Scaling relationships between human leg muscle architectural properties and body size.

A skeletal muscle's peak force production and excursion are based on its architectural properties that are, in turn, determined by its mass, muscle fiber length and physiological cross-sectional area (PCSA). In the classic interspecific study of mammalian muscle scaling, it was demonstrated that muscle mass scales positively allometrically with body mass whereas fiber length scales isometrically with body mass, indicating that larger mammals have stronger leg muscles than they would if they were geometrically similar to smaller ones. Although this relationship is highly significant across species, there has never been a detailed intraspecific architectural scaling study. We have thus created a large dataset of 896 muscles across 34 human lower extremities (18 females and 16 males) with a size range including approximately 90% and 70% of the United States population height and mass, respectively, across the range 36-103 years. Our purpose was to quantify the scaling relationships between human muscle architectural properties and body size. We found that human muscles depart greatly from isometric scaling because muscle mass scales with body mass1.3 (larger exponent than isometric scaling of 1.0) and muscle fiber length scales with negative allometry with body mass0.1 (smaller exponent than isometric scaling of 0.33). Based on the known relationship between architecture and function, these results suggest that human muscles place a premium on muscle force production (mass and PCSA) at the expense of muscle excursion (fiber length) with increasing body size, which has implications for understanding human muscle design as well as biomechanical modeling.

Accuracy and repeatability of 3D Photogrammetry to digitally reconstruct bones.

Advances in computer hardware and software permit the reconstruction of physical objects digitally from digital camera images. Given the varying shapes and sizes of human bones, a comprehensive assessment is required to establish the accuracy of digital bone reconstructions from three-dimensional (3D) photogrammetry. Five human bones (femur, radius, scapula, vertebra, patella) were marked with pencil, to establish between 9 and 29 landmarks. The distances between landmarks were measured from the physical bones and digitized from 3D reconstructions. Images used for reconstructions were taken on two separate days, allowing for repeatability to be established. In comparison to physical measurements, the mean (±standard deviation) absolute differences were between 0.2±0.1mm and 0.4±0.2mm. The mean (±standard deviation) absolute differences between reconstructions were between 0.3±<0.1mm and 0.4±0.4mm. The 3D photogrammetry procedures described are accurate and repeatable, permitting quantitative analyses to be conducted from digital reconstructions. Moreover, 3D photogrammetry may be used to capture and preserve anatomical materials for anatomy education.

MRXCAT2.0: Synthesis of realistic numerical phantoms by combining left-ventricular shape learning, biophysical simulations and tissue texture generation.

BACKGROUND: Standardised performance assessment of image acquisition, reconstruction and processing methods is limited by the absence of images paired with ground truth reference values. To this end, we propose MRXCAT2.0 to generate synthetic data, covering healthy and pathological function, using a biophysical model. We exemplify the approach by generating cardiovascular magnetic resonance (CMR) images of healthy, infarcted, dilated and hypertrophic left-ventricular (LV) function. METHOD: In MRXCAT2.0, the XCAT torso phantom is coupled with a statistical shape model, describing population (patho)physiological variability, and a biophysical model, providing known and detailed functional ground truth of LV morphology and function. CMR balanced steady-state free precession images are generated using MRXCAT2.0 while realistic image appearance is ensured by assigning texturized tissue properties to the phantom labels. FINDING: Paired CMR image and ground truth data of LV function were generated with a range of LV masses (85-140 g), ejection fractions (34-51%) and peak radial and circumferential strains (0.45 to 0.95 and - 0.18 to - 0.13, respectively). These ranges cover healthy and pathological cases, including infarction, dilated and hypertrophic cardiomyopathy. The generation of the anatomy takes a few seconds and it improves on current state-of-the-art models where the pathological representation is not explicitly addressed. For the full simulation framework, the biophysical models require approximately two hours, while image generation requires a few minutes per slice. CONCLUSION: MRXCAT2.0 offers synthesis of realistic images embedding population-based anatomical and functional variability and associated ground truth parameters to facilitate a standardized assessment of CMR acquisition, reconstruction and processing methods.

Machine-Learning-Based Methodology for Estimation of Shoulder Load in Wheelchair-Related Activities Using Wearables.

There is a high prevalence of shoulder problems in manual wheelchair users (MWUs) with a spinal cord injury. How shoulder load relates to shoulder problems remains unclear. This study aimed to develop a machine-learning-based methodology to estimate the shoulder load in wheelchair-related activities of daily living using wearable sensors. Ten able-bodied participants equipped with five inertial measurement units (IMU) on their thorax, right arm, and wheelchair performed activities exemplary of daily life of MWUs. Electromyography (EMG) was recorded from the long head of the biceps and medial part of the deltoid. A neural network was trained to predict the shoulder load based on IMU and EMG data. Different cross-validation strategies, sensor setups, and model architectures were examined. The predicted shoulder load was compared to the shoulder load determined with musculoskeletal modeling. A subject-specific biLSTM model trained on a sparse sensor setup yielded the most promising results (mean correlation coefficient = 0.74 ± 0.14, relative root-mean-squared error = 8.93% ± 2.49%). The shoulder-load profiles had a mean similarity of 0.84 ± 0.10 over all activities. This study demonstrates the feasibility of using wearable sensors and neural networks to estimate the shoulder load in wheelchair-related activities of daily living.

In vivo human gracilis whole-muscle passive stress-sarcomere strain relationship.

We measured the passive mechanical properties of intact, living human gracilis muscles (n=11 individuals, 10 male and 1 female, age: 33±12 years, mass: 89±23 kg, height: 177±8 cm). Measurements were performed in patients undergoing surgery for free-functioning myocutaneous tissue transfer of the gracilis muscle to restore elbow flexion after brachial plexus injury. Whole-muscle force of the gracilis tendon was measured in four joint configurations (JC1-JC4) with a buckle force transducer placed at the distal tendon. Sarcomere length was also measured by biopsy from the proximal gracilis muscle. After the muscle was removed, a three-dimensional volumetric reconstruction of the muscle was created via photogrammetry. Muscle length from JC1 to JC4 increased by 3.3±1.0, 7.7±1.2, 10.5±1.3 and 13.4±1.2 cm, respectively, corresponding to 15%, 34%, 46% and 59% muscle fiber strain, respectively. Muscle volume and an average optimal fiber length of 23.1±0.7 cm yielded an average muscle physiological cross-sectional area of 6.8±0.7 cm2 which is approximately 3 times that measured previously from cadaveric specimens. Absolute passive tension increased from 0.90±0.21 N in JC1 to 16.50±2.64 N in JC4. As expected, sarcomere length also increased from 3.24±0.08 µm at JC1 to 3.63±0.07 µm at JC4, which are on the descending limb of the human sarcomere length-tension curve. Peak passive muscle stress was 27.8±5.5 kPa in JC4 and muscle modulus ranged from 44.8 MPa in JC1 to 125.7 MPa in JC4. Comparison with other mammalian species indicates that human muscle passive mechanical properties are more similar to rodent muscle than to rabbit muscle. These data provide direct measurements of whole-human muscle passive mechanical properties that can be used in modeling studies and for understanding comparative passive mechanical properties among mammalian muscles.

On challenges in clinical assessment of hip fracture risk using image-based biomechanical modelling: a critical review.

INTRODUCTION: Hip fracture is a common health risk among elderly people, due to the prevalence of osteoporosis and accidental fall in the population. Accurate assessment of fracture risk is a crucial step for clinicians to consider patient-by-patient optimal treatments for effective prevention of fractures. Image-based biomechanical modeling has shown promising progress in assessment of fracture risk, and there is still a great possibility for improvement. The purpose of this paper is to identify key issues that need be addressed to improve image-based biomechanical modeling. MATERIALS AND METHODS: We critically examined issues in consideration and determination of the four biomechanical variables, i.e., risk of fall, fall-induced impact force, bone geometry and bone material quality, which are essential for prediction of hip fracture risk. We closely inspected: limitations introduced by assumptions that are adopted in existing models; deficiencies in methods for construction of biomechanical models, especially for determination of bone material properties from bone images; problems caused by separate use of the variables in clinical study of hip fracture risk; availability of clinical information that are required for validation of biomechanical models. RESULTS AND CONCLUSIONS: A number of critical issues and gaps were identified. Strategies for effectively addressing the issues were discussed.

Modeling Pulse Wave Propagation Through a Stenotic Artery With Fluid Structure Interaction: A Validation Study Using Ultrasound Pulse Wave Imaging.

Pulse wave imaging (PWI) is an ultrasound-based method that allows spatiotemporal mapping of the arterial pulse wave propagation, from which the local pulse wave velocity (PWV) can be derived. Recent reports indicate that PWI can help the assessment of atherosclerotic plaque composition and mechanical properties. However, the effect of the atherosclerotic plaque's geometry and mechanics on the arterial wall distension and local PWV remains unclear. In this study, we investigated the accuracy of a finite element (FE) fluid-structure interaction (FSI) approach to predict the velocity of a pulse wave propagating through a stenotic artery with an asymmetrical plaque, as quantified with PWI method. Experiments were designed to compare FE-FSI modeling of the pulse wave propagation through a stenotic artery against PWI obtained with manufactured phantom arteries made of polyvinyl alcohol (PVA) material. FSI-generated spatiotemporal maps were used to estimate PWV at the plaque region and compared it to the experimental results. Velocity of the pulse wave propagation and magnitude of the wall distension were correctly predicted with the FE analysis. In addition, findings indicate that a plaque with a high degree of stenosis (>70%) attenuates the propagation of the pulse pressure wave. Results of this study support the validity of the FE-FSI methods to investigate the effect of arterial wall structural and mechanical properties on the pulse wave propagation. This modeling method can help to guide the optimization of PWI to characterize plaque properties and substantiate clinical findings.

Musculoskeletal biomechanics of patients with or without adjacent segment degeneration after spinal fusion.

STUDY DESIGN: A retrospective, single center, case-control study was performed. OBJECTIVE: The present study employed patient-specific biomechanical modeling to find potential biomechanical differences after spinal fusion at L4/5 in patients with and without subsequent development of adjacent segment disease (ASD). METHODS: The study population comprised patients who underwent primary spinal fusion at L4/5 and were either asymptomatic during > 4 years of follow-up (CTRL; n = 18) or underwent revision surgery for ASD at L3/4 (n = 20). Landmarks were annotated on preoperative and follow-up lateral radiographs, and specific musculoskeletal models were created using a custom-built modeling pipeline. Simulated spinal muscle activation and lumbar intervertebral shear loads in unfused segments were analyzed in upright standing and forward flexion. Differences between the pre- and postoperative conditions were computed for each patient. RESULTS: The average postoperative muscle activity in the upright standing posture was 88.4% of the preoperative activity in the CTRL group (p <  0.0001), but did not significantly change from pre- to postoperatively in the ASD group (98.0%). The average shear load magnitude at the epifusional joint L3/4 during upright standing increased from pre- to postoperatively in the ASD group (+ 3.9 N, +/- 17.4 (n = 18)), but decreased in the CTRL group (- 4.6 N, +/- 23.3 (n = 20); p <  0.001). CONCLUSION: Patient-specific biomechanical simulation revealed that spinal fusion surgery resulted in greater shear load magnitude and muscle activation and therefore greater forces at the epifusional segment in those with ASD compared with those without ASD. This is a first report of patient-specific disc load and muscle force calculation with predictive merits for ASD.

[Application of biomechanical modeling and simulation in the development of non-invasive technologies and devices for cardiovascular testing].

The prevalence of cardiovascular disease in our country is increasing, and it has been a big problem affecting the social and economic development. It has been demonstrated that early intervention of cardiovascular risk factors can effectively reduce cardiovascular disease-caused mortality. Therefore, extensive implementation of cardiovascular testing and risk factor screening in the general population is the key to the prevention and treatment of cardiovascular disease. However, the categories of devices available for quick cardiovascular testing are limited, and in particular, many existing devices suffer from various technical problems, such as complex operation, unclear working principle, or large inter-individual variability in measurement accuracy, which lead to an overall low popularity and reliability of cardiovascular testing. In this study, we introduce the non-invasive measurement mechanisms and relevant technical progresses for several typical cardiovascular indices (e.g., peripheral/central arterial blood pressure, and arterial stiffness), with emphasis on describing the applications of biomechanical modeling and simulation in mechanism verification, analysis of influential factors, and technical improvement/innovation.

Small airway hyperresponsiveness in COPD: relationship between structure and function in lung slices.

The direct relationship between pulmonary structural changes and airway hyperresponsiveness (AHR) in chronic obstructive pulmonary disease (COPD) is unclear. We investigated AHR in relation to airway and parenchymal structural changes in a guinea pig model of COPD and in COPD patients. Precision-cut lung slices (PCLS) were prepared from guinea pigs challenged with lipopolysaccharide or saline two times weekly for 12 wk. Peripheral PCLS were obtained from patients with mild to moderate COPD and non-COPD controls. AHR to methacholine was measured in large and small airways using video-assisted microscopy. Airway smooth muscle mass and alveolar airspace size were determined in the same slices. A mathematical model was used to identify potential changes in biomechanical properties underlying AHR. In guinea pigs, lipopolysaccharide increased the sensitivity of large (>150 µm) airways toward methacholine by 4.4-fold and the maximal constriction of small airways (<150 µm) by 1.5-fold. Similarly increased small airway responsiveness was found in COPD patients. In both lipopolysaccharide-challenged guinea pigs and patients, airway smooth muscle mass was unaltered, whereas increased alveolar airspace correlated with small airway hyperresponsiveness in guinea pigs. Fitting the parameters of the model indicated that COPD weakens matrix mechanical properties and enhances stiffness differences between the airway and the parenchyma, in both species. In conclusion, this study demonstrates small airway hyperresponsiveness in PCLS from COPD patients. These changes may be related to reduced parenchymal retraction forces and biomechanical changes in the airway wall. PCLS from lipopolysaccharide-exposed guinea pigs may be useful to study mechanisms of small airway hyperresponsiveness in COPD.

Global postural re-education in pediatric idiopathic scoliosis: a biomechanical modeling and analysis of curve reduction during active and assisted self-correction.

BACKGROUND: Global postural re-education (GPR) is a physiotherapy treatment approach for pediatric idiopathic scoliosis (IS), where the physiotherapist qualitatively assesses scoliotic curvature reduction potential (with a manual correction) and patient's ability to self-correct (self-correction). To the author's knowledge, there are no studies regarding GPR applied to IS, hence there is a need to better understand the biomechanics of GPR curve reduction postures. The objective was to biomechanically and quantitatively evaluate those two re-education corrections using a computer model combined with experimental testing. METHODS: Finite elements models of 16 patients with IS (10.5-15.4 years old, average Cobb angle of 33°) where built from surface scans and 3D radiographic reconstructions taken in normal standing and self-corrected postures. The forces applied with the therapist's hands over the trunk during manual correction were recorded and used in the FEM to simulate this posture. Self-correction was simulated by moving the thoracic and lumbar apical vertebrae from their presenting position to their self-corrected position as seen on radiographs. A stiffness index was defined for each posture as the global force required to stay in the posture divided by the thoracic curve reduction (force/Cobb angle reduction). RESULTS: The average force applied by the therapist during manual correction was 31 N and resulted in a simulated average reduction of 26% (p < 0.05), while kyphosis slightly increased and lordosis remained unchanged. The actual self-correction reduced the thoracic curve by an average of 33% (p < 0.05), while the lumbar curve remained unchanged. The thoracic kyphosis and lumbar lordosis were reduced on average by 6° and 5° (p < 0.05). Self-correction simulations correlated with actual self-correction (r = 0.9). CONCLUSIONS: This study allowed quantification of thoracic curve reducibility obtained by external forces applications as well as patient's capacity to self-correct their posture, two corrections commonly used in the GPR approach.

Personalized modeling for real-time pressure ulcer prevention in sitting posture.

Ischial pressure ulcer is an important risk for every paraplegic person and a major public health issue. Pressure ulcers appear following excessive compression of buttock's soft tissues by bony structures, and particularly in ischial and sacral bones. Current prevention techniques are mainly based on daily skin inspection to spot red patches or injuries. Nevertheless, most pressure ulcers occur internally and are difficult to detect early. Estimating internal strains within soft tissues could help to evaluate the risk of pressure ulcer. A subject-specific biomechanical model could be used to assess internal strains from measured skin surface pressures. However, a realistic 3D non-linear Finite Element buttock model, with different layers of tissue materials for skin, fat and muscles, requires somewhere between minutes and hours to compute, therefore forbidding its use in a real-time daily prevention context. In this article, we propose to optimize these computations by using a reduced order modeling technique (ROM) based on proper orthogonal decompositions of the pressure and strain fields coupled with a machine learning method. ROM allows strains to be evaluated inside the model interactively (i.e. in less than a second) for any pressure field measured below the buttocks. In our case, with only 19 modes of variation of pressure patterns, an error divergence of one percent is observed compared to the full scale simulation for evaluating the strain field. This reduced model could therefore be the first step towards interactive pressure ulcer prevention in a daily set-up.

The opercular mouth-opening mechanism of largemouth bass functions as a 3D four-bar linkage with three degrees of freedom.

The planar, one degree of freedom (1-DoF) four-bar linkage is an important model for understanding the function, performance and evolution of numerous biomechanical systems. One such system is the opercular mechanism in fishes, which is thought to function like a four-bar linkage to depress the lower jaw. While anatomical and behavioral observations suggest some form of mechanical coupling, previous attempts to model the opercular mechanism as a planar four-bar have consistently produced poor model fits relative to observed kinematics. Using newly developed, open source mechanism fitting software, we fitted multiple three-dimensional (3D) four-bar models with varying DoF to in vivo kinematics in largemouth bass to test whether the opercular mechanism functions instead as a 3D four-bar with one or more DoF. We examined link position error, link rotation error and the ratio of output to input link rotation to identify a best-fit model at two different levels of variation: for each feeding strike and across all strikes from the same individual. A 3D, 3-DoF four-bar linkage was the best-fit model for the opercular mechanism, achieving link rotational errors of less than 5%. We also found that the opercular mechanism moves with multiple degrees of freedom at the level of each strike and across multiple strikes. These results suggest that active motor control may be needed to direct the force input to the mechanism by the axial muscles and achieve a particular mouth-opening trajectory. Our results also expand the versatility of four-bar models in simulating biomechanical systems and extend their utility beyond planar or single-DoF systems.

Penile compression clamps: A model of the internal mechanical state of penile soft tissues.

AIMS: Prostate cancer is the most frequently diagnosed male cancer and urinary incontinence represents a major consequence following surgery. Penile compression clamps (PCCs) which externally occlude the urethra may be used to manage the incontinence. Despite potential complication of PCCs, such as deformation-inflicted tissue damage, to date, there are no reported biomechanical criteria for design of PCCs, in terms of quantitative parameters for evaluating the safety-versus-efficacy of existing or future designs. METHODS: We developed a set of computational three-dimensional models of the penis, to which compression was applied using five generic PCC designs. The internal mechanical states of the soft tissues of the penis were then analysed using finite element simulations. RESULTS: Stresses in skin, fat, and tunica albuginea regularly exceeded 10 kPa (75 mmHg). Cuff-type and knurl-type PCCs pose the highest potential risks to tissue health with elevated tissue stresses around the entire penile perimeter (cuff) or urethral stress concentrations (knurl). The soft and contoured PCCs produced the lowest values of these mechanical parameters. CONCLUSIONS: The present study identified design characteristics, including envelopment, adaptability, and durability which provide the safest mechanical conditions in the penis and thus minimize the risk of tissue damage while still managing incontinence. Such data should help to design a safer clamp.

A Novel Nonlinear Mathematical Model of Thoracic Wall Mechanics During Cardiopulmonary Resuscitation Based on a Porcine Model of Cardiac Arrest.

Cardiopulmonary resuscitation (CPR) is used widely to rescue cardiac arrest patients, yet some physiological aspects of the procedure remain poorly understood. We conducted this study to characterize the dynamic mechanical properties of the thorax during CPR in a swine model. This is an important step toward determining optimal CPR chest compression mechanics with the goals of improving the fidelity of CPR simulation manikins and ideally chest compression delivery in real-life resuscitations. This paper presents a novel nonlinear model of the thorax that captures the complex behavior of the chest during CPR. The proposed model consists of nonlinear elasticity and damping properties along with frequency dependent hysteresis. An optimization technique was used to estimate the model coefficients for force-compression using data collected from experiments conducted on swine. To track clinically relevant, time-dependent changes of the chest's properties, the data was divided into two time periods, from 1 to 10 min (early) and greater than 10 min (late) after starting CPR. The results showed excellent agreement between the actual and the estimated forces, and energy dissipation due to viscous damping in the late stages of CPR was higher when compared to the earlier stages. These findings provide insight into improving chest compression mechanics during CPR, and may provide the basis for developing CPR simulation manikins that more accurately represent the complex real world changes that occur in the chest during CPR.

Head, Neck, Trunk, and Pelvis Tissue Mass Predictions for Young Adults Using Anthropometric Measures and Dual-Energy X-Ray Absorptiometry.

Accurate prediction of wobbling mass (WM), fat mass (FM), lean mass (LM), and bone mineral content (BMC) of living people using regression equations developed from anthropometric measures (lengths, circumferences, breadths, skinfolds) has previously been reported, but only for the extremities. Multiple linear stepwise regression was used to generate comparable equations for the head, neck, trunk, and pelvis of young adults (38 males, 38 females). Equations were validated using actual tissue masses from an independent sample of 13 males and 13 females by manually segmenting full-body dual-energy x-ray absorptiometry scans. Prediction equations exhibited adjusted R2 values ranging from .249 to .940, with more explained variance for LM and WM than BMC and FM, especially for the head and neck. Mean relative errors between predicted and actual tissue masses ranged from -11.07% (trunk FM) to 7.61% (neck FM). Actual and predicted tissue masses from all equations were significantly correlated (R2 = .329 to .937), except head BMC (R2 = .046). These results show promise for obtaining in-vivo head, neck, trunk, and pelvis tissue mass estimates in young adults. Further research is needed to improve head and neck FM and BMC predictions and develop tissue mass prediction equations for older populations.

Inverse Dynamics Modeling of Paralympic Wheelchair Curling.

Paralympic wheelchair curling is an adapted version of Olympic curling played by individuals with spinal cord injuries, cerebral palsy, multiple sclerosis, and lower extremity amputations. To the best of the authors' knowledge, there has been no experimental or computational research published regarding the biomechanics of wheelchair curling. Accordingly, the objective of the present research was to quantify the angular joint kinematics and dynamics of a Paralympic wheelchair curler throughout the delivery. The angular joint kinematics of the upper extremity were experimentally measured using an inertial measurement unit system; the translational kinematics of the curling stone were additionally evaluated with optical motion capture. The experimental kinematics were mathematically optimized to satisfy the kinematic constraints of a subject-specific multibody biomechanical model. The optimized kinematics were subsequently used to compute the resultant joint moments via inverse dynamics analysis. The main biomechanical demands throughout the delivery (ie, in terms of both kinematic and dynamic variables) were about the hip and shoulder joints, followed sequentially by the elbow and wrist. The implications of these findings are discussed in relation to wheelchair curling delivery technique, musculoskeletal modeling, and forward dynamic simulations.

Biomechanical analysis of Ponte and pedicle subtraction osteotomies for the surgical correction of kyphotic deformities.

PURPOSE: Biomechanical analysis of Ponte (PO) and pedicle subtraction osteotomies (PSO) in kyphotic deformity instrumentation. METHODS: Patient-specific biomechanical model was used to computationally simulate seven hyperkyphotic instrumentation cases with three osteotomy strategies-1-level PSO, 3-level PO, or 6-level PO; forces within the instrumented spine were assessed and results were analyzed through rANOVA tests. RESULTS: Corrections with multi-level PO were close to those with one-level PSO. In upright position, average implant forces were from 225 to 280 N and rod bending moments were around 10 Nm with no significant difference between the three strategies (p < 0.05). In simulations of 30° flexion, rod bending moments increased by 38, 2, and 8 %, implant forces increased by 28, 23 and 26 % for the 1-level PSO, 3-level PO, and 6-level PO, respectively. Correction per vertebral level was smaller than the maximum correction allowed by PO and PSO. CONCLUSIONS: Multi-level PO allows similar kyphotic correction to 1-level PSO in spinal deformities with mixed indications for PO and PSO. Loads on the instrumentation constructs in PSO were higher than multi-level PO and higher in 6-level PO than 3-level PO. High loads were located more on the osteotomy sites. The rod shape should be adapted to the anticipated spine correction on the osteotomy sites.

Methodology based on genetic heuristics for in-vivo characterizing the patient-specific biomechanical behavior of the breast tissues.

This paper presents a novel methodology to in-vivo estimate the elastic constants of a constitutive model proposed to characterize the mechanical behavior of the breast tissues. An iterative search algorithm based on genetic heuristics was constructed to in-vivo estimate these parameters using only medical images, thus avoiding invasive measurements of the mechanical response of the breast tissues. For the first time, a combination of overlap and distance coefficients were used for the evaluation of the similarity between a deformed MRI of the breast and a simulation of that deformation. The methodology was validated using breast software phantoms for virtual clinical trials, compressed to mimic MRI-guided biopsies. The biomechanical model chosen to characterize the breast tissues was an anisotropic neo-Hookean hyperelastic model. Results from this analysis showed that the algorithm is able to find the elastic constants of the constitutive equations of the proposed model with a mean relative error of about 10%. Furthermore, the overlap between the reference deformation and the simulated deformation was of around 95% showing the good performance of the proposed methodology. This methodology can be easily extended to characterize the real biomechanical behavior of the breast tissues, which means a great novelty in the field of the simulation of the breast behavior for applications such as surgical planing, surgical guidance or cancer diagnosis. This reveals the impact and relevance of the presented work.

To what extent can mastication functionality be restored following mandibular reconstruction surgery? A computer modeling approach.

STATEMENT OF PROBLEM: Advanced cases of head and neck cancer involving the mandible often require surgical removal of diseased sections and subsequent replacement with donor bone. During the procedure, the surgeon must make decisions regarding which bones or tissues to resect. This requires balancing tradeoffs related to issues such as surgical access and post-operative function; however, the latter is often difficult to predict, especially given that long-term functionality also depends on the impact of post-operative rehabilitation programs. PURPOSE: To assist in surgical decision-making, we present an approach for estimating the effects of reconstruction on key aspects of post-operative mandible function. MATERIAL AND METHODS: We develop dynamic biomechanical models of the reconstructed mandible considering different defect types and validate them using literature data. We use these models to estimate the degree of functionality that might be achieved following post-operative rehabilitation. RESULTS: We find significant potential for restoring mandibular functionality, even in cases involving large defects. This entails an average trajectory error below 2 mm, bite force comparable to a healthy individual, improved condyle mobility, and a muscle activation change capped at a maximum of 20%. CONCLUSION: These results suggest significant potential for adaptability in the masticatory system and improved post-operative rehabilitation, leading to greater restoration of jaw function.