Quantifying perception of nonlinear elastic tissue models using multidimensional scaling

Simplified soft tissue models used in surgical simulations cannot perfectly reproduce all material behaviors. In particular, many tissues exhibit the Poynting effect, which results in normal forces during shearing of tissue and is only observed in nonlinear elastic material models. In order to investigate and quantify the role of the Poynting effect on material discrimination, we performed a multidimensional scaling (MDS) study. Participants were presented with several pairs of shear and normal forces generated by a haptic device during interaction with virtual soft objects. Participants were asked to rate the similarity between the forces felt. The selection of the material parameters – and thus the magnitude of the shear\ud and normal forces – was based on a pre-study prior to the MDS experiment. It was observed that for nonlinear elastic tissue models exhibiting the Poynting effect, MDS analysis indicated that both shear and normal forces affect user perception

Fluid Structure Interaction Study of the Obstructive Sleep Apnea and Surgical Treatment Using Suture-Patch Device on the Patient’s Tongue

Up to 14% of the U.S. population is estimated to have obstructive sleep apnea (OSA) related to obesity, and there is increased incidence occurring worldwide. While treatment with continuous positive airway pressure (CPAP) resolves airway obstruction, patient compliance is relatively low. Alternative interventions are available to treat OSA patients; however, their outcomes have had variable results. For example, current technologies have demonstrated an inability to define and treat the specific anatomical site(s) causing the obstruction, resulting in suboptimal modifications of the airway and poor control of OSA. In the current study, a three-dimensional (3-D) fluid-structure interaction (FSI) numerical simulation has been applied to simulate upper airway (UA) collapse, without considering the individual muscles. The objective of this study is to demonstrate how to use the two-way FSI numerical simulation to study the characteristics of and identify the precise location of an upper airway collapse on female and male patients with OSA. This task was accomplished using Simpleware®, which is medical image processing software, and ANSYS® Fluent, which is computational fluid dynamics (CFD) and structural software. Simpleware® is able to process a patient’s 3-D computed tomography (CT) scan image and render this airway image to ANSYS® Fluent in order to generate the computational domains of fluid and structure. During FSI numerical simulation, areas that are prone to collapse and precipitate apneic episodes were identified at the tip of the soft palate and the base of the tongue, with intrathoracic pressures as low as -1370 Pa. These results are consistent with anatomical structures that are currently indicated and targeted in the treatment of OSA. The negative pressure is similar to previous values reported in human esophageal pressure measurements in UA resistance syndrome. This improved two-way FSI numerical simulation, which is the first to accurately model the UA geometry in OSA, can allow virtual modification of the airway before actual clinical treatment by ear, nose, and throat (ENT) medical doctors. The improved two-way FSI numerical simulation was later used to model and simulate a unique suture-patch device, which can be used to virtually apply force to the tongue. Based on the numerical simulation results, this device can effectively reduce the risk of UA occlusion and open up the UA at the pharynx 92% of its original area under the peak inhale volume for a specific patient. This provides a possible treatment for the patient, instead of conducting tissue removal or requiring use of a CPAP mask. Three locations to put the suture-patch device on the patient’s tongue were compared in the study, and the suture-patch at location 2 is recommended. Next, the bisection method is used to find the minimum force needed to open up the airway from occlusion. The results show that 1.25 N is the recommended force. Both male and female OSA patients were studied and compared in three different aspects: geometry, flow field, and tissue movement. The results from this case study show that tissue movement does not depend only on the apnea and hypopnea index (AHI). They show that classic symptoms, like snoring, should not be the only diagnosis of OSA. Anyone with restless sleep or daytime fatigue, with snoring syndrome, should visit an ENT doctor and have a clinical sleep test in order to find out whether he or she has OSA. Using the current FSI development, a patient-specific numerical simulation can be carried out prior to surgery to virtually audit different treatments, when the patient is diagnosed with severe OSA and needs surgical treatment. Then the ENT doctor can discuss the best treatment with the patient based on the simulation results. Moreover, ENT doctors and patients will be able to visualize the outcome of virtual surgery from numerical simulations. This will give patients more confidence and help to alleviate their trepidation about treatment options. Moreover, the patient-specific numerical simulations can be used to compare different OSA cases to study the characteristics they have in common. Therefore, patients can understand more about OSA, and ENT doctors can determine the possible ways to conduct the best treatment in the near future

Articular human joint modelling

Copyright @ Cambridge University Press 2009.The work reported in this paper encapsulates the theories and algorithms developed to drive the core analysis modules of the software which has been developed to model a musculoskeletal structure of anatomic joints. Due to local bone surface and contact geometry based joint kinematics, newly developed algorithms make the proposed modeller different from currently available modellers. There are many modellers that are capable of modelling gross human body motion. Nevertheless, none of the available modellers offer complete elements of joint modelling. It appears that joint modelling is an extension of their core analysis capability, which, in every case, appears to be musculoskeletal motion dynamics. It is felt that an analysis framework that is focused on human joints would have significant benefit and potential to be used in many orthopaedic applications. The local mobility of joints has a significant influence in human motion analysis, in understanding of joint loading, tissue behaviour and contact forces. However, in order to develop a bone surface based joint modeller, there are a number of major problems, from tissue idealizations to surface geometry discretization and non-linear motion analysis. This paper presents the following: (a) The physical deformation of biological tissues as linear or non-linear viscoelastic deformation, based on spring-dashpot elements. (b) The linear dynamic multibody modelling, where the linear formulation is established for small motions and is particularly useful for calculating the equilibrium position of the joint. This model can also be used for finding small motion behaviour or loading under static conditions. It also has the potential of quantifying the joint laxity. (c) The non-linear dynamic multibody modelling, where a non-matrix and algorithmic formulation is presented. The approach allows handling complex material and geometrical nonlinearity easily. (d) Shortest path algorithms for calculating soft tissue line of action geometries. The developed algorithms are based on calculating minimum ‘surface mass’ and ‘surface covariance’. An improved version of the ‘surface covariance’ algorithm is described as ‘residual covariance’. The resulting path is used to establish the direction of forces and moments acting on joints. This information is needed for linear or non-linear treatment of the joint motion. (e) The final contribution of the paper is the treatment of the collision. In the virtual world, the difficulty in analysing bodies in motion arises due to body interpenetrations. The collision algorithm proposed in the paper involves finding the shortest projected ray from one body to the other. The projection of the body is determined by the resultant forces acting on it due to soft tissue connections under tension. This enables the calculation of collision condition of non-convex objects accurately. After the initial collision detection, the analysis involves attaching special springs (stiffness only normal to the surfaces) at the ‘potentially colliding points’ and motion of bodies is recalculated. The collision algorithm incorporates the rotation as well as translation. The algorithm continues until the joint equilibrium is achieved. Finally, the results obtained based on the software are compared with experimental results obtained using cadaveric joints

Realistic tool-tissue interaction models for surgical simulation and planning

Surgical simulators present a safe and potentially effective method for surgical training, and can also be used in pre- and intra-operative surgical planning. Realistic modeling of medical interventions involving tool-tissue interactions has been considered to be a key requirement in the development of high-fidelity simulators and planners. The soft-tissue constitutive laws, organ geometry and boundary conditions imposed by the connective tissues surrounding the organ, and the shape of the surgical tool interacting with the organ are some of the factors that govern the accuracy of medical intervention planning.\ud \ud This thesis is divided into three parts. First, we compare the accuracy of linear and nonlinear constitutive laws for tissue. An important consequence of nonlinear models is the Poynting effect, in which shearing of tissue results in normal force; this effect is not seen in a linear elastic model. The magnitude of the normal force for myocardial tissue is shown to be larger than the human contact force discrimination threshold. Further, in order to investigate and quantify the role of the Poynting effect on material discrimination, we perform a multidimensional scaling study. Second, we consider the effects of organ geometry and boundary constraints in needle path planning. Using medical images and tissue mechanical properties, we develop a model of the prostate and surrounding organs. We show that, for needle procedures such as biopsy or brachytherapy, organ geometry and boundary constraints have more impact on target motion than tissue material parameters. Finally, we investigate the effects surgical tool shape on the accuracy of medical intervention planning. We consider the specific case of robotic needle steering, in which asymmetry of a bevel-tip needle results in the needle naturally bending when it is inserted into soft tissue. We present an analytical and finite element (FE) model for the loads developed at the bevel tip during needle-tissue interaction. The analytical model explains trends observed in the experiments. We incorporated physical parameters (rupture toughness and nonlinear material elasticity) into the FE model that included both contact and cohesive zone models to simulate tissue cleavage. The model shows that the tip forces are sensitive to the rupture toughness. In order to model the mechanics of deflection of the needle, we use an energy-based formulation that incorporates tissue-specific parameters such as rupture toughness, nonlinear material elasticity, and interaction stiffness, and needle geometric and material properties. Simulation results follow similar trends (deflection and radius of curvature) to those observed in macroscopic experimental studies of a robot-driven needle interacting with gels

Computational Models of Material Interfaces for the Study of Extracorporeal Shock Wave Therapy

Extracorporeal Shock Wave Therapy (ESWT) is a noninvasive treatment for a variety of musculoskeletal ailments. A shock wave is generated in water and then focused using an acoustic lens or reflector so the energy of the wave is concentrated in a small treatment region where mechanical stimulation enhances healing. In this work we have computationally investigated shock wave propagation in ESWT by solving a Lagrangian form of the isentropic Euler equations in the fluid and linear elasticity in the bone using high-resolution finite volume methods. We solve a full three-dimensional system of equations and use adaptive mesh refinement to concentrate grid cells near the propagating shock. We can model complex bone geometries, the reflection and mode conversion at interfaces, and the the propagation of the resulting shear stresses generated within the bone. We discuss the validity of our simplified model and present results validating this approach

Dynamic Deformation and Mechanical Properties of Brain Tissue

Traumatic brain injury is an important medical problem affecting millions of people. Mathematical models of brain biomechanics are being developed to simulate the mechanics of brain injury and to design protective devices. However, because of a lack of quantitative data on brain-skull boundary conditions and deformations, the predictions of mathematical models remain uncertain. The objectives of this dissertation are to develop methods and obtain experimental data that will be used to parameterize and validate models of traumatic brain injury. To that end, this dissertation first addresses the brain-skull boundary conditions by measuring human brain motion using tagged magnetic resonance imaging. Magnetic resonance elastography was performed in the ferret brain to measure its mechanical properties in vivo. Brain tissue is not only heterogeneous, but may also be anisotropic. To characterize tissue anisotropy, an experimental procedure combining both shear testing and indentation was developed and applied to white matter and gray matter. These measurements of brain-skull interactions and mechanical properties of the brain will be valuable in the development and validation of finite element simulations of brain biomechanics

Biomedical and biophysical limits to mathematical modeling of pulmonary system mechanics: a scoping review on aerosol and drug delivery.

Undoubtedly, the construction of the biomechanical geometry systems with the help of computer tomography (CT) and magnetic resonance imaging (MRI) has made a significant advancement in studying in vitro numerical models as accurately as possible. However, some simplifying assumptions in the computational studies of the respiratory system have caused errors and deviations from the in vivo actual state. The most important of these hypotheses is how to generate volume from the point cloud exported from CT or MRI images, not paying attention to the wall thickness and its effect in computational fluid dynamic method, statistical logic of aerosol trap in software; and most importantly, the viscoelastic effect of respiratory tract wall in living tissue pointed in the fluid-structure interaction method. So that applying the viscoelastic dynamic mesh effect in the form of the moving deforming mesh can be very effective in achieving more appropriate response quality. Also, changing the volume fraction of the pulmonary extracellular matrix constituents leads to changes in elastic modulus (storage modulus) and the viscous modulus (loss modulus) of lung tissue. Therefore, in the biomedical computational methods where the model wall is considered flexible, the viscoelastic properties of the texture must be considered correctly

Experimental, Analytical, and Numerical Evaluation of the Mechanical Properties of the Brain Tissue

A true understanding of the mechanisms behind most of the brain diseases is still out of reach. For several years, the interest of scientists has been focused on the genetic and biological causes, however, recent studies unraveled the importance of the biomechanics of the brain growth, folding, impact resistance, and deformation on its pathological conditions. While, a wide range of different methods have been used for characterization of the mechanical properties of the brain at the tissue level, the obtained results from different studies are extremely scattered and sometimes in contrast to one another. Since the brain tissue is extremely soft, its mechanical properties are quite a challenge to be obtained. In this study, the accurate analysis of the mechanical heterogeneity of the brain tissue is performed through dynamic and pseudo-static indentation techniques to evaluate the viscoelastic response of the brain and presenting its anisotropy, inhomogeneity, and rate dependence. In addition, this research provides a detailed reference for modeling the nonlinear mechanical behavior of soft tissues, in general, and the brain tissue, in particular, with addressing important considerations for mechanical modeling in uniaxial loading conditions. With thoroughly presenting the physical basis of the modeling procedure, it is shown that if such considerations are neglected, a considerable inaccurate evaluation of the mechanical properties of the tissue can be expected, although the results might mathematically be correct. Moreover, a new model is developed for the mechanical behavior of the brain tissue that addresses the tension-compression asymmetry with taking into account the compressibility of the tissue in different loading conditions. This model is implemented by utilizing a combined analytical and numerical scheme. The results of this research could be used as input variables for computer simulations of the brain tissue in studying the traumatic brain injury, malformation of the brain folds, and other pathobiological conditions associated with the mechanical behavior of the brain

Mild Traumatic Brain Injury: Combined in Silico and in Vitro Studies

Mild traumatic brain injury (TBI) is a significant public health concern worldwide and has attracted significant attention due to high-impact sport as well as improvised explosive devices used in military conflicts. The earliest sign of mild TBI is associated with cognitive, behavioral and physical/somatic changes, which are commonly invisible to existing medical techniques. Thus it is essential to target mechanisms of mild TBI and its associated damage measures for earlier diagnosis/treatment and enhanced protection strategies. In this work, the mechanism of blast-induced mild TBI was inspected through integrated in silico and in vitro models. A three-dimensional (3D) human head model with anatomical details was reconstructed from high-resolution medical images, and positioned in three different directions with respect to the blast wave. The effects of head orientations as well as cerebral blood vessel network in brain mechanics were investigated. The dynamic responses of the brain were monitored by the maximum principal strain (MPS), shear strain (SS), and intracranial pressure (ICP). The developed numerical model was validated by the shock tube experiment using a surrogate head, i.e., water-filled polycarbonate shell. Results demonstrated that the ICP alternations in the brain was initially dominated by the direct blast wave propagation and the skull flexure took effect at a later time. It is worth noting that cerebral blood vessel network induced larger MPS and SS in the brain, which were influenced by vessel diameter and density. Moreover, the contour of the head and its orientation significantly altered the flow dynamics around the head, resulting in different spatial and temporal distributions of brain mechanics. Excessive mechanical stain sensed by brain cells, especially abundant cortical astrocytes, could be a potential index factor for the brain injury. An in vitro injury model for primary cortical astrocytes was developed to identify the injury threshold. Rat cortical astrocytes cultured on silicone membrane were subjected to equibiaxial pulse stretch. The blast pressure profile on the membrane was monitored and the membrane deformations were captured through the high-speed imaging system. The simulated membrane strain, validated by experimental measures, was used to construct an exposure-response curve. It was observed that live cells declined sharply in the strain range from 18% to 35%, which was identified as the injury threshold of cortical astrocytes. The obtained damage threshold of rat cortical astrocytes could be inferred about the level of brain injury in a rat. A 3D rat head model was constructed with an impactor mimicking the loading conditions of contact sports. Results revealed that impact depth and impactor shape were the two leading factors affecting brain dynamics. The influence of impactor diameter was region-specific and an increase in impactor diameter could substantially increase brain strains in the region which located directly beneath the impactor. The lateral impact could induce higher strains in the brain than the central impact. Results suggested that indentation depth instead of impact depth would be appropriate to characterize the influence of a softer impactor. Advisor: Linxia G

Intervertebral disc characterization by shear wave elastography: an in-vitro preliminary study

Patient-specific numerical simulation of the spine is a useful tool both in clinic and research. While geometrical personalization of the spine is no more an issue, thanks to recent technological advances, non-invasive personalization of soft tissue’s mechanical properties remains a challenge. Ultrasound elastography is a relatively recent measurement technique allowing the evaluation of soft tissue’s elastic modulus through the measurement of shear wave speed (SWS). The aim of this study was to determine the feasibility of elastographic measurements in intervertebral disc (IVD). An in-vitro approach was chosen to test the hypothesis that SWS can be used to evaluate IVD mechanical properties and to assess measurement repeatability. Eleven oxtail IVDs were tested in compression to determine their stiffness and apparent elastic modulus at rest and at 400 N. Elastographic measurements were performed in these two conditions and compared to these mechanical parameters. The protocol was repeated six times to determine elastographic measurement repeatability. Average SWS over all samples was 5.3 ± 1.0 m/s, with a repeatability of 7 % at rest and 4.6 % at 400 N; stiffness and apparent elastic modulus were 266.3 ± 70.5 N/mm and 5.4 ± 1.1 MPa at rest, respectively, while at 400 N they were 781.0 ± 153.8 N/mm and 13.2 ± 2.4 MPa. Correlations were found between elastographic measurements and IVD mechanical properties; these preliminary results are promising for further in-vivo application.The authors are grateful to the ParisTech BiomecAM chair program on subject-specific musculoskeletal modelling for funding (with the support of Proteor, ParisTech and Yves Cotrel Foundations)