postureco

Research Publications

Sagittal Cervical Spine Landmark Point Detection in X-Ray Using Deep Convolutional Neural Networks

ABSTRACT

Sagittal cervical spine alignment measured on X-Ray is a key objective measure for clinicians caring for patients with a multitude of presenting symptoms. Despite its applications, there has been no research available in this field yet. This paper presents a framework for automatic detection of the Sagittal cervical spine landmark point. Inspired by UNet, we propose an encoder-decoder Convolutional Neural Network (CNN) called PoseNet. In developing our model, we first review the weaknesses of widely used regression loss functions such as the L1, and L2 losses. To address these issues, we propose a novel loss function specifically designed to improve the accuracy of the localization task under challenging situations (extreme neck pose, low or high brightness and illumination, X-Ray noises, etc.) We validate our model and loss function on a dataset of X-Ray images. The results show that our framework is capable of performing precise sagittal cervical spine landmark point detection even for challenging X-Ray images.

A. P. Fard, J. Ferrantelli, A. -L. Dupuis and M. H. Mahoor, “Sagittal Cervical Spine Landmark Point Detection in X-Ray Using Deep Convolutional Neural Networks,” in IEEE Access, vol. 10, pp. 59413-59427, 2022, doi: 10.1109/ACCESS.2022.3180028.

Conclusion: This study reports a very high degree of intra- and inter-examiner reliability of radiographic line drawing methods and establishes concurrent validity of PostureRay® EMR software in determining angles and displacements of lateral spinal alignment as an equivalent method to the hand-drawn method.

Curr Med Imaging . 2023 Feb 6. doi: 10.2174/1573405619666230206155900.

Intra-Examiner Reliability and Validity of Sagittal Cervical Spine Mensuration Methods Using Deep Convolutional Neural Networks

CONCLUSION

A machine learning tool (which is part of the PostureRay® software 2024) is simple, economical, valid, and repeatable as an instrument to aid in the measurement of the sagittal cervical spine alignment. Our investigation demonstrated the machine learning computer vision tool has a perfect R2 statistical analysis, a zero root mean square error, and an ICC of 1.0 (perfect reliability) when tested against itself with a repeated measure design. Additionally, the construct validity of the CNN software 2024 compared to an expert annotator was in the excellent range. This easy-to-use tool is far superior with regards to reliability when compared to analysis by a human clinician, even with many years of radiographic mensuration experience both manually and digitally and the tool appears to be perfect relative to itself every time, unlike the human. To our knowledge, this excellent reliability and validity has not been previously reported in the machine learning literature. Additional research is warranted to determine full spine condition implications for this technology.

https://www.mdpi.com/2077-0383/13/9/2573

Related Research Studies

“Absolute Rotational Angles (ARA) were calculated from sagittal NLC images using PostureRay® software (PostureCo, Inc., Trinity, FL, USA) for Computerized Radiographic Mensuration Analysis.”  … “The images were analyzed using the PostureRay® software to quantify the amount of C1–C2 lateral mass overhang margin at maximum right and left lateral cervical bending.”

 

J. Clin. Med. 2023, 12, 1797. https://doi.org/10.3390/jcm12051797

"The PostureRay® EMR system (PostureCo., Trinity, FL, USA) was used to digitize the images. The absolute rotation angle (ARA) between the posterior margins of the vertebral body of C2 and C7 was used to measure the global lordosis. The anterior head translation (AHT) was quantified by the horizontal distance between the vertical line projected from the posterior inferior corner of C7 and the offset of the posterior superior aspect of C2’s body (excluding the dens). The atlas plane line (APL) was measured as the angle between the horizontal line and the best fit line of approximating the midline of C1. These mensuration methods are reliable and repeatable with a standard error of measure of less than 2 degrees." 

J. Clin. Med. 2023, 12, 6414. https://doi.org/10.3390/jcm12196414

PostureRay Radiographic EMR system is the commercial software based on our predecessor research software tested used to analyze x-rays in the following CBP Non-Profit studies:

  • Harrison DE, Harrison DD, Cailliet R, Troyanovich SJ, Janik TJ, Holland B. Cobb Method or Harrison Posterior Tangent Method: Which is Better for Lateral Cervical Analysis? Spine 2000; 25(16): 2072-78. (Link)
  • Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. Centroid, Cobb or Harrison Posterior Tangents: Which to Choose for Analysis of Thoracic Kyphosis? Spine 2001; 26(11): E227-E234. (Link)
  • Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. Radiographic Analysis of Lumbar Lordosis: Cobb Method, Centroidal Method, TRALL or Harrison Posterior Tangents? Spine 2001; 26(11): E235-E242. (Link)
  • Harrison DE, Holland B, Harrison DD, Janik TJ. Further Reliability Analysis of the Harrison Radiographic Line Drawing Methods: Crossed ICCs for Lateral Posterior Tangents and AP Modified Risser-Ferguson. J Manipulative Physiol Ther 2002; 25: 93-98. (Link)
  • Harrison DE, Harrison DD, Colloca CJ, Betz JW, Janik TJ, Holland B. Repeatability Over Time of Posture, X-ray Positioning, and X-ray Line Drawing: An Analysis of Six Control Groups. J Manipulative Physiol Ther 2003; 26(2):87-98. (Link)
  • Troyanovich SJ, Harrison DE, Harrison DD, Holland B, Janik TJ. A Further Analysis of the Reliability of the Posterior Tangent Lateral Lumbar Radiographic Mensuration Procedure: Concurrent Validity of Computer Aided X-ray Digitization. J Manipulative Physiol Ther 1998; 21(7): 460-467. (Link)
  • Troyanovich SJ, Harrison SO, Harrison DD, Harrison DE, Payne M, Janik TJ, Holland B. Chiropractic Biophysics Digitized Radiographic Mensuration Analysis of the Anteroposterior Lumbar View: A Reliability Study. J Manipulative Physiol Ther 1999; 22(5): 309-315. (Link)
  • Troyanovich SJ, Harrison DE, Harrison DD, Harrison SO, Janik TJ, Holland B. Chiropractic Biophysics Digitized Radiographic Mensuration Analysis of the Anteroposterior Cervico-thoracic View: A Reliability Study. J Manipulative Physiol Ther 2000; 23: 476-82. (Link)
  • Janik TJ, Harrison DE, Harrison, DD, Payne MR, Coleman RR, Holland B.   Reliability of lateral bending and axial rotation with validity of a New Method to determine Axial Rotations on AP Radiographs. J Manipulative Physiol Ther 2001; 24(7): 445-448. (Link)
  • Oakley P, Sanchez L, Harrison D. Medical radiologists may not consider the cervical lordosis in radiology reports: A comparison of subjective qualitative assessment versus objective quantitative mensuration in 100 consecutive patients at one medical imaging center. J Contemporary Chiro 2021(4);17-25. (Link)
  • Harrison DE, Janik TJ, Harrison DD, Cailliet R, Harmon S. Can the Thoracic Kyphosis be Modeled with a Simple Geometric Shape? The Results of Circular and Elliptical Modeling in 80 Asymptomatic Subjects. J Spinal Disord 2002; 15(3): 213-220. (Link)
  • Harrison DD, Harrison DE, Janik TJ, Cailliet R, Haas JW, Ferrantelli J, Holland B. Modeling of the Sagittal Cervical Spine as a Method to Discriminate Hypo-Lordosis: Results of Elliptical and Circular Modeling in 72 Asymptomatic Subjects, 52 Acute Neck Pain Subjects, and 70 Chronic Neck Pain Subjects. Spine 2004; 29:2485-2492. (Link)
  • Harrison DE, Haas JW, Harrison DD, Janik TJ, Holland B. Do Sagittal Plane Anatomical Variations (Angulation) of the Cervical Facets and C2 Odontoid Affect the Geometrical Configuration of the Cervical Lordosis? Results from Digitizing Lateral Cervical Radiographs in 252 neck pain subjects. Clin Anat 2005; 18:104-111. (Link)
  • Harrison DE, Harrison DD, Janik TJ, Cailliet R, Holland B. Sensitivity and Specificity of Elliptical Modeling and Sagittal Lumbar Alignment Variables in Normal Versus Chronic Low Back Pain Subjects: Does Pelvic Morphology Explain Group Lordotic Differences? J Chiro Educ 2007 Spring;21(1):47-93. (Link)

    Research Studies using PostureRay

    Journal of Physical Therapy Science

    • Miller JE, Oakley PA, Levin SB, Harrison DE. Reversing thoracic hyperkyphosis: a case report featuring mirror image® thoracic extension rehabilitation. J Phys Ther Sci 2017; 29(7):1264-1267. (Link)
    • Fortner MO, Oakley PA, Harrison DE. Treating ‘slouchy’ (hyperkyphosis) posture with chiropractic biophysics®: a case report utilizing a multimodal mirror image® rehabilitation program. J Phys Ther Sci 2017; 29(8):1475-1480. (Link)
    • Wickstrom BM, Oakley PA, Harrison DE. Non-surgical relief of cervical radiculopathy through reduction of forward head posture and restoration of cervical lordosis: a case report. J Phys Ther Sci 2017; 29(8):1472-1474. (Link)
    • Haggard JS, Haggard JB, Oakley PA, Harrison DE. Reduction of progressive thoracolumbar adolescent idiopathic scoliosis by Chiropractic BioPhysics® (CBP®) mirror image® methods following failed traditional chiropractic treatment: A case report. J Phys Ther Sci 2017; 29(11):2062-2067. (Link)
    • Mitchell JR, Oakley PA, Harrison DE. Nonsurgical correction of straight back syndrome (thoracic hypokyphosis), increased lung capacity and resolution of exertional dyspnea by thoracic hyperkyphosis mirror image® traction: A CBP® case report. J Phys Ther Sci 2017; 29(11):2058-2061. (Link)
    • Mitchell JR, Oakley PA, Harrison DE. Nonsurgical correction of straight back syndrome (thoracic hypokyphosis), increased lung capacity and resolution of exertional dyspnea by thoracic hyperkyphosis mirror image® traction: A CBP® case report. J Phys Ther Sci 2017; 29(11):2058-2061. (Link)
    • Jaeger JO, Oakley PA, Moore RR, Ruggeroli EP, Harrison DE. Resolution of temporomandibular joint dysfunction (TMJD) by correcting a lateral head translation posture following previous failed traditional chiropractic therapy: A CBP® case report. J Phys Ther Sci 2018; 30(1):103-107. (Link)
    • Fortner MO, Oakley PA, Harrison DE. Non-surgical improvement of cervical lordosis is possible in advanced spinal osteoarthritis: A CBP® case report J Phys Ther Sci 2018; 30(1):108-112. (Link)
    • Fortner MO, Oakley PA, Harrison DE. Cervical extension traction as part of a multimodal rehabilitation program relieves whiplash-associated disorders in a patient having failed previous chiropractic treatment: a CBP® case report. J Phys Ther Sci 2018; 30(2):266-270. (Link)
    • Harrison DE, Oakley PA, Betz JW. Anterior head translation following cervical fusion – A probable cause of post-surgical pain and impairment: A CBP® case report. J Phys Ther Sci 2018; 30(2):271-276. (Link)
    • Dennis AK, Oakley PA, Weiner MT, VanVranken TA, Shapiro DA, Harrison DE. Alleviation of neck pain by the non-surgical rehabilitation of a pathologic cervical kyphosis to a normal lordosis: A CBP® case report. J Phys Ther Sci 2018; 30(4):654-657. (Link)
    • Fortner MO, Oakley PA, Harrison DE. Alleviation of post-traumatic dizziness by restoration of the cervical lordosis: A CBP® case study. J Phys Ther Sci 2018; 30(5):730-733. (Link)
    • Oakley PA, Jaeger JO, Brown JE, Polatis TA, Clarke JG, Whittler CD, Harrison DE. The CBP® mirror image® approach to reducing thoracic hyperkyphosis: A retrospective case series of 10 patients. J Phys Ther Sci 2018; 30(8):1039-1045. (Link)
    • Fortner MO, Oakley PA, Harrison DE. Alleviation of chronic spine pain and headaches by reducing forward head posture and thoracic hyperkyphosis: A CBP® case report. J Phys Ther Sci 2018; 30(8):1117-1123. (Link)
    • Henshaw M, Oakley PA, Harrison DE. Correction of pseudoscoliosis (lateral thoracic translation posture) for the treatment of low back pain: A CBP® case report. J Phys Ther Sci 2018; 30(9):1202-1205. (Link)
    • Weiner MT, Oakley PA, Dennis AK, Shapiro DA, Harrison DE. Increasing the cervical and lumbar lordosis is possible despite overt osteoarthritis and spinal stenosis using extension traction to relieve low back and leg pain in a 66-year old surgical candidate: A CBP® case report. J Phys Ther Sci 2018; 30(11):1364-1369. (Link)
    • Anderson JM, Oakley PA, Harrison DE. Improving Posture to Reduce the Symptoms of Parkinson’s: A CBP® Case Report. J Phys Ther Sci 2019; 31(2):153-158. (Link)
    • Gubbels C. Oakley PA, McAviney J, Harrison DE, Brown J. Reduction of Scheuermann’s deformity and scoliosis using ScoliBrace and a scoliosis specific rehabilitation program: A case report. J Phys Ther Sci 2019; 31(2):159-165. (Link)
    • Gubbels C, Werner JT, Oakley PA, Harrison DE. Reduction of thoraco-lumbar junctional kyphosis, posterior sagittal balance, and increase of lumbar lordosis and sacral inclination in an adolescent with back pain: A CBP® case report. J Phys Ther Sci 2019; 31(10):839-843. (Link)
    • Oakley PA, Navid Ehsani N, Harrison DE.  Non-surgical reduction of lumbar hyperlordosis, forward sagittal balance and pelvic tilt to relieve low back pain: A CBP® case report. J Phys Ther Sci 2019; 31(10):860-864. (Link)
    • Navid Ehsani N, Oakley PA, Harrison DE. Scheuermann’s disease: Non-surgical improvement in whole spine sagittal alignment in the treatment of a symptomatic patient using CBP technique. J Phys Ther Sci 2019; 31(11):965-970. (Link)
    • Gerstin GP, Oakley PA, Harrison DE. The treatment of dizziness by improving cervical lordosis: A CBP® case report. J Phys Ther Sci 2020; 32(12):864-868. (Link)
    • Fedorchuk C, Lightstone DF, Oakley PA, Harrison DE. Correction of a double spondylolisthesis of the lumbar spine utilizing Chiropractic BioPhysics® technique: A case report with 1-year follow-up. J Phys Ther Sci 2021; 33(1):89-93. (Link)
    • Norton TC, Oakley PA, Harrison DE. Improving the Cervical Lordosis relieves neck pain and chronic headaches in a pediatric: A CBP® case report with a 1.5-year follow-up. J Phys Ther Sci. 2021; 33: (Link)
    • Fortner MO, Woodham TJ, Oakley PA, Harrison DE. Is the cervical lordosis a key biomechanical biomarker in cervicogenic headache? A CBP® case report with follow-up. J Phys Sci Ther. 2021: (Link)

    Journal of Contemporary Chiropractic

    • Breton PY, Oakley PA, Harrison DE. Complete resolution of carpal tunnel syndrome after relieving the ‘first crush’ in ‘double crush syndrome’ by improving the cervical spine posture: A CBP® case report. J Contemp Chiropr. 2018; 2:49-53. (Link)
    • Fedorchuk CA, Oakley PA, Harrison DE. Resolution of chronic spine pain and improvement in quality of life following correction of posture in a 7-year old: A CBP® case report with follow-up. J Contemp Chiropr. 2019; 2:109-114. (Link)
    • Fortner MO, Oakley PA, Harrison DE. Chiropractic Biophysics management of straight back syndrome and exertional dyspnea: A case report with follow-up. J Contemp Chiropr. 2019; 2:115-122. (Link)
    • Haas JW, Oakley PA, Harrison DE. Cervical pseudo-scoliosis reduction and alleviation of dystonia symptoms using Chiropractic BioPhysics® (CBP®) technique: A case report with a 1.5-year follow-up. J Contemp Chiropr 2019; 2:131-137. (Link)
    • Fortner MO, Oakley PA, Harrison DE. Cervical lordosis restoration for late whiplash syndrome alleviates chronic headaches 13-years after motor vehicle collision: A CBP® case report with a 1-year follow-up. J Contemporary Chiro 2020; 3:21-27. (Link)
    • Haas JW, Oakley PA, Harrison DE. Non-surgical reduction in anterior sagittal balance subluxation and improvement in overall posture in a geriatric suffering from low back pain and sciatica: A CBP® case report. J Contemporary Chiro 2020;3:45-50. (Link)
    • Oakley PA, Harrison DE. Correction of multilevel lumbar retrolistheses by non-surgical extension traction procedures in a patient with congenital fusion of L5-S1: A CBP® case report with a 13-month follow-up. J Contemporary Chiro 2020; 3(1):137-142. (Link)
    • Woodham TJ, Fortner MO, Oakley PA, Harrison DE. Reducing ‘crooked’ lateral spine subluxation (global coronal imbalance) in 5 patients with degenerative disc disease in their 6th and 7th decade of life: A case series utilizing Chiropractic BioPhysics® technique. J Contemporary Chiro 2021; Link)
    • Chiropractic Journal of Australia
    • Oakley P, Harrison D. Restoration of barefoot gait in a 75-year old female with cervical spondylotic myelopathy: A case report utilizing Chiropractic BioPhysics (CBP®) technique. Chiropr J Australia, 2017; 45(1):16-27. (Link)
    • Berry RH, Oakley P, Harrison D. Alleviation of radiculopathy by structural rehabilitation of the cervical spine by correcting a lateral head translation posture (-TxH) using Berry translation traction as a part of CBP methods: A case report. Chiropr J Australia, 2017; 45(1):63-72. (Link)
    • Brown J, Jaeger J, Polatis T, Peters A, Oakley P, Harrison D. Increasing the lumbar lordosis by seated 3-point bending traction: A case series utilizing Chiropractic BioPhysics technique. Chiropr J Australia, 2017; 45(2):144-154. (Link)

    Various Journals

    • Jaeger JO, Oakley PA, Colloca CJ, Harrison DE. Non-surgical Reduction of Thoracic Hyper-kyphosis in a 24-year Old Music Teacher Utilizing Chiropractic BioPhysics® Technique. British Journal of Medicine & Medical Research, 2016, 11(7): 1-9
    • Fedorchuk C, Lightstone DF, McCoy M, Harrison DE. Increased telomere length and improvements in dysautonomia, quality of life, and neck and back pain following correction of sagittal cervical alignment using Chiropractic BioPhysics® technique: a case study. J Mol Genet Med 2017;11(2):1-5. (Link)
    • Fedorchuk C, Lightstone DF, McRae C, Kaczor D. Correction of grade 2 spondylolisthesis following a non-surgical structural spinal rehabilitation protocol using lumbar traction: A case study and selective review of literature. J Radiol Case Rep. 2017;11(5):13-26. (Link)
    • Fedorchuk C, Lightstone DF, Comer RD, Weiner MT, McCoy M. Improved glycosylated hemoglobin, hyperglycemia, and quality of life following thoracic hypokyphosis vertebral subluxation correction using Chiropractic BioPhysics®: A prospective case report. J Diabetes Metab 2018;9:807. doi: 10.4172/2155-6156.100080. (Link)
    • Katz EA, Katz SB, Fedorchuk CA, Lightstone DF, Banach CJ, Podoll JD. Increase in cerebral blood flow indicated by increased cerebral arterial area and pixel intensity on brain magnetic resonance angiogram following correction of cervical lordosis. Brain Circ. 2019 Jan-Mar;5(1):19-26. (Link)
    • Lightstone DF, Fedorchuk C, Guo J, McAviney J. Improvement in thoracolumbar neuromuscular levoscoliosis in a 14-year-old male with a history of stage 3 medulloblastoma and post-operative cerebellar mutism syndrome using Chiropractic Biophysics technique and Scolibrace thoracolumbosacral orthotic bracing: A case study and 30-month follow-up. Proceedings from the 14th International Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) meeting, San Francisco, April 25-27, 2019. p.159.
    • Fedorchuk C, Lightstone DF, DeVon Comer R, Katz E, Wilcox J. Improvements in Cervical Spinal Canal Diameter and Neck Disability Following Correction of Cervical Lordosis and Cervical Spondylolistheses Using Chiropractic BioPhysics Technique: A Case Series. J Radiol Case Rep. 2020;14(4):21-37. (Link)
    • Norton TC, Oakley PA, Harrison DE. Increasing the cervical lordosis in pediatrics: A Chiropractic BioPhysics® case series. Asia-Pac Chiropr J. 2020;1.2:online only. (Link)

    Additional Software Products

    PostureScreen Mobile

    RemoteScreen

    LeanScreen

    SquatScreen

    PostureCo, Inc. software is protected under US Patent No. 8,721,567, US Patent No. 9,788,759, and US Patent No. 9,801,550 with other Patents Pending Internationally