# US 9,561,004 B2 · Automated 3-D orthopedic assessments > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 9,561,004 B2 - Document ID: US9561004B2 - Status: Granted - Kind: B2 - Application number: 14/013,189 - Filed: 2013-08-29 - Published: 2014-10-30 - Granted: 2017-02-07 - Earliest claimed: 2013-04-29 - Assignees: Sectra AB - Applicants: Sectra AB - Inventors: Daniel Forsberg - Web page: https://patentgrep.com/patent/US9561004B2 ## CPC - A61B 5/4561: {Evaluating static posture, e.g. undesirable back curvature (A61B5/1116 takes precedence)} - G06T 7/0014: {using an image reference approach} - G06T 7/37: using transform domain methods - G06T 7/60: Analysis of geometric attributes - G06T 7/75: {involving models} - G16H 50/50: for simulation or modelling of medical disorders - G06T 2207/10072: Tomographic images - G06T 2207/20016: Hierarchical, coarse-to-fine, multiscale or multiresolution image processing; Pyramid transform - G06T 2207/30012: Spine; Backbone - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) - G06T: IMAGE DATA PROCESSING OR GENERATION, IN GENERAL - G16H: HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA ## Abstract Systems, methods, computer programs, and circuits can perform automated spinal assessments using a 3-D model and a 3-D patient image data set of the spine which do not rely on vertebral symmetry. ## Claims ### Claim 1 A method of providing automated measurements associated with anatomical features of a spine, comprising: electronically providing a three dimensional (3-D) model of the spine having substantially naturally shaped vertebrae, with a plurality of landmarks electronically applied to each of the vertebrae; obtaining 3-D patient image data of a spine of the patient; extracting subvolumes of the 3-D patient image data associated with the spine, respective subvolumes each including at least one vertebra in full and at least one neighboring vertebrae structure or a portion thereof; extracting subvolumes of the 3-D model corresponding to the subvolumes of the patient image data; electronically registering, subvolume by subvolume, the 3-D model and the 3-D patient image data of the spine; then electronically transferring the landmarks from the model to the 3-D patient image; and electronically calculating measurements for one or more vertebrae, including at least one of the following: (i) position in x, y and z coordinates (mm), (ii) rotation θx, θy, θz in degrees, and (iii) a local deformity (lateral wedge) value (mm) using the transferred landmarks. ### Claim 2 (depends on 1) The method of claim 1, further comprising electronically visually increasing and/or resolving respective vertebra features in the subvolumes of the 3-D patient image data to enhance those features relative to an unenhanced state before electronically registering corresponding subvolumes of the model and the patient image data. ### Claim 3 (depends on 1) The method of claim 1, wherein each vertebra comprises discrete and spaced apart landmarks associated with an axial plane, discrete and spaced apart landmarks associated with a sagittal plane and discrete and spaced apart landmarks associated with a coronal plane. ### Claim 4 (depends on 1) The method of claim 1, wherein the registration is carried out by first applying an affine registration for each vertebra, then applying a deformable registration for each vertebra. ### Claim 5 (depends on 1) The method of claim 1, wherein, before the registration, the method comprises pre-processing the patient image data to electronically estimate an initial position and rotation of each vertebrae of the patient image data by (i) calculating a spinal canal centerline, detecting disc location, (ii) calculating an initial rotation, then (iii) calculating an estimate of vertebrae center points, then (iv) adjusting vertebral rotation using the estimated center points and generating an adjusted estimated spine shape with an estimated location and rotation of the respective vertebrae of the patient data using the adjusted estimated rotation. ### Claim 6 (depends on 1) The method of claim 1, further comprising electronically generating a plurality of graphs of T1-L5 curvature using the calculated measurements, including graphs of displacement (mm) x vs. z and y vs. z, a graph of the calculated local deformity (mm) vs. z and at least one graph of a respective rotational measurement of one or more of rotation θx, θy, and θz in degrees vs. z. ### Claim 7 (depends on 1) The method of claim 1, wherein the x, y and z coordinates of each vertebrae are calculated using an average of coordinates of the transferred landmarks of a respective vertebrae. ### Claim 8 (depends on 1) The method of claim 1, wherein rotation θx, θy, θz in degrees are calculated as Euler angles, using a fixed world frame, derived from rotation matrix R=RZ(θZ)RY(θY)RX(θX), wherein: θZ corresponds to axial vertebral rotation, θY to frontal rotation and θX sagittal rotation. ### Claim 9 (depends on 1) The method of claim 1, wherein the local deformity is electronically calculated based on a vertebral height difference of vertebral height measurements between defined pairs of landmarks. ### Claim 10 (depends on 1) The method of claim 1, wherein the local deformity is electronically calculated non-invasively based on an angle between planes fitted to superior and inferior endplates using the patient image data and the transferred landmarks. ### Claim 11 (depends on 1) The method of claim 1, further comprising electronically generating graphs that illustrate a primary curvature that is defined with visually marked end vertebrae and an apical vertebrae with the end vertebrae defined by maximal and minimal frontal rotation θy. ### Claim 12 (depends on 11) The method of claim 11, further comprising electronically generating an estimated Cobb angle using the calculated measurements. ### Claim 13 (depends on 1) The method of claim 1, further comprising electronically generating statistical models of spinal curvature of groups of different 3-D patient image data using Eigenvector analysis of the calculated measurements. ### Claim 14 (depends on 1) The method of claim 1, further comprising evaluating whether a patient has idiopathic scoliosis and/or for quantifying an extent or configuration of the idiopathic scoliosis based on the calculated measurements. ### Claim 15 (depends on 1) The method of claim 1, wherein the electronic transfer of the landmarks is carried out using an electronically calculated estimated transformation that can evaluate both symmetric and asymmetric vertebrae of the 3-D patient image data. ### Claim 16 (depends on 1) The method of claim 1, wherein the electronically registering is carried out using phase-based registration. ### Claim 17 (depends on 1) The method of claim 1, wherein the electronically providing the 3-D model of the spine having substantially naturally shaped vertebrae has vertebrae at all levels, T1-L5. ### Claim 18 (depends on 1) The method of claim 1, wherein the method further comprises allowing a user to electronically define placement of the landmarks on the 3-D model using a GUI and display presenting the 3-D model. ### Claim 19 (depends on 1) The method of claim 1, wherein the electronically providing the 3-D model of the spine having substantially naturally shaped vertebrae with the landmarks is carried out by providing a menu of selectable landmark sets and allowing a user to select one or more of the landmark sets for use. ### Claim 20 (depends on 1) The method of claim 1, wherein the electronically providing the 3-D model of the spine having substantially naturally shaped vertebrae with the landmarks is carried out by providing the 3-D model with a default set of landmarks. ### Claim 21 (depends on 20) The method of claim 20, further comprising allowing a user to electronically adjust location of landmarks and/or add or remove one or more landmarks. ### Claim 22 (depends on 1) The method of claim 1, wherein the electronically providing the 3-D model of the spine having substantially naturally shaped vertebrae with the landmarks is carried out by providing a first landmark set for a first set of the calculated measurements and a second landmark set for a second set of calculated measurements, and wherein the first and second landmark sets comprise a plurality of spaced apart discrete landmarks placed about a boundary of the vertebrae and with a plurality of spaced apart landmarks in an axial plane, a plurality of the landmarks in a sagittal plane and a plurality of the landmarks in a coronal plane. ### Claim 23 (depends on 1) The method of claim 1, wherein the patient images are time-resolved images for generating visual output of curvature change over time thereby allowing monitoring of progression of a disease, change associated with a therapy and providing visualizations and associated calculated measurements associated with changes in spinal structure between images taken in different positions of a patient. ### Claim 24 A clinician workstation comprising: at least one display; and a circuit in communication with the at least one display, the circuit comprising or in communication with at least one processor configured to: provide a three dimensional (3-D) model of the spine having substantially naturally shaped vertebrae, with a plurality of landmarks electronically applied to each of the vertebrae and/or which allows a user to electronically apply landmarks to one or more vertebrae of the 3-D model; obtain 3-D patient image data of a spine of the patient; extract subvolumes of the 3-D patient image data associated with the spine, respective subvolumes each including at least one vertebra in full and at least one neighboring vertebrae structure or a portion thereof; extract subvolumes of the 3-D model corresponding to the subvolumes of the patient image data; register, subvolume by subvolume, the 3-D model and the 3-D patient image data of the spine; then transfer the landmarks from the model to the 3-D patient image; and calculate measurements for one or more vertebrae, including at least one of the following: (i) position in x, y and z coordinates (mm), (ii) rotation θx, θy, θz in degrees, and (iii) a local deformity (lateral wedge) value (mm) using the transferred landmarks. ### Claim 25 (depends on 24) The workstation of claim 24, wherein the at least one processor is configured to register, subvolume by subvolume, the 3-D model and the 3-D patient image data of the spine by (i) first applying an affine registration for each vertebra, then (ii) applying a deformable registration for each vertebra. ### Claim 26 (depends on 24) The workstation of claim 24, wherein the at least one processor of the circuit is configured to pre-process the 3-D patient image data to estimate an initial position and rotation of each vertebrae of the patient image data by (i) calculating a spinal canal centerline, detecting disc location, (ii) calculating an initial rotation, then (iii) calculating an estimate of vertebrae center points, then (iv) adjusting vertebral rotation using the estimated center points and generating an adjusted estimated spine shape with an estimated location and rotation of the respective vertebrae of the patient data using the adjusted estimated rotation, and wherein the at least one processor is configured to register the 3-D model and the 3-D patient image data of the spine using the generated adjusted estimated spine shape. ### Claim 27 (depends on 24) The workstation of claim 24, wherein the at least one processor of the circuit is configured to generate a plurality of graphs that illustrate a primary curvature that is defined with visually marked end vertebrae and an apical vertebrae with the end vertebrae defined by maximal and minimal frontal rotation θy. ### Claim 28 (depends on 24) The workstation of claim 24, wherein the at least one processor of the circuit is configured to generate an estimated Cobb angle using the calculated measurements. ### Claim 29 (depends on 24) The workstation of claim 24, wherein the patient images are time-resolved images, and wherein the at least one processor of the circuit is configured to generate visual output of graphs of change in curvature over time thereby allowing monitoring of progression of a disease, change associated with a therapy and providing visualizations and associated calculated measurements associated with changes in spinal structure between images taken in different positions of a patient. ### Claim 30 (depends on 24) The workstation of claim 24, wherein the at least one processor generates a plurality of graphs of T1-L5 curvature using the calculated measurements, including graphs of displacement (mm) x vs. z and y vs. z, a graph of the calculated local deformity (mm) vs. z and at least one graph of a respective rotational measurement of one or more of rotation θx, θy, and θz in degrees vs. z. ### Claim 31 (depends on 24) The workstation of claim 24, wherein the electronically applied landmarks of the 3-D model comprises at least four spaced apart discrete landmarks including landmarks on perimeters of the vertebrae with a plurality of spaced apart landmarks in an axial plane, a plurality of the landmarks in a sagittal plane and a plurality of the landmarks in a coronal plane. ### Claim 32 A system for evaluating spinal patient image data, comprising: at least one processor comprising a spinal deformity analysis module; and at least one display in communication with the at least one processor, wherein the spinal deformity analysis module is configured to: provide a three dimensional (3-D) model of the spine having substantially naturally shaped vertebrae to the display, the 3-D model (i) is configured to allow a user to electronically apply landmarks to one or more vertebrae of the 3-D model and/or (ii) has a plurality of landmarks electronically pre-applied to each of the vertebrae of the 3-D model; obtain 3-D patient image data of a spine of the patient; register the 3-D model and the 3-D patient image data of the spine; then transfer the landmarks from the model to the 3-D patient image; calculate measurements for the vertebrae, including a plurality of the following: (i) position in x, y and z coordinates (mm), (ii) rotation θx, θy, θz in degrees, and (iii) a local deformity (lateral wedge) value (mm) using the transferred landmarks; and generate a plurality of graphs of curvature of the spine to the display using the calculated measurements. ### Claim 33 (depends on 32) The system of claim 32, wherein the electronically applied landmarks of the 3-D model comprises at least four spaced apart discrete landmarks including landmarks on perimeters of the vertebrae with a plurality of spaced apart landmarks in an axial plane, a plurality of the landmarks in a sagittal plane and a plurality of the landmarks in a coronal plane. ### Claim 34 (depends on 32) The system of claim 32, wherein the spinal deformity analysis module generates a plurality of graphs of T1-L5 curvature using the calculated measurements, including graphs of displacement (mm) x vs. z and y vs. z, a graph of the calculated local deformity (mm) vs. z and at least one graph of a respective rotational measurement of one or more of rotation θx, θy, and θz in degrees vs. z. ### Claim 35 A computer program product for analyzing image data sets, the computer program product comprising: a non-transitory computer readable storage medium having computer readable program code embodied in the medium, the computer-readable program code comprising: computer readable program code configured to: provide a three dimensional (3-D) model of the spine having substantially naturally shaped vertebrae, with a plurality of landmarks electronically applied to each of the vertebrae; obtain 3-D patient image data of a spine of the patient; extract subvolumes of the 3-D patient image data associated with the spine, respective subvolumes each including at least one vertebra in full and at least one neighboring vertebrae structure or a portion thereof; extract subvolumes of the 3-D model corresponding to the subvolumes of the patient image data; register, subvolume by subvolume, the 3-D model and the 3-D patient image data of the spine; then transfer the landmarks from the model to the 3-D patient image; and calculate measurements for one or more vertebrae, including at least one of the following: (i) position in x, y and z coordinates (mm), (ii) rotation θx, θy, θz in degrees, and (iii) a local deformity (lateral wedge) value (mm) using the transferred landmarks.