We propose a method for automatic segmentation of individual muscles from a clinical CT. The method uses Bayesian convolutional neural networks with the U-Net architecture, using Monte Carlo dropout that infers an uncertainty metric in addition to the segmentation label. We evaluated the performance of the proposed method using two data sets: 20 fully annotated CTs of the hip and thigh regions and 18 partially annotated CTs that are publicly available from The Cancer Imaging Archive (TCIA) database. The experiments showed a Dice coefficient (DC) of 0.891±0.016 (mean±std) and an average symmetric surface distance (ASD) of 0.994±0.230 mm over 19 muscles in the set of 20 CTs. These results were statistically significant improvements compared to the state-of-the-art hierarchical multi-atlas method which resulted in 0.845 ± 0.031 DC and 1.556 ± 0.444 mm ASD. We evaluated validity of the uncertainty metric in the multi-class organ segmentation problem and demonstrated a correlation between the pixels with high uncertainty and the segmentation failure. One application of the uncertainty metric in active-learning is demonstrated, and the proposed query pixel selection method considerably reduced the manual annotation cost for expanding the training data set. The proposed method allows an accurate patient-specific analysis of individual muscle shapes in a clinical routine. This would open up various applications including personalization of biomechanical simulation and quantitative evaluation of muscle atrophy.

In this paper, we discuss the issue of safety in robot-assisted fracture reduction. We define the hazards of robot-assisted fracture reduction and design safety control methods. Although a large reduction force is required to reduce femoral neck fractures, an unexpectedly large force produced by a robot may cause injury to the patient. We have designed two mechanical failsafe units and a software force limiter; this along with velocity control can guarantee a safe operation in reduction force. In addition, to reduce the movement of bone fragments as much as possible, we devised spatially constrained control methods for fracture-reduction robots. The fracture-reduction system was evaluated using simulated fracture reductions.

In medical diagnostic imaging, an X-ray CT scanner or a MRI system have been widely used to examine 3D shapes or internal structures of living organisms or bones. However, these apparatuses are generally very expensive and of large size. A prior arrangement is also required before an examination, and thus, it is not suitable for an urgent fracture diagnosis in emergency treatment. This paper proposes a method to estimate a patient-specific 3D shape of a femur from only two fluoroscopic images using a parametric femoral model. Firstly, we develop a parametric femoral model by statistical analysis of a number of 3D femoral shapes created from CT images of 51 patients. Then, the pose and shape parameters of the parametric model are estimated from two 2D fluoroscopic images using a distance map constructed by the level set method. Experiments using synthesized images and fluoroscopic images of a phantom femur are successfully carried out and the usefulness of the proposed method is verified.

This paper describes a novel robot system for fracture reduction of a femur with a reduction path navigation system based on 3D CT image modeling. The robot has 6-degrees-of-freedom to realize fracture reduction motion with a mechanical failsafe mechanism as well as a software failsafe. Furthermore, one 6-axis force sensor is installed to realize power assist capability for a doctor as well as to measure the force applying on the patient's femur. Three of the operation modes necessary for fracture reduction operation are introduced, i.e., a JOG operation mode, a power assist mode and an automatic operation mode. The control method of the power assist mode by means of one force sensor is proposed and explained in detail. Furthermore, the control method of the automatic operation mode is described to correspond with a real-time reduction path modification by the navigation system. Experiments are conducted to verify the failsafe function and accuracy of the motion control.

This paper presents a framework for a cluster system that is suited for high-resolution image processing over the Internet during surgery. The system realizes high-performance computing (HPC) assisted surgery, which allows surgeons to utilize HPC resources remote from the operating room. One application available in the system is an intraoperative estimator for the range of motion (ROM) adjustment in total hip replacement (THR) surgery. In order to perform this computation-intensive estimation during surgery, we parallelize the ROM estimator on a cluster of 64 PCs, each with two CPUs. Acceleration techniques such as dynamic load balancing and data compression methods are incorporated into the system. The system also provides a remote-access service over the Internet with a secure execution environment. We applied the system to an actual THR surgery performed at Osaka University Hospital and confirmed that it realizes intraoperative ROM estimation without degrading the resolution of images and limiting the area for estimations.

This paper describes several new methods and software for automatic segmentation of the pelvis and the femur, based on clinically obtained multislice computed tomography (CT) data. The hip joint is composed of the acetabulum, cavity of the pelvic bone, and the femoral head. In vivo CT data sets of 60 actual patients were used in the study. The 120 (60 x 2) hip joints in the data sets were divided into four groups according to several key features for segmentation. Conventional techniques for classification of bony tissues were first employed to distinguish the pelvis and the femur from other CT tissue images in the hip joint. Automatic techniques were developed to extract the boundary between the acetabulum and the femoral head. An automatic method was built up to manage the segmentation task according to image intensity of bone tissues, size, center, shape of the femoral heads, and other characters. The processing scheme consisted of the following five steps: 1) preprocessing, including resampling 3-D CT data by a modified Sinc interpolation to create isotropic volume and to avoid Gibbs ringing, and smoothing the resulting images by a 3-D Gaussian filter; 2) detecting bone tissues from CT images by conventional techniques including histogram-based thresholding and binary morphological operations; 3) estimating initial boundary of the femoral head and the joint space between the acetabulum and the femoral head by a new approach utilizing the constraints of the greater trochanter and the shapes of the femoral head; 4) enhancing the joint space by a Hessian filter; and 5) refining the rough boundary obtained in step 3) by a moving disk technique and the filtered images obtained in step 4). The above method was implemented in a Microsoft Windows software package and the resulting software is freely available on the Internet. The feasibility of this method was tested on the data sets of 60 clinical cases (5000 CT images).

Measuring the thickness of sheet-like thin anatomical structures, such as articular cartilage and brain cortex, in three-dimensional (3-D) magnetic resonance (MR) images is an important diagnostic procedure. This paper investigates the fundamental limits on the accuracy of thickness determination in MR images. We defined thickness here as the distance between the two sides of boundaries measured at the subvoxel resolution, which are the zero-crossings of the second directional derivatives combined with Gaussian blurring along the normal directions of the sheet surface. Based on MR imaging and computer postprocessing parameters, characteristics for the accuracy of thickness determination were derived by a theoretical simulation. We especially focused on the effects of voxel anisotropy in MR imaging with variable orientation of sheet-like structure. Improved and stable accuracy features were observed when the standard deviation of Gaussian blurring combined with thickness determination processes was around square root of 2/2 times as large as the pixel size. The relation between voxel anisotropy in MR imaging and the range of sheet normal orientation within which acceptable accuracy is attainable was also clarified, based on the dependences of voxel anisotropy and the sheet normal orientation obtained by numerical simulations. Finally, in vitro experiments were conducted using an acrylic plate phantom and a resected femoral head to validate the results of theoretical simulation. The simulated thickness was demonstrated to be well-correlated with the actual in vitro thickness.