Freehand three dimensional ultrasound for imaging components of the musculoskeletal system
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There have been reports on the use of Ultrasound (US) for monitoring fracture repair and for measuring muscle volume. Change in muscle mass is a useful bio-marker for monitoring the use and disuse of muscle, and the affects of age, disease and injury. The main modality for imaging bone is X-ray and for muscle volume Magnetic Resonance (MR). Previous studies have shown US to have advantages over X-ray and MR. US can image all stages of the fracture repair process and can detect signs of healing 4-6 weeks before X-ray allowing earlier detection of possible complications. Compared to MR, US is less resource intensive, easier to access and also has fewer exclusion criteria for patients. Despite these advantages, the limited field of view that US can provide results in high operator dependency for scan interpretation and also for length and volume measurements. Three-dimensional Ultrasound (3D US) has been developed to overcome these limitations and has been used to provide extended field of view images of the foetus and the heart and to obtain accurate volume measurements for organs. In this thesis it is hypothesized that 3D US can provide a more comprehensive method of imaging fracture repair than X-ray and is also a viable alternative to MR for determining muscle volumes in vivo. Initially, an electromagnetically (EM) tracked 3D US system was evaluated for clinical use using phantom-based experiments. It was found that the presence of metal objects in or near the EM field caused distortion and resulted in errors in the volume measurements of phantoms of up to ±20%. An optically tracked system was also evaluated and it was found that length measurements of a phantom could be made to within ±1.3%. Fracture repair was monitored in five patients with lower limb fractures. Signs of healing were visible earlier on 3D US with a notable, although variable, lag between callus development on X-ray compared to 3D US. 3D US provided a clearer view of callus formation and the changes in density of the callus as it matured. Additional information gained by applying image processing methods to the 3D US data was used to develop a measure of callus density and to identify the frequency dependent appearance of the callus. Volume measurements of the rectus femoris quadricep muscle were obtained using 3DUS from eleven healthy volunteers and were validated against volume measurements derived using MR. The mean difference between muscle volume measurements obtained using 3D US and MR was 0.53 cm3 with a standard deviation of 1.09 cm3 and 95% confidence intervals of 0.20 - 1.27 cm3 In conclusion, 3D US demonstrates great potential as a tool for imaging components of the musculoskeletal system and as means of measuring callus density.