Detection of Medial Epicondyle Avulsion in Elbow Ultrasound Images via Bone Structure Reconstruction

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.

Measurement of Medial Elbow Joint Space using Landmark Detection

Ultrasound imaging of the medial elbow is crucial for the early identification of Ulnar Collateral Ligament (UCL) injuries. Specifically, measuring the elbow joint space in ultrasound images is used to assess the valgus instability of elbow. To automate this measurement, a precisely annotated dataset is necessary; however, no publicly available dataset has been proposed thus far. This study introduces a novel ultrasound medial elbow dataset for measuring joint space to diagnose Ulnar Collateral Ligament (UCL) injuries. The dataset comprises 4,201 medial elbow ultrasound images from 22 subjects, with landmark annotations on the humerus and ulna. The annotations are made precisely by the authors under the supervision of three orthopedic surgeons. We evaluated joint space measurement methods using our proposed dataset with several landmark detection approaches, including ViTPose, HRNet, PCT, YOLOv8, and U-Net. In addition, we propose using Shape Subspace (SS) for landmark refinement in heatmap-based landmark detection. The results show that the mean Euclidean distance error of joint space is 0.116 mm when using HRNet. Furthermore, the SS landmark refinement improves 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 and associated risks, which could be leveraged in large-scale screening. Lastly, we demonstrate point-based segmentation of the humerus and ulna using the detected landmarks as input. The dataset will be made publicly available upon acceptance of this paper at: https://github.com/Akahori000/Ultrasound-Medial-Elbow-Dataset.

RayEmb: Arbitrary Landmark Detection in X-Ray Images Using Ray Embedding Subspace

Intra-operative 2D-3D registration of X-ray images with pre-operatively acquired CT scans is a crucial procedure in orthopedic surgeries. Anatomical landmarks pre-annotated in the CT volume can be detected in X-ray images to establish 2D-3D correspondences, which are then utilized for registration. However, registration often fails in certain view angles due to poor landmark visibility. We propose a novel method to address this issue by detecting arbitrary landmark points in X-ray images. Our approach represents 3D points as distinct subspaces, formed by feature vectors (referred to as ray embeddings) corresponding to intersecting rays. Establishing 2D-3D correspondences then becomes a task of finding ray embeddings that are close to a given subspace, essentially performing an intersection test. Unlike conventional methods for landmark estimation, our approach eliminates the need for manually annotating fixed landmarks. We trained our model using the synthetic images generated from CTPelvic1K CLINIC dataset, which contains 103 CT volumes, and evaluated it on the DeepFluoro dataset, comprising real X-ray images. Experimental results demonstrate the superiority of our method over conventional methods. The code is available at https://github.com/Pragyanstha/rayemb.

X-Ray to CT Rigid Registration Using Scene Coordinate Regression

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.