In vivo measurement of breast tissues stiffness using a light aspiration device.

BACKGROUND: This paper addresses the question of the in vivo measurement of breast tissue stiffness, which has been poorly adressed until now, except for elastography imaging which has shown promising results but which is still difficult for clinicians to use on a day-to-day basis. Estimating subject-specific tissue stiffness is indeed a critical area of research due to the development of a large number of Finite Element (FE) breast models for various medical applications. METHODS: This paper proposes to use an original aspiration device, put into contact with breast surface, and to estimate tissue stiffness using an inverse analysis of the aspiration experiment. The method assumes that breast tissue is composed of a bilayered structure made of fatty and fribroglandular tissues (lower layer) superimposed with the skin (upper layer). Young moduli of both layers are therefore estimated based on repeating low intensity suction tests (<40 mbar) of breast tissues using cups of 7 different diameters. FINDINGS: Seven volunteers were involved in this pilot study with average Young moduli of 56.3 kPa  ± 16.4 and 3.04 kPa  ± 1.17 respectively for the skin and the fatty and fibroglandular tissue. The measurements were carried out in a reasonable time scale (<60 min in total) without any discomfort perceived by the participants. These encouraging results should be confirmed in a clinical study that will include a much larger number of volunteers and patients.

30 years of ocular proton therapy, the Nice view.

PURPOSE: Radiotherapy with protons (PT) is a standard treatment of ocular tumors. It achieves excellent tumor control, limited toxicities, and the preservation of important functional outcomes, such as vision. Although PT may appear as one homogenous technique, it can be performed using dedicated ocular passive scattering PT or, increasingly, Pencil Beam Scanning (PBS), both with various degrees of patient-oriented customization. MATERAIAL AND METHODS: MEDICYC PT facility of Nice are detailed with respect to their technical, dosimetric, microdosimetric and radiobiological, patient and tumor-customization process of PT planning and delivery that are key. 6684 patients have been treated for ocular tumors (1991-2020). Machine characteristics (accelerator, beam line, beam monitoring) allow efficient proton extraction, high dose rate, sharp lateral and distal penumbrae, and limited stray radiation in comparison to beam energy reduction and subsequent straggling with high-energy PBS PT. Patient preparation before PT includes customized setup and image-guidance, CT-based planning, and ocular PT software modelling of the patient eye with integration of beam modifiers. Clinical reports have shown excellent tumor control rates (∼95%), vision preservation and limited toxicity rates (papillopathy, retinopathy, neovascular glaucoma, dry eye, madarosis, cataract). RESULTS: Although demanding, dedicated ocular PT has proven its efficiency in achieving excellent tumor control, OAR sparing and patient radioprotection. It is therefore worth adaptations of the equipments and practice. CONCLUSIONS: Some of these adaptations can be transferred to other PT centers and should be acknowledeged when using non-PT options.

Experimental characterisation and modelling of breast Cooper's ligaments.

The aim of this study was to characterise the mechanical behaviour of Cooper's ligaments. Such ligaments are collagenous breast tissue that create a three-dimensional structure over the entire breast volume. Ten ligaments were extracted from a human cadaver, from which 28 samples were cut and used to perform uniaxial tensile tests. Histological analysis showed that the main direction of the fibres visible to the naked eye corresponds to the orientation of the fibres on a microscopic scale. The specimens were cut according to this orientation, which allowed the sample to be stretched in the main fibre direction. From these experimental stretch/stress curves, an original anisotropic hyperelastic constitutive law is proposed to model the behaviour of Cooper's ligaments and the material parameter validity is discussed.

A 60 MeV proton beam-line dedicated to research and development programs.

A new proton beam-line dedicated to R&D programs has been developed at CentreAntoine Lacassagne (CAL), in Nice (France), in collaboration with the Centrenational d'études spatiales (CNES). This is the second beam-line of the MEDICYC 65 MeV cyclotron that is currently in operation, the first being the clinical 'eye-line' used for ocular proton therapy. The R&D beam-line is proposed with two configurations, the first producing a Gaussian narrow beam of a few mm width, the second a 100 mm diameter flat beam with a homogeneity better than ±3%. The energy range is (20 - ∼60) MeV, where the exact upper limit depends on the beam configuration being used. The energy spread of the non-degraded beam is (0.3 ± 0.1) MeV. A beam current between 10 pA and 10 µA can be produced with a stability better than 0.2% above 100 pA, and 2% below. The beam can be monitored online at a precision better than 5% in the flux range 1E5 (1E6) - 1E9 (1E10) p/cm2/s for a flat (Gaussian) configuration, although work is in progress to extend this range. Targeted applications for the R&D beam-line are instrumentation research, radiation tolerance tests of components and radiobiology.

In-vivo tongue stiffness measured by aspiration: Resting vs general anesthesia.

Tongue cancer treatment often results in impaired speech, swallowing, or mastication. Simulating the effect of treatments can help the patient and the treating physician to understand the effects and impact of the intervention. To simulate deformations of the tongue, identifying accurate mechanical properties of tissue is essential. However, not many succeeded in characterizing in-vivo tongue stiffness. Those who did, measured the tongue At Rest (AR), in which muscle tone subsides even if muscles are not willingly activated. We expected to find an absolute rest state in participants 'under General Anesthesia' (GA). We elaborated on previous work by measuring the mechanical behavior of the in-vivo tongue under aspiration using an improved volume-based method. Using this technique, 5 to 7 measurements were performed on 10 participants both AR and under GA. The obtained Pressure-Shape curves were first analyzed using the initial slope and its variations. Hereafter, an inverse Finite Element Analysis (FEA) was applied to identify the mechanical parameters using the Yeoh, Gent, and Ogden hyperelastic models. The measurements AR provided a mean Young's Modulus of 1638 Pa (min 1035 - max 2019) using the Yeoh constitutive model, which is in line with previous ex-vivo measurements. However, while hoping to find a rest state under GA, the tongue unexpectedly appeared to be approximately 2 to 2.5 times stiffer under GA than AR. Explanations for this were sought by examining drugs administered during GA, blood flow, perfusion, and upper airway reflexes, but neither of these explanations could be confirmed.

Reduction of Prolonged Excessive Pressure in Seated Persons With Paraplegia Using Wireless Lingual Tactile Feedback: A Randomized Controlled Trial.

Pressure ulcers (PU) are known to be a high-cost disease with a risk of severe morbidity. This paper evaluates a new clinical strategy based on an innovative medical device [Tongue Display Unit (TDU)] that implements perceptive supplementation in order to reduce prolonged excessive pressure, recognized as one of the main causes of PU. A randomized, controlled, and parallel-group trial was carried out with 12 subjects with spinal cord injuries (SCI). Subjects were assigned to the control (without TDU, [Formula: see text]) or intervention (with TDU, [Formula: see text]) group. Each subject took part in two sessions, during which the subject, seated on a pressure map sensor, watched a movie for one hour. The TDU was activated during the second session of the intervention group. Intention-to-treat analysis showed that the improvement in adequate weight shifting between the two sessions was higher in the intervention group (0.84 [0.24; 0.89]) than in the control group (0.01 [-0.01; 0.09]; [Formula: see text]) and that the ratio of prolonged excessive pressure between the two sessions was lower in the intervention group (0.74 [0.37; 1.92]) than in the control group (1.72 [1.32; 2.56]; [Formula: see text]). The pressure map sensor was evaluated as being convenient for use in daily life; however, this was not the case for the TDU. This paper shows that persons with SCI could benefit from a system based on perceptive supplementation that alerts and guides the user on how to adapt their posture in order to reduce prolonged excessive pressure, one of the main causes of PU.

Clinical workflow for personalized foot pressure ulcer prevention.

Foot pressure ulcers are a common complication of diabetes because of patient's lack of sensitivity due to neuropathy. Deep pressure ulcers appear internally when pressures applied on the foot create high internal strains nearby bony structures. Monitoring tissue strains in persons with diabetes is therefore important for an efficient prevention. We propose to use personalized biomechanical foot models to assess strains within the foot and to determine the risk of ulcer formation. Our workflow generates a foot model adapted to a patient's morphology by deforming an atlas model to conform it to the contours of segmented medical images of the patient's foot. Our biomechanical model is composed of rigid bodies for the bones, joined by ligaments and muscles, and a finite element mesh representing the soft tissues. Using our registration algorithm to conform three datasets, three new patient models were created. After applying a pressure load below these foot models, the Von Mises equivalent strains and "cluster volumes" (i.e. volumes of contiguous elements with strains above a given threshold) were measured within eight functionally meaningful foot regions. The results show the variability of both location and strain values among the three considered patients. This study also confirms that the anatomy of the foot has an influence on the risk of pressure ulcer.

Influence of the calcaneus shape on the risk of posterior heel ulcer using 3D patient-specific biomechanical modeling.

Most posterior heel ulcers are the consequence of inactivity and prolonged time lying down on the back. They appear when pressures applied on the heel create high internal strains and the soft tissues are compressed by the calcaneus. It is therefore important to monitor those strains to prevent heel pressure ulcers. Using a biomechanical lower leg model, we propose to estimate the influence of the patient-specific calcaneus shape on the strains within the foot and to determine if the risk of pressure ulceration is related to the variability of this shape. The biomechanical model is discretized using a 3D Finite Element mesh representing the soft tissues, separated into four domains implementing Neo Hookean materials with different elasticities: skin, fat, Achilles' tendon, and muscles. Bones are modelled as rigid bodies attached to the tissues. Simulations show that the shape of the calcaneus has an influence on the formation of pressure ulcers with a mean variation of the maximum strain over 6.0 percentage points over 18 distinct morphologies. Furthermore, the models confirm the influence of the cushion on which the leg is resting: a softer cushion leading to lower strains, it has less chances of creating a pressure ulcer. The methodology used for patient-specific strain estimation could be used for the prevention of heel ulcer when coupled with a pressure sensor.

Linear elastic properties of the facial soft tissues using an aspiration device: towards patient specific characterization.

Biomechanical modeling of the facial soft tissue behavior is needed in aesthetic or maxillo-facial surgeries where the simulation of the bone displacements cannot accurately predict the visible outcome on the patient's face. Because these tissues have different nature and elastic properties across the face, depending on their thickness, and their content in fat or muscle, individualizing their mechanical parameters could increase the simulation accuracy. Using a specifically designed aspiration device, the facial soft tissues deformation is measured at four different locations (cheek, cheekbone, forehead, and lower lip) on 16 young subjects. The stiffness is estimated from the deformations generated by a set of negative pressures using an inverse analysis based on a Neo Hookean model. The initial Young's modulus of the cheek, cheekbone, forehead, and lower lip are respectively estimated to be 31.0 kPa±4.6, 34.9 kPa±6.6, 17.3 kPa±4.1, and 33.7 kPa±7.3. Significant intra-subject differences in tissue stiffness are highlighted by these estimations. They also show important inter-subject variability for some locations even when mean stiffness values show no statistical difference. This study stresses the importance of using a measurement device capable of evaluating the patient specific tissue stiffness during an intervention.

Effect of saccades in tongue electrotactile stimulation for vision substitution applications.

The visual substitution paradigm aims to facilitate the life of blind people. Generally one uses electro-stimulating devices where electrodes are arranged into arrays to stimulate the skin or the tongue mucosa to send signals of visual type to the subjects. When an electro-stimulation signal is applied continuously (e.g. when static visual scenes are displayed for a long period of time), the receptors of the affected region can get saturated and the patient may lose the displayed information. We propose here some mechanisms that ameliorate the quality of perception of the electro-stimulation information. The electrical signal is encoded as 2D scenes projected onto the tongue via a Tongue Display Unit, i.e. an electro-tactile stimulator formed by a 12×12 matrix of electrodes. We propose to apply stochastic saccades on this signal. Our assumption is that this eye-inspired mechanism should make the visual substitution more efficient (by improving the perception) because of the reduction of the tactile receptors saturation. The influence of saccades was evaluated by a series of experiments. Results revealed a benefit on the persistence of perception due to saccades. This work helps to prevent the saturation of receptors on the tongue. Therefore increasing the quality of vision by the way of the electro-stimulation. It allows new enhancement features to retinal prosthesis devices which suffer from the same phenomenon.

Electrotactile vision substitution for 3D trajectory following.

Navigation for blind persons represents a challenge for researchers in vision substitution. In this field, one of the used techniques to navigate is guidance. In this study, we develop a new approach for 3D trajectory following in which the requested task is to track a light path using computer input devices (keyboard and mouse) or a rigid body handled in front of a stereoscopic camera. The light path is visualized either on direct vision or by way of a electro-stimulation device, the Tongue Display Unit, a 12 × 12 matrix of electrodes. We improve our method by a series of experiments in which the effect of the modality of perception and that of the input device. Preliminary results indicated a close correlation between the stimulated and recorded trajectories.