1 Introduction
This book defines the location of anatomic landmarks by means of two palpation protocols: manual palpation, which allows spatial location of landmarks using hands combined or not with three-dimensional (3D) digitizing, and virtual palpation on 3D computer models obtained, for example, from medical imaging. These protocols can be used independently or in combination.
Manual palpation is used clinically for various purposes:
The use of standardized definitions for the above activities allows better comparison and exchange of results (Van Sint Jan & Della Croce 2005); this is a key element for patient follow-up or for the elaboration of quality clinical and research databases. This book offers the reader accurate skeletal landmark definitions to help the above goals to be achieved with greater precision and reproducibility.
In order to help achieve the above tasks, this book includes descriptions of both manual (using the fingertips) and virtual (using a computer input device such as a mouse) palpations to identify the spatial location of the same landmarks. Such a twofold procedure enables the palpator (the individual performing the palpation) to minimize the discrepancy between the two palpation protocols, and therefore leads to better results if these protocols are to be combined (Van Sint Jan et al 2006), as during the above examples of complex analyses.
Finally, this book emphasizes that palpation is an Art, and that serious practice is required for an acceptable level of accuracy and precision to be reached. Unfortunately, palpation is often seen as a secondary task, probably because it is cheap, simple in concept (compared with the costly high-tech hardware used for medical imaging, to collect motion data or to scan a body surface) and does not require a complicated setting (unlike high-tech hardware). The truth is different: spatial location of anatomic landmarks is necessary for fundamental operations, for example to place electrodes accurately, to measure bone parameters, to define anatomic frames in clinical motion analysis, or to perform data registration. Inaccuracy in landmark selection will lead to discrepancies in the interpretation of the data, whatever the quality of the hardware used for measurements. Another example is wrapping a skin texture to a motion file when organizing animation sequences; such an operation can be performed much more quickly and precisely when accurate landmarks are used to perform the registration. For these reasons, palpation should be carried out with as much care, precision and conscientiousness as other data collection procedures.
