Yuichi Yoshii

Pragyan Shrestha, Chun Xie, Hidehiko Shishido et al.

Intraoperative fluoroscopy is a frequently used modality in minimally invasive orthopedic surgeries. Aligning the intraoperatively acquired X-ray image with the preoperatively acquired 3D model of a computed tomography (CT) scan reduces the mental burden on surgeons induced by the overlapping anatomical structures in the acquired images. This paper proposes a fully automatic registration method that is robust to extreme viewpoints and does not require manual annotation of landmark points during training. It is based on a fully convolutional neural network (CNN) that regresses the scene coordinates for a given X-ray image. The scene coordinates are defined as the intersection of the back-projected rays from a pixel toward the 3D model. Training data for a patient-specific model were generated through a realistic simulation of a C-arm device using preoperative CT scans. In contrast, intraoperative registration was achieved by solving the perspective-n-point (PnP) problem with a random sample and consensus (RANSAC) algorithm. Experiments were conducted using a pelvic CT dataset that included several real fluoroscopic (X-ray) images with ground truth annotations. The proposed method achieved an average mean target registration error (mTRE) of 3.79 mm in the 50th percentile of the simulated test dataset and projected mTRE of 9.65 mm in the 50th percentile of real fluoroscopic images for pelvis registration.

Chun Xie, Yuichi Yoshii, Itaru Kitahara

X-ray imaging is a rapid and cost-effective tool for visualizing internal human anatomy. While multi-view X-ray imaging provides complementary information that enhances diagnosis, intervention, and education, acquiring images from multiple angles increases radiation exposure and complicates clinical workflows. To address these challenges, we propose a novel view-conditioned diffusion model for synthesizing multi-view X-ray images from a single view. Unlike prior methods, which are limited in angular range, resolution, and image quality, our approach leverages the Diffusion Transformer to preserve fine details and employs a weak-to-strong training strategy for stable high-resolution image generation. Experimental results demonstrate that our method generates higher-resolution outputs with improved control over viewing angles. This capability has significant implications not only for clinical applications but also for medical education and data extension, enabling the creation of diverse, high-quality datasets for training and analysis. Our code is available at https://github.com/xiechun298/SV-DRR.

Shizuka Akahori, Shotaro Teruya, Pragyan Shrestha et al.

Ultrasound imaging of the medial elbow is crucial for the early diagnosis of Ulnar Collateral Ligament (UCL) injuries. Specifically, measuring the elbow joint space in ultrasound images is used to assess the valgus instability of the elbow caused by UCL injuries. To automate this measurement, a model trained on a precisely annotated dataset is necessary; however, no publicly available dataset exists to date. This study introduces a novel ultrasound medial elbow dataset to measure the joint space. The dataset comprises 4,201 medial elbow ultrasound images from 22 subjects, with landmark annotations on the humerus and ulna, based on the expertise of three orthopedic surgeons. We evaluated joint space measurement methods on our proposed dataset using heatmap-based, regression-based, and token-based landmark detection methods. While heatmap-based landmark detection methods generally achieve high accuracy, they sometimes produce multiple peaks on a heatmap, leading to incorrect detection. To mitigate this issue and enhance landmark localization, we propose Shape Subspace (SS) landmark refinement by measuring geometrical similarities between the detected and reference landmark positions. The results show that the mean joint space measurement error is 0.116 mm when using HRNet. Furthermore, SS landmark refinement can reduce the mean absolute error of landmark positions by 0.010 mm with HRNet and by 0.103 mm with ViTPose on average. These highlight the potential for high-precision, real-time diagnosis of UCL injuries by accurately measuring joint space. Lastly, we demonstrate point-based segmentation for the humerus and ulna using the detected landmarks as inputs. Our dataset will be publicly available at https://github.com/Akahori000/Ultrasound-Medial-Elbow-Dataset

Shizuka Akahori, Shotaro Teruya, Pragyan Shrestha et al.

This study proposes a reconstruction-based framework for detecting medial epicondyle avulsion in elbow ultrasound images, trained exclusively on normal cases. Medial epicondyle avulsion, commonly observed in baseball players, involves bone detachment and deformity, often appearing as discontinuities in bone contour. Therefore, learning the structure and continuity of normal bone is essential for detecting such abnormalities. To achieve this, we propose a masked autoencoder-based, structure-aware reconstruction framework that learns the continuity of normal bone structures. Even in the presence of avulsion, the model attempts to reconstruct the normal structure, resulting in large reconstruction errors at the avulsion site. For evaluation, we constructed a novel dataset comprising normal and avulsion ultrasound images from 16 baseball players, with pixel-level annotations under orthopedic supervision. Our method outperformed existing approaches, achieving a pixel-wise AUC of 0.965 and an image-wise AUC of 0.967. The dataset is publicly available at: https://github.com/Akahori000/Ultrasound-Medial-Epicondyle-Avulsion-Dataset.