TELEDIAGNOSTICS OF FRACTURE HEALING PROGRESS

Transcription

1 W.Glinkowski 1,2,6, J.Żyłkowski 4,6, A.Wojciechowski 3,6, P. Picewicz 5, A.Górecki 1 TELEDIAGNOSTICS OF FRACTURE HEALING PROGRESS 1 Chair and Department of Orthopedics and Traumatology of Locomotor System, Center of Excellence TeleOrto,, Medical University of Warsaw 2 Department of Anatomy, Medical University of Warsaw 3 Ist Department of Clinical Radiology, Medical University of Warsaw 4 II nd Department of Radiology, Medical University of Warsaw 5 Department of Informatics, Medical University of Warsaw 6 Polish Telemedicine Society

2 Quantitative analysis of images Problem Fracture healing is a specialized process leading to restoration of bone integrity and function. Early detection of fracture healing impairment is mostly demanded to introduce the optimal treatment leading to recovery as early as possible, instead of delayed or non union. Subjective physical examination may not lead to conclusive results.

3 Problem An assessment using more objective methods of analyzing the degree of healing of a fracture is required for the identification of bone union and treatment discontinuation. The quantitative measurement is required for fracture healing evaluation. Having definite measurements orthopaedic trauma surgeon would be able to monitor healing processes, and set predicted time for bone union, the end of immobilization or fixation removal.

4 Problem The aim of this study was to step ahead in improving ing assessment of fracture healing progress or impairment examined by initial phase of Web based analyzing tools.

5 Problem The The realistic and quantitative evaluation of fracture healing may create a new specialized EHR based orthopaedic trauma data approach. The busy orthopaedic surgeon requires suitable methods with user friendly interface to implement them into daily clinical practice. A A Web based orthopedic computer aided diagnostic system requires several components which influence its effectiveness including: image processing methodology responsible for the analysis, database structure archives and distributed patients data.

6 Dicom based Web access Analytic System Classification System Data base Prognostic System 3D visualisation Module Local Analytic System Scientific WEB End user Analytics Global System Local Data base Decision Support System (DSS) Orthopaedic Intelligence System

7 Problem A A graphical user interface needs to be applied in order to enter the data and present it to the user. Classification and controlled evaluation of healing features using dynamic Web pages design is necessary for a remote access telediagnostics.

8 Dicom based Web access Data Warehouse Database

9 Web based Integrated information system utilizing imaging data

10 Dicom based Web access

11 Dicom based Web access

12 Dicom based Web access

13 Methods enhancing diagnostic imaging Web page instructions -

14 Quantitative analysis of images Problem Methods allowing quantitative evaluation are required for Evidence Based Medicine and statistical evaluation of collected data for specialties largely utilizing images (i.e. orthopedics and orthopedic trauma)

15 Quantitative fracture healing assessment Available assessment methods Clinical exam (scaling) surgeons hands Biomechanical (strain test applicable for particular locations or hardware applied) Radiologic - (expert s evaluation) scaling (pts) Acustic & vibratonal (i.e. Ultrasonometry) DEXA scanning no software available Computed Tomography including quantitative evaluation (CT, QCT, pqct) Magnetic resonance imaging (possible for no hardware) Relative Optical Digital Image Analysis with or without digital radiography (RODIA, RODIA for DXA scan)

16 Modalities useful for analysis

17 Analytic tools - Quantitative fracture healing assessment Relative Optical Density Image Analysis RODIA System was the first method designed for fracture healing monitoring ing based on consecutive digitalized or digital x-ray images Methods incorporated into RODIA System consist of: Image conversion -> 2D matrix Quantitative monitoring of fracture healing module Telemedicine friendly Approach to data aquired from image - RODIA System is relative, Emploing entire image calibration. The calibrated result value is compartatively expressed (%), sufficiently for monitoring.

18 Analytic tools An original software 3D Reconstructor was developed based on three-dimensional reconstruction and measurements of various anatomical structures using DICOM files. The loaded images sequence is initialy modified i.e.: secondary layers are generated or reorganized. 3D Reconstructor v.2.0 allows also 2D reconstruction in custom surface led through data block and 3D reconstruction as well.

19 Humeral fracture case (opacity and separation) Transparent models of bone and callus and topograms pseudo RTG drawn from CT

20 Conclusion The current study presents part of a project resulting in a computer-assisted analysis of a fracture healing radiograph yielding assessment of fracture gap appearance and callus maturity. Various features of fracture healing are considered for analysis and clinical decision support. At various stages of healing process different image processing problems have to be addressed. In the current study, a Web based graphical user interface has been designed and implemented for testing the image processing routines and comparing the results of quantitative image analysis with the visual interpretation of extracted regions of interest. The user interface may also serve as a teaching tool.

21 Conclusions Reliable fracture healing assessment can be enhanced with Computer aided Diagnostic Methods quantitatively analyzing details of X-ray and CT images. 3D Reconstructor enhanced evaluation of original CT DICOM files seems to be more accurate over not armed evaluation of fracture healing in selected cases. Developed methods may lead toward Evidence Based Medicine in fracture treatment and affect prognosis, early prediction of impairment, effectivness of treatment, scientific verification of results seen on images, statistical analysis, modeling and documentation

22 in future Working on Mobile Web access

23 Methods enhancing diagnostic imaging Acknowledgment The project was supported by grant number N /0024 from the Ministry of Science and Higher Education.

24 Thank you for your kind attention