Thoracic response to shoulder belt loading: comparison of tabletop and frontal sled tests with PMHS.

OBJECTIVE: The recent refinement of high-rate optical tracking allows dramatically detailed thoracic deformation measurements to be taken during postmortem human subject (PMHS) sled tests. These data allow analysis of restraint belt geometry and the 3-dimensional thoracic deformations generated by belt impingement. One consequence of this new capability is a better understanding of complementary thoracic characterization experiments such as tabletop tests and how the thoracic response can be interpreted for applications involving more complex loading mechanisms. METHODS: This article reports a detailed evaluation of the timing, magnitude, and direction of the applied belt forces and the resulting thoracic deformations in 2 previously performed tests series involving frontal sled tests and tabletop belt-loading tests. RESULTS: In the sled tests, the posteriorly directed component (SAE x) of the belt tension (F(B)) was F(Bx) = 0.70 F(B) at the shoulder but only F(Bx) = 0.14 F(B) where the belt engaged the anterolateral torso inferiorly. The corresponding components on the tabletop were F(Bx) = 0.60 F(B) (shoulder) and F(Bx) = 0.48 F(B) (lower). CONCLUSIONS: When these components are cross-plotted with chest deflection, pronounced consequences of thoracic anterior wall deformation patterns due to flexion of the thoracic spine and the internal viscera's inertia can be seen in the effective thoracic stiffness. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.

Human surrogates for injury biomechanics research.

This article reviews the attributes of the human surrogates most commonly used in injury biomechanics research. In particular, the merits of human cadavers, human volunteers, animals, dummies, and computational models are assessed relative to their ability to characterize the living human response and injury in an impact environment. Although data obtained from these surrogates have enabled biomechanical engineers and designers to develop effective injury countermeasures for occupants and pedestrians involved in crashes, the magnitude of the traffic safety problem necessitates expanded efforts in research and development. This article makes the case that while there are limitations and challenges associated with any particular surrogate, each provides a critical and necessary component in the continued quest to reduce crash-related injuries and fatalities.

Prediction of cervical spine injury risk for the 6-year-old child in frontal crashes.

This article presents a series of 49 km/h sled tests using the Hybrid III 6-year-old dummy in a high-back booster, a low-back booster, and a three-point belt. Although a 10-year review at a level I trauma center showed that noncontact cervical spine injuries are rare in correctly restrained booster-age children, dummy neck loads exceeded published injury thresholds in all tests. The dummy underwent extreme neck flexion during the test, causing full-face contact with the dummy's chest. These dummy kinematics were compared to the kinematics of a 12-year-old cadaver tested in a similar impact environment. The cadaver test showed neck flexion, but also significant thoracic spinal flexion which was nonexistent in the dummy. This comparison was expanded using MADYMO simulations in which the thoracic spinal stiffness of the dummy model was decreased to give a more biofidelic kinematic response. We conclude that the stiff thoracic spine of the dummy results in high neck forces and moments that are not representative of the true injury potential.

Prediction of cervical spine injury risk for the 6-year-old child in frontal crashes.

This paper presents a series of 49 km/h sled tests using the Hybrid III 6-year-old dummy in a high-back booster, a low-back booster, and a three-point belt. Although it is shown that non-contact cervical spine injuries are rare in correctly restrained children in this age group, neck loads exceeded published injury thresholds in all tests. The dummy kinematics were compared to the kinematics of a 12-year-old cadaver tested in a similar impact environment. This comparison was expanded using MADYMO simulations. It is concluded that the stiff thoracic spine of the dummy results in high neck forces and moments that are not representative of the true injury potential.

Retention of supportive properties by eggcrate and foam wheelchair cushions.

This study investigated the reported lack of ability of the eggcrate cushion (EC) to provide wheelchair users with adequate support necessary for comfort and tolerably low-peak sitting pressures over time. The primary parameter used to quantify the ability of the cushion to distribute load was the indention force deflection (IFD) metric. The EC was compared to a high-density planar foam cushion (HD). The IFD was measured for both cushions after successive periods of compression to simulate use. Study results failed to support the common perception that the soft EC would lose its supportive properties more rapidly than the much firmer HD cushion. Although the initial IFD of the EC was much lower than that of the HD, a smaller percentage of its IFD was lost after compression. This difference between the two cushions likely was due to differences in packaging. The EC was rolled into a cylinder, compressing it to 60% of its original thickness; the HD was packaged without compression.

Seat cushion comparison for nursing home wheelchair users.

Finding solutions to the seating problems of nursing home wheelchair users is challenging due to the lack of data regarding the pressure-relieving and comfort performance of wheelchair cushions for this population. This study's goal was to determine whether commercially available seat cushions provide better pressure relief and comfort than do traditionally provided or "makeshift" cushions or pads. Using a repeated measures design, 21 nursing home wheelchair users were enlisted to help evaluate two traditionally provided or "makeshift" cushions or pads and two selected commercially available seat cushions. The peak sitting pressures for 20 subjects were recorded using an Oxford pressure monitor. Twenty-one subjects were asked to score the test cushions' comfort. Due to the somewhat surprising results for the traditionally provided eggcrate cushion, the results fell short of supporting our initial hypothesis. Nevertheless, the study did identify three cushions, the eggcrate, the gel/foam, and the foam, which provided significantly lower peak sitting pressure averages than those recorded for the mix of cushions and pads used by 50 residents in a previous survey. Select commercially available seat cushions can offer nursing home residents lower sitting pressures and increased comfort. Further investigation is required to assess the long-term performance of these and other seat cushions and to explore the predictive benefits of the statistically significant relationship identified between peak sitting pressure and comfort.

Effects of scattered radiation and veiling glare in dual-energy tissue-bone imaging: a theoretical analysis.

Dual-energy subtraction imaging allows tissue and bone structures to be separated from each other and attenuating thicknesses measured. Potential applications include chest imaging, bone mineral measurement, angiography, and mammography. However, intrinsic to most x-ray detectors is the acceptance of scattered radiation as part of the image signal. Added to that is the veiling glare component when an image intensifier is used. Together, they result in erroneous transmission measurement and degrade the accuracy of energy subtraction processing. In this paper, the effects of scattered radiation and veiling glare on energy subtraction images are examined theoretically. A model is derived and used to compute the effects on the thickness signals, image contrast, and image noise as a function of the scatter glare to primary ratios. The ratios were measured on a point-by-point basis for a Rando chest phantom. For 96% of the image field studied, the thickness signals may be subject to an error ranging from 0 to -22.5 cm for tissue and 0 to 5.2 cm for bone. The image contrast in the tissue image may be reduced by a factor ranging from 1 to 59. The percentage of the uncanceled bone signals ranges from -52% to 52%. The contrast-to-noise ratio may be reduced by a factor ranging from 1 to 18.

Pulsed-injection method for blood flow velocity measurement in intraarterial digital subtraction angiography.

The pulsed-injection method for measuring the velocity of blood flow in intraarterial digital subtraction angiography is described. With this technique, contrast material is injected at a pulsing frequency as high as 15 Hz, so that two or more boluses can be imaged simultaneously. The velocity of flow is determined by measuring the spacing between the boluses and multiplying it by the pulsing frequency. Results of tests with phantoms correlate well with flow measurements obtained with a graduated cylinder for velocities ranging from 8 to 60 cm/sec. The potential of the method for time-dependent velocity measurement has been demonstrated with simulated pulsatile flows.

Quantitative digital subtraction angiography: two scanning techniques for correction of scattered radiation and veiling glare. Work in progress.

Scattered radiation and veiling glare in digital subtraction angiography degrade contrast signals in a nonlinear and nonuniform way. This effect prohibits direct use of image data for accurate iodine measurement or energy subtraction imaging. Two techniques based on the use of scanning lead bars were proposed to measure the spatial distribution of scattered radiation and veiling glare in the unprocessed image data. With either technique, signals behind the lead bars were used to estimate the scatter-glare component and remove it from the image data. The scanning-lead-bar techniques can be used to reduce the scatter-glare component by a factor of up to 10. The scatter-glare correction leads to the recovery of degraded contrast signals and achieves reasonable linearity, uniformity, and consistency in the contrast measurement.

A technique of scatter and glare correction for videodensitometric studies in digital subtraction videoangiography.

The logarithmic amplification of video signals and the availability of data in digital form make digital subtraction videoangiography a suitable tool for videodensitometric estimation of physiological quantities. A system for this purpose was implemented with a digital video image processor. However, it was found that the radiation scattering and veiling glare present in the image-intensified video must be removed to make meaningful quantitations. An algorithm to make such a correction was developed and is presented. With this correction, the videodensitometry system was calibrated with phantoms and used to measure the left ventricular ejection fraction of a canine heart.

Computerized fluoroscopy: new technique for the noninvasive evaluation of the aorta, coronary artery bypass grafts, and left ventricular function.

A computerized fluoroscopy system has been developed on the basis of real-time digital processing of x-ray transmission data from traditional image-intensified fluoroscopy equipment. High-quality visualization of any part of the arterial system is obtained following intravenous injection of 0.5 to 0.75 ml/kg of iodinated contrast materials. This report describes the use of this technique to evaluate the aortic arch, left ventricular function, and coronary artery bypass graft patency. Fifty intravenous studies were performed in 25 patients. Among 20 patients with coronary artery bypass grafts, computerized fluoroscopy correctly identified 11 of 15 patent grafts and 11 of 11 occluded grafts as confirmed by standard coronary arteriography in 11 of these patients. Unlike computerized tomography, our technique gives a longitudinal view of the bypass graft much like direct coronary angiography. Aortic arch studies included demonstration of a right aortic arch with a small left subclavian artery, a coarctation, and a normal aortic arch in a trauma patient with a wide mediastinum. Segmental wall motion abnormalities were clearly identified by a modification of the technique which produces a negative outline on the ventriculogram in dyskinetic segments. Ejection fractions may be calculated by determining the amount of iodine in the ventricle in systole and diastole. This technique may also be used to evaluate carotid disease and peripheral vascular disease in patients undergoing coronary artery bypass procedures. Computerized fluoroscopy, therefore, allows evaluation of the entire cardiovascular system by the relatively noninvasive technique of intravenous angiography.

Digital video subtraction angiography for evaluation of peripheral vascular disease.

Digital video subtraction angiography (DVSA) has been employed to study a variety of peripheral vascular problems, using equipment developed at the University of Wisconsin. The technique is relatively simple and safe and has good patient acceptance. Experience indicates that in selected patients it is a satisfactory alternative to standard arteriography for screening and for definitive evaluation and on occasion may yield information not obtainable with conventional methods. It can aid in the performance of transluminal angioplasty and is suitable for serial evaluation of atherosclerotic vessels and bypass grafts.

Three-beam K-edge imaging of iodine using differences between fluoroscopic video images: experimental results.

In an earlier article we discussed the rationale for using differences between video images in three-beam selective iodine K-edge imaging. Rather than combining three initial images Li linearly to yield the final image k1L1 + k2L2 + k3L3, differences between the Li were first generated and then combined either to linear or quadratic order. This approach was motivated by the desire to suppress the large multiplicative biases of fluoroscopic imaging and justified by theoretically proving that k1 + k2 + k3 is approximately equal to 0. In this paper we discuss the instrumentation and experimental results obtained from this difference-based technique. A specially-constructed apparatus is described which automatically selects the optimum combination coefficients and combines the difference images up to quadratic order at realtime video rates. Three methods for generating K-edge subtraction images are compared: the former approach in which the Li are linearly combined and combination of differences to linear and quadratic order. In imaging phantoms in which the iodine distribution is known, the resultant subtraction images from all three methods appear similar. Inspection of signal sizes shows that the quadratic difference-based approach provides superior bone and tissue residual suppression by about a factor of 2. In imaging phantoms in which the iodine distribution is unknown, incomplete suppression of x-ray scatter and image intensifier veiling glare prevent a quantitative comparison of performance of the three algorithms. An experiment verification is provided of the theorem which states that k1 + k2 + k3 is approximately equal to 0.

Computerized fluoroscopy: digital subtraction for intravenous angiocardiography and arteriography.

Computerized fluoroscopy is a system comprising on-line digital time and energy subtraction algorithms designed to isolate and enhance the iodine signal from image intensified fluoroscopy. The apparatus is described and its use for time subtraction intravenous arteriography of the carotid, abdominal, extremely arteries, as well as the heart, is illustrated. Vascular diseases such as stenoses, obstruction, emboli, ulcerative plaques, and aneurysms are readily demonstrated. The technique has a potential for evaluating cardiac motion and the patency of coronary artery bypass grafts. The method appears to be a safe and less expensive alternative to catheter arteriography and angiocardiography in certain instances.

Clinical applications of computerized fluoroscopy: the extracranial carotid arteries.

Preliminary results obtained with a new computerized fluoroscopic apparatus in examination of the extracranial carotid arteries are described. All patients had clinical signs of symptoms of extracranial occlusive vascular disease. In most cases, image quality was sufficient to display patency of the internal carotid arteries, with excellent correlation between intravenous and conventional angiography. While the new technique is not totally noninvasive, it does eliminate many of the risks and costs of conventional arteriography.

A hybrid computerized fluoroscopy technique for noninvasive cardiovascular imaging.

The excellent linearity of digital image storage and retrieval permits hybrid analog-digital subtraction to extend the spatial resolution of two previously developed algorithms which employed entirely digital apparatus. A low resolution, time-integrated preinjection digital mask image is reconverted to analog form and subtracted from live analog video images of iodine administered by peripheral intravenous injection to produce a high resolution display of the cardiovascular system with contrast ten times greater than conventional fluoroscopy. Preliminary studies in dogs are compared with images obtained with our digital subtraction algorithms.

Real-time digital K-edge subtraction fluoroscopy.

We report in vitro and in vivo trials of K-edge fluoroscopy, by which iodine contrast concentration is displayed live, with tissue and bone images suppressed, free of patient-motion artifacts. Iodine and cerium, 125 and 225 mg/cm2 respectively, filter alternate TV fields of cine-pulsed 50 KVP x-rays. Weighted subtraction of successive TV fields isolates the iodine image and simultaneously minimizes artifacts. Digital techniques are used in real time. At our present x-ray tube limit, 500 mA instantaneous current, the patient exposure is 180 mR/sec and quantum mottle limits the image quality. Integrating four successive difference images provides a compromise between mottle and smoothly moving displays. Cardiovascular images of a 17-kg dog, using 1 ml/kg Renografin-60 injected into a foreleg vein, show that a 15-cm chest thickness is our present practical maximum. This method may be useful in diagnosing cardiovascular anomalies in infants without catheterization or suspension of breathing.

Computerized fluoroscopy techniques for intravenous study of cardiac chamber dynamics.

A computerized fluoroscopy system which was recently developed in our laboratories permits image contrast increases of 8-16 relative to conventional image intensifer fluoroscopy and permits study of canine and human ventricular wall motion using peripheral intravenous injections. Two time-dependent image subtraction algorithms are illustrated in connection with observation of artificially infarcted dog hearts. The first algorithm produces a display analogous to direct ventriculography using catheterization. The second displays regions of dyskinetic motion as anomalous image grey shades.