Michael Bajka

Inverse finite element characterization of soft tissues

In this work a tissue aspiration method for the in vivo determination of biological soft tissue material parameters is presented. An explicit axisymmetric finite element simulation of the aspiration experiment is used together with a Levenberg-Marquardt algorithm to estimate the material model parameters in an inverse parameter determination process. An optimal fit of the simulated experiment and the real experiment is sought with the parameter estimation algorithm. Soft biological tissue is modelled as a viscoelastic, non-linear, nearly incompressible, isotropic continuum. Viscoelasticity is accounted for by a quasi-linear formulation. The aspiration method is validated experimentally with a synthetic material. In vivo (intra-operatively during surgical interventions) and ex vivo experiments were performed on human uteri.

The mechanical role of the cervix in pregnancy

Appropriate mechanical function of the uterine cervix is critical for maintaining a pregnancy to term so that the fetus can develop fully. At the end of pregnancy, however, the cervix must allow delivery, which requires it to markedly soften, shorten and dilate. There are multiple pathways to spontaneous preterm birth, the leading global cause of death in children less than 5 years old, but all culminate in premature cervical change, because that is the last step in the final common pathway to delivery. The mechanisms underlying premature cervical change in pregnancy are poorly understood, and therefore current clinical protocols to assess preterm birth risk are limited to surrogate markers of mechanical function, such as sonographically measured cervical length. This is what motivates us to study the cervix, for which we propose investigating clinical cervical function in parallel with a quantitative engineering evaluation of its structural function. We aspire to develop a common translational language, as well as generate a rigorous integrated clinical-engineering framework for assessing cervical mechanical function at the cellular to organ level. In this review, we embark on that challenge by describing the current landscape of clinical, biochemical, and engineering concepts associated with the mechanical function of the cervix during pregnancy. Our goal is to use this common platform to inspire novel approaches to delineate normal and abnormal cervical function in pregnancy.

Evaluation of a new virtual-reality training simulator for hysteroscopy

BackgroundTo determine realism and training capacity of HystSim, a new virtual-reality simulator for the training of hysteroscopic interventions.MethodsSixty-two gynaecological surgeons with various levels of expertise were interviewed at the 13th Practical Course in Gynaecologic Endoscopy in Davos, Switzerland. All participants received a 20-min hands-on training on the simulator and filled out a four-page questionnaire. Twenty-three questions with respect to the realism of the simulation and the training capacity were answered on a seven-point Likert scale along with 11 agree–disagree statements concerning the HystSim training in general.ResultsTwenty-six participants had performed more than 50 hysteroscopies (“experts”) and 36 equal to or fewer than 50 (“novices”). Four of 60 (6.6%) responding participants judged the overall impression as “7 – absolutely realistic”, 40 (66.6%) as “6 – realistic”, and 16 (26.6%) as “5 – somewhat realistic”. Novices (6.48; 95% confidence interval [CI] 6.28–6.7) rated the overall training capacity significantly higher than experts (6.08; 95% CI 5.85–6.3), however, high-grade acceptance was found in both groups. In response to the statements, 95.2% believe that HystSim allows procedural training of diagnostic and therapeutic hysteroscopy, and 85.5% suggest that HystSim training should be offered to all novices before performing surgery on real patients.ConclusionFace validity has been established for a new hysteroscopic surgery simulator. Potential trainees and trainers assess it to be a realistic and useful tool for the training of hysteroscopy. Further systematic validation studies are needed to clarify how this system can be optimally integrated into the gynaecological curriculum.

Assessment of the in vivo biomechanical properties of the human uterine cervix in pregnancy using the aspiration test A feasibility study

OBJECTIVE To date no diagnostic tool is yet available to objectively assess the in vivo biomechanical properties of the uterine cervix during gestation. METHODS We show the first clinical application of an aspiration device to assess the in vivo biomechanical properties of the cervix in pregnancy with the aim to describe the physiological biomechanical changes throughout gestation in order to eventually detect pregnant women at risk for cervical insufficiency (CI). RESULTS Out of 15 aspiration measurements, 12 produced valid results. The stiffness values were in the range between 0.013 and 0.068 bar/mm. The results showed a good reproducibility of the aspiration test. In our previous test series on non-pregnant cervices our repetitive measurements showed a standard deviation of >20% compared to <+/-10% to our data on pregnant cervices. Stiffness values are decreasing with gestational age which indicates a progressive softening of cervical tissue towards the end of pregnancy. Three pregnant women had two subsequent measurements within a time interval of four weeks. Decreasing stiffness values in the range of 20% were recorded. DISCUSSION This preliminary study on the clinical practicability of aspiration tests showed promising results in terms of reproducibility (reliability) and clinical use (feasibility). Ongoing studies will provide further insights on its usefulness in clinical practice and in the detection of substantial changes of the cervix in pregnancy indicative for threatened preterm birth or cervical insufficiency.

Cervical softening occurs early in pregnancy: characterization of cervical stiffness in 100 healthy women using the aspiration technique

To quantitatively describe the evolution of ectocervical stiffness in normal pregnancy.

In-vivo assessment of the biomechanical properties of the uterine cervix in pregnancy

Measuring the stiffness of the cervix might be useful in the prediction of preterm delivery or successful induction of labor. For that purpose, a variety of methods for quantitative determination of physical properties of the pregnant cervix have been developed. Herein, we review studies on the clinical application of these new techniques. They are based on the quantification of mechanical, optical, or electrical properties associated with increased hydration and loss of organization in collagen structure. Quasi‐static elastography determines relative values of stiffness; hence, it can identify differences in deformability. Quasi‐static elastography unfortunately cannot quantify in absolute terms the stiffness of the cervix. Also, the current clinical studies did not demonstrate the ability to predict the time point of delivery. In contrast, measurement of maximum deformability of the cervix (e.g. quantified with the cervical consistency index) provided meaningful results, showing an increase in compliance with gestational age. These findings are consistent with aspiration measurements on the pregnant ectocervix, indicating a progressive decrease of stiffness along gestation. Cervical consistency index and aspiration measurements therefore represent promising techniques for quantitative assessment of the biomechanical properties of the cervix.

A novel procedure for the mechanical characterization of the uterine cervix during pregnancy

An in-vivo measurement procedure is presented to characterize the mechanical behavior of human uterine cervix during pregnancy. Based on the aspiration method, a new instrument was developed to provide an inherently safe and easy-to-use mechanical testing technique. Initial measurements were performed on non-pregnant women to develop an appropriate measurement protocol. An inverse analysis was carried out to determine representative model equations for cervical tissue. This model was used in a FE based parametric study focusing on the uncertainties related to the experiment. On this basis, a novel procedure was established which enabled for the first time to conduct mechanical measurements on 50 pregnant women in over 600 applications during gestation. An inverse analysis of the average tissue response at each trimester was performed to determine representative model equations for the cervix in the course of pregnancy.

Generation of variable anatomical models for surgical training simulators

The generation of variable surgical scenes is a key element for effective training with surgery simulators. Our current research aims at a high fidelity hysteroscopy simulator which challenges the trainee with a new surgical scene in every training session. We previously reported on methods able to generate a broad range of pathologies within an existing healthy organ model. This paper presents the methods necessary to produce variable models of the healthy organ. In order to build a database of uteri, a volunteer study was conducted. The segmentation was carried out interactively, also covering the establishment of an anatomically meaningful correspondence between the individual organs. The variability of the shape parameters has been characterized by principal component analysis. A new method has been developed and tested, allowing the derivation of realistic new instances based on the stochastic model and complying with non-linear shape constraints which are defined and interactively controlled by medical experts.

The creation of a high‐fidelity finite element model of the kidney for use in trauma research

A detailed finite element model of the human kidney for trauma research has been created directly from the National Library of Medicine Visible Human Female (VHF) Project data set. An image segmentation and organ reconstruction software package has been developed and employed to transform the 2D VHF images into a 3D polygonal representation. Non-uniform rational B-spline (NURBS) surfaces were then mapped to the polygonal surfaces, and were finally utilized to create a robust 3D hexahedral finite element mesh within a commercially available meshing software. The model employs a combined viscoelastic and hyperelastic material model to successfully simulate the behaviour of biological soft tissues. The finite element model was then validated for use in biomechanical research. Copyright

Experimental Observation and Modelling of Preconditioning in Soft Biological Tissues

Constitutive models for soft biological tissues and in particular for human organs are required for medical applications such as surgery simulation, surgery planning, diagnosis. In the literature the mechanical properties of biosolids are generally presented in “preconditioned” state, i.e. the stabilized conditions reached after several loading-unloading cycles. We hereby present experiments on soft tissues showing the evolution of the mechanical response in a series of loading and unloading cycles. The experimental procedure applied in this study is based on the so called “aspiration experiment” and is suitable for in-vivo applications under sterile conditions during open surgery. In the present study this technique is applied ex-vivo on bovine liver. A small tube is contacted to the target organ and a weak vacuum is generated inside the tube according to a predefined pressure history. Several identical loading and unloading cycles are applied in order to characterize the evolutive behaviour of the tissue. The experimental data are used to inform the fitting of uniaxial and threedimensional continuum mechanics models. This analysis demonstrates that a quasi-linear viscoelastic model fails in describing the observed evolution from the “virgin” to the preconditioned state. Good agreement between simulation and measurement are obtained by introducing an internal variable changing according to an evolution equation.