1. THR Simulator – The Software for Generating Radiographs of THR Prosthesis Presented by Chen-Kun Liaw, M.D., Ph.D. Tao-Yuan general hospital, Taiwan. Tai-Yin Wu, Rong-Sen Yang, Chiou- Shann Fuh, Sheng-Mou Hou

3. The Academic Importance of Acetabular Orientations Searching in Medline with keywords of “Arthroplasty, Replacement, Hip” and (“version” or “anteversion”)

4. The THR Simulator Before developing measuring methods, we must develop the “gold standard”. Before developing measuring methods, we must develop the “gold standard”. Mechanical device is straightforward but is expensive and has an unpredicted precision. Mechanical device is straightforward but is expensive and has an unpredicted precision. The method using mechanical simulator requires taking radiograph and then transforming to digital form. The method using mechanical simulator requires taking radiograph and then transforming to digital form. It takes many processes and every process may cause error thus interferes with the final precision. It takes many processes and every process may cause error thus interferes with the final precision.

5. The Mechanical Simulator Ebramzadeh, E., et al., J Bone Joint Surg Am, 2003. 85-A(12): p. 2378-84. Ebramzadeh, E., et al., J Bone Joint Surg Am, 2003. 85-A(12): p. 2378-84.

6. The Digitalized Simulator Many published methods used Fourier transformation. Many published methods used Fourier transformation. Speed (improved from O(n 3 ) to O(n 2 )) Speed (improved from O(n 3 ) to O(n 2 )) n: the length of the 3D object n: the length of the 3D object Precision: unpredictable Precision: unpredictable Ray tracing Ray tracing Transform thickness to grey scale Transform thickness to grey scale

7. Algorithm Build mathematical model of acetabulum with femoral head. Build mathematical model of acetabulum with femoral head. Ray tracing every projected pixel on virtual film. Ray tracing every projected pixel on virtual film. Calculate metal thickness where the X-ray beam passes. Calculate metal thickness where the X-ray beam passes. Transform thickness to grey scale. Transform thickness to grey scale. Draw in the virtual film. Draw in the virtual film.

8. Thickness Virtually, femoral head equals to a ball. Virtually, femoral head equals to a ball. x 2 +y 2 +z 2 <r f 2 (2) x 2 +y 2 +z 2 <r f 2 (2) (x, y, z): the point of the simulated three- dimensional Cartesian coordinate system r f : the radius of femoral head (x, y, z): the point of the simulated three- dimensional Cartesian coordinate system r f : the radius of femoral head

9. Thickness (x-d x ) 2 +(y-d y ) 2 +(z-d z ) 2 <r f 2 (3) (x-d x ) 2 +(y-d y ) 2 +(z-d z ) 2 <r f 2 (3) d x, d y, d z : femoral head movement in three directions d x, d y, d z : femoral head movement in three directions

10. Thickness Virtually, acetabulum is composed of two balls and one plane. Virtually, acetabulum is composed of two balls and one plane. x 2 +y 2 +z 2 <r ao 2 (4) x 2 +y 2 +z 2 <r ao 2 (4) x 2 +y 2 +z 2 >r io 2 (5) x 2 +y 2 +z 2 >r io 2 (5) ax+by+cz>0(6) ax+by+cz>0(6) r ao : radius of acetabulum’s outer shell r ao : radius of acetabulum’s outer shell r io : radius of acetabulum’s inner shell r io : radius of acetabulum’s inner shell (a,b,c): the normal vector of the acetabulum (a,b,c): the normal vector of the acetabulum

11. Thickness (a,b,c) = ( sinφ×cosθ, -cosφ×cosθ, sinθ) (6.1) (a,b,c) = ( sinφ×cosθ, -cosφ×cosθ, sinθ) (6.1) Vector (a,b,c): the normal vector of the acetabulum Vector (a,b,c): the normal vector of the acetabulum φ: the inclination of acetabulum φ: the inclination of acetabulum θ: the anteversion of acetabulum θ: the anteversion of acetabulum positive θ: anteversion positive θ: anteversion negative θ: retroversion negative θ: retroversion

12. Thickness The X-ray source is set at (0,0,-d t ). The X-ray source is set at (0,0,-d t ). d t : tube distance (the X-ray tube to the acetabulum center) d t : tube distance (the X-ray tube to the acetabulum center) The points at film are (x f,y f,d f ). The points at film are (x f,y f,d f ). (x f,y f ): point at film (x f,y f ): point at film d f : distance from film to the acetabulum center d f : distance from film to the acetabulum center (x,y,z ) = (t * x f, t * y f, t * (d f + d t )- d t ) 0< t <1(7) (x,y,z ) = (t * x f, t * y f, t * (d f + d t )- d t ) 0< t <1(7)

13. Transforming Thickness to Grey Scale Beer-Lambert law. Beer-Lambert law. Penetration = e -kbc Penetration = e -kbc k: molar absorbability k: molar absorbability b: path length b: path length c: concentration c: concentration k: different in different materials and different radiation energy k: different in different materials and different radiation energy Radiation energy from X-ray tube: normal distribution Radiation energy from X-ray tube: normal distribution Lookup table method Lookup table method

14. Lookup Table Method We propose to implement THR Simulator by lookup table method. We propose to implement THR Simulator by lookup table method.

15. Lookup Table Method

16. Approximation with Exponational Function GreyScale = S * (1-e -kb ) GreyScale = S * (1-e -kb ) S: GreyScale of saturation S: GreyScale of saturation b: total thickness of metal b: total thickness of metal

17. The Simulator and the basic figure of the generated radiograph.

19. Thank you for your attention!