RU2544452C1 - Method of carrying out tomosynthesis of lumbar part in side projection in patients with inflammatory diseases of spine at preoperative stage - Google Patents

Method of carrying out tomosynthesis of lumbar part in side projection in patients with inflammatory diseases of spine at preoperative stage Download PDF

Info

Publication number
RU2544452C1
RU2544452C1 RU2014123250/14A RU2014123250A RU2544452C1 RU 2544452 C1 RU2544452 C1 RU 2544452C1 RU 2014123250/14 A RU2014123250/14 A RU 2014123250/14A RU 2014123250 A RU2014123250 A RU 2014123250A RU 2544452 C1 RU2544452 C1 RU 2544452C1
Authority
RU
Russia
Prior art keywords
width
projection
spine
height
obtaining
Prior art date
Application number
RU2014123250/14A
Other languages
Russian (ru)
Inventor
Юлия Александровна Цыбульская
Наталья Викторовна Селюкова
Ирина Викторовна Шутихина
Original Assignee
Юлия Александровна Цыбульская
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Юлия Александровна Цыбульская filed Critical Юлия Александровна Цыбульская
Priority to RU2014123250/14A priority Critical patent/RU2544452C1/en
Application granted granted Critical
Publication of RU2544452C1 publication Critical patent/RU2544452C1/en

Links

Images

Abstract

FIELD: medicine.
SUBSTANCE: method of the tomosynthesis of the lumbar part in the side projection in such patients at the preoperative stage includes obtaining images of the spine zone of interest in front and side projections. After obtaining the image in the front projection the width of the vertebra body is measured in mm and divided in two. Then 1/2 of the vertebra body width is subtracted from the standard height of the scanning zone in the side projection in an on the side position of the patient at 180 mm above the table, with obtaining the individual height of the scanning zone in the side projection. Then 1/2 of the vertebra body width in mm is added to the standard width of the scanning area of 80 mm, with obtaining the individual width of the scanning zone in the side projection. The calculated individual data of the width and height of the scanning zone are set on the tomograph working console and the image in the side projection is made.
EFFECT: method makes it possible to increase the accuracy of preoperative diagnostics in case of inflammatory diseases of the spine due to obtaining the images including the spinal column with the entire width of the vertebrae bodies without summation of tissues, individual selection of the width and height of scanning.
3 dwg, 1 ex

Description

The invention relates to medicine and can be used to reliably assess the level of damage, the degree of deformation of the vertebral bodies and reduce the height of the vertebrae in patients with inflammatory diseases of the spine (for example, osteomyelitis, spinal tuberculosis).

As a rule, at the initial stage, patients with a suspected inflammatory process in the spine, accompanied by destructive changes, undergo traditional radiography. Using this method, one can determine the topic, the nature and extent of bone destruction, the condition of the spinal canal, the size and extent of abscesses, their relationship with paravertebral tissues [1-3].

The x-ray picture of spondylitis depends on the localization and prescription of the process. Almost always spondylitis occurs in the vertebral body, less often in the spinous or transverse process [2, 3]. The first radiological sign of spondylitis is a decrease in the height of the intervertebral disc [4]. However, with standard radiography, often visualization of the structures of the spinal column at the level of the lumbar is difficult due to the summation of the loops of the intestine and organs of the abdominal cavity.

In addition, the complexity of the study in the lateral projection lies in the fact that during the tomosynthesis of the spine a certain number of sections is automatically obtained. In the presence of certain anatomical features (overweight, severe scoliosis, hibus, etc.), often not the entire vertebral column "falls" into the study area.

Recently, more complex methods (computed or magnetic resonance imaging) are used to diagnose inflammatory diseases of the spine, which, of course, have a higher sensitivity in the detection of spondylitis. However, computed tomography and magnetic resonance imaging are expensive methods and have certain limitations and contraindications (claustrophobia, metal implants in the body, pacemaker, high weight of patients, etc.).

Tomosynthesis in world practice, as a rule, is used to study the mammary glands, lungs and rarely in the diagnosis of traumatic changes in the bone system (fractures, dislocations, assessment of the condition of pins and other metal structures in the bones) [5-8]. At the same time, we did not find works on the detection of inflammatory diseases of the spine (tuberculosis, osteomyelitis).

Due to the fact that the method of treating patients with inflammatory diseases of the spine is surgery, an urgent problem is the need for accurate preoperative determination of the level of damage, the degree of deformation of the vertebral bodies and a decrease in the height of the vertebrae to calculate the level, volume of resection and determine the type of intervertebral implants that will be used to mobilize the spinal column. Moreover, the most complete information can be obtained by analyzing the condition of the spine in two projections.

The prior art method is known that allows you to get two pictures of the zone of interest of the spine, this is the so-called method of zonography of the spine [9 - prototype]. Zonography is a linear X-ray tomography, in which an isolated zone of interest (spine) is obtained in the image. With zonography, 2 images are obtained, on which all structures of the spinal column and paravertebral tissues are clearly visualized. However, the disadvantage of this technique is to obtain a small number of slices in contrast to tomosynthesis and lower image clarity.

In the present invention, we proposed a method for determining the depth of the spine, taking into account the individual structure of each patient, using tomosynthesis, which allows to increase the information content of the preoperative diagnosis of the discussed category of patients.

Thus, the task to be solved in the present invention is to improve the method of obtaining an image of the lumbar spine in a lateral projection in inflammatory diseases of the spine.

Achievable technical result is to increase the accuracy of preoperative diagnosis in inflammatory diseases of the spine, by obtaining images with the capture of the spinal column over the entire width of the vertebral bodies.

We proposed to use the method of digital multislice linear tomography (tomosynthesis) to detect inflammatory diseases of the spine, which allows to obtain digital x-ray images of high information content at a low dose of radiation in contrast to computed tomography. A distinctive feature of this method is the elimination of the need for preliminary preparation of the patient, as with standard radiography, due to the fact that there is no summation of tissues (for example, intestinal loops).

During spinal tomosynthesis in a direct and lateral projection, a certain number of sections (from 36 to 44) is automatically obtained. When performing tomosynthesis in a lateral projection, taking into account standard settings, only a part of the vertebral body (for example, the right half of the vertebral body) is obtained and the destruction zone (which is located, for example, on the left) may not enter the study, which leads to excessive radiation exposure to the patient in connection with re-conducting the study. The area of "interest" in the X-ray diagnosis of the inflammatory process in the spine is the vertebral body over its entire area with the capture of the arches, both transverse processes. The limitedness of this zone of “interest” may be due to certain anatomical features of the patient (overweight, severe scoliosis, hibus, etc.). Partial visualization of the spinal column is absolutely unacceptable when planning surgical intervention in patients with inflammatory diseases of the spine (both specific and non-specific genesis).

The method is as follows.

In patients with inflammatory diseases of the spine at the preoperative stage, tomosynthesis is performed in two projections:

1) direct - to clarify the localization of the inflammatory process;

2) lateral - to assess the degree of decrease in the height of the vertebral bodies, assess the degree of deformation of the spinal column and the presence of foci of destruction in neighboring vertebrae.

Direct projection is carried out as standard, taking into account the factory settings of the Shimadzu Sonavision Safire II (100 kV, 5.00 mAs, 16 msec). At the workstation, the body width of the affected vertebra is measured in direct projection.

Next, a lateral projection is also carried out as standard, for this patient is laid lying on one side. The necessary reliable fixation of the patient during the study is ensured by the most comfortable position on the table. The scanning parameters embedded in the apparatus during the lateral projection of the lumbar spine: the scanning height above the table is 180 mm, the thickness of the scanned area is 80 mm.

Considering that when conducting a lateral projection, a limited amount of a slice is obtained, which often does not allow obtaining complete diagnostic information (for example, due to the patient’s overweight), we have developed a technique for conducting a lateral projection of the lumbar spine, which allows not to re-examine the patient with radiation exposure.

The technique is as follows.

The vertebral body width (mm) measured in a direct image is divided in half (Fig. 1). Further, ½ the width of the vertebral body is subtracted from the height of the scanning zone (180 mm), thus the scanning height is reduced. At the same time, we increase the width of the scanning zone, for which ½ the width of the vertebral body (mm) is added to the thickness of the scanned area (80 mm). Thus, it turns out that the entire vertebral body and +/- 1 cm of paravertebral tissues fall into the study area. All measurements are in millimeters.

Changed scan settings are set on the tomograph working console. The thickness of the cut does not change and is 2 mm.

Thus, we have refined the methodology for individual selection of the width and height of the scan. The use of exactly the width of half the vertebral body when calculating the scanning parameters is due to the following. Initially, the last section runs along the midline of the vertebral body and without visualization of the second half of the vertebral body. Therefore, if you change the scanning area taking into account the width of the vertebral body, you can get a full x-ray study through the entire thickness of the spinal column.

To demonstrate the differences in the visualization of the spinal column in the lateral projection obtained using various radiation studies, the observation of a 35-year-old patient is given (Fig. 2, 3a, c): hypersthenic, height 176 cm, weight 11 kg. Diagnosis: tuberculous spondylitis L1-L2 vertebrae. It was treated on an outpatient basis without effect. Upon receipt, a moderate condition. Complaints of pain in the lumbar region and subfebrile temperature. Radiography and tomosynthesis of the lumbar spine in lateral projection were performed on the patient.

The resulting images are presented in the following figures:

figure 2 - X-ray in the lateral projection of the lumbar spine. Change in the structure of the end plates of the vertebral bodies in the L1-L2 segment (arrow). Summation of the loops of the intestine and the body of the L4 vertebra (dashed arrow);

FIG. 3a, c - Tomosynthesis in the lateral projection of the lumbar spine. Image processing options. Clear visualization of bone structures over a large extent (up to Th9). Contact destruction of adjacent end plates in the L1-L2 segment (arrow).

Clinical example.

Patient A., 56 years old, morphologically verified diagnosis - tuberculous spondylitis L3-L4 vertebrae.

Hypersthenic: weight 95 kg, height 163 cm. At the preoperative stage, tomosynthesis was performed in direct projection, in which contact destruction was determined in the right half of the bodies of two adjacent vertebrae. The width of the vertebral body in direct projection was 40 mm. It is determined that 1L of the width of the vertebral body is 20 mm. Next, the height of the scanning zone was changed: 180 mm-20 mm = 160 mm. Also changed the width of the scanning zone: 80 mm + 20 mm = 100 mm.

Through measurements of the upper and lower boundaries of the study, an image was obtained through the entire thickness of the vertebral body with capture of paravertebral tissues.

Literature

1. Ratobylsky G.V., Khovrin V.V., Kamalov Yu.R., Baturin O.V. Clinical and radiological diagnosis of spinal tuberculosis at the present stage. Diagnostic and interventional radiology. 2012; 6 (1): 19-27.

2. Kornienko V.V., Pronin V.N. Diagnostic neuroradiology. Volume II Brain tumors. M .: T.M. Andreeva, 2009; 435-441.

3. Zharkov P.L. X-ray criteria for the remission and complete elimination of osteoarticular tuberculosis inflammation. M .: Vidar - M .: 2007; 104 S.

4. Trufanov G.E., Rameshvili T.E., Dergunova N.I., Mitusova G.M. Radiation diagnosis of infectious and inflammatory diseases of the spine. St. Petersburg. ELBI-SPb. 2011; 34-54.

5. Stevens G. et al. Circular Tomosynthesis: Potential in Imaging of Breast and Upper Cervical Spine-Preliminary Phantom and in Vitro Study. Radiology V. 228, 2003.

6. Gothlin J., M. Geijer The Utility of Digital Linear Tomosynthesis Imaging of Total Hip Joint Arthroplasty with Suspicion of Loosening: A Prospective Study in 40 Patients. BioMed Research International 2013.

7. Lee S. et al. Tomosynthesis. As a New Diagnostic Tool For Evaluation Of Ankylosing Spondylitis With Modified Stoke Ankylosing Spondylitis Spinal Score: A Comparison With Plain Radiographs. ACRVARHP 2013 Annual Meeting.

8. Gurney-Champion O. et al. Digital tomosynthesis for verifying spine position during radiotherapy: a phantom study. Phys. Med. Biol. 2013.

9. Selyukova H.B. Zonography in the diagnosis of tuberculosis of the spine at the outpatient stage. Problems of tuberculosis and lung diseases. 2008; 11: 21-23.

Claims (1)

  1. A method for performing lumbar tomosynthesis in a lateral projection in patients with inflammatory diseases of the spine at the preoperative stage, including obtaining images of the spinal zone of interest in the direct and lateral projection, where after obtaining the image in a direct projection, measure the width of the vertebral body in mm and divide it in half, then from the standard height of the scanning zone in the lateral projection in the patient’s position on the side 180 mm above the table is subtracted 1/2 the width of the vertebral body, obtaining the individual height of the scanning zone in the lateral roektsii, after which a standard thickness of 80 mm scanned area is added 1/2 of the vertebral body width in mm, yielding individual scanning zone width in side view; The calculated individual data of the width and height of the scanning zone is set on the tomography working console and a picture is taken in lateral projection.
RU2014123250/14A 2014-06-09 2014-06-09 Method of carrying out tomosynthesis of lumbar part in side projection in patients with inflammatory diseases of spine at preoperative stage RU2544452C1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
RU2014123250/14A RU2544452C1 (en) 2014-06-09 2014-06-09 Method of carrying out tomosynthesis of lumbar part in side projection in patients with inflammatory diseases of spine at preoperative stage

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
RU2014123250/14A RU2544452C1 (en) 2014-06-09 2014-06-09 Method of carrying out tomosynthesis of lumbar part in side projection in patients with inflammatory diseases of spine at preoperative stage

Publications (1)

Publication Number Publication Date
RU2544452C1 true RU2544452C1 (en) 2015-03-20

Family

ID=53290572

Family Applications (1)

Application Number Title Priority Date Filing Date
RU2014123250/14A RU2544452C1 (en) 2014-06-09 2014-06-09 Method of carrying out tomosynthesis of lumbar part in side projection in patients with inflammatory diseases of spine at preoperative stage

Country Status (1)

Country Link
RU (1) RU2544452C1 (en)

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6496557B2 (en) * 2000-02-09 2002-12-17 Hologic, Inc. Two-dimensional slot x-ray bone densitometry, radiography and tomography
WO2012071582A2 (en) * 2010-11-27 2012-05-31 Stephen Neushul Computed tomography and tomosynthesis system
UA82798U (en) * 2013-02-14 2013-08-12 Харьковская Медицинская Академия Последипломного Обучения Method for imaging of intervertebral foramed of lumbar spine
RU2510080C2 (en) * 2010-11-22 2014-03-20 Кэнон Кабусики Кайся Image processing device, image processing method and long-term information storage medium

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6496557B2 (en) * 2000-02-09 2002-12-17 Hologic, Inc. Two-dimensional slot x-ray bone densitometry, radiography and tomography
RU2510080C2 (en) * 2010-11-22 2014-03-20 Кэнон Кабусики Кайся Image processing device, image processing method and long-term information storage medium
WO2012071582A2 (en) * 2010-11-27 2012-05-31 Stephen Neushul Computed tomography and tomosynthesis system
UA82798U (en) * 2013-02-14 2013-08-12 Харьковская Медицинская Академия Последипломного Обучения Method for imaging of intervertebral foramed of lumbar spine

Non-Patent Citations (2)

* Cited by examiner, † Cited by third party
Title
Summary, фиг.9. ГУРЖИЕВ С.Н. и др. Томосинтез на флюорографическом цифровом аппарате "Флюоро-ПроГраф-РП"// Мед.техника, 2013, N 5, с.17-21, реферат. МИКИТЮК В.П., Цифровая многосрезовая линейная томография (томосинтез), 27.04.2011, найдено [10.12.2014] из Интернет www.vmu.ssu.gov.ua/article/9. REN L. et al. Automatic registration between reference and on-board digital tomosynthesis images for positioning verification// Med Phys. 2008 Feb;35(2):664-72, реф. PubMed, найдено [10.12.2014] из Интернет www.pubmed.com *
пар. 0014, 0060. *

Similar Documents

Publication Publication Date Title
Lee et al. Correlation between bone mineral density measured by dual-energy X-ray absorptiometry and Hounsfield units measured by diagnostic CT in lumbar spine
JP2019069169A (en) System and method for image guidance during medical procedures
Mendelsohn et al. Patient and surgeon radiation exposure during spinal instrumentation using intraoperative computed tomography-based navigation
Metska et al. Detection of vertical root fractures in vivo in endodontically treated teeth by cone-beam computed tomography scans
Flach et al. Imaging in forensic radiology: an illustrated guide for postmortem computed tomography technique and protocols
Van Vlijmen et al. A comparison between 2D and 3D cephalometry on CBCT scans of human skulls
Damilakis et al. Radiation exposure in X-ray-based imaging techniques used in osteoporosis
Dreiseidler et al. Comparison of cone-beam imaging with orthopantomography and computerized tomography for assessment in presurgical implant dentistry.
Ma et al. A novel computer-assisted drill guide template for thoracic pedicle screw placement: a cadaveric study
Zain-Alabdeen et al. A comparative study of accuracy of detection of surface osseous changes in the temporomandibular joint using multidetector CT and cone beam CT
Hernandez et al. CT determination of femoral torsion
Olcott et al. Accuracy of detection and measurement of renal calculi: in vitro comparison of three-dimensional spiral CT, radiography, and nephrotomography.
Pohlenz et al. Clinical indications and perspectives for intraoperative cone-beam computed tomography in oral and maxillofacial surgery
Christiansen et al. Periapical radiography and cone beam computed tomography for assessment of the periapical bone defect 1 week and 12 months after root-end resection
Kraus et al. Can computer-assisted surgery reduce the effective dose for spinal fusion and sacroiliac screw insertion?
EP1671095B1 (en) Localization of a target using in vivo markers
Saifuddin et al. Orientation of lumbar pars defects: implications for radiological detection and surgical management
Mulkens et al. Use of an automatic exposure control mechanism for dose optimization in multi–detector row CT examinations: clinical evaluation
Scharf SPECT/CT imaging in general orthopedic practice
Friedland et al. The use of 3-dimensional reconstructions to evaluate the anatomic relationship of the mandibular canal and impacted mandibular third molars
US7369695B2 (en) Method and apparatus for metal artifact reduction in 3D X-ray image reconstruction using artifact spatial information
Zhou et al. Monoenergetic imaging of dual-energy CT reduces artifacts from implanted metal orthopedic devices in patients with factures
Wade et al. A systematic review of the clinical effectiveness of EOS 2D/3D X-ray imaging system
Fukami et al. Bifid mandibular canal: confirmation of limited cone beam CT findings by gross anatomical and histological investigations
Lopes et al. 3-D volume rendering maxillofacial analysis of angular measurements by multislice CT