Validation of spiral CT and optical surface scanning for lower limb stump volumetry

Spiral X-ray Computed Tomography (SXCT), Optical Surface Scanning (OSS), and hydrostatic weighing methods were used to measure stump volume of trans-tibial amputees. The precision and accuracy of these methods were assessed in a validation study. A repeated measures analysis of variance statistical design was employed that required each participant to be measured (scanned) twice at each of two separate measurement sessions. For OSS and SXCT, each scan was segmented twice to determine intra-observer error. Plaster cast replicas of subject stumps were formed by certified prosthetists to serve as a reference standard. Accuracy (bias) of SXCT and OSS was determined by comparison to volumetry by hydrostatic weighing. Ten trans-tibial amputees were recruited for this study and nine completed both sessions. Plaster replica measurement precision error relative to the mean was found to be less than 1% for all modalities. The precision was slightly inferior on subjects, 1.1% and 2.2% error for hydrostatic weighting and OSS respectively, due to patient instability during measurement, but was better with SXCT where the subjects' stumps were stabilized during scan acquisition. The OSS and SXCT methods offer advantages over hydrostatic weighing and other volumetry methods since the volume data are represented digitally and can be analyzed in multiple ways. SXCT enables study of the stump and its internal tissues with the prosthesis in place. It was found that SXCT is comparable to hydrostatic weighing in both precision and accuracy. While OSS had a high precision and reproducibility, it was found to have an associated bias.