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Concussion in professional football: brain responses by finite element analysis: part 9.

OBJECTIVE: Brain responses from concussive impacts in National Football League football games were simulated by finite element analysis using a detailed anatomic model of the brain and head accelerations from laboratory reconstructions of game impacts. This study compares brain responses with physician determined signs and symptoms of concussion to investigate tissue-level injury mechanisms. METHODS: The Wayne State University Head Injury Model (Version 2001) was used because it has fine anatomic detail of the cranium and brain with more than 300,000 elements. It has 15 different material properties for brain and surrounding tissues. The model includes viscoelastic gray and white brain matter, membranes, ventricles, cranium and facial bones, soft tissues, and slip interface conditions between the brain and dura. The cranium of the finite element model was loaded by translational and rotational accelerations measured in Hybrid III dummies from 28 laboratory reconstructions of NFL impacts involving 22 concussions. Brain responses were determined using a nonlinear, finite element code to simulate the large deformation response of white and gray matter. Strain responses occurring early (during impact) and mid-late (after impact) were compared with the signs and symptoms of concussion. RESULTS: Strain concentration "hot spots" migrate through the brain with time. In 9 of 22 concussions, the early strain "hot spots" occur in the temporal lobe adjacent to the impact and migrate to the far temporal lobe after head acceleration. In all cases, the largest strains occur later in the fornix, midbrain, and corpus callosum. They significantly correlated with removal from play, cognitive and memory problems, and loss of consciousness. Dizziness correlated with early strain in the orbital-frontal cortex and temporal lobe. The strain migration helps explain coup-contrecoup injuries. CONCLUSION: Finite element modeling showed the largest brain deformations occurred after the primary head acceleration. Midbrain strain correlated with memory and cognitive problems and removal from play after concussion. Concussion injuries happen during the rapid displacement and rotation of the cranium, after peak head acceleration and momentum transfer in helmet impacts.

Brain Concussion↗

A hip surgery simulator based on patient specific models generated by automatic segmentation.

The use of surgical simulator systems for education and preoperative planning is likely to increase in the future. A natural course of development of these systems is to incorporate patient specific anatomical models. This step requires some kind of segmentation process in which the different anatomical parts are extracted. Anatomical datasets are, however, usually very large and manual processing would be too demanding. Hence, automatic, or semi-automatic, methods to handle this step are required. The framework presented in this paper uses nonrigid registration, based on the morphon method, to automatically segment the hip anatomy and generate models for a hip surgery simulator system.

Computer Simulation↗

Anatomical and physiological models for surgical simulation.

A considerable amount of effort has been aimed towards developing real-time deformable objects for surgical simulation, but very little work has been aimed towards including physiology within the soft tissue models. A simulator that links the structural and functional aspects of the human body would allow the user to develop a better understanding of the intrinsic link between anatomy and physiology. This positional paper discusses the challenges facing the creation of and the development of an integrated physiological and anatomical soft tissue model for use in surgical simulators. It explores the artificial dichotomy between anatomy and physiology and the issues it raises, by considering a suturing simulator capable of modelling ischaemia.

Animals↗

New views of male pelvic anatomy: role of computer-generated 3D images.

There is considerable controversy concerning the role of cadaveric dissection in teaching gross anatomy and the potential of using 3D computer-generated images to substitute for actual laboratory dissections. There are currently few high-quality 3D virtual models of anatomy available to evaluate the utility of computer-generated images. Existing 3D models are frequently of structures that are easily examined in three dimensions by removal from the cadaver, i.e., the heart, skull, and brain. We have focused on developing a 3D model of the pelvis, a region that is conceptually difficult and relatively inaccessible for student dissection. We feel students will benefit tremendously from 3D views of the pelvic anatomy. We generated 3D models of the male pelvic anatomy from hand-segmented color Visible Human Male cryosection data, reconstructed and visualized by Columbia University's in-house 3D Vesalius trade mark Visualizer.(1) These 3D models depict the anatomy of the region in a realistic true-to-life color and texture. They can be used to create 3D anatomical scenes, with arbitrary complexity, where the component anatomical structures are displayed in correct 3D anatomical relationships. Moreover, a sequence of 3D scenes can be defined to simulate actual dissection. Structures can be added in a layered sequence from the bony framework to build from the "inside-out" or disassembled much like a true laboratory dissection from the "outside-in." These 3D reconstructed anatomical models can provide views of the structures from new perspectives and have the potential to improve understanding of the anatomical relationships of the pelvic region (http://www.cellbiology.lsuhsc.edu/People/Faculty/Venuti_Figures/movie_index.html).

Anatomy, Cross-Sectional↗

Computer graphic modeling in surgery.

The application of computer-based solid modeling techniques to human anatomy shows great promise for enhancing surgical instruction and research. Such advances will directly benefit patient care. The increasing availability of powerful modeling programs for the microcomputer and the interactive peripheral technologies make the delivery of this new modality practical at the present time. We continue to refine our methodology for producing accurate and esthetic anatomic models and have developed a technique for three-dimensional "sculpting" of elongated structures. We continue to explore the possibility of using sectional scanning data to create anatomic images. Several applications have been described, ranging from surgical simulations to a ballistic injury model, in order to indicate the potential scope of this powerful technology.

Computer Graphics↗

Giving form to the function of the heart: embedding cellular models in an anatomical framework.

A computational framework is presented for integrating the electrical, mechanical, and biochemical functions of the heart. The construction of efficient finite element representations of canine and porcine ventricular geometry and microstructure is outlined. Computational techniques are applied to solve large deformation soft tissue mechanics by using orthotropic constitutive laws for myocardial tissue and models of active tension generation embedded at the Gauss points in the finite element mesh. The reaction-diffusion equations governing electrical current flow in the heart are solved on a grid of deforming material points that access systems of ordinary differential equations representing the cellular processes underlying the cardiac action potential. Navier-Stokes equations are solved to predict coronary blood flow in a system of branching blood vessels embedded in the deforming myocardium.

Animals↗

Knowledge-based segmentation of thoracic computed tomography images for assessment of split lung function.

The assessment of differential left and right lung function is important for patients under consideration for lung resection procedures such as single lung transplantation. We developed an automated, knowledge-based segmentation algorithm for purposes of deriving functional information from dynamic computed tomography (CT) image data. Median lung attenuation (HU) and area measurements were automatically calculated for each lung from thoracic CT images acquired during a forced expiratory maneuver as indicators of the amount and rate of airflow. The accuracy of these derived measures from fully automated segmentation was validated against those from segmentation using manual editing by an expert observer. A total of 1313 axial images were analyzed from 49 patients. The images were segmented using our knowledge-based system that identifies the chest wall, mediastinum, trachea, large airways and lung parenchyma on CT images. The key components of the system are an anatomical model, an inference engine and image processing routines, and segmentation involves matching objects extracted from the image to anatomical objects described in the model. The segmentation results from all images were inspected by the expert observer. Manual editing was required to correct 183 (13.94%) of the images, and the sensitivity, specificity, and accuracy of the knowledge-based segmentation were greater than 98.55% in classifying pixels as lung or nonlung. There was no significant difference between median lung attenuation or area values from automated and edited segmentations (p > 0.70). Using the knowledge-based segmentation method we can automatically derive indirect quantitative measures of single lung function that cannot be obtained using conventional pulmonary function tests.

Algorithms↗

Network interactions among limbic cortices, basal forebrain, and cerebellum differentiate a tone conditioned as a Pavlovian excitor or inhibitor: fluorodeoxyglucose mapping and covariance structural modeling.

1. The objective was to examine how opposite learned behavioral responses to the same physical tone were differentiated by the pattern of interactions between extraauditory neural regions. This was pursued using a new approach combining behavior, neuroimaging, and network analysis to integrate information about differences in regional activity with differences in the covariance relationships between brain areas. 2. A tone was used as either a Pavlovian conditioned excitor or inhibitor. Rats were conditioned with reinforced trials of a conditioned excitor (A+) intermixed with nonreinforced trials of a tone-light compound (AX-). The tone was the excitor (A+) for the tone-excitor group and was the inhibitor (X-) for the tone-inhibitor group. After conditioning, all rats were injected with [14C(U)]2-fluoro-2-deoxyglucose (FDG) and presented with the same tone. 3. FDG autoradiography was used to measure regional activity and to generate interregional correlations of activity resulting from the presentation of the tone. A stepwise discriminant analysis was used to select brain regions that differentiated the excitor from the inhibitor effects. 4. Network analysis consisted of constructing an anatomic model of the brain regions, selected by the discriminant analysis, linking the regions with their known anatomical connections. Then, functional models for the tone-excitor and -inhibitor groups were constructed using structural equation modeling. Correlations of activity between regions were decomposed to calculate numerical weights, or path coefficients, for each anatomic path. These path coefficients were used to compare the interactions for the tone-excitor and -inhibitor models. 5. Regional differences in FDG uptake were found in the sulcal frontal cortex (SFC), lateral septum (LS), medial septum/diagonal band (MS/DB), retrosplenial cortex (RS), and dentate-interpositus nuclei of the cerebellum (DEN). Discriminant analysis selected three other regions that significantly discriminated the tone-excitor and -inhibitor groups: perirhinal cortex (PRh), nucleus accumbens (ACB), and the anteroventral nucleus of the thalamus (AVN). 6. Structural equation modeling identified two functional circuits that differentiated the groups. One involved the basal forebrain regions (LS, MS/DB, ACB) and the other limbic thalamocortical structures (SFC, RS, PRh, AVN). Differences in the interactions within these circuits were mainly in sign of the covariance relationships between regions, from positive for the tone-excitor model to negative path coefficients for the tone-inhibitor model. The path coefficient between the basal forebrain circuit and the limbic thalamocortical circuit showed the largest magnitude difference. This quantitative difference was mediated by a path from the MS/DB to PRh.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Anatomically based geometric modelling of the musculo-skeletal system and other organs.

Anatomically based finite element geometries are becoming increasingly popular in physiological modelling, owing to the demand for modelling that links organ function to spatially distributed properties at the protein, cell and tissue level. We present a collection of anatomically based finite element geometries of the musculo-skeletal system and other organs suitable for use in continuum analysis. These meshes are derived from the widely used Visible Human (VH) dataset and constitute a contribution to the world wide International Union of Physiological Sciences (IUPS) Physiome Project (www.physiome.org.nz). The method of mesh generation and fitting of tricubic Hermite volume meshes to a given dataset is illustrated using a least-squares algorithm that is modified with smoothing (Sobolev) constraints via the penalty method to account for sparse and scattered data. A technique ("host mesh" fitting) based on "free-form" deformation (FFD) is used to customise the fitted (generic) geometry. Lung lobes, the rectus femoris muscle and the lower limb bones are used as examples to illustrate these methods. Geometries of the lower limb, knee joint, forearm and neck are also presented. Finally, the issues and limitations of the methods are discussed.

Algorithms↗

[Reconstruction, application and evaluation of a finite element method to study the pelvic floor. Preliminary results].

BACKGROUND: To verify the possibility to apply the Finite Element Method of structural analysis (FEM) to the study of pelvis, with particular attention to the ligamental structures linking pubis to the cervix-urethra tract. METHODS: By means of FEMAP and Hypermesh pre-processors, the three-dimensional reconstruction of the anatomical model, has been mathematically made, using photographs of 80 cadaveric pelvis structure cross sections (3 mm one from the next). Then, with the NASTRAN code, the model has been solved. The deflection of the pelvis structures has been simulated and the more stressed anatomical zones have been located studying the distribution of stress in the numerical model. RESULTS: The analysis has pointed out that the most stressed areas of the pelvic floor are the cervix-urethra tract and the perineum trapezium below. The observation of the extent of the displacements, in the simulation of the deflection of the pelvis structures, has pointed out the importance of the role of the ligaments linking pubis to the cervix-urethra tract to distribute the resultant of loads on the pelvis structures in harmonic way. CONCLUSIONS: The results confirm the role of the ligamental structures between pubis and the cervix-urethra tract that, stressed as tie rods, subdivide the global load in the several components, with anterior-lateral direction, showing a non secondary role in the pelvis dynamics. The rational of the reconstruction of such structures in urological surgery is therefore strengthened, in order to restore the anatomical and functional support.

Finite Element Analysis↗

VIP-Man: an image-based whole-body adult male model constructed from color photographs of the Visible Human Project for multi-particle Monte Carlo calculations.

Human anatomical models have been indispensable to radiation protection dosimetry using Monte Carlo calculations. Existing MIRD-based mathematical models are easy to compute and standardize, but they are simplified and crude compared to human anatomy. This article describes the development of an image-based whole-body model, called VIP-Man, using transversal color photographic images obtained from the National Library of Medicine's Visible Human Project for Monte Carlo organ dose calculations involving photons, electron, neutrons, and protons. As the first of a series of papers on dose calculations based on VIP-Man, this article provides detailed information about how to construct an image-based model, as well as how to adopt it into well-tested Monte Carlo codes, EGS4, MCNP4B, and MCNPX.

Adult↗

Hybrid segmentation framework for tissue images containing gene expression data.

Associating specific gene activity with functional locations in the brain results in a greater understanding of the role of the gene. To perform such an association for the over 20,000 genes in the mammalian genome, reliable automated methods that characterize the distribution of gene expression in relation to a standard anatomical model are required. In this work, we propose a new automatic method that results in the segmentation of gene expression images into distinct anatomical regions in which the expression can be quantified and compared with other images. Our method utilizes shape models from training images, texture differentiation at region boundaries, and features of anatomical landmarks, to deform a subdivision mesh-based atlas to fit gene expression images. The subdivision mesh provides a common coordinate system for internal brain data through which gene expression patterns can be compared across images. The automated large-scale annotation will help scientists interpret gene expression patterns at cellular resolution more efficiently.

Algorithms↗

Catheter-based dilation of the sinus ostia: initial safety and feasibility analysis in a cadaver model.

BACKGROUND: Over the past 20 years, many patients have benefited from endoscopic sinus surgery and its ability to relieve sinus obstruction. However, problems still occur with surgery, thereby leaving room for innovation. Recently, catheter-based technology has provided new options for treating cardiac, vascular, and urologic diseases. We speculated that catheter technology also might offer new treatment options for sinusitis patients. The purpose of this investigation was to explore the feasibility and safety of catheter-based technology to relieve sinus ostial obstruction. METHODS: Anatomic models and human cadaver specimens were used initially to design and iterate catheters to open sinus ostial drainage pathways. Thereafter, the safety of balloon-catheter dilation was evaluated in six human cadaver heads. CT scan obtained before and after catheter ostial dilation was analyzed for evidence of catheter-induced trauma. Dilated ostia also were examined by endoscopy and gross anatomic dissection for unwanted catheter-induced trauma. RESULTS: Catheters successfully dilated 31 of 31 ostia, including 9 maxillary, 11 sphenoid, and 11 frontal ostia/recesses. CT scan, endoscopy, and gross anatomic dissection revealed that such dilation did not cause trauma to surrounding structures such as the orbit or skull base. Mucosal trauma imparted by catheter dilation appeared to be less than that normally seen with standard endoscopic instruments. CONCLUSION: This initial study suggests that catheter technology can be used to dilate sinus ostia safely. Mucosal preservation and ease of use make catheters an attractive minimally invasive treatment strategy. Additional testing in patients is indicated to gain additional safety information and to explore the usefulness of catheter-based technology.

Cadaver↗

Learning functional structure from fMR images.

We propose a novel method using Bayesian networks to learn the structure of effective connectivity among brain regions involved in a functional MR experiment. The approach is exploratory in the sense that it does not require an a priori model as in the earlier approaches, such as the Structural Equation Modeling or Dynamic Causal Modeling, which can only affirm or refute the connectivity of a previously known anatomical model or a hypothesized model. The conditional probabilities that render the interactions among brain regions in Bayesian networks represent the connectivity in the complete statistical sense. The present method is applicable even when the number of regions involved in the cognitive network is large or unknown. We demonstrate the present approach by using synthetic data and fMRI data collected in silent word reading and counting Stroop tasks.

Adult↗

The influence of semicircular canal morphology on endolymph flow dynamics. An anatomically descriptive mathematical model.

The classic Steinhausen/Groen mathematical description of endolymph flow in a toroidal semicircular canal is extended to the case where the size, shape, and curvature of the canal lumen change continuously through the duct, utricle, and ampulla. The resulting second-order differential equation has three coefficients, unlike the equation of a torsion pendulum, which has only two. The salient anatomical parameters which determine endolymph motion are: the length of the central streamline occupying the center of the canal lumen; the area enclosed by this streamline as projected into the plane of rotation; the average inverse cross-sectional area of the lumen (taken around the central streamline); and the average inverse squared cross-sectional area, weighted by a local wall shape factor. These parameters are evaluated and the average displacement of the face of the cupula is estimated for the human, guinea pig, and rat, based on new anatomical data presented in companion papers. The model predicts that the dynamic range of human average cupula motion lies between 520 A and 10 microns.

Animals↗

Three-dimensional mapping of temporo-limbic regions and the lateral ventricles in schizophrenia: gender effects.

BACKGROUND: Local alterations in morphological parameters are poorly characterized in several brain regions widely implicated in schizophrenia neuropathology. METHODS: Surface-based anatomical modeling was applied to magnetic resonance data to obtain three-dimensional (3D) average anatomical maps and measures of location, shape, asymmetry, and volume for the lateral ventricles, hippocampus, amygdala, and superior temporal gyrus in schizophrenic (n = 25; 15 male) and normal subjects (n = 28; 15 male) matched for demographic variables. For all regions, intra-group variability was visualized and group differences assessed statistically to discriminate local alterations in anatomy across sex and diagnosis. RESULTS: Posterior hippocampal volumes, lengths, and widths were reduced in patients. The right amygdala showed volume increases in schizophrenia patients versus controls. Ventricular enlargements, pronounced in the left hemisphere, occurred in the superior and lateral dimensions in patients, and these effects interacted with gender. Superior horn anterior extremes, inferior horn volumes, and hippocampal asymmetries exhibited gender effects. Significant group differences were absent in superior temporal gyrus parameters. Finally, regional variability profiles differed across groups. CONCLUSIONS: Clear morphometric differences of the lateral ventricles, hippocampus, and amygdala indicate regional displacements and shape distortions in several functional systems in schizophrenia. Alterations in these structures as mapped in 3D may provide the foundation for establishing brain abnormalities not previously defined at such a local level.

Adult↗

Oral implant treatment planning in a virtual reality environment.

A system for three-dimensional oral implant treatment planning is presented. Virtual reality technologies are used in order to improve the human image interpretation and planning performance. The methods described are based on computer tomography (CT) data of the mandible and of the maxilla. A novel approach to volume rendering and voxel based modelling of implants is introduced which allows interactive three-dimensional manipulation of the anatomic model and real-time manipulation of virtual implants. A spline-based reconstruction method is described to assess the implant site in a clinically oriented view with regard to bone structures and angulation. Two parameters are deduced which represent the bone properties at the surface of implants. While an implant is navigated with six degrees of freedom, these parameters are acoustically rendered which is a novel approach to exploration of spatial bone properties in a CT data set.

Computer Simulation↗

Feasibility and validation of registration of three-dimensional left atrial models derived from computed tomography with a noncontact cardiac mapping system.

OBJECTIVES: The purpose of this study was to determine the feasibility and assess the validity of registering three-dimensional (3D) models from computed tomographic (CT) images using a cardiac mapping system. BACKGROUND: Registration of 3D anatomic models with an interventional system could help identify and navigate mapping and ablation catheters over a complex structure such as the left atrium (LA). METHODS: ECG-gated, contrast-enhanced cardiac CT imaging was performed in 14 patients with atrial fibrillation. Segmentation was used to create 3D models of the LA. The 3D models were registered with the mapping system using a series of fiducial points. Registration was accomplished retrospectively in the first 10 patients, and catheter navigation was visualized from recorded data. In the final four patients, registration was accomplished in real time during electrophysiologic study. The mapping catheter position, as it was navigated inside the LA, was applied to the registered model in real time. For the validation study, temporary pacing leads were implanted in the LA of 10 dogs. Following this, CT scanning, segmentation, LA model importation, and registration was described previously. After registration, a mapping catheter was positioned at the site of each buried lead according to the registered model with no fluoroscopic guidance. A radiofrequency lesion was created at this location, and the dog was sacrificed, the heart removed and stained, and the distance between the buried lead and the lesion measured. RESULTS: During the feasibility study, the location of the catheter in the registered model correlated with fluoroscopy, angiography, and intracardiac electrograms. LA endocardial potentials during sinus rhythm and any premature atrial contractions also were successfully delineated over the registered models. In the validation study, the mean target registration error was 2.0 +/- 3.6 mm. CONCLUSIONS: Registration of CT-derived 3D models of the LA using a cardiac mapping system is feasible and accurate.

Animals↗