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Length and angle measurements of the lower extremity in digital composite overview images

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Abstract

We here introduce a digital scanning method for determining leg length and angles. The leg length and angle measurements, image quality and radiation dose were evaluated. A composite overview image was reconstructed from a series of individual images. In 45 overview images, the total leg length and the femoro-tibial angle were determined by two radiologists, and the inter- and intra-observer variability was examined in the light of the measured values as well as the subjective assessment of the image quality. A dose comparison was carried out with a series of conventional whole leg images. The mean standard deviation of the multiple measurements of leg length was 0.4 mm for researcher I and 0.5 mm for researcher II. The difference in the mean values of the measured leg lengths between the researchers was 0.3 mm. The mean standard deviation of the multiple measurements of the femoro-tibial angle was 0.1° for both researchers. The difference in the mean values of the measured femoro-tibial angle between the researchers was 0.03°. On average, the marks for the image quality awarded by researcher II with an average score of 2 were very significantly worse than those awarded by researcher I with an average score of 1.5. The mean entrance dose value determined was 0.16 mGy lower in the digital system (0.49 mGy) than that of the comparative conventional series (0.65 mGy). Where there is a large number of possible length and angle measurements, the proposed procedure offers the advantages of good image quality, digital image processing, measurements that are easy to perform, reproducible and accurate, and lower radiation dose, and it is superior to conventional whole leg images.

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References

  1. Hagstedt B, Norman O, Olsson TH, Tjornstrand B (1980) Technical accuracy in high tibial osteotomy for gonarthrosis. Acta Orthop Scand 51:963–970

    CAS  PubMed  Google Scholar 

  2. Ecker ML, Lotke PA, Windsor RE, Cella JP (1987) Long-term results after total condylar knee arthroplasty. Significance of radiolucent lines. Clin Orthop 216:151–158

    PubMed  Google Scholar 

  3. Tjornstrand BA, Egund N, Hagstedt BV (1981) High tibial osteotomy: a seven-year clinical and radiographic follow-up. Clin Orthop 160:124–136

    PubMed  Google Scholar 

  4. Tjornstrand B, Egund N, Hagstedt B, Lindstrand A (1981) Tibial osteotomy in medial gonarthrosis. The importance of over-correction of varus deformity. Arch Orthop Trauma Surg 99:83–89

    PubMed  Google Scholar 

  5. Waugh W (1986) Tibial osteotomy in the management of osteoarthritis of the knee. Clin Orthop 210:55–61

    PubMed  Google Scholar 

  6. Odenbring S, Berggren AM, Peil L (1993) Roentgenographic assessment of the hip-knee-ankle axis in medial gonarthrosis. A study of reproducibility. Clin Orthop 289:195–196

    PubMed  Google Scholar 

  7. Heijens E, Gladbach B, Pfeil J (1999) Definition, quantification, and correction of translation deformities using long leg, frontal plane radiography. J Pediatr Orthop B 8:285–291

    CAS  PubMed  Google Scholar 

  8. Strecker W, Keppler P, Kinzl L (1998) Analysis of leg geometry. Langenbecks Arch Chir Suppl Kongressbd 115:581–586

    CAS  Google Scholar 

  9. Beattie P, Isaacson K, Riddle DL, Rothstein JM (1990) Validity of derived measurements of leg-length differences obtained by use of a tape measure. Phys Ther 70:150–157

    CAS  PubMed  Google Scholar 

  10. Fisk JW, Baigent ML (1975) Clinical and radiological assessment of leg length. N Z Med J 81:477–480

    CAS  PubMed  Google Scholar 

  11. Glass RB, Poznanski AK (1985) Leg-length determination with biplanar CT scanograms. Radiology 156:833–834

    CAS  PubMed  Google Scholar 

  12. Krettek C, Henzler D, Hoffmann R, Tscherne H (1994) A new procedure for determination of leg length and differences in leg length using sonography. I. Development and experimental studies. Unfallchirurg 97:98–106

    CAS  PubMed  Google Scholar 

  13. Waidelich HA, Strecker W, Schneider E (1992) Computed tomographic torsion-angle and length measurement of the lower extremity. The methods, normal values and radiation load. Rofo Fortschr Geb Röntgenstr Neuen Bildgeb Verfahr 157:245–251

    Google Scholar 

  14. Temme JB, Chu WK, Anderson JC (1987) CT scanograms compared with orthoroentgenograms in long bone measurement. Radiol Technol 59:65–68

    CAS  PubMed  Google Scholar 

  15. Aaron A, Weinstein D, Thickman D, Eilert R (1992) Comparison of orthoroentgenography and computed tomography in the measurement of limb-length discrepancy. J Bone Joint Surg Am 74:897–902

    CAS  PubMed  Google Scholar 

  16. Krettek C, Koch T, Henzler D, Blauth M, Hoffmann R (1996) A new procedure for determining leg length and leg length inequality using ultrasound. II. Comparison of ultrasound, teleradiography and 2 clinical procedures in 50 patients. Unfallchirurg 99:43–51

    CAS  PubMed  Google Scholar 

  17. Aitken AG, Flodmark O, Newman DE, Kilcoyne RF, Shuman WP, Mack LA (1985) Leg length determination by CT digital radiography. Am J Roentgenol 144:613–615

    CAS  Google Scholar 

  18. Keppler P, Strecker W, Kinzl L (1998) Analysis of leg geometry—standard techniques and normal values. Chirurg 69:1141–1152

    Article  CAS  PubMed  Google Scholar 

  19. Moreland JR, Bassett LW, Hanker GJ (1987) Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg Am 69:745–749

    CAS  PubMed  Google Scholar 

  20. Cooke TD, Scudamore RA, Bryant JT, Sorbie C, Siu D, Fisher B (1991) A quantitative approach to radiography of the lower limb. Principles and applications. J Bone Joint Surg Br 73:715–720

    CAS  PubMed  Google Scholar 

  21. Sanfridsson J et al (2000) Radiation dose and image information in computed radiography. Acta Radiologica 41:310–316

    Article  CAS  PubMed  Google Scholar 

  22. Sanfridsson J (2001) Orthopaedic measurements with computed radiography. Methodological development, accuracy, and radiation dose with special reference to the weight-bearing lower extremity and the dislocating patella. Acta Radiologica 423:1–40

    Article  Google Scholar 

  23. Terjesen T, Benum P, Rossvoll I, Svenningsen S, Floystad Isern AE, Nordbo T (1991) Leg length discrepancy measured by ultrasonography. Acta Orthop Scand 62:121–124

    CAS  PubMed  Google Scholar 

  24. Holst A, Thomas W (1988) Measuring leg length and leg length difference with the method of real time Sonography. Sportverletz Sportschaden 2:55–60

    CAS  PubMed  Google Scholar 

  25. Junk S, Terjesen T, Rossvoll I, Braten M (1992) Leg length inequality measured by ultrasound and clinical methods. Eur J Radiol 14:185–188

    Article  CAS  PubMed  Google Scholar 

  26. van Eeuwijk AHW, Lobregt S, Gerritsen FA (1997) A novel method for digital X-ray imaging of the complete spine. Proceedings of CVRMed-MRCAS’97. Lect Notes Comput Sci 1205:521–530

    Google Scholar 

  27. Geijer et al (2001) Digital radiography of scoliosis with a scanning method: initial evaluation. Radiology 218:402–410

    CAS  PubMed  Google Scholar 

  28. Verdonck B, Nijlunsing R, Melman N, Geijer H (2001) Image quality and X-ray dose for translation reconstruction overview imaging of the spine, colon and legs. CARS 2001. Proceedings of the Computed Assisted Radiology and Surgery, 27–30 June 2001, Berlin, Germany. Elsevier, Amsterdam, pp 500–505

  29. Geijer H, Verdonck B, Beckmann K-W, Andersson T, Persliden J (2003) Digital radiography of scoliosis with a scanning method: radiation dose optimization. Eur Radiol 13:543–551

    PubMed  Google Scholar 

  30. Petersen TD, Rohr W Jr (1987) Improved assessment of lower extremity alignment using new roentgenographic techniques. Clin Orthop 219:112–119

    PubMed  Google Scholar 

  31. Siu D, Cooke TD, Broekhoven LD, Lam M, Fisher B, Saunders G, Challis TW (1991) A standardized technique for lower limb radiography. Practice, applications, and error analysis. Invest Radiol 26:71–77

    CAS  PubMed  Google Scholar 

  32. Keppler P, Strecker W, Kinzl L, Simmnacher M, Claes L (1999) Sonographic imaging of leg geometry. Orthopade 28:1015–1022

    Article  CAS  PubMed  Google Scholar 

  33. Mannello DM (1992) Leg length inequality. J Manipulative Physiol Ther 15:576–590

    CAS  PubMed  Google Scholar 

  34. Wright JG, Treble N, Feinstein AR (1991) Measurement of lower limb alignment using long radiographs. J Bone Joint Surg Br 73:721–723

    CAS  PubMed  Google Scholar 

  35. Tokarowski A, Piechota L, Wojciechowski P, Gajos L, Kusz D (1995) Measurement of lower extremity length using computed tomography. Chir Narzadow Ruchu Ortop Pol 60:123–127

    CAS  PubMed  Google Scholar 

  36. Cooke TD, Li J, Scudamore RA (1994) Radiographic assessment of bony contributions to knee deformity. Orthop Clin North Am 25:387–393

    CAS  PubMed  Google Scholar 

  37. Stricker SJ, Faustgen JP (1994) Radiographic measurement of bowleg deformity: variability due to method and limb rotation. J Pediatr Orthop 14:147–151

    CAS  PubMed  Google Scholar 

  38. Swanson KE, Stocks GW, Warren PD, Hazel MR, Janssen HF (2000) Does axial limb rotation affect the alignment measurements in deformed limbs? Clin Orthop 371:246–252

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank P. Gieles, L. Linssen and B. Verdonck from Philips Medical Systems, The Netherlands, for their support in application, technical background and statistics.

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Correspondence to M. Boewer.

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Boewer, M., Arndt, H., Ostermann, P.A.W. et al. Length and angle measurements of the lower extremity in digital composite overview images. Eur Radiol 15, 158–164 (2005). https://doi.org/10.1007/s00330-004-2352-y

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  • DOI: https://doi.org/10.1007/s00330-004-2352-y

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