Towards Estimating the Uncertainty Associated with Three-Dimensional Geometry Reconstructed from Medical Image Data.

Patient-specific computational modeling is increasingly used to assist with visualization, planning, and execution of medical treatments. This trend is placing more reliance on medical imaging to provide accurate representations of anatomical structures. Digital image analysis is used to extract anatomical data for use in clinical assessment/planning. However, the presence of image artifacts, whether due to interactions between the physical object and the scanning modality or the scanning process, can degrade image accuracy. The process of extracting anatomical structures from the medical images introduces additional sources of variability, e.g., when thresholding or when eroding along apparent edges of biological structures. An estimate of the uncertainty associated with extracting anatomical data from medical images would therefore assist with assessing the reliability of patient-specific treatment plans. To this end, two image datasets were developed and analyzed using standard image analysis procedures. The first dataset was developed by performing a "virtual voxelization" of a CAD model of a sphere, representing the idealized scenario of no error in the image acquisition and reconstruction algorithms (i.e., a perfect scan). The second dataset was acquired by scanning three spherical balls using a laboratory-grade CT scanner. For the idealized sphere, the error in sphere diameter was less than or equal to 2% if 5 or more voxels were present across the diameter. The measurement error degraded to approximately 4% for a similar degree of voxelization of the physical phantom. The adaptation of established thresholding procedures to improve segmentation accuracy was also investigated.

Replacement of daily load attenuates but does not prevent changes to the musculoskeletal system during bed rest.

The dose-response effects of exercise in reduced gravity on musculoskeletal health have not been well documented. It is not known whether or not individualized exercise prescriptions can be effective in preventing the substantial loss in bone mineral density and muscle function that have been observed in space flight and in bed rest. In this study, typical daily loads to the lower extremities were quantified in free-living subjects who were then randomly assigned to control or exercise groups. Subjects were confined to 6-degree head-down bed rest for 84 days. The exercise group performed individually prescribed 1 g loaded locomotor exercise to replace their free-living daily load. Eleven subjects (5 exercise, 6 control) completed the protocol. Volumetric bone mineral density results from quantitative computed tomography demonstrated that control subjects lost significant amounts of bone in the intertrochanteric and total hip regions (p < 0.0125), whereas the exercise group showed no significant change from baseline in any region (p > 0.0125). Pre-and post-bed rest muscle volumes were calculated from analysis of magnetic resonance imaging data. The exercise group retained a larger percentage of their total quadriceps and gastrocnemius muscle volume (- 7.2% ± 5.9, - 13.8% ± 6.1, respectively) than their control counterparts (- 23.3% ± 5.9, - 33.0 ± 8.2, respectively; p < 0.01). Both groups significantly lost strength in several measured activities (p < 0.05). The declines in peak torque during repeated exertions of knee flexion and knee extension were significantly less in the exercise group than in the control group (p < 0.05) but work done was not significantly different between groups (p > 0.05). The decline in VO2max was 17% ± 18 in exercising subjects (p < 0.05) and 31% ± 13 in control subjects (p = 0.003; difference between groups was not significant p = 0.26). Changes in blood and urine measures showed trends but no significant differences between groups (p > 0.05). In summary, the decline in a number of important measures of musculoskeletal and cardiovascular health was attenuated but not eliminated by a subject-specific program of locomotor exercise designed to replace daily load accumulated during free living. We conclude that single daily bouts of exposure to locomotor exercise can play a role in a countermeasures program during bed rest, and perhaps space flight, but are not sufficient in their own right to ensure musculoskeletal or cardiovascular health.

A novel lunar bed rest analogue.

INTRODUCTION: Humans will eventually return to the Moon and thus there is a need for a ground-based analogue to enable the study of physiological adaptations to lunar gravity. An important unanswered question is whether or not living on the lunar surface will provide adequate loading of the musculoskeletal system to prevent or attenuate the bone loss that is seen in microgravity. Previous simulations have involved tilting subjects to an approximately 9.5 degrees angle to achieve a lunar gravity component parallel to the long-axis of the body. However, subjects in these earlier simulations were not weight-bearing, and thus these protocols did not provide an analogue for load on the musculoskeletal system. METHODS: We present a novel analogue which includes the capability to simulate standing and sitting in a lunar loading environment. A bed oriented at a 9.5 degrees angle was mounted on six linear bearings and was free to travel with one degree of freedom along rails. This allowed approximately 1/6 body weight loading of the feet during standing. "Lunar" sitting was also successfully simulated. RESULTS: A feasibility study demonstrated that the analogue was tolerated by subjects for 6 d of continuous bed rest and that the reaction forces at the feet during periods of standing were a reasonable simulation of lunar standing. During the 6 d, mean change in the volume of the quadriceps muscles was -1.6% +/- 1.7%. DISCUSSION: The proposed analogue would appear to be an acceptable simulation of lunar gravity and deserves further exploration in studies of longer duration.

Muscle volume, strength, endurance, and exercise loads during 6-month missions in space.

INTRODUCTION: Decrements in muscular strength during long-duration missions in space could be mission-critical during construction and exploration activities. The purpose of this study was to quantify changes in muscle volume, strength, and endurance of crewmembers on the International Space Station (ISS) in the context of new measurements of loading during exercise countermeasures. METHODS: Strength and muscle volumes were measured from four male ISS crewmembers (49.5 +/- 4.7 yr, 179.3 +/- 7.1 cm, 85.2 +/- 10.4 kg) before and after long-duration spaceflight (181 +/- 15 d). Preflight and in-flight measurements of forces between foot and shoe allowed comparisons of loading from 1-g exercise and exercise countermeasures on ISS. RESULTS: Muscle volume change was greater in the calf (-10 to 16%) than the thigh (-4% to -7%), but there was no change in the upper arm (+0.4 to -0.8%). Isometric and isokinetic strength changes at the knee (range -10.4 to -24.1%), ankle (range -4 to -22.3%), and elbow (range -7.5 to -16.7%) were observed. Although there was an overall postflight decline in total work (-14%) during the endurance test, an increase in postflight resistance to fatigue was observed. The peak in-shoe forces during running and cycling on ISS were approximately 46% and 50% lower compared to 1-g values. DISCUSSION: Muscle volume and strength were decreased in the lower extremities of crewmembers during long-duration spaceflight on ISS despite the use of exercise countermeasures. in-flight countermeasures were insufficient to replicate the daily mechanical loading experienced by the crewmembers before flight. Future exercise protocols need careful assessment both in terms of intensity and duration to maximize the "dose" of exercise and to increase loads compared to the measured levels.

Enhanced daily load stimulus to bone in spaceflight and on earth.

INTRODUCTION: It has been hypothesized that bone loss arising from long-duration space travel is caused by a reduction in mechanical stimuli to the skeleton. The daily load stimulus (DLS) theory was first proposed to relate daily time histories of mechanical loading from ground reaction forces to bone homeostasis. In this methods paper, an enhanced daily load stimulus (EDLS) is proposed to account for recently developed theories on saturation and recovery of the osteogenic potential of bone with repeated cyclic loading and the potential benefits of standing. MODEL DEVELOPMENT: To determine periods of continuous activity (sitting, standing, walking, running, and other activity), an activity determination algorithm based on entire days of in-shoe forces was developed. The rainflow peak counting method was used to analyze the in-shoe force data from entire working days in preparation for the calculation of the EDLS. Parameters characterizing saturation and recovery with cyclical loading from running and walking as well as the effects of standing were estimated based on data in the literature. DISCUSSION: The activity algorithm proved to be accurate and robust when applied to in-shoe force data from entire waking days. The EDLS may be useful in prescribing "dose-based" exercise prescriptions to crewmembers during long-duration spaceflights and missions to the Moon and Mars. Validation of the proposed EDLS model will be possible with data from an ongoing human bed rest study examining changes in bone mineral density with controlled skeletal loading.

An ambulatory biomechanical data collection system for use in space: design and validation.

INTRODUCTION: Loss in bone mineral density and muscle strength in astronauts following long-duration spaceflight have been well documented, but the altered force and movement environments in microgravity which may contribute to these changes have not been well characterized. This paper describes the instrumentation, software, and data collection procedures developed for the "Foot" experiment that was conducted on the International Space Station (ISS) to provide insight into the biomechanics of daily activity in a microgravity environment. METHODS: The instrumentation used for data collection included the Ambulatory Data Acquisition System (ADAS), ADAS electromyography (EMG) modules, the Joint Excursion System, and the Total Force-Foot Ground interface system, which were all integrated into a specially designed Lower Extremity Monitoring Suit. There were 14 total channels of data that were collected at sampling rates between 8 Hz and 1024 Hz, including 7 channels of EMG, 4 channels of joint angle data, 2 channels of in-shoe ground reaction force, and a marker channel for event recording. Data were typically collected for between 6.5 and 11.8 h of activity during 4 d on Earth and 4-7 d in flight. RESULTS: Exemplar data sets collected preflight on astronauts in 1 g to validate the instrumentation are presented. DISCUSSION: We conclude that the system provides valid and useful biomechanical information on long-term activity. The analysis of data collected on-orbit using the system described here will be presented in a series of future papers characterizing the biomechanics of astronaut activity during complete working days on the Earth and on the ISS.

Gravity replacement during running in simulated microgravity.

INTRODUCTION: During treadmill exercise on the International Space Station (ISS), a restoring load from a subject load device (SLD) is applied through a shoulder-and-waist harness to pull the exercising crewmember toward the treadmill surface. The capacity of this arrangement to provide 1-g-like reaction forces may be critical for effective use of the treadmill as a countermeasure to musculoskeletal changes during prolonged spaceflight. This study in simulated microgravity evaluated the comfort and function during running of the ISS harness used with a new SLD in a system that allows more even distribution of the load between the waist and shoulders. METHODS: Using a zero-gravity locomotion simulator, 12 subjects completed three 5-min running trials at a constant speed (3.35 m x s(-1)) using three SLD loads [50%, 75%, and 100% of bodyweight (BW)] presented at random and a shoulder-to-waist loading ratio of 50:50. Subjective ratings of discomfort, ground reaction forces (GRFs), and SLD loads were collected. RESULTS: A load of 100% BW resulted in similar GRF profiles (peak and rate of change of force) to those reported for 1-g running over ground and were also comfortably tolerated (mean Borg scale rating 3.9/10). DISCUSSION: With an appropriate harness and SLD system, 1-g-like GRF profiles can be generated at the feet during simulated microgravity running. Such forces can be achieved with a level of discomfort rated better than "somewhat uncomfortable," suggesting that running with 1-g loads could be an effective component of musculoskeletal countermeasures during long-duration spaceflight.

Comparison of knee motion on Earth and in space: an observational study.

BACKGROUND: Spaceflight has been shown to cause atrophy, reduced functional capacity, and increased fatigue in lower-limb skeletal muscles. The mechanisms of these losses are not fully understood but are thought to result, in part, from alteration in muscle usage. METHODS: Knee-joint angles and lower-extremity muscle activity were measured continually, via elecrogoniometry and surface electromyography respectively, from two subjects during entire working days of activity on Earth and onboard the International Space Station (ISS). RESULTS: On Earth the distribution of angular positions of the knee was typically bimodal, with peaks of >75 degrees of flexion and in almost full extension (<15 degrees of flexion). However, on the ISS, a single peak in the mid-range of the available range of motion was seen. The knee joint was also moved through fewer excursions and the excursions were smaller in amplitude, resulting in a reduced span of angles traversed. The velocities of the excursions in space were lower than those used on Earth. CONCLUSION: These results demonstrate that, in space, overall knee-joint motion is reduced, and there is a transformation in the type of muscle action compared to that seen on Earth, with more isometric action at the expense of concentric and particularly eccentric action.