Methods for medical applications

The possibility to realize highly customized orthoses is receiving boost thanks to the widespread diffusion of low-cost 3D printing technologies. However, rapid prototyping (RP) with 3D printers is only the final stage of patient personalized orthotics processes. A reverse engineering (RE) process is in fact essential before RP, to digitize the 3D anatomy of interest and to process the obtained surface with suitable modeling software, in order to produce the virtual solid model of the orthosis to be printed. In this paper, we focus on the specific and demanding case of the customized production of hand orthosis. We design and test the essential steps of the entire production process with particular emphasis on the accurate acquisition of the forearm geometry and on the subsequent production of a printable model of the orthosis. The choice of the various hardware and software tools (3D scanner, modeling software, and FDM printer) is aimed at the mitigation of the design and production costs while guaranteeing suitable levels of data accuracy, process efficiency, and design versatility. Eventually, the proposed method is critically analyzed so that the residual issues and critical aspects are highlighted in order to discuss possible alternative approaches and to derive insightful observations that could guide future research activities.

Automatic recognition of different tissue types in histological images is an essential part in the digital pathology toolbox. Texture analysis is commonly used to address this problem; mainly in the context of estimating the tumour/stroma ratio on histological samples. However, although histological images typically contain more than two tissue types, only few studies have addressed the multi-class problem. For colorectal cancer, one of the most prevalent tumour types, there are in fact no published results on multiclass texture separation. In this paper we present a new dataset of 5,000 histological images of human colorectal cancer including eight different types of tissue. We used this set to assess the classification performance of a wide range of texture descriptors and classifiers. As a result, we found an optimal classification strategy that markedly outperformed traditional methods, improving the state of the art for tumour-stroma separation from 96.9% to 98.6% accuracy and setting a new standard for multiclass tissue separation (87.4% accuracy for eight classes). We make our dataset of histological images publicly available under a Creative Commons license and encourage other researchers to use it as a benchmark for their studies.

Endocanalar posts are necessary to build up and retain coronal restorations but they do not reinforce dental roots. It was observed that the dislodgement of post-retained restorations commonly occurs after several years of function and long-term retention may be influenced by various factors such as temperature changes. Temperature changes, in fact, produce micrometric deformations of post and surrounding tissues/materials that may generate high stress concentrations at the interface thus leading to failure. In this study we present an optical system based on the projection moiré technique that has been utilized to monitor the displacement field of endocanalar glass-fibre posts subjected to temperature changes. Measurements were performed on forty samples and the average displacement values registered at the apical and middle region were determined for six different temperature levels. A total of 480 displacement measurements was hence performed. The values of the standard deviation computed for each of the tested temperatures over the forty samples appear reasonably small which proves the robustness and the reliability of the proposed optical technique. The possible implications for the use of the system in the applicative context were discussed.

Keywords: Dental materials , Endocanalar post , Projection moiré , Thermal deformation , Thermal stress

Functionally Graded Scaffolds (FGSs) are porous biomaterials where porosity changes in space with a specific gradient. In spite of their wide use in bone tissue engineering, possible models that relate the scaffold gradient to the mechanical and biological requirements for the regeneration of the bony tissue are currently missing. In this study we attempt to bridge the gap by developing a mechanobiology-based optimization algorithm aimed to determine the optimal graded porosity distribution in FGSs. The algorithm combines the parametric finite element model of a FGS, a computational mechano-regulation model and a numerical optimization routine. For assigned boundary and loading conditions, the algorithm builds iteratively different scaffold geometry configurations with different porosity distributions until the best microstructure geometry is reached, i.e. the geometry that allows the amount of bone formation to be maximized. We tested different porosity distribution laws, loading conditions and scaffold Young's modulus values. For each combination of these variables, the explicit equation of the porosity distribution law-i.e the law that describes the pore dimensions in function of the spatial coordinates-was determined that allows the highest amounts of bone to be generated. The results show that the loading conditions affect significantly the optimal porosity distribution. For a pure compression loading, it was found that the pore dimensions are almost constant throughout the entire scaffold and using a FGS allows the formation of amounts of bone slightly larger than those obtainable with a homogeneous porosity scaffold. For a pure shear loading, instead, FGSs allow to significantly increase the bone formation compared to a homogeneous porosity scaffolds. Although experimental data is still necessary to properly relate the mechanical/biological environment to the scaffold microstructure, this model represents an important step towards optimizing geometry of functionally graded scaffolds based on mechanobiological criteria.

Complexity of scaffold geometries and biological mechanisms involved in the bone generation process make the design of scaffolds a quite challenging task. The most common approaches utilized in bone tissue engineering require costly protocols and time-consuming experiments. In this study we present an algorithm that, combining parametric finite element models of scaffolds with numerical optimization methods and a computational mechano-regulation model, is able to predict the optimal scaffold microstructure. The scaffold geometrical parameters are perturbed until the best geometry that allows the largest amounts of bone to be generated, is reached. We study the effects of the following factors: (1) the shape of the pores; (2) their spatial distribution; (3) the number of pores per unit area. The optimal dimensions of the pores have been determined for different values of scaffold Young's modulus and compression loading acting on the scaffold upper surface. Pores with rectangular section were predicted to lead to the formation of larger amounts of bone compared to square section pores; similarly, elliptic pores were predicted to allow the generation of greater amounts of bone compared to circular pores. The number of pores per unit area appears to have rather negligible effects on the bone regeneration process. Finally, the algorithm predicts that for increasing loads, increasing values of the scaffold Young's modulus are preferable. The results shown in the article represent a proof-of-principle demonstration of the possibility to optimize the scaffold microstructure geometry based on mechanobiological criteria.

Keywords: Mechano-regulation algorithm , Mechanobiology , Numerical optimization , Scaffold microstructure

The usual assumption made in mechanical characterization of soft biotissues with Atomic Force Microscopy (AFM) is that the specimen behaves as a purely elastic material. However, there is a limit indentation rate below which viscous effects can be neglected. A parametric study including about 200 FEM analyses shows that in the case of immature porcine zona pellucida (ZP) samples viscous effects become more significant for sharp tips. A linear relationship between the limit indentation rate and the geometry of the AFM probe is derived for the porcine ZP samples analyzed in this study.

Keywords: Atomic Force Microscopy , Indentation rate , Mechanical characterization , Probe geometry , Soft matter , Viscous effects

Three-dimensional deformation analysis of human organs is very important from both diagnostic and therapeutic point of view. For example, comparing the deformation field in healthy and pathologic cardiac walls in the systolic phase allows to gather early and accurate information on the onset of heart diseases. MRI tagging is utilized in medicine to visualize with a great deal of detail the structure and morphology of tissues. The tagging process introduces a volumetric system of planes of reference similar to the process of introducing a grating in the 3-D moiré method in transparent media. The paper will analyze the kinematics of 3-D deformation fields and the fundamental concepts involved in 3-D deformation analysis within the restrictions imposed by the MRI method thus providing solutions for the inherent shortcomings encountered in the MRI tagging technique.

Keywords: Deformation of cardiac wall , Digital moiré , Large deformation analysis , MRI tagging , Rotations

This paper describes the implementation of a Multimodal Guidance System (MGS) for upper limb rehabilitation through vision, haptic and sound. The system consists of a haptic device that physically renders virtual path of 2D shapes through the point-based approach, while sound technology provides audio feedback inputs about patient's actions while performing a manual task as for example: starting and/or finishing an sketch; different sounds related to the hand's velocity while sketching. The goal of this sonification approach is to strengthen the patient's understanding of the virtual shape which is used in the rehabilitation process, and to inform the patient about some attributes that could otherwise remain unseen. Our results provide conclusive evidence that the effect of using the sound as additional feedback increases the accuracy in the tasks operations.

Keywords: Haptic guidance , Sound interaction , Upper-limb rehabilitation

Abstract: The aim of this work is to show a quick and simple procedure able to identify the geometrical parameters of the intervertebral disc that strongly affect the behavior of the FEM model. First, we allocated a selection criterion for the minimum number of geometrical parameters that describe, with a good degree of approximation, a healthy human vertebra. Next, we carried out a sensitivity analysis using the ‘Taguchi orthogonal array' to arrive at a quick identification of the parameters that strongly affect the behavior of the Fem model.

Keywords: geometrical parameters , intervertebral disc , Spine , subject-specific finite element models , Taguchi method

Objective: To define and validate a method for the measurement of 3-dimensional (3D) morphometric parameters in polygonal mesh models of canine femora. Study Design: Ex vivo/computerized model. Sample Population: Sixteen femora from 8 medium to large-breed canine cadavers (mean body weight 28.3 kg, mean age 5.3 years). Methods: Femora were measured with a 3D scanner, obtaining 3D meshes. A computer-aided design-based (CAD) software tool was purposely developed, which allowed automatic calculation of morphometric parameters on a mesh model. Anatomic and mechanical lateral proximal femoral angles (aLPFA and mLPFA), anatomic and mechanical lateral distal femoral angles (aLDFA and mLDFA), femoral neck angle (FNA), femoral torsion angle (FTA), and femoral varus angle (FVA) were measured in 3D space. Angles were also measured onto projected planes and radiographic images. Results: Mean (SD) femoral angles (degrees) measured in 3D space were: aLPFA 115.2 (3.9), mLPFA 105.5 (4.2), aLDFA 88.6 (4.5), mLDFA 93.4 (3.9), FNA 129.6 (4.3), FTA 45 (4.5), and FVA −1.4 (4.5). Onto projection planes, aLPFA was 103.7 (5.9), mLPFA 98.4 (5.3), aLDFA 88.3 (5.5), mLDFA 93.6 (4.2), FNA 132.1 (3.5), FTA 19.1 (5.7), and FVA −1.7 (5.5). With radiographic imaging, aLPFA was 109.6 (5.9), mLPFA 105.3 (5.2), aLDFA 92.6 (3.8), mLDFA 96.9 (2.9), FNA 120.2 (8.0), FTA 30.2 (5.7), and FVA 2.6 (3.8). Conclusion: The proposed method gives reliable and consistent information about 3D bone conformation. Results are obtained automatically and depend only on femur morphology, avoiding any operator-related bias. Angles in 3D space are different from those measured with standard radiographic methods, mainly due to the different definition of femoral axes.

In regenerative medicine, 3D scaffolds are used to sustain the regeneration of tissues in removed or damaged parts of the human body. As such practices are being widely experimented in clinical applications, the design, the materials and the manufacturing process to obtain efficient 3D biocompatible lattices are being significantly investigated. Nevertheless, most of the proposed designs are based on regular 3D shapes obtained from the repetition of unit cells disposed in a three-dimensional array. This approach does not exploit the whole potential of computer-aided design tools coupled with manufacturing capabilities for freeform shapes. In this paper, we propose a method to model biomimetic lattices controlling the porosity and the pores size of scaffolds to be integrated with the anatomical shape of the defect. The method has been implemented in bone tissue case study and implements a generative design approach based on Voronoi diagrams.

Keywords: 3D scaffolds , generative design , Voronoi diagram

The present work collects some results of the three-years Research Program "BioForming", funded by the Italian Ministry of Education (MIUR) and aimed to investigate the possibility of using flexible sheet forming processes, i.e. Super Plastic Forming (SPF) and Single Point Incremental Forming (SPIF), for the manufacturing of patient-oriented titanium prostheses. The prosthetic implants used as case studies were from the skull; in particular, two different Ti alloys and geometries were considered: one to be produced in Ti-Gr23 by SPF and one to be produced in Ti-Gr2 by SPIF. Numerical simulations implementing material behaviours evaluated by characterization tests were conducted in order to design both the manufacturing processes. Subsequently, experimental tests were carried out implementing numerical results in terms of: (i) gas pressure profile able to determine a constant (and optimal) strain rate during the SPF process; (ii) tool path able to avoid rupture during the SPIF process. Post forming characteristics of the prostheses in terms of thickness distributions were measured and compared to data from simulations for validation purposes. A good correlation between numerical and experimental thickness distributions has been obtained; in addition, the possibility of successfully adopting both the SPF and the SPIF processes for the manufacturing of prostheses has been demonstrated.

Cranioplasty is a surgery in which a prosthesis must be anchored on skull bone to repair a defect. One of the most used materials is the titanium. However, titanium prostheses could be made using the incremental sheet forming (ISF). Since titanium and bone are characterized by different Young modules, a detailed design of anchoring system is required to avoid cranial rupture. Aim of this study was to present a design procedure in order to identify the optimal anchoring system in case of craniofacial prostheses made with ISF. In detail, an optimization process and a predictive model for bone stress were used, choosing the numerical outputs of different FEM analyses as input data. The results indicate that our predictive and optimization models are accurate and, so, that this procedure could be very helpful for the prosthesis design, as demonstrated by the application of the procedure to a real case study.

Keywords: Anchoring system , Design procedure , Incremental sheet forming , Titanium prosthesis

Recent Face Analysis advances have focused the attention on studying and formalizing 3D facial shape. Landmarks, i.e. typical points of the face, are perfectly suited to the purpose, as their position on visage shape allows to build up a map of each human being's appearance. This turns to be extremely useful for a large variety of fields and related applications. In particular, the forensic context is taken into consideration in this study. This work is intended as a survey of current research advances in forensic science involving 3D facial landmarks. In particular, by selecting recent scientific contributions in this field, a literature review is proposed for in-depth analyzing which landmarks are adopted, and how, in this discipline. The main outcome concerns the identification of a leading research branch, which is landmark-based facial reconstruction from skull. The choice of selecting 3D contributions is driven by the idea that the most innovative Face Analysis research trends work on three-dimensional data, such as depth maps and meshes, with three-dimensional software and tools. The third dimension improves the accurateness and is robust to colour and lightning variations.

Keywords: 3D face , Fiducial point , Forensic , Landmarks , Reconstruction

In this paper, we propose a forearm rehabilitation system based on a serious game in Augmented Reality (AR). We designed and developed a simplified AR arcade brick breaking game to induce rehabilitation of the forearm muscles. We record the electromyographic signals using a low cost device to evaluate the applied force. We collected and analysed data in order to find a relationship between the applied force and the difficulty of the game. This research focuses on the dehospitalization of subjects in the middle or final stages of their rehabilitation where the new technologies, like Virtual and Augmented Reality, may improve the experience of repetitive exercises. The results achieved prove that the force applied by the user to hit the virtual sphere with real cardboard cube is related to sphere speed. In a rehabilitation scenario the results could be used to evaluate the improvements analysing the performance history.

Keywords: Brick serious games , Rehabilitation , Virtual and Augmented Reality

Over the past decades, the technological development in the medical field, coupled with the ongoing scientific research, has led to the development and improvement of dental prostheses supported by screw-retained metal frameworks. A key point in the manufacture of the framework is the achievement of a passive fit, intended as the capability of an implant-supported reconstruction to transmit minimum strain to implant components as well as to the surrounding bone, when subject to any load. The fitting of four different kinds of screw-retained metal frameworks was tested in this article. They differ both in materials and manufacturing process: two frameworks are made by casting, one framework is made by computer-aided design and computer-aided manufacturing and one framework is made by electric resistance spot welding (WeldONE, DENTSPLY Implants Manufacturing GmbH, Mannheim, Germany). The passivity of the frameworks was evaluated on the entire system, composed of a resin master cast, the implant analogues embedded in the cast and the frameworks. Strains were recorded by means of an electrical strain gauge connected to a control unit for strain gauge measurements. The experimental tests were carried out in the laboratories of the Department of INdustrial engineering at the University of Bologna. The results of the test campaigns, which compared three samples for each technological process, showed that no significant differences exist between the four framework types. In particular, the frameworks made by the resistance welding approach led to a mechanical response that is well comparable to that of the other tested frameworks.

Keywords: Dental prosthesis , passive fit , screw-retained framework , strain gauge analysis

Ultrasound is by far the most adopted method for safe screening and diagnosis in the prenatal phase, thanks to its non-harmful nature with respect to radiation-based imaging techniques. The main drawback of ultrasound imaging is its sensitivity to scattering noise, which makes automatic tissues segmentation a tricky task, limiting the possible range of applications. An algorithm for automatically extracting the facial surface is presented here. The method provides a comprehensive segmentation process and does not require any human intervention or training procedures, leading from the output of the scanner directly to the 3D mesh describing the face. The proposed segmentation technique is based on a two-step statistical process that relies on both volumetric histogram processing and 2D segmentation. The completely unattended nature of such a procedure makes it possible to rapidly populate a large database of 3D point clouds describing healthy and unhealthy faces, enhancing the diagnosis of rare syndromes through statistical analyses.

Keywords: 3D histogram processing , 3D ultrasound , DICOM , Image segmentation

A 3D automatic facial expression recognition procedure is presented in this work. The method is based on point-by-point mapping of seventeen Differential Geometry descriptors onto the probe facial depth map, which is then partitioned into seventy-nine regions. Then, features such as mean, median, mode, volumes, histograms are computed for each region and for each descriptor, to reach a varied large set of parameters representing the query face. Each set of parameters, given by a geometrical descriptor, a region, and a feature, form a trio, whose featuring numerical values are compared with appropriate thresholds, set via experimentation in a previous phase by processing a limited portion of the public facial Bosphorus database. This allows the identification of the emotion-based expression of the query 3D face among the six basic ones (anger, disgust, fear, joy, sadness, surprise). The algorithm was tested on the Bosphorus database and is suitable for applications in security, marketing, medical. The three-dimensional context has been preferred due to its invariance to different lightening/make-up/camouflage conditions.

Keywords: 3D face , Differential geometry , Emotions , Face expression recognition (FER) , Facial expression recognition , Shape index

The aim of this work is to automatically diagnose and formalize prenatal cleft lip with representative key points and identify the type of defect (unilateral, bilateral, right, or left) in three-dimensional ultrasonography (3D US). Geometry has been used as a framework for describing facial shapes and curvatures. Then, descriptors coming from this field are employed for identifying the typical key points of the defect and its dimensions. The descriptive accuracy of these descriptors has allowed us to automatically extract reference points, quantitative distances, labial profiles, and to provide information about facial asymmetry. Eighteen foetal faces, ten of healthy foetuses and eight with different types of cleft lips, have been obtained through a Voluson system and used for testing the algorithm. Cleft lip has been diagnosed and correctly characterized in all cases. Transverse and cranio-caudal length of the cleft have been computed and upper lip profile has been automatically extract to have a visual quantification of the overall labial defect. The asymmetry information obtained is consistent with the defect. This algorithm has been designed to support practitioners in identifying and classifying cleft lips. The gained results have shown that geometry might be a proper tool for describing faces and for diagnosis.

Keywords: 3D ultrasound , Cleft lip , Dysmorphisms , Landmarking , Syndrome diagnosis

Bone tissue engineered 3-D constructs customized to patient-specific needs are emerging as attractive biomimetic scaffolds to enhance bone cell and tissue growth and differentiation. The article outlines the features of the most common additive manufacturing technologies (3D printing, stereolithography, fused deposition modeling, and selective laser sintering) used to fabricate bone tissue engineering scaffolds. It concentrates, in particular, on the current state of knowledge concerning powder-based 3D printing, including a description of the properties of powders and binder solutions, the critical phases of scaffold manufacturing, and its applications in bone tissue engineering. Clinical aspects and future applications are also discussed.

Keywords: 3D printing , Additive manufacturing technologies , Binder , Bone , Depowdering , Powder , Scaffold , Sintering