A new method to generate a patient-specific finite element model of the human buttocks.

Finite element (FE) models are very efficient tools to study internal stresses in human structures that induce severe pressure sores. Unfortunately, methods currently used to generate FE models are not suitable for clinical application involving wheelchair users. A clinical-oriented method, based on calibrated-biplanar radiographs, was therefore developed to generate a subject-specific FE model of the buttocks in a non-weighted sitting position. The model was then used to analyze the stress distribution within the buttocks and compare two wheelchair seat cushions designs. Additional radiographs and pressure measurements in a weighted sitting position were acquired to validate the FE model experimentally. Results from the FE model were in good agreement with experimental data and related literature. An internal peak pressure of 45.3 kPa was observed while seated on a flat foam cushion, corresponding to an interface pressure of 23.6 kPa. Both pressures occurred underneath the ischial tuberosities. When compared to the flat foam cushion, the contoured foam cushion reduced internal and interface peak pressures by 18% and 33%, respectively. The method developed in this study has a great potential for clinical use. The FE model, by predicting realistic stress distributions, allows for the selection of a convenient wheelchair seat cushion.     

Geometric image registration under arbitrarily-shaped locally variant illuminations

In geometric image registration, illumination variations that exist between image pairs tend to degrade the precision of the registration, which can negatively affect subsequent processing. In this paper, we present a model to improve the sub-pixel geometric registration precision of image pairs when there exists locally variant illuminations with arbitrary shape. This model extends on our previous work to include multiple local shading levels of arbitrary shape, where the ill-posed problem is conditioned by constraining the solution to an estimated number of shading levels. The proposed model is solved using least-squares estimation and is cast in an iterative coarse-to-fine framework, which allows a convergence rate that is similar to competing intensity-based image registration approaches. The primary advantage of the proposed approach is the nearly tenfold improvement in sub-pixel precision for the registration when convergence is obtained in this class of technique.     

Accessing the influence of repositioning on the pelvis' 3-D orientation in wheelchair users.

This study aimed at evaluating the effects of mechanical repositioning, obtained by the increase in seat-to-back (STB) and system tilt angles, on the position of the pelvis with spinal-cord injured subjects seated in a wheelchair. The noninvasive method used combined magnetic resonance imaging (MRI) images of the whole pelvis obtained in a supine posture and ultrasound images of the pelvic iliac crests obtained in four seating positions. The matching of the two image data sets enabled the location of fourteen pelvic landmarks in the seated positions. From these landmarks, the pelvic tilt, obliquity, and transverse rotation, and the three-dimensional (3-D) motion of the pelvis were calculated. Results showed that the increase in STB angle is not equal to the calculated increase in pelvic tilt and that the pelvis rotated posteriorly, moved forward and downwards. An increase in the system tilt moved the pelvis rearwards and downwards, which counter-balanced the movement seen with the increase in STB. At the return to the first position, no significant changes were observed in the pelvis' position and orientation compared to the initial posture. Results also demonstrated the importance in calculating the total 3-D rotations and translations to characterize adequately the pelvic movement.     

Optimized vertical stereo base radiographic setup for the clinical three-dimensional reconstruction of the human spine

This paper presents a method to determine the stereoradiographic planes and anatomical vertebral landmarks giving the most reliable three-dimensional reconstructions of the thoracic and lumbar spine for clinical studies. The present investigation was limited to stereoradiographic setups with a normal vertical stereo base. Possible X-ray tube positions are thus corresponding to angles ranging from 0 (conventional posteroanterior radiograph) up to 30 degrees (dimension of the X-ray room). An X-ray phantom was used as a specimen from which three-dimensional reconstructions with the direct linear transformation (DLT) algorithm were obtained. Visibility of landmarks located on pedicles, end-plates, transverse and spinous processes was evaluated for the whole thoracic and lumbar spine (T1 to L5). Process landmarks were discarded because their poor visibility on radiographs produced inaccurate three-dimensional reconstructions. Considering the size, shape and orientation of vertebrae, an angle of 20 degrees between the posteroanterior horizontal position and the angled position of the X-ray tube gave optimal results. Landmarks located on pedicles and end-plates produced the most reliable three-dimensional reconstructions of the spine. Pedicles were found to be more reliable landmarks than end-plates. Validation of the technique with reconstructed steel beads reveals three-dimensional errors under 1.0 mm. Since vertebral landmarks were more difficult to identify on radiographs than steel beads, reconstruction results were compared with those obtained with a biplanar orthogonal setup. This shows that three-dimensional errors of 8.0 mm may be expected on actual reconstructions of the spine and errors as large as 15.0 mm may be present on poorly visible landmarks.     

Training learning strategies with computer-aided cooperative learning

This paper describes the combination of two potent training technologies (computer-based instruction and cooperative learning) into a system called computer-aided cooperative learning (CACL) and the use of CACL to train students in a general learning strategy. This six-steps strategy involves setting a task-appropriate mood, reading for general understanding, recall as much of the material as possible, detecting errors and omissions, elaborating upon the material to make it more memorable and reviewing. CACL capitalizes on the strengths and overcomes some of the weaknesses of each of the constituent technologies. The resulting program is described and some data demonstrating its effectiveness is presented. Students using CACL recalled more material from each of two passages studied individually than did students who did not use CACL. CACL appears to be a promising technology for the delivery of learning strategies. Future research and development efforts should examine CACL's usefulness to the training of more sophisticated learning strategies.     

Differences between pelvic skin and bone landmark identification in different seated positions on spinal-cord injured subjects

The purpose of this paper was to determine the differences between internal and external pelvic landmark locations in different seating positions. A computer tool developed for the registration of two series of images was used to obtain the internal geometry. First, images of the pelvis were acquired by magnetic resonance imaging (MRI) for each subject, in a supine position; internal landmarks were then identified on the images. Second, ultrasound images of the iliac crests were acquired in four seated positions. A registration algorithm was applied to obtain the transformation matrix between the two image reference systems. The MRI anatomical landmarks were, therefore, transferred into the ultrasound referential, to obtain their three-dimensional (3-D) location in the different seating positions. The external landmarks in those seated positions were identified with a 3-D digitizer. The results revealed that generally the internal and external coordinates of corresponding landmarks are statistically different. The differences are not only due to soft tissue thickness but also to different interpretations of the landmarks' locations between the supine and the seated postures. However, these differences generally did not affect significantly the accuracy with which orientation indexes can be estimated (pelvic tilt, obliquity, transverse rotation). Correlations were found between the internal and external coordinates, implying that linear regressions can be established.     

Assessment of the 3-d reconstruction and high-resolution geometrical modeling of the human skeletal trunk from 2-D radiographic images

This paper presents an in vivo validation of a method for the three-dimensional (3-D) high-resolution modeling of the human spine, rib cage, and pelvis for the study of spinal deformities. The method uses an adaptation of a standard close-range photogrammetry method called direct linear transformation to reconstruct the 3-D coordinates of anatomical landmarks from three radiographic images of the subject's trunk. It then deforms in 3-D 1-mm-resolution anatomical primitives (reference bones) obtained by serial computed tomography-scan reconstruction of a dry specimen. The free-form deformation is calculated using dual kriging equations. In vivo validation of this method on 40 scoliotic vertebrae gives an overall accuracy of 3.3 +/- 3.8 mm, making it an adequate tool for clinical studies and mechanical analysis purposes.     

Reproductive performance of two generations of female semidomesticated mink fed diets containing organic mercury contaminated freshwater fish

OBJECT: This study was conducted to determine the prevalence of cerebrovascular disease and its risk factors among patients with normal-pressure hydrocephalus (NPH) and to assess the influence of these factors on the outcome of shunt placement. METHODS: A cohort of 101 patients with NPH underwent shunt placement and was followed for 1 year. Gait disturbance and dementia were quantified using an NPH scale and handicap was determined using a modified Rankin scale (mRS). Primary outcome measures consisted of the differences between preoperative and last NPH scale and mRS scores. The presence of risk factors such as hypertension, diabetes mellitus, cardiac disease, peripheral vascular disease, male gender, and advancing age was recorded. Cerebrovascular disease was defined as a history of stroke or a computerized tomography (CT) scan revealing infarcts or moderate-to-severe white matter hypodense lesions. The prevalence of risk factors for cerebrovascular disease was higher in the 45 patients with cerebrovascular disease than the 56 without it. Risk factors did not influence outcome after shunt placement. Intent-to-treat analysis revealed that the mean improvement in the various scales was significantly less for patients with a history of stroke (14 patients), CT scans revealing infarctions (13), or white matter hypodense lesions (32 patients) than for those without cerebrovascular disease. The proportion of patients who responded to shunt placement was also significantly lower among patients with than those without cerebrovascular disease (p=0.02). CONCLUSIONS: The authors identified a subgroup of patients with NPH and cerebrovascular disease who showed disappointing results after shunt placement. Cerebrovascular disease was an important predictor of poor outcome.