• RecurringMeetings
• 2016-01-05-1400

Recurring Meeting of Cleveland Clinic Core Team - Multidisciplinary Simulation Center

Date: January 5, 2016

Time: 2:00 PM EST

Means: In person meeting

Attendees:

1. Ahmet Erdemir
2. Tammy Owings
3. Benjamin Landis
4. Robb Colbrunn
5. Tara Bonner
6. John-Eric Jelovsek (Multidisciplinary Simulation Center)

Agenda:

1. Discuss immediate action items from past meetings.

   • http://wiki.simtk.org/multis/RecurringMeetings/2015-12-08-1400

2. Preliminary modeling & simulation work.

3. Decide immediate action items for next meeting.
4. Other.

Immediate Action Items:

• Tammy
  • Follow up with physicians for training on musculoskeletal imaging using ultrasound.
• Ben
  • Setup a meeting with Robb and Ahmet to go over the scans of ultrasound probes in Meshlab.
  • Scan the ultrasound probe 18L6 to obtain the geometry of its casing.
  • Decide upon geometries and material properties to use for a sample simplified model of a multi-layer tissue region.
• Robb
  • Document surgical tools and their handling on the wiki with photos.
  • Start working on cabling and signal generation to synchronize ultrasound imaging and force measurements.
• Tara
  • Update force collection interface to report maximum shear and normal forces during use of ultrasound probe.

Notes:

1. Discuss immediate action items from past meetings.
   • Ahmet reported that there has not been any progress to acquire detailed ultrasound probe drawings from Siemens. He finished and submitted the quarterly progress report and materials related to the renewal of IRB approval. He went over the materials, in particular the progress report and the quad chart, to inform the team about the extent of reporting. Progress reports will be every three months; submission of IRB renewal will be once a year.
   • Tammy updated the experimentation protocol for ultrasound imaging of the forearm. She also collected sample data on upper arm and upper thigh. Imaging of upper thigh was problematic as the probes did not seem to provide adequate depth to visualize the bone for medial and central/proximal placement. It may be necessary to use the curved probe designed for deep tissue imaging.
   • Tammy's efforts to identify training opportunities from Siemens were not fruitful. Eric has reached out to the head of musculoskeletal radiology at the Cleveland Clinic. He will identify a physician and a technician for Tammy to observe. Tammy will follow up on this and maybe ask about imaging of deep tissues, e.g. medial thigh.
   • Robb met with Eric and took a lot of pictures in regard to surgical tools and their handling. He will place these on the wiki. The group reiterated on the surgical tools that will be instrumented and used for experimentation.
     • The team discussed which forces are of interest. Ahmet described that the forces applied on the tissue would be important to measure as these would drive modeling and simulations. Yet, he acknowledged that these may not be equivalent to haptic forces acting on the surgeons hand, particularly when the tool requires internal forces to operate. For example, when using the forceps, one can measure pulling forces, yet may not know the equal and opposite squeezing forces applied by the surgeon's hand. If these are also measured, a full understanding of tissue manipulation and resulting forces in the hand would be possible. Nonetheless, this may be challenging and the projects goal is to first quantify reaction forces at the tool tip generated by tissue manipulation.
     • Various surgical tools were noted again. At the fundamental level, cutting forces will be collected using a scalpel. Forces during cutting with scissors are also of interest, yet instrumentation may be challenging. Measurements of forces during pulling of tissue, e.g. retraction by a forceps, are desirable. To simplify the study, these a hemostat may be used instead of a forceps. Eric emphasized the potential need to measure forces applied when using a cauterizer, e.g. for cutting. Such tools are commonly used in the field and will likely have different loading footprints to cut the tissue. Ahmet noted that we may need to consider it. Robb also raised the possible need for quantifying forces for suturing. Ahmet recommended to treat that as a needle puncture problem.
   • Ben collected three-dimensional scans of three ultrasound probes. He cleaned up the data, i.e. aligned and fused. Ahmet asked him to set up a meeting with him and Robb to go over the geometries. He also requested him to acquire data for the fourth probe as well.
   • Tara showed the mock-up interface for measurement of forces during an ultrasound imaging test session. The interface is clean and user-friendly. The collection scheme moves automatically through different probe positioning. It provides the opportunity for the experimenter to accept or reject a trial or skip conditions. The team asked her to add reporting of maximum shear and normal forces at the end of a trial. This will help the experimented decide to reject and accept a trial more easily. Data will be collected into a TDMS file bot raw and processed, e.g. after coordinate system transformation.
   • Tara mentioned that the laptop, NI-DAQ, and ATI load cell work. Robb will start working on cabling and testing sending signals to ultrasound.

2. Preliminary modeling & simulation work.

   • Ben and Ahmet met to discuss a project to build sample models of multi-layer tissue structures of an extremity in FEBio and SOFA. Ben described the activity and his progress. He has been learning FEBio and going over documentation of SOFA. Ahmet asked him to decide upon geometric and material properties of a simple model to start implementation.
3. Decide immediate action items for next meeting.
   • See Immediate Action Items above.
4. Other.
   • None noted.