Recurring Meeting of Cleveland Clinic Core Team

Date: Nov 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.
     • Specimen transportation jig needs to be designed (to hold the specimen in neutral position and applying tension on patella, without disturbing the registration markers while transporting the specimen from Clinic to Case imaging facility).
     • The design of fixture will be included in specimen preparation for MRI.
     • A test session will be conducted on Nov. 14th to test/ analyse the current protocol and check the artefacts related to the brass registration system. Other material samples will also be tested in this session.
     • Current protocol will be used to test and modify the setting based on which tissues we are interested in and the ease of automating segmentation. (T1 for ligaments, tendons and meniscus and T2 for cartilage)
   • Specimen preparation and registration specifications
     • Target outcomes were clearly defined by Ahmet.
     • The page is divided in sections for different preparation stages (imaging, joint testing etc).
     • Preparation for registration is divided into initialisation (anatomical coordinate system to optotrak) and registration preparation (image to joint coordinate system).
     • Sections for preparation for actual steps (initialization, registration , MRI etc) were clearly defined.
     • Jason will prepare a flowchart to describe the work flow including all the preparation stages for initialization and registration.
     • Information for the preparation stages for initialization and registration can be included in the specimen preparation page and will be either linked to from other pages (e.g registration specifications) or eventually be moved to dedicated pages.
     • Specimen preparation will also include preparation for tissue testing.
     • The post-processing information (analysis and mathematics) can be put in separate pages.
   • Robotics testing specifications
     • Tibiofemoral joint testing information was finalized and will be followed as prescribed.
     • Secondary conditions will be discussed and added as necessary.
     • Repeatability test ( e.g A-P laxity at 30 degrees) will be added at three stages (at time= 0,0.5 and 1) to ensure the specimen did not fail.
     • Patellofemoral joint primary test conditions were agreed upon. Suggested flexion angles are part of the gait cycle but do not entirely represent gait cycle. Conditions need to be reworded to clarify the information.
     • Secondary conditions will be added as necessary if time permits.
     • Robb will update/ attach the document describing the naming conventions for tibiofemoral joint.
     • Pressure sensor calibration task will be assigned to Jason.
   • 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.
   • A specimen transportation fixture needs to be designed. The team will meet and discuss the design needs.