Search

A transtibial prosthetic interface typically comprises a compliant liner and an outer rigid socket. The preponderance of today's conventional liners are mass produced in standard sizes, and conventional socket design is labor-intensive and artisanal, lacking clear scientific rationale. This work tests the clinical efficacy of a novel, physics-based digital design framework to create custom prosthetic liner-socket interfaces. In this investigation, we hypothesize that the novel digital approach will improve comfort outcomes compared to a conventional method of liner-socket design. The digital design framework generates custom transtibial prosthetic interfaces starting from MRI or CT image scans of the residual limb. The interface design employs FEA to simulate limb deformation under load. Interfaces are fabricated for 9 limbs from 8 amputees (1 bilateral). Testing compares novel and conventional interfaces across four assessments: 5-min walking trial, thermal imaging, 90-s standing pressure trial, and an evaluation questionnaire. Outcome measures include antalgic gait criterion, skin surface pressures, skin temperature changes, and direct questionnaire feedback. Antalgic gait is compared via a repeated measures linear mixed model while the other assessments are compared via a non-parametric Wilcoxon sign-rank test. A statistically significant ([Formula: see text]) decrease in pain is demonstrated when walking on the novel interfaces compared to the conventional. Standing pressure data show a significant decrease in pressure on novel interfaces at the anterior distal tibia ([Formula: see text]), with no significant difference at other measured locations. Thermal results show no statistically significant difference related to skin temperature. Questionnaire feedback shows improved comfort on novel interfaces on posterior and medial sides while standing and the medial side while walking. Study results support the hypothesis that the novel digital approach improves comfort outcomes compared to the evaluated conventional method. The digital interface design methodology also has the potential to provide benefits in design time, repeatability, and cost., (© 2024. The Author(s).)

Given its real-time capability to quantify mechanical tissue properties, ultrasound shear wave elastography holds significant promise in clinical musculoskeletal imaging. However, existing shear wave elastography methods fall short in enabling full-limb analysis of 3D anatomical structures under diverse loading conditions, and may introduce measurement bias due to sonographer-applied force on the transducer. These limitations pose numerous challenges, particularly for 3D computational biomechanical tissue modeling in areas like prosthetic socket design. In this feasibility study, a clinical linear ultrasound transducer system with integrated shear wave elastography capabilities was utilized to scan both a calibrated phantom and human limbs in a water tank imaging setup. By conducting 2D and 3D scans under varying compressive loads, this study demonstrates the feasibility of volumetric ultrasound shear wave elastography of human limbs. Our preliminary results showcase a potential method for evaluating 3D spatially varying tissue properties, offering future extensions to computational biomechanical modeling of tissue for various clinical scenarios., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The objective of this study is to evaluate the mechanical properties and energy absorption characteristics of the gyroid, dual-lattice and spinodoid structures, as biomimetic lattices, through finite element analysis and experimental characterisation. As part of the study, gyroid and dual-lattice structures at 10% volume fraction were 3D-printed using an elastic resin, and mechanically tested under uniaxial compression. Computational models were calibrated to the observed experimental data and the response of higher volume fraction structures were simulated in an explicit finite element solver. Stress-strain data of groups of lattices at different volume fractions were studied and energy absorption parameters including total energy absorbed per unit volume, energy absorption efficiency and onset of densification strain were calculated. Also, the structures were characterized into bending-dominant and stretch-dominant structures, according to their nodal connectivity and Gibson-and-Ashby's law. The results of the study showed that the dual-lattice is capable of absorbing more energy at each volume fraction cohort. However, gyroid structures showed higher energy absorption efficiency and the onset of densification at higher strains. The spinodoid structure was found to be the poorest structure in terms of energy absorption, specifically at low volume fractions. Also, the results showed that the dual-lattice was a stretch dominated structure, while the gyroid structure was a bending dominated structure, which may be a reason that it is a better candidate for energy absorption applications., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Mechanical properties of an aneurysmatic thoracic aorta are potential markers of future growth and remodelling and can help to estimate the risk of rupture. Aortic geometries obtained from routine medical imaging do not display wall stress distribution and mechanical properties. Mechanical properties for a given vessel may be determined from medical images at different physiological pressures using inverse finite element analysis. However, without considering pre-stresses, the estimation of mechanical properties will lack accuracy. In the present paper, we propose and evaluate a mechanical parameter identification technique, which recovers pre-stresses by determining the zero-pressure configuration of the aortic geometry. We first validated the method on a cylindrical geometry and subsequently applied it to a realistic aortic geometry. The verification of the assessed parameters was performed using synthetically generated reference data for both geometries. The method was able to estimate the true mechanical properties with an accuracy ranging from 98% to 99%.

The regeneration of the ruptured scapholunate interosseous ligament (SLIL) represents a clinical challenge. Here, we propose the use of a Bone-Ligament-Bone (BLB) 3D-printed polyethylene terephthalate (PET) scaffold for achieving mechanical stabilisation of the scaphoid and lunate following SLIL rupture. The BLB scaffold featured two bone compartments bridged by aligned fibres (ligament compartment) mimicking the architecture of the native tissue. The scaffold presented tensile stiffness in the range of 260 ± 38 N/mm and ultimate load of 113 ± 13 N, which would support physiological loading. A finite element analysis (FEA), using inverse finite element analysis (iFEA) for material property identification, showed an adequate fit between simulation and experimental data. The scaffold was then biofunctionalized using two different methods: injected with a Gelatin Methacryloyl solution containing human mesenchymal stem cell spheroids (hMSC) or seeded with tendon-derived stem cells (TDSC) and placed in a bioreactor to undergo cyclic deformation. The first approach demonstrated high cell viability, as cells migrated out of the spheroid and colonised the interstitial space of the scaffold. These cells adopted an elongated morphology suggesting the internal architecture of the scaffold exerted topographical guidance. The second method demonstrated the high resilience of the scaffold to cyclic deformation and the secretion of a fibroblastic related protein was enhanced by the mechanical stimulation. This process promoted the expression of relevant proteins, such as Tenomodulin (TNMD), indicating mechanical stimulation may enhance cell differentiation and be useful prior to surgical implantation. In conclusion, the PET scaffold presented several promising characteristics for the immediate mechanical stabilisation of disassociated scaphoid and lunate and, in the longer-term, the regeneration of the ruptured SLIL., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Cedryck Vaquette reports financial support was provided by MTPConnect Biomedical Technology Horizons. Cedryck Vaquette reports a relationship with MTPConnect Biomedical Technology Horizons that includes: funding grants. Cedryck Vaquette, Randy Bindra have a patent #PCT/AU2018/000133 issued to U.S. Patent and Trademark Office., (Copyright © 2023 Elsevier B.V. All rights reserved.)

In this study, we evaluate the performance of three algorithms as computational models of trabecular bone architecture, through systematic evaluation of morphometric, topological, and mechanical properties. Here, we consider the widely-used gyroid lattice structure, the recently-developed spinodoid structure and a structure similar to Voronoi lattices introduced here as the dual-lattice. While all computational models were calibrated to recreate the trabecular tissue volume (e.g. BV/TV), it was found that both the gyroid- and spinodoid-based structures showed substantial differences in many other morphometric and topological parameters and, in turn, showed lower effective mechanical properties compared to trabecular bone. The newly-developed dual-lattice structures better captured both morphometric parameters and mechanical properties, despite certain differences being evident their topological configuration compared to trabecular bone. Still, these computational algorithms provide useful platforms to investigate trabecular bone mechanics and for designing biomimetic structures, which could be produced through additive manufacturing for applications that include bone substitutes, scaffolds and porous implants. Furthermore, the software for the creation of the structures has been added to the open source toolbox GIBBON and is therefore freely available to the community., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Finite element analysis (FEA) can be used to evaluate applied interface pressures and internal tissue strains for computational prosthetic socket design. This type of framework requires realistic patient-specific limb geometry and constitutive properties. In recent studies, indentations and inverse FEA with MRI-derived 3D patient geometries were used for constitutive parameter identification. However, long computational times and use of specialized equipment presents challenges for clinical, deployment. In this study, we present a novel approach for constitutive parameter identification using a combination of FEA, ultrasound indentation, and shear wave elastography. Local shear modulus measurement using elastography during an ultrasound indentation experiment has particular significance for biomechanical modeling of the residual limb since there are known regional dependencies of soft tissue properties such as varying levels of scarring and atrophy. Beyond prosthesis design, this work has broader implications to the fields of muscle health and monitoring of disease progression., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Development of in-silico models of patient-specific cerebral artery networks presents several significant technical challenges: (i) The resolution and smoothness of medical CT images are much lower than the required element/cell length for FEA/CFD/FSI models; (ii) contact between vessels, and indeed self contact of high tortuosity vessel segments are not clearly identifiable from medical CT images. Commercial model construction software does not provide customised solutions for such technical challenges, with the result that accurate, efficient and automated development of patient-specific models of the cerebral vessels is not facilitated. This paper presents the development of a customised and highly automated platform for the generation of high resolution patient-specific FEA/CFD/FSI models from clinical images. This platform is used to perform the first fluid-structure-interaction patient-specific analysis of blood flow and artery deformation of an occluded cerebral vessel. Results demonstrate that in addition to flow disruption, clot occlusion significantly alters the geometry and strain distribution in the vessel network, with the blocked M2 segment undergoing axial elongation. The new computational approach presented in this study can be further developed as a clinical diagnostic tool and as a platform for thrombectomy device design., (Copyright © 2021. Published by Elsevier Ltd.)

Rupture of the scapholunate interosseous ligament can cause the dissociation of scaphoid and lunate bones, resulting in impaired wrist function. Current treatments (e.g., tendon-based surgical reconstruction, screw-based fixation, fusion, or carpectomy) may restore wrist stability, but do not address regeneration of the ruptured ligament, and may result in wrist functional limitations and osteoarthritis. Recently a novel multiphasic bone-ligament-bone scaffold was proposed, which aims to reconstruct the ruptured ligament, and which can be 3D-printed using medical-grade polycaprolactone. This scaffold is composed of a central ligament-scaffold section and features a bone attachment terminal at either end. Since the ligament-scaffold is the primary load bearing structure during physiological wrist motion, its geometry, mechanical properties, and the surgical placement of the scaffold are critical for performance optimisation. This study presents a patient-specific computational biomechanical evaluation of the effect of scaffold length, and positioning of the bone attachment sites. Through segmentation and image processing of medical image data for natural wrist motion, detailed 3D geometries as well as patient-specific physiological wrist motion could be derived. This data formed the input for detailed finite element analysis, enabling computational of scaffold stress and strain distributions, which are key predictors of scaffold structural integrity. The computational analysis demonstrated that longer scaffolds present reduced peak scaffold stresses and a more homogeneous stress state compared to shorter scaffolds. Furthermore, it was found that scaffolds attached at proximal sites experience lower stresses than those attached at distal sites. However, scaffold length, rather than bone terminal location, most strongly influences peak stress. For each scaffold terminal placement configuration, a basic metric was computed indicative of bone fracture risk. This metric was the minimum distance from the bone surface to the internal scaffold bone terminal. Analysis of this minimum bone thickness data confirmed further optimisation of terminal locations is warranted., Competing Interests: The authors have declared that no competing interests exist.

Treatment of acute ischemic stroke has been recently improved with the introduction of endovascular mechanical thrombectomy, a minimally invasive procedure able to remove a clot using aspiration devices and/or stent-retrievers. Despite the promising and encouraging results, improvements to the procedure and to the stent design are the focus of the recent efforts. Computational studies can pave the road to these improvements, providing their ability to describe and accurately reproduce a real procedure. A patient with ischemic stroke due to intracranial large vessel occlusion was selected and after the creation of the cerebral vasculature from computed tomography images and a histologic analysis to determine the clot composition, the entire thrombectomy procedure was virtually replicated. As in the real situation, the computational replica showed that two attempts were necessary to remove the clot, as a result of the position of the stent retriever with respect to the clot. Furthermore, the results indicated that clot fragmentation did not occur as the deformations were mainly in a compressive state without the possibility for clot cracks to propagate. The accurate representation of the procedure can be used as an important step for operative optimization planning and future improvements of stent designs., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The aim of this work is to propose a methodology for identifying relationships between morphological features of the cerebral vasculature and the outcome of in silico simulations of thrombectomy, the mechanical treatment for acute ischemic stroke. Fourteen patient-specific cerebral vasculature segmentations were collected and used for geometric characterization of the intracranial arteries mostly affected by large vessel occlusions, i.e., internal carotid artery (ICA), middle cerebral artery (MCA) and anterior cerebral artery (ACA). First, a set of global parameters was created, including the geometrical information commonly provided in the clinical context, namely the total length, the average diameter and the tortuosity (length over head-tail distance) of the intracranial ICA. Then, a more exhaustive geometrical analysis was performed to collect a set of local parameters . A total of 27 parameters was measured from each patient-specific vascular configuration. Fourteen virtual thrombectomy simulations were performed with a blood clot with the same length and composition placed in the middle of the MCA. The model of TREVO ProVue stent-retriever was used for all the simulations. Results from simulations produced five unsuccessful outcomes, i.e., the clot was not removed from the vessels. The geometric parameters of the successful and unsuccessful simulations were compared to find relations between the vascular geometry and the outcome. None of the global parameters alone or combined proved able to discriminate between positive and negative outcome, while a combination of local parameters allowed to correctly identify the successful from the unsuccessful simulations. Although these results are limited by the number of patients considered, this study indicates a promising methodology to relate patient-specific geometry to virtual thrombectomy outcome, which might eventually guide decision making in the treatment of acute ischemic stroke., Competing Interests: HM reports co-founder and shareholder of Nico.lab, a company that focuses on the use of artificial intelligence for medical image analysis. CM received funds from the European Commission (related to this project, paid to institution); and from CVON/Dutch Heart Foundation, Stryker, TWIN Foundation, Health Evaluation Program Netherlands (unrelated; all paid to institution). CM is shareholder of Nico.lab, a company that focuses on the use of artificial intelligence for medical imaging analysis. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Bridio, Luraghi, Rodriguez Matas, Dubini, Giassi, Maggio, Kawamoto, Moerman, McGarry, Konduri, Arrarte Terreros, Marquering, van Bavel, Majoie and Migliavacca.)

Mechanical thrombectomy can be significantly affected by the mechanical properties of the occluding thrombus. In this study, we provide the first characterisation of the volumetric behaviour of blood clots. We propose a new hyperelastic model for the volumetric and isochoric deformation of clot. We demonstrate that the proposed model provides significant improvements over established models in terms of accurate prediction of nonlinear stress-strain and volumetric behaviours of clots with low and high red blood cell compositions. We perform a rigorous investigation of the factors that govern clot occlusion of a tapered vessel. The motivation for such an analysis is twofold: (i) the role of clot composition on the in vivo occlusion location is an open clinical question that has significant implications for thrombectomy procedures; (ii) in vitro measurement of occlusion location in an engineered tapered tube can be used as a quick and simple methodology to assess the mechanical properties/compositions of clots. Simulations demonstrate that both isochoric and volumetric behaviours of clots are key determinants of clot lodgement location, in addition to clot-vessel friction. The proposed formulation is shown to provide accurate predictions of in vitro measurement of clot occlusion location in a silicone tapered vessel, in addition to accurately predicting the deformed shape of the clot., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Medical devices, such as silicone-based prostheses designed for soft tissue implantation, often induce a suboptimal foreign-body response which results in a hardened avascular fibrotic capsule around the device, often leading to patient discomfort or implant failure. Here, it is proposed that additive manufacturing techniques can be used to deposit durable coatings with multiscale porosity on soft tissue implant surfaces to promote optimal tissue integration. Specifically, the "liquid rope coil effect", is exploited via direct ink writing, to create a controlled macro open-pore architecture, including over highly curved surfaces, while adapting atomizing spray deposition of a silicone ink to create a microporous texture. The potential to tailor the degree of tissue integration and vascularization using these fabrication techniques is demonstrated through subdermal and submuscular implantation studies in rodent and porcine models respectively, illustrating the implant coating's potential applications in both traditional soft tissue prosthetics and active drug-eluting devices., (© 2021 The Authors. Advanced Healthcare Materials published by Wiley-VCH GmbH.)

Regional variance in human aortic bioarchitecture responsible for the elasticity of the vessel is poorly understood. The current study quantifies the elements responsible for aortic compliance, namely, elastin, collagen and smooth muscle cells, using histological and stereological techniques on human tissue with a focus on regional heterogeneity. Using donated cadaveric tissue, a series of samples were excised between the proximal ascending aorta and the distal abdominal aorta, for five cadavers, each of which underwent various staining procedures to enhance specific constituents of the wall. Using polarised light microscopy techniques, the orientation of collagen fibres was studied for each location and each tunical layer of the aorta. Significant transmural and longitudinal heterogeneity in collagen fibre orientations were uncovered throughout the vessel. It is shown that a von Mises mixture model is required accurately to fit the complex collagen fibre distributions that exist along the aorta. Additionally, collagen and smooth muscle cell density was observed to increase with increasing distance from the heart, whereas elastin density decreased. Evidence clearly demonstrates that the aorta is a highly heterogeneous vessel which cannot be simplistically represented by a single compliance value. The quantification and fitting of the regional aortic bioarchitectural data, although not without its limitations, including mean cohort age of 77.6 years, facilitates the development of next-generation finite element models that can potentially simulate the influence of regional aortic composition and microstructure on vessel biomechanics., (© 2019 Anatomical Society.)

Effective prosthetic socket design following lower limb amputation depends upon the accurate characterization of the shape of the residual limb as well as its volume and shape fluctuations., Objective: This study proposes a novel framework for the measurement and analysis of residual limb shape and deformation, using a high-resolution and low-cost system., Methods: A multi-camera system was designed to capture sets of simultaneous images of the entire residuum surface. The images were analyzed using a specially developed open-source three-dimensional digital image correlation (3D-DIC) toolbox, to obtain the accurate time-varying shapes as well as the full-field deformation and strain maps on the residuum skin surface. Measurements on a transtibial amputee residuum were obtained during knee flexions, muscle contractions, and swelling upon socket removal., Results: It was demonstrated that 3D-DIC can be employed to quantify with high resolution time-varying residuum shapes, deformations, and strains. Additionally, the enclosed volumes and cross-sectional areas were computed and analyzed., Conclusion: This novel low-cost framework provides a promising solution for the in vivo evaluation of residuum shapes and strains, as well as has the potential for characterizing the mechanical properties of the underlying soft tissues., Significance: These data may be used to inform data-driven computational algorithms for the design of prosthetic sockets, as well as of other wearable technologies mechanically interfacing with the skin.

Ultrasound is a cost-effective, readily available, and non-ionizing modality for musculoskeletal imaging. Though some research groups have pursued methods that involve submerging the transducer and imaged body segment into a water bath, many limitations remain in regards to acquiring an unloaded volumetric image of an entire human limb in a fast, safe, and adequately accurate manner. A 3D dataset of a limb is useful in several rehabilitative applications including biomechanical modeling of soft tissue, prosthetic socket design, monitoring muscle condition and disease progression, bone health, and orthopedic surgery. This paper builds on previous work from our group and presents the design, prototyping, and preliminary testing of a novel multi-modal imaging system for rapidly acquiring volumetric ultrasound imagery of human limbs, with a particular focus on residual limbs for improved prosthesis design. Our system employs a mechanized water tank setup to scan a limb with a clinical ultrasound transducer and 3D optical imagery to track motion during a scan. The iterative closest point algorithm is utilized to compensate for motion and stitch the images into a final dataset. The results show preliminary 2D and 3D imaging of both a tissue-mimicking phantom and residual limbs. A volumetric error compares the ultrasound image data obtained to a previous MRI method. The results indicate potential for future clinical implementation. Concepts presented in this paper could reasonably transfer to other imaging applications such as acoustic tomography, where motion artifact may distort image reconstruction.

Pressure ulcers occur due to sustained mechanical loading. Deep tissue injury is a severe type of pressure ulcer, which is believed to originate in subcutaneous tissues adjacent to bony prominences. In previous experimental-numerical studies the relationship between internal tissue state and damage development was investigated using a 2D analysis. However, recent studies suggest that a local analysis is not sufficient. In the present study we developed a method to create animal-specific 3D finite element models of an indentation test on the tibialis anterior muscle of rats based on MRI data. A detailed description on how the animal specific models are created is given. Furthermore, two indenter geometries are compared and the influence of errors in determining the indenter orientation on the resulting internal strain distribution in a defined volume of tissue was investigated. We conclude that with a spherically-shaped indenter errors in estimating the indenter orientation do not unduly influence the results of the simulation.

Low back pain is a major cause of disability and requires the development of new devices to treat pathologies and improve prognosis following surgery. Understanding the effects of new devices on the biomechanics of the spine is crucial in the development of new effective and functional devices. The aim of this study was to develop a preliminary parametric, scalable and anatomically accurate finite-element model of the lumbar spine allowing for the evaluation of the performance of spinal devices. The principal anatomical surfaces of the lumbar spine were first identified, and then accurately fitted from a previous model supplied by S14 Implants (Bordeaux, France). Finally, the reconstructed model was defined according to 17 parameters which are used to scale the model according to patient dimensions. The developed model, available as a toolbox named the lumbar model generator, enables generating a population of models using subject-specific dimensions obtained from data scans or averaged dimensions evaluated from the correlation analysis. This toolbox allows patient-specific assessment, taking into account individual morphological variation. The models have applications in the design process of new devices, evaluating the biomechanics of the spine and helping clinicians when deciding on treatment strategies., (© 2018 The Author(s).)

This article describes the motivation, design, and progress of the Journal of Open Source Software (JOSS). JOSS is a free and open-access journal that publishes articles describing research software. It has the dual goals of improving the quality of the software submitted and providing a mechanism for research software developers to receive credit. While designed to work within the current merit system of science, JOSS addresses the dearth of rewards for key contributions to science made in the form of software. JOSS publishes articles that encapsulate scholarship contained in the software itself, and its rigorous peer review targets the software components: functionality, documentation, tests, continuous integration, and the license. A JOSS article contains an abstract describing the purpose and functionality of the software, references, and a link to the software archive. The article is the entry point of a JOSS submission, which encompasses the full set of software artifacts. Submission and review proceed in the open, on GitHub. Editors, reviewers, and authors work collaboratively and openly. Unlike other journals, JOSS does not reject articles requiring major revision; while not yet accepted, articles remain visible and under review until the authors make adequate changes (or withdraw, if unable to meet requirements). Once an article is accepted, JOSS gives it a digital object identifier (DOI), deposits its metadata in Crossref, and the article can begin collecting citations on indexers like Google Scholar and other services. Authors retain copyright of their JOSS article, releasing it under a Creative Commons Attribution 4.0 International License. In its first year, starting in May 2016, JOSS published 111 articles, with more than 40 additional articles under review. JOSS is a sponsored project of the nonprofit organization NumFOCUS and is an affiliate of the Open Source Initiative (OSI)., Competing Interests: Daniel S. Katz is an Academic Editor for PeerJ CS. Abigail Cabunoc Mayes is an employee of Mozilla Foundation. Tracy K. Teal is an employee of Data Carpentry., (© Copyright 2018 Smith et al.)

Objective: The purpose of this manuscript is to compute skin strain data from a flexed biological limb, using portable, inexpensive, and easily available resources., Methods: We apply and evaluate this approach on a person with bilateral transtibial amputations, imaging left and right residual limbs in extended and flexed knee postures. We map 3-D deformations to a flexed biological limb using freeware and a simple point-and-shoot camera. Mean principal strain, maximum shear strain, as well as lines of maximum, minimum, and nonextension are computed from 3-D digital models to inform directional mappings of the strain field for an unloaded residual limb., Results: Peak tensile strains are ∼0.3 on the anterior surface of the knee in the proximal region of the patella, whereas peak compressive strains are ∼ -0.5 on the posterior surface of the knee. Peak maximum shear strains are ∼0.3 on the posterior surface of the knee. The accuracy and precision of this methodology are assessed for a ground-truth model. The mean point location distance is found to be 0.08 cm, and the overall standard deviation for point location difference vectors is 0.05 cm., Conclusion: This low-cost and mobile methodology may prove critical for applications such as the prosthetic socket interface where whole-limb skin strain data are required from patients in the field outside of traditional, large-scale clinical centers., Significance: Such data may inform the design of wearable technologies that directly interface with human skin.

Pressure ulcers are a type of local soft tissue injury due to sustained mechanical loading and remain a common issue in patient care. People with spinal cord injury (SCI) are especially at risk of pressure ulcers due to impaired mobility and sensory perception. The development of load improving support structures relies on realistic tissue load evaluation e.g. using finite element analysis (FEA). FEA requires realistic subject-specific mechanical properties and geometries. This study focuses on the effect of geometry. MRI is used for the creation of geometrically accurate models of the human buttock for three able-bodied volunteers and three volunteers with SCI. The effect of geometry on observed internal tissue deformations for each subject is studied by comparing FEA findings for equivalent loading conditions. The large variations found between subjects confirms the importance of subject-specific FEA.

Deformation of skeletal muscle in the proximity of bony structures may lead to deep tissue injury category of pressure ulcers. Changes in mechanical properties have been proposed as a risk factor in the development of deep tissue injury and may be useful as a diagnostic tool for early detection. MRE allows for the estimation of mechanical properties of soft tissue through analysis of shear wave data. The shear waves originate from vibrations induced by an external actuator placed on the tissue surface. In this study a combined Magnetic Resonance (MR) compatible indentation and MR Elastography (MRE) setup is presented to study mechanical properties associated with deep tissue injury in rats. The proposed setup allows for MRE investigations combined with damage-inducing large strain indentation of the Tibialis Anterior muscle in the rat hind leg inside a small animal MR scanner. An alginate cast allowed proper fixation of the animal leg with anatomical perfect fit, provided boundary condition information for FEA and provided good susceptibility matching. MR Elastography data could be recorded for the Tibialis Anterior muscle prior to, during, and after indentation. A decaying shear wave with an average amplitude of approximately 2 μm propagated in the whole muscle. MRE elastograms representing local tissue shear storage modulus Gd showed significant increased mean values due to damage-inducing indentation (from 4.2 ± 0.1 kPa before to 5.1 ± 0.6 kPa after, p<0.05). The proposed setup enables controlled deformation under MRI-guidance, monitoring of the wound development by MRI, and quantification of tissue mechanical properties by MRE. We expect that improved knowledge of changes in soft tissue mechanical properties due to deep tissue injury, will provide new insights in the etiology of deep tissue injuries, skeletal muscle damage and other related muscle pathologies., Competing Interests: The authors have declared that no competing interests exist.

Although the socket is critical in a prosthetic system for a person with limb amputation, the methods of its design are largely artisanal. A roadblock for a repeatable and quantitative socket design process is the lack of predictive and patient specific biomechanical models of the residuum. This study presents the evaluation of such a model using a combined experimental-numerical approach. The model geometry and tissue boundaries are derived from magnetic resonance imaging (MRI). The soft tissue non-linear elastic and viscoelastic mechanical behavior was evaluated using inverse finite element analysis (FEA) of in-vivo indentation experiments. A custom designed robotic in-vivo indentation system was used to provide a rich experimental data set of force versus time at 18 sites across a limb. During FEA, the tissues were represented by two layers, namely the skin-adipose layer and an underlying muscle-soft tissue complex. The non-linear elastic behavior was modeled using 2nd order Ogden hyperelastic formulations, and viscoelasticity was modeled using the quasi-linear theory of viscoelasticity. To determine the material parameters for each tissue, an inverse FEA based optimization routine was used that minimizes the combined mean of the squared force differences between the numerical and experimental force-time curves for indentations at 4 distinct anatomical regions on the residuum. The optimization provided the following material parameters for the skin-adipose layer: [c=5.22kPam=4.79γ=3.57MPaτ=0.32s] and for the muscle-soft tissue complex [c=5.20kPam=4.78γ=3.47MPaτ=0.34s]. These parameters were evaluated to predict the force-time curves for the remaining 14 anatomical locations. The mean percentage error (mean absolute error/ maximum experimental force) for these predictions was 7±3%. The mean percentage error at the 4 sites used for the optimization was 4%., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

This paper discusses tension-compression asymmetry properties of Ogden hyperelastic formulations. It is shown that if all negative or all positive Ogden coefficients are used, tension-compression asymmetry occurs the degree of which cannot be separately controlled from the degree of non-linearity. A simple hybrid form is therefore proposed providing separate control over the tension-compression asymmetry. It is demonstrated how this form relates to a newly introduced generalised strain tensor class which encompasses both the tension-compression asymmetric Seth-Hill strain class and the tension-compression symmetric Bažant strain class. If the control parameter is set to q=0.5 a tension-compression symmetric form involving Bažant strains is obtained with the property Ψ(λ1,λ2,λ3)=Ψ(1λ1,1λ2,1λ3). The symmetric form may be desirable for the definition of ground matrix contributions in soft tissue modelling allowing all deviation from the symmetry to stem solely from fibrous reinforcement. Such an application is also presented demonstrating the use of the proposed formulation in the modelling of the non-linear elastic and transversely isotropic behaviour of skeletal muscle tissue in compression (the model implementation and fitting procedure have been made freely available). The presented hyperelastic formulations may aid researchers in independently controlling the degree of tension-compression asymmetry from the degree of non-linearity, and in the case of anisotropic materials may assist in determining the role played by, either the ground matrix, or the fibrous reinforcing structures, in generating asymmetry., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Incisional hernia is a severe complication post-laparoscopic/laparotomy surgery that is commonly associated with the linea alba. However, the few studies on the mechanical properties of the linea alba in the literature appear contradictory, possible due to challenges with the physical dimensions of samples and variations in protocol. This study focuses on the tensile mechanical characterisation of the porcine linea alba, as determined by uniaxial and equi-load biaxial testing using image-based strain measurement methods. Results show that the linea alba demonstrated a non-linear elastic, anisotropic behaviour which is often observed in biological soft tissues. The transverse direction (parallel to fibres) was found to be approximately eight times stiffer than the longitudinal (cross-fibre) direction under both uniaxial and equi-load biaxial loading. The equi-load biaxial tensile tests revealed that contraction could occur in the transverse direction despite increasing load, probably due to the anisotropy of the tissue. Optical surface marker tracking and digital image correlation methods were found to greatly improve the accuracy of stretch measurement, resulting in a 75% change in the apparent stiffness compared to using strain derived from machine cross-head displacement. Additionally, a finite element model of the experiments using a combination of an Ogden and fibre exponential power law model for the linea alba was implemented to quantify the effect of clamping and tissue dimensions (which are suboptimal for tensile testing) on the results. The preliminary model results were used to apply a correction factor to the uniaxial experimental data prior to inverse optimisation to derive best fit material parameters for the fibre reinforced Ogden model. Application of the model to the equi-load biaxial case showed some differences compared to the experimental data, suggesting a more complex anisotropic model may be necessary to capture biaxial behaviour. These results provide an improved assessment of the mechanical properties of the porcine linea alba for wound closure and other studies., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Appropriate mechanical representation of passive muscle tissue is crucial for human body impact modelling. In this paper the experimental and modelling results of compressive loading of freshly slaughtered porcine muscle samples using a drop-tower testing rig are reported. Fibre and cross-fibre compression tests at strain rates varying from 11,600%/s to 37,800%/s were performed. Experimental results show a nonlinear stress-stretch relationship as well as a clear rate dependency of the stress. The mean (standard deviation) engineering stress in the fibre direction at a stretch of 0.7 was 22.47 kPa (5.34 kPa) at a strain rate of 22,000%/s and 38.11k Pa (5.41 kPa) at a strain rate of 37,800%/s. For the cross-fibre direction, the engineering stresses were 5.95 kPa (1.12 kPa) at a strain rate of 11,600%/s, 25.52 kPa (5.12 kPa) at a strain rate of 22,000%/s and 43.66 kPa (6.62 kPa) at a strain rate of 37,800%/s. Significant local strain variations were observed, as well as an average mass loss of 8% due to fluid exudation, highlighting the difficulties in these kinds of tests. The inverse analysis shows for the first time that the mechanical response in terms of both applied load and tissue deformation for each of the strain rates can be captured using a 1st order Ogden hyperelastic material law extended with a three-term quasilinear viscoelastic (QVL) expansion to model viscoelastic effects. An optimisation procedure was used to derive optimal material parameters for which the error in the predicted boundary condition force at maximum compression was less than 3% for all three rates of testing (11,600%/s, 22,000%/s and 37,800%/s). This model may be appropriate for whole body impact modelling at these rates., (© 2013 Elsevier Ltd. All rights reserved.)

Passive skeletal muscle derives its structural response from the combination of the titin filaments in the muscle fibres, the collagen fibres in the connective tissue and incompressibility due to the high fluid content. Experiments have shown that skeletal muscle tissue presents a highly asymmetrical three-dimensional behaviour when passively loaded in tension or compression, but structural models predicting this are not available. The objective of this paper is to develop a mathematical model to study the internal mechanisms which resist externally applied deformation in skeletal muscle bulk. One cylindrical muscle fibre surrounded by connective tissue was considered. The collagenous fibres of the endomysium and perimysium were grouped and modelled as tension-only oriented wavy helices wrapped around the muscle fibre. The titin filaments are represented as non-linear tension-only springs. The model calculates the force developed by the titin molecules and the collagen network when the muscle fibre undergoes an isochoric along-fibre stretch. The model was evaluated using a range of literature based input parameters and compared to the experimental fibre-direction stress-stretch data available. Results show the fibre direction non-linearity and tension/compression asymmetry are partially captured by this structural model. The titin filament load dominates at low tensile stretches, but for higher stretches the collagen network was responsible for most of the stiffness. The oblique and initially wavy collagen fibres account for the non-linear tensile response since, as the collagen fibres are being recruited, they straighten and re-orient. The main contribution of the model is that it shows that the overall compression/tension response is strongly influenced by a pressure term induced by the radial component of collagen fibre stretch acting on the incompressible muscle fibre. Thus for along-fibre tension or compression the model predicts that the collagen network contributes to overall muscle stiffness through two different mechanisms: (1) a longitudinal force directly opposing tension and (2) a pressure force on the muscle fibres resulting in an indirect longitudinal load. Although the model presented considers only a single muscle fibre and evaluation is limited to along-fibre loading, this is the first model to propose these two internal mechanisms for resisting externally applied deformation of skeletal muscle tissue., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

MRI is an ideal method for non-invasive soft tissue mechanical properties investigation. This requires mechanical excitation of the body's tissues and measurement of the corresponding boundary conditions such as soft tissue deformation inside the MRI environment. However, this is technically difficult since load application and measurement of boundary conditions requires MRI compatible actuators and sensors. This paper describes a novel MRI compatible computer controlled soft tissue indentor and optical Fibre Bragg Grating (FBG) force sensor. The high acquisition rate (100Hz) force sensor was calibrated for forces up to 15N and demonstrated a maximum error of 0.043N. Performance and MRI compatibility of the devices was verified using indentation tests on a silicone gel phantom and the upper arm of a volunteer. The computer controlled indentor provided a highly repeatable tissue deformation. Since the indentor and force sensor are composed of non-ferromagnetic materials, they are MRI compatible and no artefacts or temporal SNR reductions were observed. In a phantom study the mean and standard deviation of the temporal SNR levels without the indentor present were 500.18 and 207.08, respectively. With the indentor present the mean and standard deviation were 501.95 and 200.45, respectively. This computer controlled MRI compatible soft tissue indentation system with an integrated force sensor has a broad range of applications and will be used in the future for the non-invasive analysis of the mechanical properties of skeletal muscle tissue., (Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.)

Object: This study proposes a scale space based algorithm for automated segmentation of single-shot tagged images of modest SNR. Furthermore the algorithm was designed for analysis of discontinuous or shearing types of motion, i.e. segmentation of broken tag patterns., Materials and Methods: The proposed algorithm utilises non-linear scale space for automatic segmentation of single-shot tagged images. The algorithm's ability to automatically segment tagged shearing motion was evaluated in a numerical simulation and in vivo. A typical shearing deformation was simulated in a Shepp-Logan phantom allowing for quantitative evaluation of the algorithm's success rate as a function of both SNR and the amount of deformation. For a qualitative in vivo evaluation tagged images showing deformations in the calf muscles and eye movement in a healthy volunteer were acquired., Results: Both the numerical simulation and the in vivo tagged data demonstrated the algorithm's ability for automated segmentation of single-shot tagged MR provided that SNR of the images is above 10 and the amount of deformation does not exceed the tag spacing. The latter constraint can be met by adjusting the tag delay or the tag spacing., Conclusion: The scale space based algorithm for automatic segmentation of single-shot tagged MR enables the application of tagged MR to complex (shearing) deformation and the processing of datasets with relatively low SNR.

The passive mechanical properties of muscle tissue are important for many biomechanics applications. However, significant gaps remain in our understanding of the three-dimensional tensile response of passive skeletal muscle tissue to applied loading. In particular, the nature of the anisotropy remains unclear and the response to loading at intermediate fibre directions and the Poisson's ratios in tension have not been reported. Accordingly, tensile tests were performed along and perpendicular to the muscle fibre direction as well as at 30°, 45° and 60° to the muscle fibre direction in samples of Longissimus dorsi muscle taken from freshly slaughtered pigs. Strain was measured using an optical non-contact method. The results show the transverse or cross fibre (TT') direction is broadly linear and is the stiffest (77 kPa stress at a stretch of 1.1), but that failure occurs at low stretches (approximately λ=1.15). In contrast the longitudinal or fibre direction (L) is nonlinear and much less stiff (10 kPa stress at a stretch of 1.1) but failure occurs at higher stretches (approximatelyλ=1.65). An almost sinusoidal variation in stress response was observed at intermediate angles. The following Poisson's ratios were measured: VLT=VLT'=0.47, VTT'=0.28 and VTL=0.74. These observations have not been previously reported and they contribute significantly to our understanding of the three dimensional deformation response of skeletal muscle tissue., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Purpose: Typically spatial modulation of the magnetization (SPAMM) tagged magnetic resonance imaging (MRI) requires many repeated motion cycles limiting the applicability to highly repeatable tissue motions only. This paper describes the validation of a novel SPAMM tagged MRI and post-processing framework for the measurement of complex and dynamic 3D soft tissue deformation following just three motion cycles. Techniques are applied to indentation induced deformation measurement of the upper arm and a silicone gel phantom., Methods: A SPAMM tagged MRI methodology is presented allowing continuous (3.3-3.6 Hz) sampling of 3D dynamic soft tissue deformation using non segmented 3D acquisitions. The 3D deformation is reconstructed by the combination of three mutually orthogonal tagging directions, thus requiring only three repeated motion cycles. In addition a fully automatic post-processing framework is presented employing Gabor scale-space and filter-bank analysis for tag extrema segmentation and triangulated surface fitting aided by Gabor filter bank derived surface normals. Deformation is derived following tracking of tag surface triplet triangle intersections. The dynamic deformation measurements were validated using indentation tests (∼20 mm deep at 12 mm/s) on a silicone gel soft tissue phantom containing contrasting markers which provide a reference measure of deformation. In addition, the techniques were evaluated in vivo for dynamic skeletal muscle tissue deformation measurement during indentation of the biceps region of the upper arm in a volunteer., Results: For the phantom and volunteer tag point location precision were 44 and 92 μm, respectively resulting in individual displacements precisions of 61 and 91 μm, respectively. For both the phantom and volunteer data cumulative displacement measurement accuracy could be evaluated and the difference between initial and final locations showed a mean and standard deviation of 0.44 and 0.59 mm for the phantom and 0.40 and 0.73 mm for the human data. Finally accuracy of (cumulative) displacement was evaluated using marker tracking in the silicone gel phantom. Differences between true and predicted marker locations showed a mean of 0.35 mm and a standard deviation of 0.63 mm., Conclusions: A novel SPAMM tagged MRI and fully automatic post-processing framework for the measurement of complex 3D dynamic soft tissue deformation following just three repeated motion cycles was presented. The techniques demonstrate dynamic measurement of complex 3D soft tissue deformation at subvoxel accuracy and precision and were validated for 3.3-3.6 Hz sampling of deformation speeds up to 12 mm/s.

Purpose: This study presents and validates a novel (non-ECG-triggered) MRI sequence based on spatial modulation of the magnetization (SPAMM) to noninvasively measure 3D (quasistatic) soft tissue deformations using only six acquisitions (three static and three indentations). In the current SPAMM tagged MRI approaches, data are typically constructed from many repeated motion cycles. This has so far restricted its application to the measurement of highly repeatable and periodic movements (e.g., cardiac deformation). In biomechanical applications where soft tissue deformation is artificially induced, often by indentation, significant repeatability constraints exist, and for clinical applications, discomfort and health issues generally preclude a large number of repetitions., Methods: A novel (non-ECG-triggered) SPAMM tagged MRI sequence is presented, whereby a single 1-1 (first order) SPAMM set is acquired following a 3D transient field echo acquisition. Full 3D deformation measurement is achieved through the combination of only six acquisitions (three static and three motion cycles). The 3D deformation measurements were validated using quasistatic indentation tests and marker tracking in a silicone gel soft tissue phantom. In addition, the technique's ability to measure 3D soft tissue deformation in vivo was evaluated using indentation of the biceps region of the upper arm in a volunteer., Results: Following comparison to marker tracking in the silicone gel phantom, the SPAMM tagged MRI based displacement measurement demonstrated subvoxel accuracy with a mean displacement difference of 72 microm and a standard deviation of 289 microm. In addition, precision of displacement magnitude was evaluated for both the phantom and the volunteer data. The standard deviations of the displacement magnitude with respect to the average displacement magnitude were 75 and 169 microm for the phantom and volunteer data, respectively., Conclusions: The subvoxel accuracy and precision demonstrated in the phantom in combination with the precision comparison between the phantom and the volunteer data provide confidence in the methods presented for measurement of soft tissue deformation in vivo. To the author's knowledge, since only six acquisitions are required, the presented methodology is the fastest SPAMM tagged MRI method currently available for the noninvasive measurement of quasistatic 3D soft tissue deformation.

The mechanical properties of human soft tissue are crucial for impact biomechanics, rehabilitation engineering, and surgical simulation. Validation of these constitutive models using human data remains challenging and often requires the use of non-invasive imaging and inverse finite element (FE) analysis. Post-processing data from imaging methods such as tagged magnetic resonance imaging (MRI) can be challenging. Digital image correlation (DIC), however, is a relatively straightforward imaging method. DIC has been used in the past to study the planar and superficial properties of soft tissue and excised soft tissue layers. However, DIC has not been used to non-invasive study of the bulk properties of human soft tissue in vivo. Thus, the goal of this study was to assess the use of DIC in combination with FE modelling to determine the bulk material properties of human soft tissue. Indentation experiments were performed on a silicone gel soft tissue phantom. A two camera DIC setup was then used to record the 3D surface deformation. The experiment was then simulated using a FE model. The gel was modelled as Neo-Hookean hyperelastic, and the material parameters were determined by minimising the error between the experimental and FE data. The iterative FE analysis determined material parameters (micro=1.80kPa, K=2999kPa) that were in close agreement with parameters derived independently from regression to uniaxial compression tests (micro=1.71kPa, K=2857kPa). Furthermore the FE model was capable of reproducing the experimental indentor force as well as the surface deformation found (R(2)=0.81). It was therefore concluded that a two camera DIC configuration combined with FE modelling can be used to determine the bulk mechanical properties of materials that can be represented using hyperelastic Neo-Hookean constitutive laws.