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Image-based biomechanical models of the musculoskeletal system.

ABSTRACT: Finite element modeling is a precious tool for the investigation of the biomechanics of the musculoskeletal system. A key element for the development of anatomically accurate, state-of-the art finite element models is medical imaging. Indeed, the workflow for the generation of a finite element model includes steps which require the availability of medical images of the subject of interest: segmentation, which is the assignment of each voxel of the images to a specific material such as bone and cartilage, allowing for a three-dimensional reconstruction of the anatomy; meshing, which is the creation of the computational mesh necessary for the approximation of the equations describing the physics of the problem; assignment of the material properties to the various parts of the model, which can be estimated for example from quantitative computed tomography for the bone tissue and with other techniques (elastography, T1rho, and T2 mapping from magnetic resonance imaging) for soft tissues. This paper presents a brief overview of the techniques used for image segmentation, meshing, and assessing the mechanical properties of biological tissues, with focus on finite element models of the musculoskeletal system. Both consolidated methods and recent advances such as those based on artificial intelligence are described.

SUBMITTER: Galbusera F

PROVIDER: S-EPMC7423821 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Image-based biomechanical models of the musculoskeletal system.

Galbusera Fabio F Cina Andrea A Panico Matteo M Albano Domenico D Messina Carmelo C

European radiology experimental 20200813 1

Finite element modeling is a precious tool for the investigation of the biomechanics of the musculoskeletal system. A key element for the development of anatomically accurate, state-of-the art finite element models is medical imaging. Indeed, the workflow for the generation of a finite element model includes steps which require the availability of medical images of the subject of interest: segmentation, which is the assignment of each voxel of the images to a specific material such as bone and c ...[more]

PMID: 32789547

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Project description:ObjectivesClarity regarding accuracy and effectiveness for interventional procedures around the foot and ankle is lacking. Consequently, a board of 53 members of the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the published literature to evaluate the evidence on image-guided musculoskeletal interventional procedures around this anatomical region.MethodsWe report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around foot and ankle in order to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper that was shared with all panel members for final approval.ResultsA list of 16 evidence-based statements on clinical indications for image-guided musculoskeletal interventional procedures in the foot and ankle were drafted after a literature review. The highest level of evidence was reported for four statements, all receiving 100% agreement.ConclusionAccording to this consensus, image-guided interventions should not be considered a first-level approach for treating Achilles tendinopathy, while ultrasonography guidance is strongly recommended to improve the efficacy of interventional procedures for plantar fasciitis and Morton's neuroma, particularly using platelet-rich plasma and corticosteroids, respectively.Key points• The expert panel of the ESSR listed 16 evidence-based statements on clinical indications of image-guided musculoskeletal interventional procedures in the foot and ankle. • Strong consensus was obtained for all statements. • The highest level of evidence was reached by four statements concerning the effectiveness of US-guided injections of corticosteroid for Morton's neuroma and PRP for plantar fasciitis.

Project description:The accuracy of deformable image registration tools can vary widely between imaging modalities and specific implementations of the same algorithms. A biomechanical model-based algorithm initially developed in-house at an academic institution was translated into a commercial radiotherapy treatment planning system and validated for multiple imaging modalities and anatomic sites.Biomechanical deformable registration (Morfeus) is a geometry-driven algorithm based on the finite element method. Boundary conditions are derived from the model-based segmentation of controlling structures in each image which establishes a point-to-point surface correspondence. For each controlling structure, material properties and fixed or sliding interfaces are assigned. The displacements of internal volumes for controlling structures and other structures implicitly deformed are solved with finite element analysis. Registration was performed for 74 patients with images (mean vector resolution) of thoracic and abdominal 4DCT (2.8 mm) and MR (5.3 mm), liver CT-MR (4.5 mm), and prostate MR (2.6 mm). Accuracy was quantified between deformed and actual target images using distance-to-agreement (DTA) for structure surfaces and the target registration error (TRE) for internal point landmarks.The results of the commercial implementation were as follows. The mean DTA was ? 1.0 mm for controlling structures and 1.0-3.5 mm for implicitly deformed structures on average. TRE ranged from 2.0 mm on prostate MR to 5.1 mm on lung MR on average, within 0.1 mm or lower than the image voxel sizes. Accuracy was not overly sensitive to changes in the material properties or variability in structure segmentations, as changing these inputs affected DTA and TRE by ? 0.8 mm. Maximum DTA > 5 mm occurred for 88% of the structures evaluated although these were within the inherent segmentation uncertainty for 82% of structures. Differences in accuracy between the commercial and in-house research implementations were ? 0.5 mm for mean DTA and ? 0.7 mm for mean TRE.Accuracy of biomechanical deformable registration evaluated on a large cohort of images in the thorax, abdomen and prostate was similar to the image voxel resolution on average across multiple modalities. Validation of this treatment planning system implementation supports biomechanical deformable registration as a versatile clinical tool to enable accurate target delineation at planning and treatment adaptation.

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Image-based biomechanical models of the musculoskeletal system.

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Image-based biomechanical models of the musculoskeletal system.

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