title: Measurement of joint kinematics using a conventional clinical single-perspective flat-panel radiography system.
abstract: OBJECTIVE
  The ability to accurately measure joint kinematics is an important tool in studying both normal joint function and pathologies associated with injury and disease. The purpose of this study is to evaluate the efficacy, accuracy, precision, and clinical safety of measuring 3D joint motion using a conventional flat-panel radiography system prior to its application in an in vivo study.
  
  
  METHODS
  An automated, image-based tracking algorithm was implemented to measure the three-dimensional pose of a sparse object from a two-dimensional radiographic projection. The algorithm was tested to determine its efficiency and failure rate, defined as the number of image frames where automated tracking failed, or required user intervention. The accuracy and precision of measuring three-dimensional motion were assessed using a robotic controlled, tibiofemoral knee phantom programmed to mimic a subject with a total knee replacement performing a stair ascent activity. Accuracy was assessed by comparing the measurements of the single-plane radiographic tracking technique to those of an optical tracking system, and quantified by the measurement discrepancy between the two systems using the Bland-Altman technique. Precision was assessed through a series of repeated measurements of the tibiofemoral kinematics, and was quantified using the across-trial deviations of the repeated kinematic measurements. The safety of the imaging procedure was assessed by measuring the effective dose of ionizing radiation associated with the x-ray exposures, and analyzing its relative risk to a human subject.
  
  
  RESULTS
  The automated tracking algorithm displayed a failure rate of 2% and achieved an average computational throughput of 8 image frames/s. Mean differences between the radiographic and optical measurements for translations and rotations were less than 0.08 mm and 0.07° in-plane, and 0.24 mm and 0.6° out-of-plane. The repeatability of kinematics measurements performed using the radiographic tracking technique was better than ±0.09 mm and 0.12° in-plane, and ±0.70 mm and ±0.07° out-of-plane. The effective dose associated with the imaging protocol used was 15 μSv for 10 s of radiographic cine acquisition.
  
  
  CONCLUSIONS
  This study demonstrates the ability to accurately measure knee-joint kinematics using a single-plane radiographic measurement technique. The measurement technique can be easily implemented at most clinical centers equipped with a modern-day radiographic x-ray system. The dose of ionizing radiation associated with the image acquisition represents a minimal risk to any subjects undergoing the examination.
authors.affiliation: Biomedical Engineering Graduate Program, The University of Western Ontario, London, Ontario, Canada. Petar.Seslija@vch.ca
authors.forename: Petar
authors.initials: P
authors.lastname: Seslija
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Teeter
authors.forename: Xunhua
authors.initials: X
authors.lastname: Yuan
authors.forename: Douglas D R
authors.initials: DD
authors.lastname: Naudie
authors.forename: Robert B
authors.initials: RB
authors.lastname: Bourne
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Macdonald
authors.forename: Terry M
authors.initials: TM
authors.lastname: Peters
authors.forename: David W
authors.initials: DW
authors.lastname: Holdsworth
mesh_terms: D000465:Algorithms; D001696:Biomechanical Phenomena; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007719:Knee Joint / Q000000981:diagnostic imaging*; D055595:Mechanical Phenomena; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D011859:Radiography / Q000009:adverse effects / Q000295:instrumentation*; D011874:Radiometry; D012449:Safety