Visualization of scoliotic spine using ultrasound-accessible skeletal landmarks

PURPOSE: Ultrasound imaging is an attractive alternative to X-ray for scoliosis diagnosis and monitoring due to its safety and inexpensiveness. The transverse processes as skeletal landmarks are accessible by means of ultrasound and are sufficient for quantifying scoliosis, but do not provide an intuitively comprehendible visualization of the spine. METHODS: We created a method for visualization of the scoliotic spine using a 3D transform field, resulting from thin-spline interpolation of a landmark-based registration between the transverse processes that we localized in both the patient’s ultrasound and an average healthy spine model. Additional anchor points were computationally generated to control the thin-spline interpolation, in order to gain a transform field that accurately represents the deformation of the patient’s spine. The transform field is applied to the average spine model, resulting in a 3D surface model depicting the patient’s spine. We applied ground truth CT from pediatric scoliosis patients in which we reconstructed the bone surface and localized the transverse processes. We warped the average spine model and analyzed the match between the patient’s bone surface and the warped spine. RESULTS: Visual inspection revealed accurate rendering of the scoliotic spine. Notable misalignments occurred mainly in the anterior-posterior direction at the first and last vertebra, which is immaterial for scoliosis quantification. The average Hausdorff distance computed for 4 patients was 2.4 mm. CONCLUSIONS: We achieved qualitatively accurate and intuitive visualization to depict the 3D deformation of the patient’s spine when compared to ground truth CT.