Recurring Meeting of Cleveland Clinic Core Team

Date: November 5, 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 tasks progress (finalize specimen specification to order specimens).
2. Discuss/finalize tissue testing equipment purchase.
3. Decide tasks for the next meeting.
4. Other.

Immediate Action Items:

See notes for details.

• All

  • Read and update joint testing, specimen preparation, and specimen registration specifications.
  • Meet for discussions on a specimen transportation fixture design.

• Snehal

  • Create a document to detail the bounds of tissue testing time requirement.
  • Create a task to start describing imaging infrastructure.

• Jason

  • Create a detailed flowchart to incorporate specimen preparation, initialization, registration and imaging.

• Robb

  • Explore the extensibility of Biomomentum, Inc. testing systems, for load control and for attachment of camera.

• Robb & Tara

  • Provide information on experimentation infrastructure.

Notes:

1. Discuss tasks progress (finalize specimen specification to order specimens).
   • Specimen specifications and ordering.
     • The team needs to deliberate on the advantages and disadvantages of ordering specimens that include pelvis to toes, e.g., registration issues, increased testing time, freeze thaw cycles, sharing/exchange with other groups, etc. With a full lower extremity specimen, including all joints, supported with the knowledge acquired from Open Knee(s) experience on specimen preparation and testing, and model development, specimen-specific modeling of the entire lower extremity (hip, knee and ankle joints) may be possible. This can be a branching project.
     • For immediate needs, 2 specimens from different donors will be ordered with the current specifications (hip to toes).
     • X-ray imaging on specimens will need to be done with an axial load on the joint.
     • The team will continue adding and updating discussion points to the wiki to improve upon primary specimen specifications and identify secondary specimens.
   • Imaging specifications.
     • The current protocol will be used as a starting point to modify imaging settings based on tissues of interest and potential ease of automated segmentation, e.g., T1 for ligaments, tendons and meniscus, and T2 for cartilage.
     • A test session will be conducted on November 14, 2013 to evaluate the current protocol and potentially other alternative imaging protocols. In this session, imaging artifacts related to the brass registration system will be assessed along with other material samples.
     • A specimen transportation fixture needs to be designed. This fixture needs to hold the femur and tibia of the specimen at a neutral position and apply tension on patella. As such, transporting the specimen from the Cleveland Clinic to the University Hospitals imaging facility should be possible without disturbing the registration markers. The team will meet and discuss the design needs.
     • The design of fixture will be included as part of specimen preparation specifications for MRI.
   • Specimen preparation and registration specifications.
     • Target outcomes were clearly defined by Ahmet.
     • Specifications for specimen preparation is divided in sections for different preparation stages, e.g. for registration, imaging, joint testing, etc.
     • Specifications for registration is divided into initialization (establishing the transformation between an anatomical coordinate system and Optotrak motion analysis marker coordinate system) and registration (establishing the transformation between the image coordinate system and Optotrak motion analysis marker coordinate system).
     • Jason will prepare a flowchart to describe the work flow including all the preparation stages for the specimen, incorporating initialization and registration.
     • Specifications for specimen initialization and registration can be included in the specimen preparation page or it can be cross-linked linked. The post-processing information for initialization and registration can be put in separate pages.
     • Specifications for specimen preparation will also include preparation for tissue testing.
   • Robotics testing specifications.
     • Information on tibiofemoral joint testing information was finalized and will be followed as prescribed.
     • Secondary conditions for the tibiofemoral joint testing will be discussed and added as necessary.
     • Repeatability testing, e.g, A-P laxity at 30 degrees, will be added at three stages (beginning, middle, end of robotics testing) to ensure the specimen did not fail.
     • Robb will update the wiki or attach a document to describe file naming conventions for tibiofemoral joint testing.
     • Patellofemoral joint primary test conditions were agreed upon. Suggested flexion angles represents the range of tibiofemoral joint angles during gait cycle. Yet, the tibiofemoral joint pose and orientation may not represent gait cycle. Conditions need to be reworded to clarify the information.
     • If time permits, secondary conditions will be added to patellofemoral joint testing.
     • Pressure sensor calibration task will be assigned to Jason to support patellofemoral joint testing.
   • FEBio feature specifications.
     • Ahmet added a new specifications task for FEBio feature request for connectors. This will be the next priority for implementation of Open Knee(s) related FEBio features. A test problem will be provided as part of this specifications task.
   • Tissues testing specifications.
     • Snehal will attempt preparation and testing of a tendon sample.
   • Documentation specifications.
     • Robb and Tara will update the experimentation infrastructure information.
     • Snehal will create an imaging infrastructure task to summarize medical imaging facilities at University Hospitals.
2. Discuss/finalize tissue testing equipment purchase.
   • Robb, Tara and Snehal talked to Biomomentum, Inc. engineers and discussed the project's testing needs and the capabilities of their testing systems.
     • An existing Biomomentum, Inc. machine with an added axis will provide the group more functionality than that we currently have.
     • The quoted single axis machine has better resolution but the software has fewer capabilities than our existing systems.
     • At this moment, no force control is implemented in machines from Biomomentum, Inc. The company is developing this functionality, which may be included in upcoming testing systems, which we may purchase.
     • Protocols for stress relaxation tests are built in to the system. However, due to lack of force control, creep tests cannot be performed.
     • From Open Knee(s), current Biomomentum, Inc. systems seems to have adequate capabilities. Potential camera attachment and further needs for control still need discussions.
   • Snehal will provide a detail of maximum number of hours and frequency of use per specimen as a bound for potential usage plan for the next 4 years.

   • Snehal spoke to a representative from Bose Corp. ElectroForce Systems Group about one of their material testing machines (3100 series). They were informed about the budget constraints and they will provide their feedback in the coming weeks.

3. Decide tasks for the next meeting.
   • See Immediate Action Items above.
4. Other.
   • Cleveland Clinic - University of Utah and the Advisory Board meeting minutes were discussed.
   • Ahmet met all the Advisory Board members and updated them on the progress.
     • All the Advisory Board members will be added as team members at project site so that they can actively oversee the project progress.
     • Various projects were discussed with the Advisory Board. Those related to Open knee can be worked on as secondary branching projects.
     • The Advisory Board members with engineering backgrounds showed interest in MRI segmentation reproducibility. A community project can be developed to accomplish that.
     • Qmetrics, Inc. (as advised by Dr. Winalski) may be able to help the team for image segmentation.