Methodological improvement of 3D fluoroscopic analysis for the robust quantification of 3D kinematics of human joints

3D video-fluoroscopy is an accurate but cumbersome technique to estimate natural or prosthetic human joint kinematics. This dissertation proposes innovative methodologies to improve the 3D fluoroscopic analysis reliability and usability. Being based on direct radiographic imaging of the joint, and avoiding soft tissue artefact that limits the accuracy of skin marker based techniques, the fluoroscopic analysis has a potential accuracy of the order of mm/deg or better. It can provide fundamental informations for clinical and methodological applications, but, notwithstanding the number of methodological protocols proposed in the literature, time consuming user interaction is exploited to obtain consistent results. The user-dependency prevented a reliable quantification of the actual accuracy and precision of the methods, and, consequently, slowed down the translation to the clinical practice. The objective of the present work was to speed up this process introducing methodological improvements in the analysis. In the thesis, the fluoroscopic analysis was characterized in depth, in order to evaluate its pros and cons, and to provide reliable solutions to overcome its limitations. To this aim, an analytical approach was followed. The major sources of error were isolated with in-silico preliminary studies as: (a) geometric distortion and calibration errors, (b) 2D images and 3D models resolutions, (c) incorrect contour extraction, (d) bone model symmetries, (e) optimization algorithm limitations, (f) user errors. The effect of each criticality was quantified, and verified with an in-vivo preliminary study on the elbow joint. The dominant source of error was identified in the limited extent of the convergence domain for the local optimization algorithms, which forced the user to manually specify the starting pose for the estimating process. To solve this problem, two different approaches were followed: to increase the optimal pose convergence basin, the local approach used sequential alignments of the 6 degrees of freedom in order of sensitivity, or a geometrical feature-based estimation of the initial conditions for the optimization; the global approach used an unsupervised memetic algorithm to optimally explore the search domain. The performances of the technique were evaluated with a series of in-silico studies and validated in-vitro with a phantom based comparison with a radiostereometric gold-standard. The accuracy of the method is joint-dependent, and for the intact knee joint, the new unsupervised algorithm guaranteed a maximum error lower than 0.5 mm for in-plane translations, 10 mm for out-of-plane translation, and of 3 deg for rotations in a mono-planar setup; and lower than 0.5 mm for translations and 1 deg for rotations in a bi-planar setups. The bi-planar setup is best suited when accurate results are needed, such as for methodological research studies. The mono-planar analysis may be enough for clinical application when the analysis time and cost may be an issue. A further reduction of the user interaction was obtained for prosthetic joints kinematics. A mixed region-growing and level-set segmentation method was proposed and halved the analysis time, delegating the computational burden to the machine. In-silico and in-vivo studies demonstrated that the reliability of the new semiautomatic method was comparable to a user defined manual gold-standard. The improved fluoroscopic analysis was finally applied to a first in-vivo methodological study on the foot kinematics. Preliminary evaluations showed that the presented methodology represents a feasible gold-standard for the validation of skin marker based foot kinematics protocols.

Reti di contratti e reti di imprese

Il lavoro di ricerca prende le mosse da una premessa di ordine economico. Il fenomeno delle reti di impresa, infatti, nasce dalla realtà economica dei mercati. In tale contesto non può prescindere dal delineare un quadro della situazione- anche di crisi- congiunturale che ha visto coinvolte specialmente le imprese italiane. In tale prospettiva, si è reso necessario indagare il fenomeno della globalizzazione, con riferimento alle sue origini,caratteristiche e conseguenze. Ci si sofferma poi sulla ricostruzione dogmatica del fenomeno. Si parte dalla ricostruzione dello stesso in termini di contratto plurilaterale- sia esso con comunione di scopo oppure plurilaterale di scambio- per criticare tale impostazione, non del tutto soddisfacente, in quanto ritenuto remissiva di fronte alla attuale vis espansiva del contratto plurilaterale. Più convincente appare lo schema del collegamento contrattuale, che ha il pregio di preservare l’autonomia e l’indipendenza degli imprenditori aderenti, pur inseriti nel contesto di un’operazione economica unitaria, volta a perseguire uno scopo comune, l’“interesse di rete”, considerato meritevole di tutela secondo l’ordinamento giuridico ex art. 1322 2.co. c.c. In effetti il contratto ben si presta a disegnare modelli di rete sia con distribuzione simmetrica del potere decisionale, sia con distribuzione asimmetrica, vale a dire con un elevato livello di gerarchia interna. Non può d’altra parte non ravvisarsi un’affinità con le ipotesi di collegamento contrattuale in fase di produzione, consistente nel delegare ad un terzo parte della produzione, e nella fase distributiva, per cui la distribuzione avviene attraverso reti di contratti. Si affronta la materia della responsabilità della rete, impostando il problema sotto due profili: la responsabilità interna ed esterna. La prima viene risolta sulla base dell’affidamento reciproco maturato da ogni imprenditore. La seconda viene distinta in responsabilità extracontrattuale, ricondotta nella fattispecie all’art. 2050 c.c., e contrattuale.