Hojin Ha

Three-Dimensional Printing: Basic Principles and Applications in Medicine and Radiology

The advent of three-dimensional printing (3DP) technology has enabled the creation of a tangible and complex 3D object that goes beyond a simple 3D-shaded visualization on a flat monitor. Since the early 2000s, 3DP machines have been used only in hard tissue applications. Recently developed multi-materials for 3DP have been used extensively for a variety of medical applications, such as personalized surgical planning and guidance, customized implants, biomedical research, and preclinical education. In this review article, we discuss the 3D reconstruction process, touching on medical imaging, and various 3DP systems applicable to medicine. In addition, the 3DP medical applications using multi-materials are introduced, as well as our recent results.

Multi-VENC acquisition of four-dimensional phase-contrast MRI to improve precision of velocity field measurement

The present study aims to improve precision of four‐dimensional (4D) phase‐contrast (PC) MRI technique by using multiple velocity encoding (VENC) parameters.

Effect of swirling inlet condition on the flow field in a stenosed arterial vessel model.

Blood flow in an artery is closely related to atherosclerosis progression. Hemodynamic environments influence platelet activation, aggregation, and rupture of atherosclerotic plaque. The existence of swirling flow components in an artery is frequently observed under in vivo conditions. However, the fluid-dynamic roles of spiral flow are not fully understood to date. In this study, the spiral blood flow effect in an axisymmetric stenosis model was experimentally investigated using particle image velocimetry velocity field measurement technique and streakline flow visualization. Spiral inserts with two different helical pitches (10D and 10/3D) were installed upstream of the stenosis to induce swirling flows. Results show that the spiral flow significantly reduces the length of recirculation flow and provokes early breakout of turbulent transition, but variation of swirling intensity does not induce significant changes of turbulence intensity. The present results about the spiral flow effects through the stenosis will contribute in achieving better understanding of the hemodynamic characteristics of atherosclerosis and in discovering better diagnosis procedures and clinical treatments.

Velocity field measurements of valvular blood flow in a human superficial vein using high-frequency ultrasound speckle image velocimetry

This study aims to investigate the blood flow around the perivalvular area in a human superficial vein using high-frequency ultrasound (HFUS) speckle image velocimetry. HFUS B-mode images were captured from the superficial veins of human lower extremity with a 35-MHz transducer. To measure the instantaneous velocity fields of blood flow, a cross-correlation particle image velocimetry (PIV) algorithm was applied to two B-mode images that were captured consecutively. The echo speckles of red blood cells (RBCs) were used as flow tracers. In the vicinity of the venous valve, the opening and closing motions of valve cusps were simultaneously visualized with the phasic variation of velocity fields. Large-scale vortices were observed behind the sinus pockets while the main bloodstream was directed proximally. This measurement technique combining PIV algorithm and HFUS B-mode imaging was found to be unique and useful for investigating the hemodynamic characteristics of blood flow in the perivalvular area and for diagnosing venous insufficiency and valve abnormality in superficial blood vessels.

Fluid-dynamic optimal design of helical vascular graft for stenotic disturbed flow.

Although a helical configuration of a prosthetic vascular graft appears to be clinically beneficial in suppressing thrombosis and intimal hyperplasia, an optimization of a helical design has yet to be achieved because of the lack of a detailed understanding on hemodynamic features in helical grafts and their fluid dynamic influences. In the present study, the swirling flow in a helical graft was hypothesized to have beneficial influences on a disturbed flow structure such as stenotic flow. The characteristics of swirling flows generated by helical tubes with various helical pitches and curvatures were investigated to prove the hypothesis. The fluid dynamic influences of these helical tubes on stenotic flow were quantitatively analysed by using a particle image velocimetry technique. Results showed that the swirling intensity and helicity of the swirling flow have a linear relation with a modified Germano number (Gn*) of the helical pipe. In addition, the swirling flow generated a beneficial flow structure at the stenosis by reducing the size of the recirculation flow under steady and pulsatile flow conditions. Therefore, the beneficial effects of a helical graft on the flow field can be estimated by using the magnitude of Gn*. Finally, an optimized helical design with a maximum Gn* was suggested for the future design of a vascular graft.

Hemodynamic features and platelet aggregation in a stenosed microchannel

Platelet aggregation has been known to be closely influenced by the surrounding hemodynamic environments. Especially, platelet activation, aggregation, and thrombus formation frequently occur at the locally stenosed blood vessel where recirculation and stagnation flow regions are developed. However, the relationship between hemodynamic feature and platelet aggregation is not fully understood yet. The main objective of this study is to investigate the hemodynamic characteristics of blood flow in a stenosis channel and their effects on platelet aggregation. Whole blood was injected into a stenosed microchannel with 85% severity at various flow rates, ranging from 10 to 50mLhr(-1). The velocity vector field of the blood flow in the stenosed microchannel was measured using newly developed LED (light emitting diode)-illumination microparticle image velocimetry (micro-PIV). The blood flow is highly disturbed by the micro-stenosis, and a recirculation flow region is formed at the post-stenosis region. The occurring site and the shape of the platelet aggregation are highly influenced by the hemodynamic characteristics of blood flow around the stenosis. Especially, the platelet aggregation is found to occur at the interface where the downward momentum of the central jet at the post-stenosis region and the upward momentum of the recirculation flow are balanced. These experimental results would be helpful to understand the platelet aggregation under disturbed blood flow conditions.

Turbulent Kinetic Energy Measurement Using Phase Contrast MRI for Estimating the Post-Stenotic Pressure Drop: In Vitro Validation and Clinical Application

Background Although the measurement of turbulence kinetic energy (TKE) by using magnetic resonance imaging (MRI) has been introduced as an alternative index for quantifying energy loss through the cardiac valve, experimental verification and clinical application of this parameter are still required. Objectives The goal of this study is to verify MRI measurements of TKE by using a phantom stenosis with particle image velocimetry (PIV) as the reference standard. In addition, the feasibility of measuring TKE with MRI is explored. Methods MRI measurements of TKE through a phantom stenosis was performed by using clinical 3T MRI scanner. The MRI measurements were verified experimentally by using PIV as the reference standard. In vivo application of MRI-driven TKE was explored in seven patients with aortic valve disease and one healthy volunteer. Transvalvular gradients measured by MRI and echocardiography were compared. Results MRI and PIV measurements of TKE are consistent for turbulent flow (0.666 < R2 < 0.738) with a mean difference of −11.13 J/m3 (SD = 4.34 J/m3). Results of MRI and PIV measurements differ by 2.76 ± 0.82 cm/s (velocity) and −11.13 ± 4.34 J/m3 (TKE) for turbulent flow (Re > 400). The turbulence pressure drop correlates strongly with total TKE (R2 = 0.986). However, in vivo measurements of TKE are not consistent with the transvalvular pressure gradient estimated by echocardiography. Conclusions These results suggest that TKE measurement via MRI may provide a potential benefit as an energy-loss index to characterize blood flow through the aortic valve. However, further clinical studies are necessary to reach definitive conclusions regarding this technique.

Hybrid PIV-PTV technique for measuring blood flow in rat mesenteric vessels.

The micro-particle tracking velocimetry (μ-PTV) technique is used to obtain the velocity fields of blood flow in the microvasculature under in vivo conditions because it can provide the blood velocity distribution in microvessels with high spatial resolution. The in vivo μ-PTV technique usually requires a few to tens of seconds to obtain a whole velocity profile across the vessel diameter because of the limited number density of tracer particles under in vivo conditions. Thus, the μ-PTV technique alone is limited in measuring unsteady blood flows that fluctuate irregularly due to the heart beating and muscle movement in surrounding tissues. In this study, a new hybrid PIV-PTV technique was established by combining PTV and particle image velocimetry (PIV) techniques to resolve the drawbacks of the μ-PTV method in measuring blood flow in microvessels under in vivo conditions. Images of red blood cells (RBCs) and fluorescent particles in rat mesenteric vessels were obtained simultaneously. Temporal variations of the centerline blood velocity were monitored using a fast Fourier transform-based cross-correlation PIV method. The fluorescence particle images were analyzed using the μ-PTV technique to extract the spatial distribution of the velocity vectors. Data from the μ-PTV and PIV methods were combined to obtain a better estimate of the velocity profile in actual blood flow. This technique will be useful in investigating hemodynamics in microcirculation by measuring unsteady irregular blood flows more accurately.

Cardiac outflow and wall motion in hypothermic chick embryos.

Cardiac outflow in the early developmental stage of a chick embryo is known to be highly variable depending on environmental temperature. To investigate the effects of environmental hypothermia on the blood flow in the outflow tract (OFT) of chick embryonic hearts, microscopic flow images were consecutively captured from chick embryos at HH stage 17 (2.5 days of incubation) at room temperature. Instantaneous velocity field information of blood flow in OFT was obtained using a micro-particle image velocimetry technique. The cyclic variations of the OFT vessel diameter and wall thickness were simultaneously measured. The experimental results show that environmental hypothermia causes bradycardia with a decrease in peak velocity during systole and the occurrence of backflow during diastole in the OFT. These abnormal phenomena seem to be attributed to the suppression of myocardial wall motion under hypothermic conditions.

Post-stenotic plug-like jet with a vortex ring demonstrated by 4D flow MRI

PURPOSE To investigate the details of the flow structure of a plug-like jet that had a vortex ring in pulsatile stenotic phantoms using 4D flow MRI. METHOD Pulsatile Newtonian flows in two stenotic phantoms with 50% and 75% reductions in area were scanned by 4D flow MRI. Blood analog working fluid was circulated via the stenotic phantom using a pulsatile pump at a constant pulsating frequency of 1Hz. The velocity and vorticity fields of the plug-like jet with a vortex ring were quantitatively analyzed in the spatial and temporal domains. RESULTS Pulsatile stenotic flow showed a plug-like jet at the specific stenotic degree of 50% in our pulsatile waveform design. This plug-like jet was found at the decelerating period in the post-stenotic region of 26.4mm (1.2 D). It revealed a vortex ring structure with vorticity strength in the range of ±100s(-1). CONCLUSION We observed a plug-like jet with a vortex ring in pulsatile stenotic flow by in vitro visualization using 4D flow MRI. In this plug-like jet, the local fastest flow region occurred at the post-systole phase in the post-stenotic region, which was distinguishable from a typical stenotic jet flow at systole phase.