Methods for medical applications

The research reported in this paper applies an explicit non-linear FEA solver to simulate the interaction between a clamp and a hyper-elastic material that aims to mimic the biological tissue of the colon. More in detail, the paper provides new results as a continuation of a previous works aimed at the evaluation of this solver to manage contact and dynamic loading on complex, multiple shapes. Results concern with the evaluation of the contact force during clamping, thus to the assessment of the force-feedback. The analysis is carried out on two geometries, using the hyper-elastic Mooney-Rivlin model for the mechanical behavior of the soft tissues. A pressure is applied on the colon to simulate the surgical clamp, which goes progressively in contact with tissue surface. To assess FEA criticality, and, then, its feasibility, the stress-strain and the contact force are analysed according to geometrical model and thickness variation, leaving the pressure constant. Doing so, their effect on the force-feedback can be foreseen, understanding their role on the accuracy of the final result.

Keywords: Computer assisted surgical planning , Finite element analysis , Segmentation , Soft tissues simulations

The umbilical cord is a complex structure containing three vessels, one straight vein and two coiled arteries, encased by the Wharton Jelly (WJ) a spongy structure made of collagen and hydrated macromolecules. Fetal blood reaches the placenta through the arteries and flows back to the fetus through the vein. The role of the WJ in maintaining cord circulation proficiency and the ultimate reason for arterial coiling still lack of reasonable mechanistic interpretations. We performed biaxial tension tests and evidenced significant differences in the mechanical properties of the core and peripheral WJ. The core region, located between the arteries and the vein, resulted rather stiffer close to the fetus. Finite element modelling and optimization based inverse method were used to create 2D and 3D models of the cord and to simulate stress distribution in different hemodynamic conditions, compressive loads and arterial coiling. We recorded a facilitated stress transmission from the arteries to the vein through the soft core of periplacental WJ. This condition generates a pressure gradient that boosts the venous backflow circulation towards the fetus. Peripheral WJ allows arteries to act as pressure buffering chambers during the cardiac diastole and helps to dissipate compressive forces away from vessels. Altered WJ biomechanics may represent the structural basis of cord vulnerability in many high-risk clinical conditions.

Blepharospasm (BSP) is an adult-onset focal dystonia with phenomenologically heterogeneous effects, including, but not limited to, blinks, brief or prolonged spasms, and a narrowing or closure of the eyelids. In spite of the clear and well-known symptomatology, objectively rating the severity of this dystonia is a rather complex task since BSP symptoms are so subtle and hardly perceptible that even expert neurologists can rate the gravity of the pathology differently in the same patients. Software tools have been developed to help clinicians in the rating procedure. Currently, a computerised video-based system is available that is capable of objectively determining the eye closure time, however, it cannot distinguish the typical symptoms of the pathology. In this study, we attempt to take a step forward by proposing a neural network-based software able not only to measure the eye closure, time but also to recognise and count the typical blepharospasm symptoms. The software, after detecting the state of the eyes (open or closed), the movement of specific facial landmarks, and properly implementing artificial neural networks with an optimised topology, can recognise blinking, and brief and prolonged spasms. Comparing the software predictions with the observations of an expert neurologist allowed assessment of the sensitivity and specificity of the proposed software. The levels of sensitivity were high for recognising brief and prolonged spasms but were lower in the case of blinks. The proposed software is an automatic tool capable of making objective ‘measurements' of blepharospasm symptoms.

Keywords: Blepharospasm , Blepharospasm rating scale , Eye closure time , Focal dystonia , Neural network topology optimisation

Scaffolds are porous biomaterials that serve to replace missing portions of bone. Scaffolds must possess a proper geometry and hence have to be adequately designed to correctly undergo to the load and to favor the differentiation of the mesenchymal stem cells invading it, into osteoblasts. It is commonly known that scaffold geometry affects the quality of the regenerated bone creating within the scaffold pores. Scaffold properly designed trigger favorable values of biophysical stimuli that are responsible for the reactions cascade leading to the bone formation. In this paper an optimization algorithm is proposed that, based on mechano-regulation criteria, identifies the optimal geometry of scaffolds, i.e. the geometry that favors the formation of the largest amounts of bone in the shortest time. In detail, the algorithm, written in the Matlab environment, incorporates parametric finite element models of different scaffold types, a computational mechanobiological model and structural optimization routines. The scaffold geometry is iteratively perturbed by the algorithm until the optimal geometry is computed, i.e. the geometry that triggers the most favorable values of the biophysical stimulus which lead to the formation of mature bone. Mesenchymal stem cells were hypothesized to spread within the fracture domain and uniformly occupy the scaffold pores.

Keywords: Hexahedron unit cell , Mechanobiology , Rhombicuboctahedron unit cell , Unit cell geometry

Visibility is a very important topic in computer graphics and especially in calculations of global illumination. Visibility determination, the process of deciding which surface can be seen from a certain point, has also problematic applications in biomedical engineering. The problem of visibility computation with mathematical tools can be presented as a visibility network. Instead of utilizing a 2D visibility network or graphs whose construction is well known, in this paper, a new method for the construction of 3D visibility graphs will be proposed. Drawing graphs as nodes connected by links in a 3D space is visually compelling but computationally difficult. Thus, the construction of 3D visibility graphs is highly complex and requires professional computers or supercomputers. A new method for optimizing the algorithm visibility network in a 3D space and a new method for quantifying the complexity of a network in DNA pattern recognition in biomedical engineering have been developed. Statistical methods have been used to calculate the topological properties of a visibility graph in pattern recognition. A new nhyper hybrid method is also used for combining an intelligent neural network system for DNA pattern recognition with the topological properties of visibility networks of a 3D space and for evaluating its prospective use in the prediction of cancer.

Purpose: Orbital fractures are the most commonly encountered midfacial fractures, and usually, the fracture involves the floor and/or the medial wall of the orbit. This paper aims to present an innovative approach for primary and secondary reconstructions of fractured orbital walls through the use of computer-assisted techniques and additive manufacturing. Design/methodology/approach: First, through the 3D anatomical modelling, the geometry of the implant is shaped to fill the orbital defect and recover the facial symmetry. Subsequently, starting from the modelled implant, a customised mould is designed taking into account medical and technological requirements. Findings: The selective laser sintered mould is able to model and form several kind of prosthetic materials (e.g. titanium meshes and demineralised bone tissue), resulting in customised implants and allowing accurate orbital cavity reconstructions. The case study proved that this procedure, at the same time, reduces the morbidity on the patients, the duration of surgery and the related costs. Originality/value: This innovative approach has great potential, as it is an easy and in-office procedure, and it offers several advantages over other existing methods.

Keywords: Customized implant , Orbital cavity reconstruction , Reverse engineering , Selective laser sintering , Surgery , Surgical guide

This study defines a methodological procedure for the design and manufacturing of a prosthetic implant for the reconstruction of a midsagittal bony-deficiency of the skull due to the Apert congenital disorder. Conventional techniques for craniofacial defects reconstruction rely on the mirrored-image technique. When the cranial lesion extends over the midline or in case of bilateral defects, other approaches based on thin plate spline interpolation or constrained anatomical deformation are applied. The proposed method uses the anthropometric theory of cranial landmarks identification for the retrieval of a template healthy skull, useful as a guide in the successive implant design. Then, anatomical deformation of the region of interest and free-form modelling allow to get the customized shape of the implant. A full bulk and a porous implant have been provided according to the surgeon advises. The models have been 3D printed for a pre-surgical analysis and further treatment plan. They fulfilled the expectancies of the surgeon thus positive results are predictable. This methodology results to be reproducible to any other craniofacial defect spanning over the entire skull.

Keywords: Additive Manufacturing , Apert Syndrome , Biomedical design , Design process , Implant design

To date, standard methods for assessing the severity of chest wall deformities are mostly linked to X-ray and CT scans. However, the use of radiations limits their use when there is a need to monitor the development of the pathology over time. This is particularly important when dealing with patients suffering from Pectus Carinatum, whose treatment mainly requires the use of corrective braces and a systematic supervision. In recent years, the assessment of severity of chest deformities by means of radiation-free devices became increasingly popular but not yet adopted as standard clinical practice. The present study aims to define an objective measure by defining a severity index (named External Pectus Carinatum Index) used to monitor the course of the disease during treatment. Computed on the optical acquisition of the patients' chest by means of an appositely devised, fast and easy-to-use, body scanner, the proposed index has been validated on a sample composed of a control group and a group of Pectus Carinatum patients. The index proved to be reliable and accurate in the characterization of the pathology, enabling the definition of a threshold that allows to distinguish the cases of patients with PC from those of healthy subjects. [Figure not available: see fulltext.]

Keywords: Index , Optical imaging , Pectus Carinatum , Severity assessment , Three-dimensional

Background: The integration of computer-aided design/computer-aided manufacturing (CAD/CAM) tools and medicine is rapidly developing for designing medical devices. A novel design for a 3D-printed patient-specific surgical template for thoracic pedicle screw insertion, using a procedure based on reverse engineering, is presented. Methods: The surgeon chooses the entry point on the vertebra. The optimal insertion direction and the size of the screws are defined via an algorithm on the basis of a patient-specific vertebra CAD model. The template features an innovative shape for a comfortable and univocal placement and a novel disengaging device. Results: Three spinal fusions were performed to test the template. Excellent results were achieved in terms of the accuracy of the screw positioning, reduction in surgery duration, and number of X-rays. Conclusions: A novel design for a customized, 3D-printed surgical template for thoracic spinal arthrodesis was presented, and improvements in terms of precision, duration, and safety were achieved without changing the standard procedure.

Keywords: 3D imaging , additive manufacturing , bone , computer-assisted surgery , imaged guided surgery , in vivo , modelling , pedicle screw fixation , screw direction optimization , spine , surgical template , thoracic , thoracic spinal arthrodesis , X-ray minimization

mHealth technology, by using habitual devices, i.e., smartphones, improves prevention, diagnosis, treatment, monitoring, and management of health. Monitoring heart profile during intense sports activities allows to diagnose pathologies, not identifiable with the traditional Holter approach and, therefore, it can help preventing possible injuries. On the other hand, denoising and extracting features from electrocardiographic (ECG) signal acquired during physical activity is a challenging task due to motion artifacts and measurement noise. In this paper, we propose a solution enabling a complete analysis of ECG signal through the implementation of a robust denoising algorithm, which has been characterized on synthetic signals and then has been tested on real traces acquired with a low-cost smartphone-based device during motorbike and car races.

Keywords: Compressive sensing (CS) , denoising , electrocardiographic (ECG) , mHealth , motion artifacts , races , wearable

Background and Objective: The biomechanical analysis of the abdominal wall should take into account muscle activation and related phenomena, such as intra-abdominal pressure variation and abdomen surface deformation. The geometry of abdominal surface and its deformation during contraction have not been extensively characterized, while represent a key issue to be investigated. Methods: In this work, the antero-lateral abdominal wall surface of ten healthy volunteers in supine position is acquired via laser scanning in relaxed conditions and during abdominal muscles contraction, repeating each acquisition six times. The average relaxed and contracted abdominal surfaces are compared for each subject and displacements measured. Results: Muscular activation induces raising in the region adjacent to linea alba along the posterior-anterior direction and a simultaneous lowering along lateral-medial direction of the abdominal wall sides. Displacements reach a maximum value of 12.5 mm for the involved subjects. The coefficient of variation associated to the abdomen surface measurements in the same configuration (relaxed or contracted) is below 0.75%. Non-parametric Mann-Whitney U test highlights that the differences between relaxed and contracted abdominal wall surfaces are significant (p < 0.01). Conclusions: Laser scanning is an accurate and reliable method to evaluate surface changes on the abdominal wall during muscular contraction. The results of this experimental activity can be useful to validate numerical models aimed at describing abdominal wall biomechanics.

Keywords: Abdomen surface , Abdominal wall , Deformation , Laser scanner , Muscle contraction

The final subject position is often the only evidence in the case of the fall of a human being from a given height. Foreseeing the body trajectory and the respective driving force may not be trivial due to the possibility of rotations and to an unknown initial position and momentum of the subject. This article illustrates how multibody models can be used for this aim, with specific reference to an actual case, where a worker fell into a stair well, prior to stair mounting, and he was found in an unexpected posture. The aim of the analysis was establishing if this worker was dead in that same place, if he had been pushed, and which was his initial position. A multibody model of the subject has been built (“numerical android”), given his stature and his known mass. Multiple simulations have been performed, following a design of experiments where various initial positions and velocity as well as pushing forces have been considered, while the objective function to be minimized was the deviation of the numerical android position from the actual worker position. At the end of the analysis, it was possible to point how a very limited set of conditions, all including the application of an external pushing force (or initial speed), could produce the given final posture with an error on the distance function equal to 0.39 m. The full analysis gives a demonstration of the potentiality of multibody models as a tool for the analysis of falls in forensic inquiries.

Keywords: accident , android , biomechanics , crime , doe , fall , forensic , multibody

The development of systems for supporting neuro-rehabilitation is of primary importance, due to the high number of people in need of rehabilitation and the limited effectiveness of most of the current developed systems. Our research work aims at developing more engaging interaction modalities for neuro rehabilitation systems, through virtual reality, music based on harp therapy and fragrance feedback modalities and which are also fun and motivational for the patients. The proposed interaction modalities consist of a set of virtual immersive environments which includes an olfactory feedback, where odours are used to increase the sense of presence and the attention of the patients during the execution of the exercises. While the patient performs the rehabilitation exercise, the harp therapist plays the harp accordingly to the patient emotional condition. The system shows a virtual scenario, including virtual objects and/or 360 videos used to increase his sense of presence in the scenario. Odours are associated with virtual scenarios.

Background Preclinical training in perforator flap harvesting is typically conducted on living animal models; however, repeated training is not possible with these models because of ethical and/or economical constraints. We describe an anterolateral thigh flap (ALT flap) training model using chicken thigh that seems to be an appropriate training model prior, for example, to raise a perforator flap in a living rat or swine model. Methods A total of 10 chicken legs were used in this study. Six chicken legs were anatomically dissected to confirm the presence of the perforator and to identify the main vascular tree. In four chicken legs, a skin flap was planned based on the perforator and intramuscular dissection was performed under magnification. Results The perforator was identified in all dissections and was consistently found 3 cm above the line extending from the patella to the head of the femur in its third proximal. Proximally, the mean diameter of the artery and vein was 0.56 (σ = 0.04) and 0.84 (σ = 0.06) mm, respectively. The mean dissection time to raise the flap was 88 (σ = 7) min. Conclusion This is the first description of a nonliving biological simulation model for training in perforator flap dissection that mimics an ALT flap. As an ex vivo chicken model, it is a cost effective and readily accessible model suitable for repeated practice.

Keywords: ALT , chicken , perforator flap , training

Background: Autotransplantation of cryopreserved ovarian tissue is currently the main option to preserve fertility for cancer patients. To avoid cancer cell reintroduction at transplantation, amulti-step culture systemhas been proposed to obtain fully competent oocytes for in vitro fertilization. Current in vitro systems are limited by the low number and health of secondary follicles produced during the first step culture of ovarian tissue fragments. To overcome such limitations, bioreactor designs have been proposed to enhance oxygen supply to the tissue, with inconsistent results. This retrospective study investigates, on theoretical grounds, whether the lack of a rational design of the proposed bioreactors prevented the full exploitation of follicle growth potential. Methods: Models describing oxygen transport in bioreactors and tissue were developed and used to predict oxygen availability inside ovarian tissue in the pertinent literature. Results: The proposed theoretical analysis suggests that a successful outcome is associated with enhanced oxygen availability in the cultured tissue in the considered bioreactor designs. This suggests that a rational approach to bioreactor design for ovarian tissue culture in vitro may help exploit tissue potential to support follicle growth.

Keywords: Design , In vitro culture , Ioreactor , Ovarian tissue , Oxygen , Transport

The present study wants to bring to light a new type of crutch designed for a chronic patient with perennial limited mobility, who must use this support every time a move is needed. The main purpose of the project consists in recommending a correct use of the crutch through technology, limiting the damage normally caused by a bad use of crutches and giving a support both for the patient and for the doctor. All of the features of the crutches were defined through relationship matrices and a benchmarking, which helped us for defining the requirements; other important features were defined, taking a look to the technological progresses applied to new, patented crutches. The result is a sensorized crutch, functional and oriented to meet the user's needs in order to prevent an incorrect use of the support avoiding the growth of other pains.

Keywords: Analysis , Benchmarking , Crutch , Industrial Design Structure (IDeS) , Matrix of relative dependence , Matrix of relative importance , Medical prosthesis mobility , Patient , Project , Sensors , Tool

Our purpose is to develop the preoperative diagnosis stage for orthopedic surgical treatments using additive manufacturing technology. Our methods involve fast implementations of an additive manufactured bone model, converted from CAT data, through appropriate software use. Then, additive manufacturing of the formed surfaces through special 3D-printers. With the structural model redesigned and printed in three dimensions, the surgeon is able to look at the printed bone and he can handle it because the model perfectly reproduces the real one upon which he will operate. We found that additive manufacturing models can precisely characterize the anatomical structures of fractures or lesions. The studied practice helps the surgeon to provide a complete preoperative valuation and a correct surgery, with minimized duration and risks. This structural model is also an effective device for communication between doctor and patient.

Keywords: 3D-printing , Additive manufacturing-modeling , CAT scan , Diagnosis , Orthopedics , Surgery

This paper presents the application of a low-cost 3D printing technology in pre-operative planning and intra-operative decision-making. Starting from Computed Tomography (CT) scans, we were able to reconstruct a 3D model of the area of interest with a very simple and rapid workflow, using open-source software and an entry level 3D printer. The use of High Temperature Poly-Lactic Acid (HTPLA) by ProtoPasta allowed fabricating sterilizable models, which could be used within the surgical field. We believe that our method is an appealing alternative to high-end commercial products, being superior for cost and speed of production. It could be advantageous especially for small and less affluent hospitals that could produce customized sterilizable tools with little investment and high versatility.

Keywords: 3D printing , Computed tomography , Diagnostic imaging , Mesh reconstruction , Rapid prototyping , Surgical planning

3D reconstruction of human anatomy from cross-sectional imaging has recently gained increasing importance in several medical fields thus designating the 3D bones reconstruction accuracy, critical for the success of the whole surgical intervention. The 3D anatomic model quality depends on the quality of the reconstructed image, on the quality of the images segmentation step and on the error introduced by the iso-surface triangulation algorithm. The influence of image processing procedures and relative parametrization has been largely studied in the scientific literature; however, the analysis of the direct impact of the quality of the reconstructed medical images is still lacking. In this paper, a comparative study on the influence of both image reconstruction algorithm (standard and iterative) and applied kernel is reported. Research was performed on the 3D reconstruction of a pig tibia, by using Philips Brilliance 64 CT scanner. At the stage of scanning and at the stage of 3D reconstruction, the same procedures were followed, while only image reconstruction algorithm and kernel were changed. The influence of such selection on the accuracy of bone geometry was assessed by comparing it against the 3D model obtained with a professional 3D scanner. Results show an average error in reconstructing the geometry of around 0.1 mm with a variance of 0.08 mm. The presented study highlights new opportunities to control the deviations on the geometry accuracy of the bones structures at the stage of cross sectional imaging generation.

Keywords: 3D model reconstruction , Accuracy , Computed tomography , Kernel reconstruction