagnostic and prognostic performance, interdisciplinary collaboration, triggered by MI, will result in a better perception of the underlying biological mechanisms. Toward the development of a unifying theory describing these mechanisms, medical physicists can formulate new hypotheses, provide the physical constraints bounding them, and consequently design appropriate experiments. Their new scientific and working environment calls for interventions in their syllabi to educate scientists with enhanced capabilities for holistic views and synthesis.     

DeskCAT互动CT教学实验系统剖析——兼谈CT的实验教学

该文作者根据多年来对医学成像课程的教学实践与体会,结合医院、医学院校与高校有关专业的教学实验需求,总结了国际上CT实验教学的四种模式:"自编程模式"、"MATLAB模式"、"DR+转台模式"以及"台式CT教学实验模式"。着重介绍了加拿大MODUS公司设计的"基于光学射线源的台式CT教学实验系统:Desk CAT"。剖析了其结构特点和优点,介绍了该系统的许多重要功能例如能仿真SPECT与双能CT等。