Recurring Meeting of Cleveland Clinic Core Team

Date: February 23, 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

Agenda:

1. Discuss immediate action items from past meetings.

   • http://wiki.simtk.org/multis/RecurringMeetings/2016-02-16

2. Readiness for in vivo testing.
3. Decide immediate action items for next meeting.
4. Other.

Immediate Action Items:

• Ahmet
  • Continue working on the design of ultrasound probe - force transducer attachment and the handle.
  • Incorporate notes on mock-up test to in vivo testing specifications page.
  • Review simple model wiki page for recommendations.
• Tammy
  • Document tips for in vivo testing protocol based on mock-up test.
  • Purchase ultrasound gel, and other supplies, e.g. foot rest, for in vivo testing.
  • Purchase snowboard/ski bag for in vitro testing.
  • Check surgical mats for standardization of laying surface for in vivo testing.
  • Document ultrasound image transfer and storage protocol and removal from ultrasound system.
• Ben
  • Follow up with tetrahedral element convergence in simple model of indentation.
  • Follow up with installation of modeler for SOFA, surgical simulation software.

• Ahmet & Ben

  • Go over Salome for generation of geometries and meshes for modeling.

• Robb & Tara

  • Document data file labeling for in vivo testing.
  • Convert subject configuration format to XML.
• Tara
  • Update data collection features for force measurements during in vivo testing.

Notes:

1. Discuss immediate action items from past meetings.
   • Ahmet met with Ryan Klatte (of Medical Device Solutions at Cleveland Clinic) to outsource the design and manufacturing of the ultrasound probe - force transducer attachment and the handle. Ryan will provide a quote for the work this week. Ahmet will continue working with Ryan and his colleagues in this regard.
   • Tammy met with Ahmet and collected mock-up data using the ultrasound system to understand operational burden of in vivo testing. Both Tammy and Ahmet identified adjustments to data collection scheme. More details are provided in the agenda item below on readiness for in vivo testing.
   • Tammy and Ahmet talked to Snehal Chokhandre. Snehal mentioned that there may be a leg specimen available. Tammy will follow up to see if the specimen is suitable for our use.
   • Tammy identified bags for specimen transportation. She will purchase one that can accommodate a whole leg.
   • Ben requested Ahmet to provide feedback on the wiki page for simple model of indentation utilizing FEBio. He has not populated the source code repository with the models. Ben has been working on getting a simulation running with a model using tetrahedral mesh. He faced convergence issues that he will try to work on in the upcoming week. Ben has also been working on the modeling workflow starting from STL surfaces. This strategy will allow implementing modeling steps analogous to those when using actual anatomy.
   • Ben and Ahmet did not meet to discuss the use of high performance computing in Cleveland Clinic. Ben has been trying to get the tetrahedral mesh models to converge first.
   • Robb ordered the orientation/tilt sensor. He has played with drivers to ensure he can incorporate the sensor into his data collections software.
   • Robb documented ultrasound settings when using synchronization through the EKG channel. He also uploaded a sample ultrasound image to the wiki including detailed information on synchronization signal and connections.
   • Robb passed data file labeling information to Tara for her to incorporate into force measurement system. The labeling system still needs to be documented on the wiki.
   • Robb and Tara worked on the subject configuration file to incorporate into force measurement system. Ahmet requested that the file format should accommodate XML.
2. Readiness for in vivo testing.
   • Work on data collection system is ongoing:
     • An orientation/tilt sensor was purchased.
     • Wiring for synchronization has been completed.
     • Tara started incorporating the specifications of output data file for force measurement system.
     • Tara incorporated the data file naming convention. Documentation should be provided in the wiki. When repeated for an the specific location, the system appends a repetition/trial number at the end of the filename. Ahmet requested that a repetition number to be added to the first file even when the data collection was not repeated.
     • Subject data file scheme was implemented in the data collection system. This information can be entered through the data collection interface. Subject window may need to be divided into tabs for visualization and editing of different regions of subject data file, e.g. general information, anthropometrics, and indicators for trials. Data collection procedure automatically refers the full path of force data for each location it is collected. The data file format will be moved to XML.
   • Ahmet met with Ryan Klatte in the engineering design group. He will receive a quote this week for further design and manufacturing of fixtures to hold different ultrasound probes.
   • Tammy and Ahmet conducted a mock up trial to understand the workload during experimentation and to identify improvements:
     • The whole testing, including anthropometric measurements and imaging of all regions and locations, took about three hours. This can be reduced to less than two hours, given that the mock-up testing included a lot of discussions and trial-and-error.
     • Subject data collection interface and file should include entries for the location of circumference measurements, i.e., distance from proximal landmark.
     • The water soluble marker worked well for clean up after testing.
     • The time duration for ultrasound imaging can be set at protocols menu, e.g. by changing the beat number.
     • At a given location, Tammy zooms in to see the boundaries. It is not known that if zooming in changes the resolution of the collected images.
     • It is possible to set brightness and contrast automatically or manually. It may be useful to provide guidance on which settings to use.
     • For a given location, it may be convenient to conduct indentation immediately after ultrasound imaging for thickness measurement. This may require Tara to update the order of locations in the force measurement interface.
     • Supplies will be needed: ultrasound gel, laundry detergent to clean the sheets and towels, markers.
     • Most of measurements was conducted by 14L5. As the overall thickness of the tissue gets larger, the use of 9L4 became apparent. 9L4 was needed for upper arm, posterior proximal location. For lower leg 14L5 was useful for distal locations, starting with central medial lower leg location 9L4 would be required.

     • It is desirable to standardize laying surface. In modeling & simulation, for gravity compensation, we need to know actual properties the mat. Tammy will explore surgical mats.

     • In the anterior and posterior lower leg imaging targeted tibia, medial and lateral imaging targeted fibula.
     • The horizontal mark of the probe was towards the distal side. This resulted in image orientation with the distal side on the right of the image.
     • A foot rest needs to be purchased to keep the foot straight up. A hand rest will help Tammy to stabilize her hand.
     • A 10 second image collection results in ~20-30 MB of a file. Ultrasound image storage burden for a single subject will likely be more than 1 GB. Tammy needs to device a strategy to transfer data files from the ultrasound system to the data management infrastructure. In following, the data files should be removed from the ultrasound system.
     • Data will be collected first when the subject lays on his/her back. This will allow imaging of anterior, medial, and lateral regions. After the subject lays on his/her stomach, posterior regions will be collected. Tammy prefers to start with the arm than move to the leg.
   • Snehal Chokhandre informed Tammy and Ahmet that a cadaver leg specimen may be available for fine tuning of in vitro test protocols. Tammy will follow up; if not specimens will be ordered.
3. Decide immediate action items for next meeting.
   • See Immediate Action Items above.
4. Other.
   • None noted.