The computerized multiparameter system for

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[33] Majoch S. Kinezyterapia w bocznych skrzywieniach kręgosłupa. W: Zembaty A. Fizjoterapia. PZWL Warszawa. 1987, 209-244. [34] Malmros B, Mortensen L, ...
AI-METH 2002 – Artificial Intelligence Methods

November 13-15, 2002, Gliwice, Poland

The computerized multiparameter system for evaluation of the scoliosis angle Andrzej Dyszkiewicz* **, Zygmunt Wróbel and Marcin Binkowski * * Institute of Computer Science, Silesia University, Department of Biomedical Computer Systems 41 – 200 Sosnowiec ul. B!dzi"ska 39 e-mail: [email protected], [email protected] ** Silesia Hospital in Cieszyn 43-400 Cieszyn ul. Bielska 4, Laboratory of Biotechnology 43-400 Cieszyn ul. Go#dzików 2

Abstract The work presents the clinical outline of the stature defects and scoliosis as well as the contemporary methodology of the radiogram measurements. In order to increase the repeatability of the results and to create the computer records, which support the monitoring of the scoliosis, the algorithm for the processing of the radiologic image was developed. It automatises the time consuming process of measuring and processing data by a doctor. The image processing is initiated by an interactive procedure where key points of biological structures are marked with a cursor. Other measurements are done automatically. The algorithm is also an attempt to use the author’s modification of the measuring of the spine geometry, which increases precision when compared to the methods by Cobb, Fergusson and Gruca. Keywords: scoliosis, expers systems, diagnosis of spirometric

1.

Introduction

The side curvatures of the spine are a huge individual and social problem. The frequency of occurrence of this problem is different in various populations and it alternates between 3-15% of children and youth at large. During the last several years it shows distinct increase tendency [1,8,9]. The curvation is a hard impediment of posture, which is accompanied by the secondary alterations in the blood circulation and in the respiratory system. The alteration of the aforementioned systems leads to the limitation of a general efficiency of the ill [15,17]. Finally it can cause early disability and it can also shorten one’s life. Numerous clinical researches, which took place at health centres, were conducted. The examinations allowed to surmise some ethiophatogenic conceptions, though it did not solve the problem in the final way [15,16,18]. The spine as an axis structure of a human body fulfils the whole range of crucial functions. Since it is a collection of suitably modelled modules – vertebra with joints- it characterises the possibilities to do progressive and rotary moves, simultaneously meeting the function of a support. Static as well as dynamics of this system is inseparably connected with muscles, treated as units with specific class and functional. Presented executive system is coupled with steering system, which is situated in the spinal cord and in the central nervous system, by means of information channel sensory neurone and a system of energy channels (blood vessels). Loads, which have an affect on individual parts of the spine, increase as they approach the basis, which is the pelvis. Consequently the built of the parts of the spine gets more massive and towards the effect of the gravitation. The vertebra are built of the two basic elements: massive and cylindrical disc and thin and diverse curve. The two parts create a channel for the spinal cord. Every curve has seven appendixes: in the back the spinous process, on the sides the tranverse process, up and down there are even joint processes. Vertebral bodies, which are structurally adapted to carry static loads, fulfil the function of a support. The edges of the vertebra which neighbour with each-other are equipped with limiting cartilage plates which protect the spongy

structure of vertebral bodies against overload and mediate in the exchange of body fluids between the body and structure of pulp nucleus. The task of the curves is to cover the spinal cord and to ensure the joint connections of individual vertebra. The spinous and tranverse processes are the places of catches of ligament intervertebra and they are also the shoulders of the lever for muscles of the spine. The nucleus that distances the intervertebra discs fulfils triple function: joines the neighboured vertebral bodies, is a part of intervertebra joints and elasticly carries dynamic forces. A bigger height of nucleus in thecervical and lumbar section structuraly enables a bigger scope of motion in these sections [2,7,14,23,29,42,43]. The three-dimensional body system in the standing position, functioning as a biomechanizm with a lot of degrees of freedom, keeped against gravitation in the conditions of unstable equilibrium, should be considered in the dynamic depiction. A starting point to partial considering is the fulfilment of the criterion of physiology in the scope of bones, joints and ligaments. The correct built of skeleton, passive stabilisation and proper movement in the range of individual elements, are essential. These elements create merely potential possibilities of receiving and bearing the correct posture, however its image is dependent on function and efficiency of central nervous system [12,13,25]. Currently it is claimed that approaching and sustaining the correct position is the same moving task as any other moving activity. Producing and establishing essential and proper unconditioned coordination reflex requires even millions of requires, however the quality of created habits is dependent on conscious action and inborn predispositions. Gradually worked out, more simple movement abilities create a base for the following predispositions, which are built-in into more complex movement patterns. Established system of individual segments of body, as well as balance is not a static state, but the one that oscillate around the balance point, with a tendency to optimalization. The secondary disturbance of control of posture is caused by a little bit different mechanism. It is probable that as a result of disturbance of functions of OUN, occures a deviation of posture from the pattern recognised as a correct [19,31,32,33,34,36]. Accepting and carrying incorrect body posture causes the dissimilar from normal

decomposition of density of postural impulses from district receptors [4,29,34,35]. It is only a matter of time and suitable number of repetitions to strengthen in OUN the pattern, which would reply to pathological body posture, and it would cause a habit. Some situations, which are disadvantageous for posture, like not ergonomic positions during work or play, heavy satchels, are the additional stimuluses, which increase the development of inappropriate posture. The danger in this respect is the bigger, the earlier period of posturogenesis concerns given situation, because once strengthen habit is extremely hard to rebuilt. To correct incorrect posture it is indispensable to learn once more to take and sustain correct posture. It is hard to put it into practice, because the corrected posture is something unnatural, artificial and tiresome for a child [37,38,45,46]. Experience shows that classic corrective exercises are mostly not too efficient, provided that the procedures, which would mould ability to keep the corrected posture automatically, would be taken into consideration. It would restrain this incorrect habit and create a correct one. Aside from easier to correct defects of posture there is another very essential problem – idiopathic side curvatures of the spine [39,40,47,50,51]. It is possible to divide them into two categories. The first one shows not a big tendency to progression and the second one has a malignant course and is little susceptible to conservative treatment methods. Some coexisting factors can be named here: disorders of blood circulation, hormonal and vestigial quantities of toxic factors [4,5,6,21,22,24,26]. Genetic and acquired modifications of path biosynthesis of collagen [28,29,30] and various types of pathologies of intervertebral disc have a huge importance [3,41,44,48,49]. Conducted in 1973 Stagnare’s examinations showed that with 10 to 39 degrees of scoliosis angle according to Cobb only 38% gives in to progression and remaining 62% acts in a stable way. Usage of various techniques of kinesistheraphy, physiotherapy or their combinations gives the best effects in relation to non-developable idiopathic scoliosis [27,35]. Since the conservative methods do not fulfil the expectations concerning the possibility to stop the progression of curvature in the malignant cases, the whole attention of orthopedy was directed to draw up new treatment techniques of surgery method of treatment. These techniques reduce mainly to different forms of part stiffening of the spine, which as Garlicki said “is only a change of one kind of disability to another, it does not mean though that the skolioses is cured”. Therefore the main task of medicine is early diagnosis of skolioses and prevention of progress process with help of specified conservetive methods [12,17]. Nowadays there are several formulas used the most often in Poland like Cobb’s method and Fergusson method. These methods show a lot of simplifications and inaccuracies. The Total Cobbe angle informs us about the level of scoliosis. It does not monitor all the process of vertebra deformations that is a very important marker of scoliosis duration and it’s progression. Fergusson’s angle includes the torsion of only three extreme vertebra of scoliosis without residual deformation. A big amount of existing methods, which are designed for indirect and direct posturometric diagnosis, which is used in skoliosis, caused a lack of uniform schema of evaluation of state of a patient and evolution of illness. An exapmle of trajektore of power distribution and photodynamic method are presented in fig. 1.

Fig. 1. Trajectory of power distribution in the standing and sitting position and photodynamic method A common phenomenon which is observed even in the leading centres are big methodological discrepancies in the range of diagnostic as well as in treatment of skoliosis, which partly result from the various access to technologically advanced apparatus and also individual experiences of the leaders. Such a situation is connected to the certain danger of lack of possibilities of full relocation of clinical experiences on a system of work of outpatient, regional clinics, where the access of expensive equipment is very limited and out of necessity it is supplemented by more simple methods. A counterbalance for such a situations, which was produced in USA are periodic, intermedium thematic congresses, which every time work out exact diagnosticlytherapeuthical criterions, which stay in force till the next actualisation n the area of the whole country. It should be realised that while comparing the results of application of advanced technology with a system of a few relatively connected simple methods supplemented by computer techniques, many a time a higher acuteness and peculiarity, than in case of expensive novelties, are gained [10,11]. Taking into account the unfavourable financial realities of polish science there is a growing interest concerning the low-outlay adaptations of more simple methods. A system of mathematical correlation between different methods, which describe a chosen phenomenon, uncovers a new multidimensional space of description, characterised by a much higher of specificity One of the methods used in a lot of centres as a parameter, which monitors the development of skolioses, is spirometer experiment. Unfortunately, from the bioengineering point of view it is possible to notice that the two lung spaces coupled by an angle

of scoliosis are the source of averaged volumetric parameter and it can be described as a compensatory structure. Increase of value of angle of scoliosis causes decrease of volumetric space on the chord site and proportional increase of volumetric on the curve site. Proportions are preserved best with not very big scoliosis, which do not exceed the 15-180. Then equilibrium is established. Pressure of lung is compensated by emphysema of the second lung. During the increasing angle of scoliosis the summary volumetric parameter is decreasing. Therefore, cases when spirometr parameter represents angle of scoliosis are usually so advanced that they should be treated surgically [16,17]. In practice of ambulatory treatment such a big state of advanced is seldom met because the posture defects and scoliosis not higher then 150 are dominated. In the case when diagnosis by radiology is too loading the parameter which monitors course of disease is the posturometry. It is evaluated by manual and with usage of different types of posturometric equipment or moiré effects or termovision techniques. Examples of used methods and instuments are presented on fig. 2

Reflection moiré

Projective moiré Fig. 2. Instruments and a manner of measurement of dimensional parameter of body Non-invasive of simple posturometric methods and precision of planimetry radiography is linked by method, which consists of multisegments system of evaluation of trajectory of movement thorax. System of tapes and transducers braiding thorax enables estimate of movement its any areas. Based on knowledge that it stay in directly depending on scoliosis angle and ribs movement and activity of respiration muscles is obtained as well topography as quantitative parameter, which respond to not high movement changing induce by for example limb shortening, shoulder syndrome and the like. Block diagram is presented on fig. 3, but diagram of idea and komputer aplication view are presented on fig. 4.

Shadow moiré

spirometr

right tape f converter of move

upper converter of move

converter A/D

lower converter of move

computer left tape of converter of move f

Fig. 3. A schema of system for analysing the trajectory of respiratory A patient with movement sensors Fig. 4. System of measurement respiratory trajectory Apply of integrated system, which estimates basic parameters of geometry of thorax by radioplanimetry method and next repeatedly bio-engineery and spiromethry cause effective and credibility supervision in every period of disease. The main window of aplication is presented on fig. 5

User interface

Image gained from a server or an electronically card

Interactive movement pointer

A choice of a mode of work in the neurone network

A graph of respiratory parameters

Evolution of Cobb’s angle of scoliosis in the automatically mode Fig. 5. Expert program of automatically determining of scoliosis and torsion angle. Image is made in the start of research. It is analysis neural net give starting geometrical parameters. Based on these parameters the parameters of three-dimensional trajectory of respiratory are compared. Spirometric research are conversed by using a module that is presented on fig. 6.

Fig. 6. A system of electronically conversion of result of spirometrical examination. Monitor in parrale capacity of expiration begin have the especially meaning when it do not increase proportionally to age. It happens in the case of achievement of limiting value of scoliosis, which is qualified to surgical treatment.

2.

The aim of the compilation

The aim of this compilation is a practical use of contemporary existing measurement methods of side curvature of the spine to construct practical alghoritm.

Dialog window of converter

A main dialog window

Spirometr and a reader of cards

This algorithm enables automatic measurement of spine geometry on the matrix image. The image is loaded to the computer memory in the form of digital. Mathematical analysis of geometric of bone radiograms combined with results of trajectory of movement of thorax enable the creations of individual patient indexes with the description of progression and regression factors of a disease. In regional out-patient clinics, individual files can be created based on clients data base "Znachor". Chosen information about base is presented on fig 7

A window of a special control

A window of registration of a patient

Fig. 7. Interactive date base for a regional out-patient clinic “Znachor”

Left sacrum

Planimetry assumptions

Histogram of density of sclerosis reaction in the hips

Right sacrum

Analyser of Cobb’s angle, respiratory trajectory and spirometr

Automatic analyser of asymmetry of sclerosis reaction in the sacrum formed as a result of scoliosis and by asymmetry distribution of terrestrial gravity force in the pelvis.

Automatic analyser of density of discrete elements of the long bones.

Podoskop

Fig. 8 Asymmetry of distribution of forces which have an effect on feet during testing with parallel analysis of bone remodelling in the long bones. 3.

Material and methods

In the first part the measurement alghoritm assumes conducting geometrical measurements according to Cobb’s and Ferguson’s recommendation. In the second part there is own modification of process used. It depends on the execution of measurement of torsion and angle of scoliosis in the level of every vertebra with project results on two vertical charts placed on both site of radiogram. Proposed method enables part observation of scoliosis on the background of averaging parameters. Analyser of radiograms co-operates with spiromethr and appliance to evaluation of trajectory of respiratory of thorax. Multiparameter of patients on the long-term observations significantly enables more accurate evaluation of a disease progression or regression.

References [1] Borejko M, Dziak A. Badanie radiologiczne w ortopedii. PZWL, Warszawa 1979, 32-61. [2] Blauth M, Knop C, Bastian L. Reduction and positioning of cervical spine. Zentralbl Chir 1998, 123(8), 894 [3] Chiuba K, Andersson G, Masuda K. A new culture system to study the metabolism of the intervertebral disc in vitro. Spine 1998, 23(17), 1821 [4] Chiba K, Andersson G, Masuda K. Metabolism of the extracellular matrix formed by intervertebral disc cells cultured in alginate. Spine 1997, 22(24), 2885-93 [5] Chou C. Pathological studies on calcification of the intervertebral discs. Journal of the Japanese Orthopaedic Association 1982, 56(4), 331-45 [6] Cole T, Burkhardt D, Ghosh P. Effects of spinal fusion on the proteoglycans of the canine intervertebral disc. Journal of Orthopaedic Research 1985, 3(3), 277-91

[7] Crow N, Brogden B. The normal lumbosacral spine. Radiology 1959, 71-95 [8] Dziak A. Bóle krzy!a. PZWL Warszawa 1994, 17-94 [9] Dega W. Wady postawy. W: Ortopedia i rehabilitacja. PZWL Warszawa 1996, 456-475 [10] Dyszkiewicz A, Wróbel Z. Mo!liwo"ci zastosowania cyfrowej techniki obliczeniowej w naukach przyrodniczych, medycynie i ochronie "rodowiska. Probl #rod Ochr Katowice 1999, 7, 223-255 [11] Dyszkiewicz A, Sapota G, Wróbel Z. Standaryzowana fotometria zdj$% radiologicznych uk&adu kostnego w tworzeniu komputerowych algorytmów densytometrycznych. IV konf. TIM 99, Jaszowiec 18-20.11.99, BP 3-9 [12] Dyszkiewicz A, Koprowski R, Wróbel Z. System oceny patologii chodu z zastosowaniem przestrzennej analizy akcelerometrycznej. Konf. Modelowanie i Pomiary w Medycynie. 8-12.05.2000 Krynica Górska [13] Dyszkiewicz A, Koprowski R, Wróbel Z. Akcelerometryczna ocena narz'du równowagi oraz monitorowania terapii. Probl Tech Med 1999, 1-4, 17 [14] Dyszkiewicz A, Sapota G, Imielski K. Perspectivy automatizace plynule menitelne zateze pro krcni trakci. Rehab Fizik Lek 1999,4(6), 119 [15] Dyszkiewicz A, Kuna J, Koprowski R, Wróbel Z. Simplified analysis of spine thermovision picture in diagnostics of scoliosis. Acta Bioeng Biomech 2001, 1, 93 [16] Dyszkiewicz A, Koprowski R, Wróbel Z. Skomputeryzowana procedura indywidualnego nadzoru spirometrycznego w poradni pulmonologicznej. II Seminarium NaukowoTechniczne „Karty elektroniczne, krok w XXI wiek” Na&$czów 13-14.09.1999 [17] Dyszkiewicz A, Wróbel Z. System przestrzennej analizy toru oddychania w wybranych przypadkach klinicznych. Krynica Górska, MPM 2002, 195 [18] Dyszkiewicz A, Kawulok J, Wróbel Z. System elektronicznej rejestracji radiogramów we wspó&pracy z pracowni' spirometryczn' oraz sieci' neuronow' do diagnostyki skolioz. Krynica Górska, MPM 2002, 169 [19] Ferrari K, Goti P, Sanna A, Misuri G. Short-term effects of bracing on exercise performance in mild idiopathic thoracic scoliosis. Lung, 1997, 175, 299 [20] Gass C. Gray’s anatomy of the human body. Philadelphia 1973, 215 [21] Glushko T, Gusakova V, Makova N. Tissue changes in the intervertebral disk following hypokinesia in rats of different ages Arkhiv Anatomii, Gistologii i Embriologii 1987, 93(12), 50-5 [22] G&owacki A, Ku(ma EM, Olczyk K, Kucharz EJ. Glikozaminoglikany. Post Biochem 1995, 41, 139 [23] Hadley L. Anatomico-Roentgenographic study of the spine. Springfield 1964, 95-121 [24] Holm S, Nachemson A. Variations in the nutrition of the canine intervertebral disc induced by motion. Spine 1983 8(8), 866-74 [25] Ijsselstijn H, Tibboel D, Hop W. Long-term pulmonary sequelae in children with congenital diaphragmatic hernia. Eur Surg Res 1997, 29, 12 [26] Ishibara H, Urban J.Effects of low oxygen concentrations and metabolic inhibitors on proteoglycan and protein synthesis rates in the intervertebral disc. Journal of Orthopaedic Research 1999. 17(6), 829 [27] Król J, Pucher A. Skoliozy. W: Milanowska K. Rehabilitacja medyczna. PZWL Warszawa 1993, 230-264

[28] Kucharz EJ. The collagens: biochemistry and pathophisiology. Springer Verleg, Berlin, New York 1992 [29] Kucharz EJ. Budowa i metabolizm kolagenu oraz jego udzia& w chorobach ko"ci. Terapia 1999, 7, 32 [30] Kucharz EJ. Metabolizm kolagenu w procesie w&óknienia w'troby. Post Hig Med Do"w 1987, 41, 302 [31] Li Z, Liu J, Wu Y, Wang M. Effect of massotherapy on the in vivo free radical metabolism in patients with prolapse of lumbar intervertebral disc and cervical spondylopathy. J Tradit Chin Med 1995, 15(1), 53-8 [32] Macpherson J. The cat vertebral collumn: stance configuration and range of motion. Exp Brain Res 1998 Apr, 119(3), 324-332 [33] Majoch S. Kinezyterapia w bocznych skrzywieniach kr$gos&upa. W: Zembaty A. Fizjoterapia. PZWL Warszawa 1987, 209-244 [34] Malmros B, Mortensen L, Jansen M. Positive effects of physiotherapy on chronic pain and performance in osteoporosis. Osteop Int 1998, 8(3), 215-221 [35] Milanowska K. Wady postawy. W: Rehabilitacja medyczna. PZWL Warszawa, 1993, 274-288 [36] Moskowitz R, Ziv I, Denko C. Spondylosis in sand rats: a model of intervertebral disc degeneration and hyperostosis. Journal of Orthopaedic Research 1990, 8(3), 401-11 [37] Nawotny J. Neurofizjologiczne aspekty korekcji odchyle) od prawid&owej postawy cia&a. W: Nawotny J. Dysfunkcje kr$gos&upa, diagnostyka, terapia. Katowice 1993, 21-37 [38] Nowakowski A. Bóle krzy!a. W: Dega W, Senger A. Ortopedia i rehabilitacja. PZWL Warszawa 1996, 204-226. [39] Ociepka R, *$czy)ski R. System aktywnej korekcji idiopatycznych skolioz oparty na patogenezie i patomechanice skrzywienia, W: Nawotny J. Dysfunkcje kr$gos&upa cz II. Katowice 1993, 157 [40] Olczyk K. Zmiany sk&adników &'cznotkankowych ludzkich l$d(wiowych kr'!ków mi$dzykr$gowych w przebiegu starzenia i w przypadkach wypadni$% j'dra mia!d!ystego. #LAM Katowice 1990, Prac Hab [41] Oshima K, Ishibara H, Urban J. The use of coccygeal discs to study intervertebral disc metabolism. Journal of Orthopaedic Research 1993, 11(3), 332-8 [42] Powers J. Magnetic resonance imaging in marrow diseases. Clinical Orthopaedics & Related Research 1986, 206, 79-85 [43] Sartoris D, Resnick D. Computed tomography of the spine: an update and review Critical Reviews in Diagnostic Imaging 1987, 27(4), 271-96 [44] Scott J, Haigh M. Proteoglycan-collagen interactions in intervertebral disc. A chondroitin sulphate proteoglycan associates with collagen fibrils in rabbit annulus fibrosus at the d-e bands. Biosc Reports 1986, 6(10), 879-88 [45] Tylman D. Postawa i jej wady. W: Patomechanika bocznych skrzywie) kr$gos&upa. Severus Warszawa 1995, 44 [46] Tylman D. Boczne skrzywienia kr$gos&upa. W: Patomechanika bocznych skrzywie) kr$gos&upa. Severus Warszawa 1995, 62-106 [47] Wagner T. Choroba zwyrodnieniowa stawów. W:Ma&dyk E, Wagner T.Patomorfologia stawów. PZWL Warszawa 1991, 157-168. [48] Wierzchowska E. Budowa i czynno"% tkanki kostnej. W: Ma&dyk E . Patomorfologia chorób tkanki &'cznej. PZWL Warszawa 1981, 19-27. [49] Wren T, Carter D. A microstructural model for the tensile constitutive and failure behavior of soft sceletal connective tissue. J Biomech Eng 1998 Feb, 120(1), 55-61