The assessment of implant shape-dependent failure mechanisms in primary total hip arthroplasty using finite element analysis.

The three mechanisms known to be responsible for the failure of uncemented femoral stems in primary total hip arthroplasty (THA) are the stress shielding, excessive bone-implant interface stress, and excessive initial micromotion. Since implant designers usually have to sacrifice two mechanisms to improve the other one, the aim of this study was to assess which of them plays a more important role in the failure of uncemented stems. Two hip implant stems which are widely used in the primary THA and their mid-term clinical outcomes are available, were selected. Then, the amount of the three failure mechanisms created by each stem during the normal walking gait cycle was determined for a 70 kg female patient using the finite element method. The results indicated that the stem with better clinical outcome induced an average of 36.6% less stress shielding in the proximal regions of femur bone compared with the other stem. However, the maximum bone-implant interface stress and maximum initial micromotion were, respectively, 30 and 155% higher for the stem with better clinical outcomes. It was therefore concluded that the stress shielding has a more significant impact on the mid-term life of uncemented stems. However, care must be taken to ensure that the other two failure mechanisms do not exceed a certain threshold. It was also observed that the thinner and shorter stem created a smaller amount of stress shielding in the femur bone. The outcomes of this study can be used to design new hip implant stems that can potentially last longer.

Prediction of Mechanical Properties of Artificially Weathered Wood by Color Change and Machine Learning.

Color parameters were used in this study to develop a machine learning model for predicting the mechanical properties of artificially weathered fir, alder, oak, and poplar wood. A CIELAB color measuring system was employed to study the color changes in wood samples. The color parameters were fed into a decision tree model for predicting the MOE and MOR values of the wood samples. The results indicated a reduction in the mechanical properties of the samples, where fir and alder were the most and least degraded wood under weathering conditions, respectively. The mechanical degradation was correlated with the color change, where the most resistant wood to color change exhibited less reduction in the mechanical properties. The predictive machine learning model estimated the MOE and MOR values with a maximum R2 of 0.87 and 0.88, respectively. Thus, variations in the color parameters of wood can be considered informative features linked to the mechanical properties of small-sized and clear wood. Further research could study the effectiveness of the model when analyzing large-sized timber.

Quantitative ultrasound and machine learning for assessment of steatohepatitis in a rat model.

OBJECTIVES: To develop a machine learning model based on quantitative ultrasound (QUS) parameters to improve classification of steatohepatitis with shear wave elastography in rats by using histopathology scoring as the reference standard. METHODS: This study received approval from the institutional animal care committee. Sixty male Sprague-Dawley rats were either fed a standard chow or a methionine- and choline-deficient diet. Ultrasound-based radiofrequency images were recorded in vivo to generate QUS and elastography maps. Random forests classification models and a bootstrap method were used to identify the QUS parameters that improved the classification accuracy of elastography. Receiver-operating characteristic analyses were performed. RESULTS: For classification of not steatohepatitis vs borderline or steatohepatitis, the area under the receiver-operating characteristic curve (AUC) increased from 0.63 for elastography alone to 0.72 for a model that combined elastography and QUS techniques (p < 0.001). For detection of liver steatosis grades 0 vs ≥ 1, ≤ 1 vs ≥ 2, ≤ 2 vs 3, respectively, the AUCs increased from 0.70, 0.65, and 0.69 to 0.78, 0.78, and 0.75 (p < 0.001). For detection of liver inflammation grades 0 vs ≥ 1, ≤ 1 vs ≥ 2, ≤ 2 vs 3, respectively, the AUCs increased from 0.58, 0.77, and 0.78 to 0.66, 0.84, and 0.87 (p < 0.001). For staging of liver fibrosis grades 0 vs ≥ 1, ≤ 1 vs ≥ 2, and ≤ 2 vs ≥ 3, respectively, the AUCs increased from 0.79, 0.92, and 0.91 to 0.85, 0.98, and 0.97 (p < 0.001). CONCLUSION: QUS parameters improved the classification accuracy of steatohepatitis, liver steatosis, inflammation, and fibrosis compared to shear wave elastography alone. KEY POINTS: • Quantitative ultrasound and shear wave elastography improved classification accuracy of liver steatohepatitis and its histological features (liver steatosis, inflammation, and fibrosis) compared to elastography alone. • A machine learning approach based on random forest models and incorporating local attenuation and homodyned-K tissue modeling shows promise for classification of nonalcoholic steatohepatitis. • Further research should be performed to demonstrate the applicability of this multi-parametric QUS approach in a human cohort and to validate the combinations of parameters providing the highest classification accuracy.

Acoustic radiation force induced resonance elastography of coagulating blood: theoretical viscoelasticity modeling and ex-vivo experimentation.

Deep vein thrombosis is a common vascular disease that can lead to pulmonary embolism and death. The early diagnosis and clot age staging are important parameters for reliable therapy planning. This article presents an acoustic radiation force induced resonance elastography method for the viscoelastic characterization of clotting blood. The physical concept of this method relies on the mechanical resonance of the blood clot occurring at specific frequencies. Resonances are induced by focusing ultrasound beams inside the sample under investigation. Coupled to an analytical model of wave scattering, the ability of the proposed method to characterize the viscoelasticity of a mimicked venous thrombosis in the acute phase is demonstrated. Experiments with a gelatin-agar inclusion sample of known viscoelasticity are performed for validation and establishment of the proof of concept. In addition, an inversion method is applied in-vitro for the kinetic monitoring of the blood coagulation process of six human blood samples obtained from two volunteers. The computed elasticity and viscosity values of blood samples at the end of the 90 min kinetics were estimated at 411 ± 71 Pa and 0.25 ± 0.03 Pa.s for volunteer #1, and 387 ± 35 Pa and 0.23 ± 0.02 Pa.s for volunteer #2, respectively. The proposed method allowed reproducible time-varying thrombus viscoelastic measurements from samples having physiological dimensions.

Detection of Steatohepatitis in a Rat Model by Using Spectroscopic Shear-Wave US Elastography.

Purpose To compare low- versus high-frequency ultrasonographic (US) elastography for detection of steatohepatitis in rats by using histopathologic findings as the reference standard. Materials and Methods Between March and September 2014, after receiving approval from the institutional animal care committee, 60 male Sprague-Dawley rats were fed either a standard chow for 4 weeks or a methionine- and choline-deficient diet for 1, 4, 8, or 12 weeks to induce a continuum of steatohepatitis severity. Liver shear stiffness was assessed in vivo by using US elastography at low (40-130-Hz) and high (130-220-Hz) frequencies. Histologic features (steatosis, inflammation, and fibrosis) and modified nonalcoholic steatohepatitis categories were used as reference standards. Definite steatohepatitis was divided into steatohepatitis with fibrosis stage 1 or lower and stage 2 and higher. Analyses included the Kendall τ correlation, multivariable linear regression analyses, Kruskal-Wallis rank sum test, and post hoc Dunn test with Holm correction. Results Correlations between liver shear stiffness and histologic features were higher at high frequencies than at low frequencies (low frequency: 0.08, 0.24, and 0.20 for steatosis, inflammation, and fibrosis, respectively; high frequency: 0.11, 0.35, and 0.50, respectively). The absolute value of multivariable regression coefficients was higher at high frequencies for the presence of steatosis, inflammation grade, and fibrosis stage (low frequency: -0.475, 0.157, and 0.209, respectively; high frequency: -0.893, 0.357, and 0.447, respectively). The model fit was better at high frequencies (adjusted R2 = 0.57) than at low frequencies (adjusted R2 = 0.21). There was a significant difference between steatohepatitis categories at both low and high frequencies (P = .022 and P < .001, respectively). Conclusion Liver shear stiffness measured with US elastography provided better distinction of steatohepatitis categories at high frequencies than at low frequencies. Further, liver shear stiffness decreased with steatosis and increased with inflammation and fibrosis at both low and high frequencies. © RSNA, 2016 Online supplemental material is available for this article.

A Frequency-Shift Method to Measure Shear-Wave Attenuation in Soft Tissues.

In vivo quantification of shear-wave attenuation in soft tissues may help to better understand human tissue rheology and lead to new diagnostic strategies. Attenuation is difficult to measure in acoustic radiation force elastography because the shear-wave amplitude decreases due to a combination of diffraction and viscous attenuation. Diffraction correction requires assuming a cylindrical wavefront and an isotropic propagation medium, which may not be the case in some applications. In this paper, the frequency-shift method, used in ultrasound imaging and seismology, was adapted for shear-wave attenuation measurement in elastography. This method is not sensitive to diffraction effects. For a linear frequency dependence of the attenuation, a closed-form relation was obtained between the decrease in the peak frequency of the gamma-distributed wave amplitude spectrum and the attenuation coefficient of the propagation medium. The proposed method was tested against a plane-wave reference method in homogeneous agar-gelatin phantoms with 0%, 10%, and 20% oil concentrations, and hence different attenuations of 0.117, 0.202, and 0.292 [Formula: see text]/Hz, respectively. Applicability to biological tissues was demonstrated with two ex vivo porcine liver samples (0.79 and 1.35 [Formula: see text]/Hz) and an in vivo human muscle, measured along (0.43 [Formula: see text]/Hz) and across (1.77 [Formula: see text]/Hz) the tissue fibers. In all cases, the data supported the assumptions of a gamma-distributed spectrum for the source and linear frequency attenuation for the tissue. This method provides tissue attenuation, which is relevant diagnostic information to model viscosity, in addition to shear-wave velocity used to assess elasticity. Data processing is simple and could be performed automatically in real time for clinical applications.

A Flow Perfusion Bioreactor System for Vocal Fold Tissue Engineering Applications.

The human vocal folds (VFs) undergo complex biomechanical stimulation during phonation. The aim of the present study was to develop and validate a phono-mimetic VF flow perfusion bioreactor, which mimics the mechanical microenvironment of the human VFs in vitro. The bioreactor uses airflow-induced self-oscillations, which have been shown to produce mechanical loading and contact forces that are representative of human phonation. The bioreactor consisted of two synthetic VF replicas within a silicone body. A cell-scaffold mixture (CSM) consisting of human VF fibroblasts, hyaluronic acid, gelatin, and a polyethylene glycol cross-linker was injected into cavities within the replicas. Cell culture medium (CCM) was perfused through the scaffold by using a customized secondary flow loop. After the injection, the bioreactor was operated with no stimulation over a 3-day period to allow for cell adaptation. Phonation was subsequently induced by using a variable speed centrifugal blower for 2 h each day over a period of 4 days. A similar bioreactor without biomechanical stimulation was used as the nonphonatory control. The CSM was harvested from both VF replicas 7 days after the injection. The results confirmed that the phono-mimetic bioreactor supports cell viability and extracellular matrix proteins synthesis, as expected. Many scaffold materials were found to degrade because of challenges from phonation-induced biomechanical stimulation as well as due to biochemical reactions with the CCM. The bioreactor concept enables future investigations of the effects of different phonatory characteristics, that is, voice regimes, on the behavior of the human VF cells. It will also help study the long-term functional outcomes of the VF-specific biomaterials before animal and clinical studies.

Ultrasound Shear Wave Viscoelastography: Model-Independent Quantification of the Complex Shear Modulus.

Ultrasound shear wave elastography methods are commonly used for estimation of mechanical properties of soft biological tissues in diagnostic medicine. A limitation of most currently used elastography methods is that they yield only the shear storage modulus ( G' ) but not the loss modulus ( G'' ). Therefore, no information on viscosity or loss tangent (tan δ) is provided. In this paper, an ultrasound shear wave viscoelastography method is developed for model-independent quantification of frequency-dependent viscoelastic complex shear modulus of macroscopically homogeneous tissues. Three in vitro tissue-mimicking phantoms and two ex vivo porcine liver samples were evaluated. Shear waves were remotely induced within the samples using several acoustic radiation force pushes to generate a semicylindrical wave field similar to those generated by most clinically used elastography systems. The complex shear modulus was estimated over a broad frequency range (up to 1000 Hz) through the analytical solution of the developed inverse wave propagation problem using the measured shear wave speed and amplitude decay versus propagation distance. The shear storage and loss moduli obtained for the in vitro phantoms were compared with those from a planar shear wave method and the average differences over the whole frequency range studied were smaller than 7% and 15%, respectively. The reliability of the proposed method highlights its potential for viscoelastic tissue characterization, which may improve noninvasive diagnosis.

Ultrasound viscoelasticity assessment using an adaptive torsional shear wave propagation method.

PURPOSE: Different approaches have been used in dynamic elastography to assess mechanical properties of biological tissues. Most techniques are based on a simple inversion based on the measurement of the shear wave speed to assess elasticity, whereas some recent strategies use more elaborated analytical or finite element method (FEM) models. In this study, a new method is proposed for the quantification of both shear storage and loss moduli of confined lesions, in the context of breast imaging, using adaptive torsional shear waves (ATSWs) generated remotely with radiation pressure. METHODS: A FEM model was developed to solve the inverse wave propagation problem and obtain viscoelastic properties of interrogated media. The inverse problem was formulated and solved in the frequency domain and its robustness to noise and geometric constraints was evaluated. The proposed model was validated in vitro with two independent rheology methods on several homogeneous and heterogeneous breast tissue-mimicking phantoms over a broad range of frequencies (up to 400 Hz). RESULTS: Viscoelastic properties matched benchmark rheology methods with discrepancies of 8%-38% for the shear modulus G' and 9%-67% for the loss modulus G″. The robustness study indicated good estimations of storage and loss moduli (maximum mean errors of 19% on G' and 32% on G″) for signal-to-noise ratios between 19.5 and 8.5 dB. Larger errors were noticed in the case of biases in lesion dimension and position. CONCLUSIONS: The ATSW method revealed that it is possible to estimate the viscoelasticity of biological tissues with torsional shear waves when small biases in lesion geometry exist.

Viscoelasticity of hyaluronic acid-gelatin hydrogels for vocal fold tissue engineering.

Crosslinked injectable hyaluronic acid (HA)-gelatin (Ge) hydrogels have remarkable viscoelastic and biological properties for vocal fold tissue engineering. Patient-specific tuning of the viscoelastic properties of this injectable biomaterial could improve tissue regeneration. The frequency-dependent viscoelasticity of crosslinked HA-Ge hydrogels was measured as a function of the concentration of HA, Ge, and crosslinker. Synthetic extracellular matrix hydrogels were fabricated using thiol-modified HA and Ge, and crosslinked by poly(ethylene glycol) diacrylate. A recently developed characterization method based on Rayleigh wave propagation was used to quantify the frequency-dependent viscoelastic properties of these hydrogels, including shear storage and loss moduli, over a broad frequency range; that is, from 40 to 4000 Hz. The viscoelastic properties of the hydrogels increased with frequency. The storage and loss moduli values and the rate of increase with frequency varied with the concentrations of the constituents. The range of the viscoelastic properties of the hydrogels was within that of human vocal fold tissue obtained from in vivo and ex vivo measurements. Frequency-dependent parametric relations were obtained using a linear least-squares regression. The results are useful to better fine-tune the storage and loss moduli of HA-Ge hydrogels by varying the concentrations of the constituents for use in patient-specific treatments.

Frequency adaptation for enhanced radiation force amplitude in dynamic elastography.

In remote dynamic elastography, the amplitude of the generated displacement field is directly related to the amplitude of the radiation force. Therefore, displacement improvement for better tissue characterization requires the optimization of the radiation force amplitude by increasing the push duration and/or the excitation amplitude applied on the transducer. The main problem of these approaches is that the Food and Drug Administration (FDA) thresholds for medical applications and transducer limitations may be easily exceeded. In the present study, the effect of the frequency used for the generation of the radiation force on the amplitude of the displacement field was investigated. We found that amplitudes of displacements generated by adapted radiation force sequences were greater than those generated by standard nonadapted ones (i.e., single push acoustic radiation force impulse and supersonic shear imaging). Gains in magnitude were between 20 to 158% for in vitro measurements on agar-gelatin phantoms, and 170 to 336% for ex vivo measurements on a human breast sample, depending on focus depths and attenuations of tested samples. The signal-to-noise ratio was also improved more than 4-fold with adapted sequences. We conclude that frequency adaptation is a complementary technique that is efficient for the optimization of displacement amplitudes. This technique can be used safely to optimize the deposited local acoustic energy without increasing the risk of damaging tissues and transducer elements.

Non-invasive in vivo measurement of the shear modulus of human vocal fold tissue.

Voice is the essential part of singing and speech communication. Voice disorders significantly affect the quality of life. The viscoelastic mechanical properties of the vocal fold mucosa determine the characteristics of the vocal folds oscillations, and thereby voice quality. In the present study, a non-invasive method was developed to determine the shear modulus of human vocal fold tissue in vivo via measurements of the mucosal wave propagation speed during phonation. Images of four human subjects' vocal folds were captured using high speed digital imaging (HSDI) and magnetic resonance imaging (MRI) for different phonation pitches, specifically fundamental frequencies between 110 and 440 Hz. The MRI images were used to obtain the morphometric dimensions of each subject's vocal folds in order to determine the pixel size in the high-speed images. The mucosal wave propagation speed was determined for each subject and at each pitch value using an automated image processing algorithm. The transverse shear modulus of the vocal fold mucosa was then calculated from a surface (Rayleigh) wave propagation dispersion equation using the measured wave speeds. It was found that the mucosal wave propagation speed and therefore the shear modulus of the vocal fold tissue were generally greater at higher pitches. The results were in good agreement with those from other studies obtained via in vitro measurements, thereby supporting the validity of the proposed measurement method. This method offers the potential for in vivo clinical assessments of vocal folds viscoelasticity from HSDI.

Rayleigh wave propagation method for the characterization of a thin layer of biomaterials.

An experimental method based on Rayleigh wave propagation was developed for quantifying the frequency-dependent viscoelastic properties of a small volume of expensive biomaterials over a broad frequency range. Synthetic silicone rubber and gelatin materials were fabricated and tested to evaluate the proposed method. Planar harmonic Rayleigh waves at different frequencies, from 80 to 4000 Hz, were launched on the surface of a sample composed of a substrate with known material properties coated with a thin layer of the soft material to be characterized. A transfer function method was used to obtain the complex Rayleigh wavenumber. An inverse wave propagation problem was solved and a complex nonlinear dispersion equation was obtained. The complex shear and elastic moduli of the sample materials were then calculated through the numerical solution of the obtained dispersion equation using the measured wavenumbers. The results were in good agreement with those of a previous independent study. The proposed method was found to be reliable and cost effective for the measurement of viscoelastic properties of a thin layer of expensive biomaterials, such as phonosurgical biomaterials, over a wide frequency range.

Experimental methods for the characterization of the frequency-dependent viscoelastic properties of soft materials.

A characterization method based on Rayleigh wave propagation was developed for the quantification of the frequency-dependent viscoelastic properties of soft materials at high frequencies; i.e., up to 4 kHz. Planar harmonic surface waves were produced on the surface of silicone rubber samples. The phase and amplitude of the propagating waves were measured at different locations along the propagation direction, which allowed the calculation of the complex Rayleigh wavenumbers at each excitation frequency using a transfer function method. An inverse wave propagation problem was then solved to obtain the complex shear/elastic moduli from the measured wavenumbers. In a separate, related investigation, dynamic indentation tests using atomic force microscopy (AFM) were performed at frequencies up to 300 Hz. No systematic verification study is available for the AFM-based method, which can be used when the dimensions of the test samples are too small for other existing testing methods. The results obtained from the Rayleigh wave propagation and AFM-based indentation methods were compared with those from a well-established method, which involves the generation of standing longitudinal compression waves in rod-shaped test specimens. The results were cross validated and qualitatively confirmed theoretical expectations presented in the literature for the frequency-dependence of polymers.

Robotic assisted reduction of femoral shaft fractures using Stewart platform.

A robotic system with 6 DOF mobility was proposed for reduction of femoral shaft fractures based on Stewart platform. A plan for implementing the platform on bone fragments was introduced and a step by step strategy for performing the reduction procedure, based on the system's inverse kinematic solution, was proposed. The efficacy of the system was evaluated in some case studies and it was shown that it can be locked to act as an external fixator.