Faculty Bibliography

Background and Purpose. The gold standard for detection of implant wear and migration is currently radiostereometry (RSA). The purpose of this study is to compare a three-dimensional computed tomography technique (3D CT) to standard RSA as an alternative technique for measuring migration of acetabular cups in total hip arthroplasty. Materials and Methods. With tantalum beads, we marked one cemented and one uncemented cup and mounted these on a similarly marked pelvic model. A comparison was made between 3D CT and standard RSA for measuring migration. Twelve repeated stereoradiographs and CT scans with double examinations in each position and gradual migration of the implants were made. Precision and accuracy of the 3D CT were calculated. Results. The accuracy of the 3D CT ranged between 0.07 and 0.32 mm for translations and 0.21 and 0.82 degrees for rotation. The precision ranged between 0.01 and 0.09 mm for translations and 0.06 and 0.29 degrees for rotations, respectively. For standard RSA, the precision ranged between 0.04 and 0.09 mm for translations and 0.08 and 0.32 degrees for rotations, respectively. There was no significant difference in precision between 3D CT and standard RSA. The effective radiation dose of the 3D CT method, comparable to RSA, was estimated to be 0.33 mSv. Interpretation. Low dose 3D CT is a comparable method to standard RSA in an experimental setting.

The mathematical basis for the Gaussian entanglement is discussed in detail, as well as its implications in the internal space-time structure of relativistic extended particles. It is shown that the Gaussian entanglement shares the same set of mathematical formulas with the harmonic oscillator in the Lorentz-covariant world. It is thus possible to transfer the concept of entanglement to the Lorentz-covariant picture of the bound state, which requires both space and time separations between two constituent particles. These space and time variables become entangled as the bound state moves with a relativistic speed. It is shown also that our inability to measure the time-separation variable leads to an entanglement entropy together with a rise in the temperature of the bound state. As was noted by Paul A. M. Dirac in 1963, the system of two oscillators contains the symmetries of the O (3, 2) de Sitter group containing two O (3, 1) Lorentz groups as its subgroups. Dirac noted also that the system contains the symmetry of the Sp (4) group, which serves as the basic language for two-mode squeezed states. Since the Sp (4) symmetry contains both rotations and squeezes, one interesting case is the combination of rotation and squeeze, resulting in a shear. While the current literature is mostly on the entanglement based on squeeze along the normal coordinates, the shear transformation is an interesting future possibility. The mathematical issues on this problem are clarified.

Neutrino oscillation experiments presently suggest that neutrinos have a small but finite mass. If neutrinos have mass, there should be a Lorentz frame in which they can be brought to rest. This paper discusses how Wigner's little groups can be used to distinguish between massive and massless particles. We derive a representation of the SL(2, c) group which separates out the two sets of spinors: one set is gauge dependent and the other set is gauge invariant and represents polarized neutrinos. We show that a similar calculation can be done for the Dirac equation. In the large-momentum/zero-mass limit, the Dirac spinors can be separated into large and small components. The large components are gauge invariant, while the small components are not. These small components represent spin-1/2 non-zero-mass particles. If we renormalize the large components, these gauge invariant spinors represent the polarization of neutrinos. Massive neutrinos cannot be invariant under gauge transformations

OBJECT Artificial disc replacement (ADR) devices are unlike implants used in cervical fusion in that they are continuously exposed to stress not only within the implant site but also at their site of attachment to the adjacent vertebra. An imaging technique with higher accuracy than plain radiography and with the possibility of 3D visualization would provide more detailed information about the motion quality and stability of the implant in relation to the vertebrae. Such high-accuracy studies have previously been conducted with radiostereometric analysis (RSA), which requires implantation of tantalum markers in the adjacent vertebrae. The aim of this study was to evaluate in vivo motion and stability of implanted artificial discs. A noninvasive analysis was performed with CT, with an accuracy higher than that of plain radiographs and almost as high as RSA in cervical spine. METHODS Twenty-eight patients with ADR were included from a larger cohort of a randomized controlled trial comparing treatment of cervical radiculopathy with ADR or anterior cervical decompression and fusion. Surgical levels included C4-7; 18 patients had 1-level surgery and 10 patients had 2-level surgery. Follow-up time ranged from 19 to 50 months, with an average of 40 months. Two CT volumes of the cervical spine, 1 in flexion and 1 in extension, were obtained in each patient and then spatially registered using a customized imaging tool, previously used and validated for the cervical spine. Motion between the components in the artificial disc, as well as motion between the components and adjacent vertebrae, were calculated in 3 planes. Intraclass correlation (ICC) between independent observers and repeatability of the method were also calculated. RESULTS Intrinsic motion, expressed as degrees in rotation and millimeters in translation, was detectable in a majority of the ADRs. In the sagittal plane, in which the flexion/extension was performed, sagittal rotation ranged between 0.2 degrees and 15.8 degrees and translation between 0.0 and 5.5 mm. Eight percent of the ADRs were classified as unstable, as motion between at least 1 of the components and the adjacent vertebra was detected. Five percent were classified as ankylotic, with no detectable motion, and another 8% showed very limited motion due to heterotopic ossification. Repeatability for the motion in the sagittal plane was calculated to be 1.30 degrees for rotation and 1.29 mm for translation (95% confidence level), ICC 0.99 and 0.84, respectively. All 3 patients with unstable devices had undergone 1-level ADRs at C5-6. They all underwent revision surgery due to increased neck pain, and instability was established during the surgery. CONCLUSIONS The majority of the artificial discs in this study showed intrinsic mobility several years after implantation and were also shown to be properly attached. Implant instability was detected in 8% of patients and, as all of these patients underwent revision surgery due to increasing neck pain, this might be a more serious problem than heterotopic bone formation.

Eighteen consecutive patients, treated with a Taylor Spatial Frame for complex tibia conditions, gave their informed consent to undergo Na(18)F(-) PET/CT bone scans. We present a Patlak-like analysis utilizing an approximated blood time-activity curve eliminating the need for blood aliquots. Additionally, standardized uptake values (SUV) derived from dynamic acquisitions were compared to this Patlak-like approach. Spherical volumes of interest (VOIs) were drawn to include broken bone, other (normal) bone, and muscle. The SUV m (t) (m = max, mean) and a series of slopes were computed as (SUV m (t i ) - SUV m (t j ))/(t i - t j ), for pairs of time values t i and t j . A Patlak-like analysis was performed for the same time values by computing ((VOI p (t i )/VOI e (t i ))-(VOI p (t j )/VOI e (t j )))/(t i - t j ), where p = broken bone, other bone, and muscle and e = expected activity in a VOI. Paired comparisons between Patlak-like and SUV m slopes showed good agreement by both linear regression and correlation coefficient analysis (r = 84%, r s = 78%-SUVmax, r = 92%, and r s = 91%-SUVmean), suggesting static scans could substitute for dynamic studies. Patlak-like slope differences of 0.1 min(-1) or greater between examinations and SUVmax differences of ~5 usually indicated good remodeling progress, while negative Patlak-like slope differences of -0.06 min(-1) usually indicated poor remodeling progress in this cohort.

This study describes a 3D-CT method for analyzing facet joint motion and vertebral rotation in the lumbar spine after TDR. Ten patients were examined before and then three years after surgery, each time with two CT scans: provoked flexion and provoked extension. After 3D registration, the facet joint 3D translation and segmental vertebral 3D rotation were analyzed at the operated level (L5-S1) and adjacent level (L4-L5). Pain was evaluated using VAS. The median (+/-SD) 3D movement in the operated level for the left facet joint was 3.2 mm (+/-1.9 mm) before and 3.5 mm (+/-1.7 mm) after surgery and for the right facet joint was 3.0 mm (+/-1.0 mm) before and 3.6 mm (+/-1.4 mm) after surgery. The median vertebral rotation in the sagittal plane at the operated level was 5.4 degrees (+/-2.3 degrees ) before surgery and 6.8 degrees (+/-1.7 degrees ) after surgery and in the adjacent level was 7.7 degrees (+/-4.0 degrees ) before and 9.2 degrees (+/-2.7 degrees ) after surgery. The median VAS was reduced from 6 (range 5-8) to 3 (range 2-8) in extension and from 4 (range 2-6) to 2 (range 1-3) in flexion.

The second-order differential equation for a damped harmonic oscillator can be converted to two coupled first-order equations, with two two-by-two matrices leading to the group Sp(2). It is shown that this oscillator system contains the essential features of Wigner's little groups dictating the internal space-time symmetries of particles in the Lorentz-covariant world. The little groups are the subgroups of the Lorentz group whose transformations leave the four-momentum of a given particle invariant. It is shown that the damping modes of the oscillator correspond to the little groups for massive and imaginary-mass particles respectively. When the system makes the transition from the oscillation to damping mode, it corresponds to the little group for massless particles. Rotations around the momentum leave the four-momentum invariant. This degree of freedom extends the Sp(2) symmetry to that of SL (2, c) corresponding to the Lorentz group applicable to the four-dimensional Minkowski space. The Poincare sphere contains the S L (2, c) symmetry. In addition, it has a non-Lorentzian parameter allowing us to reduce the mass continuously to zero. It is thus possible to construct the little group for massless particles from that of the massive particle by reducing its mass to zero. Spin-1/2 particles and spin-1 particles are discussed in detail.

Background - Determination of the amount of wear in a polyethylene liner following total hip arthroplasty (THA) is important for both the clinical care of individual patients and the development of new types of liners. Patients and methods - We measured in vivo wear of the polyethylene liner using computed tomography (CT) (obtained in the course of regular clinical care) and compared it to coordinate-measuring machine (CMM) readings. Also, changes in liner thickness of the same retrieved polyethylene liner were measured using a micrometer, and were compared to CT and CMM measurements. The distance between the centers of the acetabular cup and femoral head component was measured in 3D CT, using a semi-automatic analysis method. CMM readings were performed on each acetabular liner and data were analyzed using 3D computer-aided design software. Micrometer readings compared the thickest and thinnest regions of the liner. We analyzed 10 THA CTs and retrievals that met minimal requirements for CT slice thickness and explanted cup condition. Results - For the 10 cups, the mean difference between the CT readings and the CMM readings was -0.09 (-0.38 to 0.20) mm. This difference was not statistically significant (p = 0.6). Between CT and micrometer, the mean difference was 0.11 (-0.33 to 0.55) mm. This difference was not statistically significant (p = 0.6). Interpretation - Our results show that CT imaging is ready to be used as a tool in clinical wear measurement of polyethylene liners used in THA.

Diagnosis of new bone growth in patients with compound tibia fractures or deformities treated using a Taylor spatial frame is difficult with conventional radiography because the frame obstructs the images and creates artifacts. The use of Na(18)F PET studies may help to eliminate this difficulty. METHODS: Patients were positioned on the pallet of a clinical PET/CT scanner and made as comfortable as possible with their legs immobilized. One bed position covering the site of the fracture, including the Taylor spatial frame, was chosen for the study. A topogram was performed, as well as diagnostic and attenuation correction CT. The patients were given 2 MBq of Na(18)F per kilogram of body weight. A 45-min list-mode acquisition was performed starting at the time of injection, followed by a 5-min static acquisition 60 min after injection. The patients were examined 6 wk after the Taylor spatial frame had been applied and again at 3 mo to assess new bone growth. RESULTS: A list-mode reconstruction sequence of 1 x 1,800 and 1 x 2,700 s, as well as the 5-min static scan, allowed visualization of regional bone turnover. CONCLUSION: With Na(18)F PET/CT, it was possible to confirm regional bone turnover as a means of visualizing bone remodeling without the interference of artifacts from the Taylor spatial frame. Furthermore, dynamic list-mode acquisition allowed different sequences to be performed, enabling, for example, visualization of tracer transport from blood to the fracture site.

As the most advantageous total hip arthroplasty (THA) operation is the first, timely replacement of only the liner is socially and economically important because the utilization of THA is increasing as younger and more active patients are receiving implants and they are living longer. Automatic algorithms were developed to infer liner wear by estimating the separation between the acetabular cup and femoral component head given a computed tomography (CT) volume. Two series of CT volumes of a hip phantom were acquired with the femoral component head placed at 14 different positions relative to the acetabular cup. The mean and standard deviation (SD) of the diameter of the acetabular cup and femoral component head, in addition to the range of error in the expected wear values and the repeatability of all the measurements, were calculated. The algorithms resulted in a mean (+/-SD) for the diameter of the acetabular cup of 54.21 (+/-0.011) mm and for the femoral component head of 22.09 (+/-0.02) mm. The wear error was +/-0.1 mm and the repeatability was 0.077 mm. This approach is applicable clinically as it utilizes readily available computed tomography imaging systems and requires only five minutes of human interaction.