Automated radiographic assessment of hands in rheumatoid arthritis

J.A. Kauffman

Research output: ThesisPhD Thesis - Research UT, graduation UTAcademic

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Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease leading to severe joint damage, particularly in the wrist, fingers and toes. To prevent irreversible joint damage, it is crucial that RA is treated in an early stage. The effect of treatment methods can differ per patient. Therefore it is important that disease activity is carefully monitored, such that a treatment can be altered if necessary. In order to visualize joint damage, radiographs of hands and feet are often used. In the past fifty years several methods have been developed to express visible joint damage in a quantifiable score. In general these methods are time-consuming and depend on subjective visual readings. With the introduction of the computer and the availability of digitized radiographs, researchers have been looking for new automated methods to measure the progression of joint damage. A measurable effect in early RA is joint space narrowing which is caused by degradation of the cartilage between the bones. A considerable part of this thesis deals with this subject. Firstly, different methods are evaluated on how to quantify the joint space width in an accurate and robust manner. Hereby methods developed by others have been evaluated. Subsequently, we present several image processing methods for analyzing radiographs. The first is a segmentation method based on a model of the hand skeleton. With this model it is possible to detect the locations of the bones and the joints in radiographs. The second part describes a method that accurately detects the bone margins within the joint. Finally, the joint space width is calculated using the detected joint margins. This method is evaluated by comparing measurement results with both manual measurements, and automated measurements developed by others. It is shown that automated measurements are more precise than manual measurements. It was observed from the image data, that a large variability of hand positioning is allowed during x-ray acquisition. This does not only complicate automated analysis, but can also have an effect on the projection angle within a specific joint. In successive radiographs, a change in the projection angle can negatively affect the precision of measurements. By using projection simulations it is demonstrated that this effect is relevant. Therefore, we recommend to standardize the protocol for radiographic acquisitions. A special positioning aid has been designed, which can be used to place a hand in a standard position. Another measurable effect of RA is the development of bone damage in the form of erosions. To be able to measure this effect, we investigated the possibility to make subtraction measurements between successive radiographs that have been taken with some time in between. It is demonstrated that different radiographs of the same bone can be compared using an image registration algorithm. By determining the difference between two images developing erosions can be revealed. However, with the current available radiographs it is not yet possible to quantify bone damage. We expect that in the future this will become feasible by applying the recommended positioning aid during x-ray acquisition.
Original languageUndefined
Awarding Institution
  • University of Twente
Supervisors/Advisors
  • Bernelot Moens, H.J., Advisor
  • Slump, Cornelis Herman, Supervisor
Thesis sponsors
Award date7 May 2009
Place of PublicationEnschede, the Netherlands
Publisher
Print ISBNs978-90-365-2830-6
DOIs
Publication statusPublished - 7 May 2009

Keywords

  • EWI-15338
  • IR-61094
  • METIS-263841
  • joint space width
  • Rheumatoid Arthritis
  • Image Processing
  • erosion

Cite this

Kauffman, J. A. (2009). Automated radiographic assessment of hands in rheumatoid arthritis. Enschede, the Netherlands: University of Twente. https://doi.org/10.3990/1.9789036528306
Kauffman, J.A.. / Automated radiographic assessment of hands in rheumatoid arthritis. Enschede, the Netherlands : University of Twente, 2009. 144 p.
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abstract = "Rheumatoid arthritis (RA) is a chronic inflammatory disease leading to severe joint damage, particularly in the wrist, fingers and toes. To prevent irreversible joint damage, it is crucial that RA is treated in an early stage. The effect of treatment methods can differ per patient. Therefore it is important that disease activity is carefully monitored, such that a treatment can be altered if necessary. In order to visualize joint damage, radiographs of hands and feet are often used. In the past fifty years several methods have been developed to express visible joint damage in a quantifiable score. In general these methods are time-consuming and depend on subjective visual readings. With the introduction of the computer and the availability of digitized radiographs, researchers have been looking for new automated methods to measure the progression of joint damage. A measurable effect in early RA is joint space narrowing which is caused by degradation of the cartilage between the bones. A considerable part of this thesis deals with this subject. Firstly, different methods are evaluated on how to quantify the joint space width in an accurate and robust manner. Hereby methods developed by others have been evaluated. Subsequently, we present several image processing methods for analyzing radiographs. The first is a segmentation method based on a model of the hand skeleton. With this model it is possible to detect the locations of the bones and the joints in radiographs. The second part describes a method that accurately detects the bone margins within the joint. Finally, the joint space width is calculated using the detected joint margins. This method is evaluated by comparing measurement results with both manual measurements, and automated measurements developed by others. It is shown that automated measurements are more precise than manual measurements. It was observed from the image data, that a large variability of hand positioning is allowed during x-ray acquisition. This does not only complicate automated analysis, but can also have an effect on the projection angle within a specific joint. In successive radiographs, a change in the projection angle can negatively affect the precision of measurements. By using projection simulations it is demonstrated that this effect is relevant. Therefore, we recommend to standardize the protocol for radiographic acquisitions. A special positioning aid has been designed, which can be used to place a hand in a standard position. Another measurable effect of RA is the development of bone damage in the form of erosions. To be able to measure this effect, we investigated the possibility to make subtraction measurements between successive radiographs that have been taken with some time in between. It is demonstrated that different radiographs of the same bone can be compared using an image registration algorithm. By determining the difference between two images developing erosions can be revealed. However, with the current available radiographs it is not yet possible to quantify bone damage. We expect that in the future this will become feasible by applying the recommended positioning aid during x-ray acquisition.",
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Kauffman, JA 2009, 'Automated radiographic assessment of hands in rheumatoid arthritis', University of Twente, Enschede, the Netherlands. https://doi.org/10.3990/1.9789036528306

Automated radiographic assessment of hands in rheumatoid arthritis. / Kauffman, J.A.

Enschede, the Netherlands : University of Twente, 2009. 144 p.

Research output: ThesisPhD Thesis - Research UT, graduation UTAcademic

TY - THES

T1 - Automated radiographic assessment of hands in rheumatoid arthritis

AU - Kauffman, J.A.

N1 - 10.3990/1.9789036528306

PY - 2009/5/7

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N2 - Rheumatoid arthritis (RA) is a chronic inflammatory disease leading to severe joint damage, particularly in the wrist, fingers and toes. To prevent irreversible joint damage, it is crucial that RA is treated in an early stage. The effect of treatment methods can differ per patient. Therefore it is important that disease activity is carefully monitored, such that a treatment can be altered if necessary. In order to visualize joint damage, radiographs of hands and feet are often used. In the past fifty years several methods have been developed to express visible joint damage in a quantifiable score. In general these methods are time-consuming and depend on subjective visual readings. With the introduction of the computer and the availability of digitized radiographs, researchers have been looking for new automated methods to measure the progression of joint damage. A measurable effect in early RA is joint space narrowing which is caused by degradation of the cartilage between the bones. A considerable part of this thesis deals with this subject. Firstly, different methods are evaluated on how to quantify the joint space width in an accurate and robust manner. Hereby methods developed by others have been evaluated. Subsequently, we present several image processing methods for analyzing radiographs. The first is a segmentation method based on a model of the hand skeleton. With this model it is possible to detect the locations of the bones and the joints in radiographs. The second part describes a method that accurately detects the bone margins within the joint. Finally, the joint space width is calculated using the detected joint margins. This method is evaluated by comparing measurement results with both manual measurements, and automated measurements developed by others. It is shown that automated measurements are more precise than manual measurements. It was observed from the image data, that a large variability of hand positioning is allowed during x-ray acquisition. This does not only complicate automated analysis, but can also have an effect on the projection angle within a specific joint. In successive radiographs, a change in the projection angle can negatively affect the precision of measurements. By using projection simulations it is demonstrated that this effect is relevant. Therefore, we recommend to standardize the protocol for radiographic acquisitions. A special positioning aid has been designed, which can be used to place a hand in a standard position. Another measurable effect of RA is the development of bone damage in the form of erosions. To be able to measure this effect, we investigated the possibility to make subtraction measurements between successive radiographs that have been taken with some time in between. It is demonstrated that different radiographs of the same bone can be compared using an image registration algorithm. By determining the difference between two images developing erosions can be revealed. However, with the current available radiographs it is not yet possible to quantify bone damage. We expect that in the future this will become feasible by applying the recommended positioning aid during x-ray acquisition.

AB - Rheumatoid arthritis (RA) is a chronic inflammatory disease leading to severe joint damage, particularly in the wrist, fingers and toes. To prevent irreversible joint damage, it is crucial that RA is treated in an early stage. The effect of treatment methods can differ per patient. Therefore it is important that disease activity is carefully monitored, such that a treatment can be altered if necessary. In order to visualize joint damage, radiographs of hands and feet are often used. In the past fifty years several methods have been developed to express visible joint damage in a quantifiable score. In general these methods are time-consuming and depend on subjective visual readings. With the introduction of the computer and the availability of digitized radiographs, researchers have been looking for new automated methods to measure the progression of joint damage. A measurable effect in early RA is joint space narrowing which is caused by degradation of the cartilage between the bones. A considerable part of this thesis deals with this subject. Firstly, different methods are evaluated on how to quantify the joint space width in an accurate and robust manner. Hereby methods developed by others have been evaluated. Subsequently, we present several image processing methods for analyzing radiographs. The first is a segmentation method based on a model of the hand skeleton. With this model it is possible to detect the locations of the bones and the joints in radiographs. The second part describes a method that accurately detects the bone margins within the joint. Finally, the joint space width is calculated using the detected joint margins. This method is evaluated by comparing measurement results with both manual measurements, and automated measurements developed by others. It is shown that automated measurements are more precise than manual measurements. It was observed from the image data, that a large variability of hand positioning is allowed during x-ray acquisition. This does not only complicate automated analysis, but can also have an effect on the projection angle within a specific joint. In successive radiographs, a change in the projection angle can negatively affect the precision of measurements. By using projection simulations it is demonstrated that this effect is relevant. Therefore, we recommend to standardize the protocol for radiographic acquisitions. A special positioning aid has been designed, which can be used to place a hand in a standard position. Another measurable effect of RA is the development of bone damage in the form of erosions. To be able to measure this effect, we investigated the possibility to make subtraction measurements between successive radiographs that have been taken with some time in between. It is demonstrated that different radiographs of the same bone can be compared using an image registration algorithm. By determining the difference between two images developing erosions can be revealed. However, with the current available radiographs it is not yet possible to quantify bone damage. We expect that in the future this will become feasible by applying the recommended positioning aid during x-ray acquisition.

KW - EWI-15338

KW - IR-61094

KW - METIS-263841

KW - joint space width

KW - Rheumatoid Arthritis

KW - Image Processing

KW - erosion

U2 - 10.3990/1.9789036528306

DO - 10.3990/1.9789036528306

M3 - PhD Thesis - Research UT, graduation UT

SN - 978-90-365-2830-6

PB - University of Twente

CY - Enschede, the Netherlands

ER -

Kauffman JA. Automated radiographic assessment of hands in rheumatoid arthritis. Enschede, the Netherlands: University of Twente, 2009. 144 p. https://doi.org/10.3990/1.9789036528306