Search Results (43)

Background/Objectives: Relapsing polychondritis (RP) is a rare autoimmune disorder marked by recurrent inflammation of cartilaginous tissues, including the airways. Airway involvement, such as subglottic stenosis and airway malacia, significantly impacts prognosis. Although spirometry is the standard for evaluating respiratory function, it may be unfeasible in patients with severe airway narrowing or tracheostomy. This study evaluated the potential of a smartphone-based application, DepthRecorder, which uses the iPhone’s TrueDepth camera to analyze thoracic motion in real time. Methods: Twelve patients with RP were enrolled. All underwent simultaneous respiratory assessment using spirometry and the DepthRecorder application. Thoracic motion data were corrected for height using previously validated regression formulas. Correlation between DepthRecorder and spirometry values was analyzed using Spearman’s rank correlation for forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), and the FEV₁/FVC ratio. Results: Mean age was 53.8 ± 13.3 years, with equal numbers of males and females. Before correction, DepthRecorder showed moderate correlations for FEV₁ (ρ = 0.48, p = 0.003) and FEV₁/FVC (%) (ρ = 0.57, p < 0.001). After correction, stronger correlations were observed for FVC (ρ = 0.76, p < 0.001), FEV₁ (ρ = 0.72, p < 0.001), and FEV₁/FVC (%) (ρ = 0.60, p < 0.001). Conclusions: The DepthRecorder application demonstrated strong correlations with spirometry following height-based correction. This method may offer a practical, non-invasive tool for respiratory assessment in RP patients who cannot undergo conventional lung function testing. Further studies are needed to validate these findings and establish clinical reference standards. Full article

Objectives. The present study aimed to quantify changes in spinal kinematics during Nordic walking compared to regular walking (RW) for 60 s on a training path among physically fit young males (n = 20, aged 19–22 years). Methods. Two walking speeds were analyzed: 3 km/h and 5 km/h. The experimental setup was designed to assess spinal angular rotations using five kinematic parameters: upper spine, lower spine, thoracic region, lumbar region, and pelvis. Results. The data were acquired from 9 compact inertial sensors and the following motion analysis is carried out using 3D MioMotion IMU sensor’s analysis system. The differences in the obtained cyclic biomechanical parameters were detected using functional data analysis (FDA) statistical tests. Conclusions. The key finding of the study is that Nordic walking significantly alters the angular kinematic pattern of spinal movement as it revealed significant differences in all five measured parameters when compared to normal walking. Notably, the most pronounced changes were observed in the upper spine and pelvis motion. Additionally, Nordic walking increased stance phase duration and velocity: (i) significantly increased the duration of the stance phase in all three planes of motion; (ii) significantly increased the velocity during the stance phase across all three planes. These reported findings highlight the biomechanical, preventive, therapeutic, and rehabilitative potential of Nordic walking. Full article

Objectives: We investigated the performance of a slow computed tomography (CT) protocol to reduce alignment errors arising from motion when using CT-on-rail (CTOR) for image guidance for patients receiving thoracic stereotactic body radiation therapy (SBRT). Methods: A Quasar lung phantom with a moving tumor was programmed with three breathing rates and three motion amplitudes. MIP and average 4DCT images were used for contouring and alignment, respectively. Ten CTOR images were obtained for each of the breathing rates and amplitudes, under both CT protocols. We used in-house CAT software for image guidance, centering the tumor in the lung window within the gross tumor volume contour. Longitudinal coordinate reproducibility was compared between the two protocols. We also retrospectively analyzed CBCT SBRT image guidance alignment data from 31 patients to evaluate the systematic error in the longitudinal direction between simulation and daily treatments. Results: The mean (standard deviation) alignments (mm) for the standard and slow CT protocol ranged from 0.7 (0.68) and 1.0 (0.0), respectively, for the 28 BPM breathing rate and 5 mm amplitude combination to 5.2 (2.0) and 1.6 (0.52) for the 8 BPM breathing rate and 15 mm amplitude combination. Our retrospective analysis of patient alignment data showed a notable systematic difference in the relative bone and gross tumor volume alignment between the simulation and daily cone beam CT datasets. The mean longitudinal difference was −0.19 cm (standard deviation, 0.17 cm; range, 0.28 cm to −1.14 cm). Therefore, the position of the vertebral body cannot be used as a surrogate for mean tumor position in the longitudinal direction. Longitudinal position must be accurately determined for each patient using multiple CT images. Conclusions: A slow CT protocol improved the alignment with slower breathing rates being more challenging. A 5 mm PTV is not sufficient for tumor motion greater than 9 mm. Averaging the coordinates from multiple CTOR images is recommended. Full article

Thoracic injuries account for a high percentage of combat casualty mortalities, with 80% of preventable deaths resulting from abdominal or thoracic hemorrhage. An effective method for detecting and triaging thoracic injuries is point-of-care ultrasound (POCUS), as it is a cheap and portable noninvasive imaging method. POCUS image interpretation of pneumothorax (PTX) or hemothorax (HTX) injuries requires a skilled radiologist, which will likely not be available in austere situations where injury detection and triage are most critical. With the recent growth in artificial intelligence (AI) for healthcare, the hypothesis for this study is that deep learning (DL) models for classifying images as showing HTX or PTX injury, or being negative for injury can be developed for lowering the skill threshold for POCUS diagnostics on the future battlefield. Three-class deep learning classification AI models were developed using a motion-mode ultrasound dataset captured in animal study experiments from more than 25 swine subjects. Cluster analysis was used to define the “population” based on brightness, contrast, and kurtosis properties. A MobileNetV3 DL model architecture was tuned across a variety of hyperparameters, with the results ultimately being evaluated using images captured in real-time. Different hyperparameter configurations were blind-tested, resulting in models trained on filtered data having a real-time accuracy from 89 to 96%, as opposed to 78–95% when trained without filtering and optimization. The best model achieved a blind accuracy of 85% when inferencing on data collected in real-time, surpassing previous YOLOv8 models by 17%. AI models can be developed that are suitable for high performance in real-time for thoracic injury determination and are suitable for potentially addressing challenges with responding to emergency casualty situations and reducing the skill threshold for using and interpreting POCUS. Full article

Background/Objectives: The assessment of relationships between trunk muscle activity and thoraco-lumbar movements during sagittal bending has demonstrated that low back pain (LBP) subgroups (flexion pattern and active extension pattern motor control impairment) reveal distinct relationships that differentiate these subgroups from control groups. The study objective was to establish whether such relationships exist during various daily activities. Methods: Fifty participants with non-specific chronic low back pain (NSCLBP) (27 flexion pattern (FP), 23 active extension pattern (AEP)) and 28 healthy controls were recruited. Spinal kinematics were analysed using 3D motion analysis (Vicon™, Oxford, UK) and the muscle activity recorded via surface electromyography during a range of activities (box lift, box replace, reach up, step up, step down, stand-to-sit, and sit-to-stand). The mean sagittal angles for upper and lower thoracic and lumbar regions were correlated with normalised mean amplitude electromyography of bilateral transversus abdominis/internal oblique (IO), external oblique (EO), superficial lumbar multifidus (LM), and erector spinae (ES). Relationships were assessed via Pearson correlations (significance p < 0.01). Results: In the AEP group, increased spinal extension was associated with altered LM activity during box-replace, reach-up, step-up, and step-down tasks. In the FP group, increased lower lumbar spinal flexion was associated with reduced muscle activation, while increased lower thoracic flexion was associated with increased muscle activation. The control group elicited no significant associations. Correlations ranged between −0.812 and 0.754. Conclusions: Differential relationships between muscle activity and spinal kinematics exist in AEP, FP, and pain-free control groups, reinforcing previous observations that flexion or extension-related LBP involves distinct motor control strategies during different activities. These insights could inform targeted intervention approaches, such as movement-based interventions and wearable technologies, for these groups. Full article

Deformable lung CT registration plays a crucial role in clinical applications such as respiratory motion tracking, disease progression analysis, and radiotherapy planning. While voxel-based registration has traditionally dominated this domain, it often suffers from high computational costs and sensitivity to intensity variations. In this work, we propose a novel point-based deformable registration framework tailored to the unique challenges of lung CT alignment. Our approach combines geometric keypoint attention at coarse resolutions to enhance the global correspondence with attention-based refinement modules at finer scales to accurately model subtle anatomical deformations. Furthermore, we adopt a bi-directional training strategy that enforces forward and backward consistency through cycle supervision, promoting anatomically coherent transformations. We evaluate our method on the large-scale Lung250M benchmark and achieve state-of-the-art results, significantly surpassing the existing voxel-based and point-based baselines in the target registration accuracy. These findings highlight the potential of sparse geometric modeling for complex respiratory motion and establish a strong foundation for future point-based deformable registration in thoracic imaging. Full article

Background: The Upper Limb Neural Tension Test (ULNTT) is a common assessment for neurodynamic function, yet the relationship between ULNTT findings and specific spinal biomechanical patterns remains poorly understood, particularly in the context of cervicobrachial neuralgia. This study aimed to investigate the association between ULNTT asymmetry and cervicothoracic spine biomechanics using advanced motion capture analysis. Methods: A longitudinal experimental study was conducted on two groups of asymptomatic participants: one with ULNTT asymmetry > 10° (AS group, n = 12) and another with symmetrical ULNTT (S group, n = 11). Neurodynamic testing and 3D motion capture of spinal kinematics during head lateral bending were performed at baseline. The AS group then underwent manual medicine intervention targeting spinal mobility impairments, followed by post-intervention reassessment. Spine biomechanics data, focusing on the C5-T4 region, were analyzed using the least squares approximation method to derive parameters describing upper thoracic (T1-T4_VERT) and lower cervical (C5-T1_CONC) lateral bending, and their interrelationship (ANGLE_TANG). Results: At baseline, the AS group showed significant differences between sides in neurodynamic parameters and T1-T4_VERT, with limited upper thoracic lateral bending contralateral to the side of the restricted ULNTT. Significant intergroup differences were also observed for these parameters. Following intervention in the AS group, significant improvements were noted in neurodynamic parameters and T1-T4_VERT, with no significant between-side differences post-intervention. Conclusions: These are preliminary results and preliminary conclusions based on the first study on a small group of patients. Given the limitations, this study provides evidence for a relationship between ULNTT asymmetry and upper thoracic spine biomechanics, specifically a contralateral limitation in lateral bending. These findings suggest a functional link between brachial plexus neurodynamics and upper thoracic spine mobility, offering potential insights into the pathophysiology of cervicobrachial conditions and highlighting the potential role of manual therapy in addressing both neurodynamic and biomechanical impairments. The developed motion capture analysis method offers a novel approach to quantify fine spinal motion patterns. Full article

Background: Gait assessment is a complex task involving locomotion and balance control across all body segments, requiring a global analysis in the event of motor disorders. Among these are spinal disorders, where an understanding of spinal kinematics during walking is important to improve treatment decisions and outcomes. The technique of stereophotogrammetric motion analysis is currently the gold standard in this context. A new integrated protocol for whole-body kinematic gait analysis is proposed in this study, which takes into account the movements of the spine. Methods: A new protocol with 30 passive markers was developed to analyze gait. Of these markers, 22 implemented the Davis protocol for gait measurement, while the other 8 were placed onto the spine to record spinal movements. The protocol’s accuracy was assessed through comparisons of the constructive angles of a manikin replicating the human body and the angles measured with the optoelectronic system. An assessment of intra- and inter-operator repeatability and protocol usability was carried out by recruiting and applying the protocol in a population composed of ten subjects (mean age 17.36—SD 10.12) without any history of spine pathology. Results: The protocol was validated successfully. The validation accuracy was more than satisfactory: the measured RMSE was 1.2 ± 1° for the data collected with the optoelectronic system with respect to the manikin. The intra-operator repeatability was also good in the sagittal and frontal planes (average ICC > 0.867), and the inter-operator repeatability was moderate or good in all planes (average ICC > 0.77). The usability score obtained using the System Usability Scale was satisfactory (mean 74.75, SD 5.88). Conclusions: This study proposes a new protocol to assess total body kinematics, including the spine in its three main segments, during gait. The successful validation of this protocol in terms of reliability and usability allows for its subsequent clinical application. Full article

Background/Objectives: To compare the image quality of chest radiography with a dual-energy X-ray imaging system using AI technology (DE-AI) to that of conventional chest radiography with a standard protocol. Methods: In this prospective study, 52 healthy volunteers underwent dual-energy chest radiography. Images were obtained using two exposures at 60 kVp and 120 kVp, separated by a 150 ms interval. Four images were generated for each participant: a conventional image, an enhanced standard image, a soft-tissue-selective image, and a bone-selective image. A machine learning model optimized the cancellation parameters for generating soft-tissue and bone-selective images. To enhance image quality, motion artifacts were minimized using Laplacian pyramid diffeomorphic registration, while a wavelet directional cycle-consistent adversarial network (WavCycleGAN) reduced image noise. Four radiologists independently evaluated the visibility of thirteen anatomical regions (eight soft-tissue regions and five bone regions) and the overall image with a five-point scale of preference. Pooled mean values were calculated for each anatomic region through meta-analysis using a random-effects model. Results: Radiologists preferred DE-AI images to conventional chest radiographs in various anatomic regions. The enhanced standard image showed superior quality in 9 of 13 anatomic regions. Preference for the soft-tissue-selective image was statistically significant for three of eight anatomic regions. Preference for the bone-selective image was statistically significant for four of five anatomic regions. Conclusions: Images produced by DE-AI provide better visualization of thoracic structures. Full article

Current routine diagnostic procedures for back pain mainly focus on static spinal analyses. Dynamic Surface Topography (DST) is an easy-to-use, radiation-free addition, allowing spine analyses under dynamic conditions. Until now, it is unclear if this method is applicable to back pain patients, and data reports are missing. Within a prospective observational study, 32 patients suffering from thoracic and lumbar back pain were examined while walking, randomized at four speeds (2, 3, 4, 5 km/h), using a DST measuring device (DIERS 4Dmotion^® Lab). The measurement results were compared with those of a healthy reference group. We calculated the intrasegmental rotation for every subject and summed up the spinal motion in a standardized gait cycle. The Mann–Whitney U Test was used to compare the painful and healthy reference groups at the four different speeds. In a subgroup analysis, the painful group was divided into two groups: one with less pain (≤3 points on the Visual Analogue Scale) and one with more pain (>3 points on the Visual Analogue Scale). The Kruskal–Wallis Test was used to compare these subgroups with the healthy reference group. Of the 32 included patients, not all could walk at the intended speeds (5 km/h: 28/32). At speeds of 2–4 km/h, our results point to greater total segmental rotation of back pain patients compared to the healthy reference group. At a speed of 3 km/h, we observed more movement in the patients with more pain. Overall, we monitored small differences on average between the groups but large standard deviations. We conclude that the DST measuring approach is eligible for back pain patients when they feel confident enough to walk on a treadmill. Initial results suggest that DST can be used to obtain interesting therapeutic information for an individual patient. Full article

Background: The prolonged use of smartphones may lead to cervical posture deformities and other associated issues. Among these conditions, cervical extension type is one of the most commonly observed, characterized by increased cervical lordosis, forward head posture, and thoracic kyphosis. These biomechanical changes may lead to neck pain, a restricted range of motion (ROM), and heightened cervical muscle tone. The purpose of this study was to evaluate the impact of combining cervical stabilization exercises with either scapular stabilization or thoracic exercises on the mechanical properties of cervical muscles, the pressure pain threshold (PPT), and the ROM in individuals with cervical extension type. Methods: This study included 32 subjects with cervical extension type who were randomly divided into two groups: 16 subjects were placed in either the cervical and scapular stabilization exercises group (CSG) or the cervical stabilization with thoracic exercises group (CTG). After four weeks of exercise intervention, the following assessments were conducted: measurement of muscle tone, stiffness, and elasticity of the sternocleidomastoid (SCM) and upper trapezius (UT) muscles using Myoton PRO; evaluation of the PPT of the SCM and UT muscles using a pressure pain threshold meter; and assessment of cervical ROM (extension, flexion, and rotation) using motion analysis equipment. Results: Both groups showed significant differences in muscle tone, stiffness, elasticity, PPT, and cervical ROM (p < 0.05). The PPT of the UT muscle was significantly improved in the CSG compared to the CTG (p < 0.05). Conclusions: There were significant improvements in muscle tone, stiffness, elasticity, pain, and cervical ROM after exercise intervention in both groups of subjects with cervical extension. Cervical stabilization exercises, along with scapular stabilization, have better effects on improving UT muscle pain. Full article

Introduction: This systematic review evaluates the application of motion capture analysis (MCA) in assessing postoperative functional outcomes in adolescent idiopathic scoliosis (AIS) patients treated with spinal fusion. Material and Methods: A comprehensive search of PubMed, Scopus, Embase, and Cochrane Library was conducted for studies published between January 2013 and September 2024. Eligible studies included original research examining AIS patients’ post-spinal fusion, specifically assessing kinematic outcomes via MCA. Key outcomes included gait parameters, range of motion (ROM), and trunk–pelvic kinematics. Results: Nine studies comprising 216 participants (81.5% female), predominantly with Lenke 1 and 3 curve types. MCA revealed significant improvements in gait symmetry, stride length, and trunk–pelvic kinematics within one year of surgery. Enhanced mediolateral stability and normalized transverse plane motion were commonly observed. However, persistent reductions in thoracic–pelvic ROM and flexibility highlight postoperative limitations. Redistributing mechanical loads to adjacent unfused segments raises concerns about long-term compensatory mechanisms and risks for adjacent segment degeneration. Conclusions: While spinal fusion effectively restores coronal and sagittal alignment and improves functional mobility, limitations in ROM and dynamic adaptability necessitate targeted rehabilitation. Future research should standardize MCA methodologies and explore motion-preserving surgical techniques to address residual functional deficits. Full article

Background/Objectives: 5DCT was first proposed in 2005 as a motion-compensated CT simulation approach for radiotherapy treatment planning to avoid sorting artifacts that arise in 4DCT when patients breathe irregularly. Since March 2019, 5DCT has been clinically implemented for routine use at our institution to leverage this technological advantage. The clinical workflow includes a quality assurance report that describes the output of primary workflow steps. This study reports on the challenges and quality of the clinical 5DCT workflow using these quality assurance reports. Methods: We evaluated all thoracic 5DCT simulation datasets consecutively acquired at our institution between March 2019 and December 2022 for thoracic radiotherapy treatment planning. The 5DCT datasets utilized motion models constructed from 25 fast-helical free-breathing computed tomography (FHFBCTs) with simultaneous respiratory bellows signal monitoring to reconstruct individual, user-specified breathing-phase images (termed 5DCT phase images) for internal target volume contouring. Each 5DCT dataset was accompanied by a structured quality assurance report composed of qualitative and quantitative measures of the breathing pattern, image quality, DIR quality, model fitting accuracy, and a validation process by which the original FHFBCT scans were regenerated with the 5DCT model. Measures of breathing irregularity, image quality, and DIR quality were retrospectively categorized on a grading scale from 1 (regular breathing and accurate registration/modeling) to 4 (irregular breathing and inaccurate registration/modeling). The validation process was graded according to the same scale, and this grade was termed the suitability-for-treatment-planning (STP) grade. We correlated the graded variables to the STP grade. In addition to the quality assurance reports, we reviewed the contour sessions to determine how often 5DCT phase images were used for treatment planning and delivery. Results: There were 169 5DCT simulation datasets available from 156 patients for analysis. The STP was moderately correlated with breathing irregularity, image quality, and DIR quality (Spearman coefficients: 0.26, 0.30, and 0.50, respectively). Multiple linear regression analysis demonstrated that STP was correlated with regular breathing patterns (p = 0.008), image quality (p < 0.001), and better DIR quality (p < 0.001). 5DCT datasets were used for treatment planning in 82% of cases, while in 12% of cases, a backup image process was used. In total, 6% of image datasets were not used for treatment planning due to factors unrelated to the 5DCT workflow quality. Conclusions: The strongest association with STP was with DIR quality grades, as indicated by both Spearman and multiple linear regression analysis, implying that improvements to DIR accuracy and evaluation may be the best route for further improvement to 5DCT. The high rate of 5DCT phase image use for treatment planning showed that the workflow was reliable, and this has encouraged us to continue to develop and improve the workflow steps. Full article

This study aimed to compare the effects of Pilates (PIL) and whole-body high-intensity interval training (WBHIIT) on the spinal curvature of sedentary women. After being invited, 26 sedentary women aged between 20 and 54 voluntarily agreed to participate in the study. The sample was obtained through convenience sampling, and the participants chose either PIL or WBHIIT, which resulted in 13 participants in each group. Spinal posture was assessed pre- and post-intervention through videogrammetry during standing and walking. Markers were placed on the back, and the volunteers were instructed to remain in a standing position on a stationary treadmill for ten seconds. Subsequently, the treadmill was activated at a speed of 5 km/h. After one minute of walking, a complete gait cycle was recorded for analysis. The results showed no significant changes in spinal angles in static position between groups. However, in the walking position, there was a large-magnitude increase in the spinal range of motion (ROM) post-intervention (PIL Lumbar d = 1.8; PIL Thoracic d = 2.9; WBHIIT Lumbar d = 1.0; WBHIIT Thoracic d = 3.5) within groups in the sagittal plane. The adaptations promoted by these interventions in spinal ROM are important for reducing the risks of spinal stiffness and pain due to sedentary behaviour. Full article

(1) Background: This study examines the association between asymmetrical movements of an assembly line and machining workers and their overall well-being. The primary aim is to quantify the extent to which asymmetrical movements serve as predictors of work-related musculoskeletal disorders (WMSDs) among these workers and their overall well-being. The study emphasises the predictive relationships between asymmetry metrics and health outcomes. (2) Methods: The study included 86 employees from an automotive manufacturing plant, categorised into machining workers (MWEs) and assembly workers (AWEs). The employment duration spanned from 6 months to 40 years. Inertial motion capture technology was employed alongside the Goldberg 28-item General Health Questionnaire for a retrospective observational analysis and assessment of worker well-being. Movement dynamics were evaluated using a Motion Activity Index (MAI) to measure movement intensity, asymmetry, and quality. (3) Results: The machining group demonstrated nearly double the range of motion (median ROM: 36.6° vs. 25.5°, p = 0.019) and peak angular velocities up to eight times higher (median: 40°/s vs. 5°/s) in lumbar and thoracic rotations compared to the assembly group. Significant differences in ROM and movement speeds were observed (p < 0.001). The MAI showed higher dynamic and symmetrical movements in the machining group (36.6% vs. 25.5%, p = 0.019). No significant mental health issues were identified, aside from complaints related to somatic symptoms. (4) Conclusions: This study highlights significant occupational risks due to movement asymmetry in industrial settings, revealing substantial differences in joint angular displacements, velocities, and accelerations between machining and assembly workers. The findings emphasise the importance of targeted ergonomic interventions to enhance worker well-being and advocate for preventive health measures in occupational environments. Full article