Recurring Meeting of Cleveland Clinic Core Team

Date: October 29, 2013

Time: 10:30 AM EST

Means: In person meeting

Attendees:

1. Ahmet Erdemir
2. Jason Halloran
3. Snehal Chokhandre
4. Robb Colbrunn
5. Tara Bonner

Agenda:

1. Discuss assigned tasks progress.
2. Decide meeting agenda and time for tissue testing equipment purchase.
3. Decide action items for next meeting.
4. Other.

Immediate Action Items:

See notes for details.

• All

  • Start reviewing specifications and make necessary edits.
  • Finalize joint testing specifications.

• Robb, Tara & Snehal

  • Contact Biomomentum Inc. to discuss testing equipment specifications.

• Snehal & Tara

  • Update wiki to describe for imaging and joint testing, if necessary create separate pages.

• Snehal

  • Request quotes for ordering specimens including pelvis to toes.

Notes:

1. Discuss assigned tasks progress.
   • Documentation and publications.
     • Tara and Robb will update the information regarding all the project related testing equipment (mechanical testing infrastructure).
     • Scott will work on the Open Knee - Generation 1 manuscript.
   • Specimen specifications.
     • Science Care, Inc. can provide x-rays for assessment of osteoarthritis severity before order confirmation.
     • Snehal will update the specifications and request price information for pelvis to toe specimens.
     • Some knee specimens used in the pivot shift test (Dr. Saluan) may be used in this project if they fit the need.
     • Suitable specimens from the surgical skills lab may also be used if needed.
     • Anatomy Gifts Registry and other vendors will be contacted to acquire specimens.
   • Imaging specifications.
     • CT may also be used to obtain better bone geometry (per Dr. Winalski).
     • Craig updated the page with images and information for settings currently used for knee imaging.
     • Specimen transportation information will need to be incorporated to the imaging specifications.
     • A new transportation and imaging fixture design is necessary to make sure that the marker placement is not disturbed. This fixture can help secure tibia and femur and also load the patella to avoid any undesirable slackness in the patellar ligament during imaging. The fixture will need to accommodate the knee specimen and the registration markers while fitting in the knee coil of the MRI.
     • Jason, Ahmet and Snehal will meet Chris Flask of the imaging facility at University Hospitals to discuss imaging requirements.
   • Joint testing specifications.
     • Prerequisite protocols were discussed.
     • Primary conditions are the minimum necessary test conditions whereas secondary conditions will be developed and tested based upon the availability of time and resources.
     • Previously used tibiofemoral joint testing conditions (currently listed) will be used for the project as primary conditions. Randomizing order of testing steps may not be necessary as the study is not aiming for testing a hypothesis.
     • For tibiofemoral joint testing, a few test conditions, e.g AP laxity at 30 degrees, will be repeated at the beginning, middle, and end of the session to ensure that the specimen remains intact during the test.
     • Secondary conditions need to be added to patellofemoral testing protocol.
     • Before any joint testing, various issues related to registration and measurements require resolution.
       • Quantification of registration errors is necessary for all marker sets, and possibly for all specimens.
       • Repeatability of acquisition of fiducial marker coordinates using the Optotrak Motion Capture System needs to be quantified. Robb and Tara will work on Optotrak related issues.
       • Repeatability of the holder angle (assigned during tibiofemoral joint testing) may need to be assessed.
     • Joint testing specifications will be finalized in the next meeting.
   • Tissue testing specifications.
     • To ensure adequate data collection on tendons, pilot tests will be conducted on tendon samples. The team has not acquired tendon data using previously established tissue testing protocols.
   • Specimen preparation.
     • The dissection will be done before the marker placement to facilitate placement of markers and securing the knee in a transportation fixture.
     • Information regarding the location of specimen preparation activity and access to all the necessary tools will be added.
     • Specimen preparation page will need to include separate sections for initial preparation, preparation for registration, for MRI, for robotics testing, and for tissue testing. If necessary separate pages will be created.
     • A fixture/ clamp will be useful to cut the bones without disturbing marker placement.
   • Registration.
     • Target outcome of these specifications are two fold: association of anatomical imaging with mechanical testing data, association of mechanical testing data to a clinical coordinate system.

     • Initialization will refer to setting up anatomical coordinate systems in relation to coordinate system of the Optotrak and the robot. Relevant steps will be included in the specimen preparation page.

     • Registration will refer to association of anatomical imaging coordinate system with mechanical testing coordinate system (marker registration). Post-processing steps, to accomplish registration, will be described in this page.

2. Discuss tissue testing equipment purchase.
   • The overall expected cost for minimum required tissue testing (excluding indirect expenses) for 6 specimens is approximately $36k.
   • The goals is find the most cost effective solution.
   • Paying weekly or monthly for using the existing equipment may not be optimal since we will not be continuously testing all the specimens.
   • A more open access to the testing equipment is desirable in order to test more samples without the expenses exceeding the proposed budget.
   • New testing equipment may be purchased for the project which can also be used by the Bio-robotics core for other projects (fee for service).
   • The testing equipment from Biomometum Inc. is being considered which may provide a cost effective option to perform tissues testing for the project.
   • Robb,Tara and Snehal will talk to Biomomentum engineers to make sure the testing equipment meets the project needs.
   • Ahmet send the quote for Mach-1 tissue testing machine (Biomomentum, Inc) to Tara,Robb and Snehal and is awaiting response from NIH regarding equipment purchase.
3. Decide action items for next meeting
   • See details above.
4. Other.
   • Experimentation workflow was explained by Jason.
   • Imaging and tibiofemoral joint testing will be done on day 1 of joint testing. The specimen will be kept refrigerated and the patellofemoral joint testing and tissue testing sample preparation will be done on day 2 of joint testing.