Generación de modelos físicos personalizados y segmentación de la pared arterial y el trombo intraluminal en imágenes de aneurismas aórticos abdominales

Esta tesis doctoral está encuadrada dentro del marco general de la ingeniería biomédica aplicada al tratamiento de las enfermedades cardiovasculares, enfermedades que provocan alrededor de 1.9 millones (40%) de muertes al año en la Unión Europea. En este contexto surge el proyecto europeo SCATh-Smart Catheterization, cuyo objetivo principal es mejorar los procedimientos de cateterismo aórtico introduciendo nuevas tecnologías de planificación y navegación quirúrgica y minimizando el uso de fluoroscopía. En particular, esta tesis aborda el modelado y diagnóstico de aneurismas aórticos abdominales (AAA) y del trombo intraluminal (TIL), allí donde esté presente, así como la segmentación de estas estructuras en imágenes preoperatorias de RM. Los modelos físicos específicos del paciente, construidos a partir de imágenes médicas preoperatorias, tienen múltiples usos, que van desde la evaluación preoperatoria de estructuras anatómicas a la planificación quirúrgica para el guiado de catéteres. En el diagnóstico y tratamiento de AAA, los modelos físicos son útiles a la hora de evaluar diversas variables biomecánicas y fisiológicas de las estructuras vasculares. Existen múltiples técnicas que requieren de la generación de modelos físicos que representen la anatomía vascular. Una de las principales aplicaciones de los modelos físicos es el análisis de elementos finitos (FE). Las simulaciones de FE para AAA pueden ser específicas para el paciente y permiten modelar estados de estrés complejos, incluyendo los efectos provocados por el TIL. La aplicación de métodos numéricos de análisis tiene como requisito previo la generación de una malla computacional que representa la geometría de interés mediante un conjunto de elementos poliédricos, siendo los hexaédricos los que presentan mejores resultados. En las estructuras vasculares, generar mallas hexaédricas es un proceso especialmente exigente debido a la compleja anatomía 3D ramificada. La mayoría de los AAA se encuentran situados en la bifurcación de la arteria aorta en las arterias iliacas y es necesario modelar de manera fiel dicha bifurcación. En el caso de que la sangre se estanque en el aneurisma provocando un TIL, éste forma una estructura adyacente a la pared aórtica. De este modo, el contorno externo del TIL es el mismo que el contorno interno de la pared, por lo que las mallas resultantes deben reflejar esta particularidad, lo que se denomina como "mallas conformadas". El fin último de este trabajo es modelar las estructuras vasculares de modo que proporcionen nuevas herramientas para un mejor diagnóstico clínico, facilitando medidas de riesgo de rotura de la arteria, presión sistólica o diastólica, etc. Por tanto, el primer objetivo de esta tesis es diseñar un método novedoso y robusto para generar mallas hexaédricas tanto de la pared aórtica como del trombo. Para la identificación de estas estructuras se utilizan imágenes de resonancia magnética (RM). Deben mantenerse sus propiedades de adyacencia utilizando elementos de alta calidad, prestando especial atención al modelado de la bifurcación y a que sean adecuadas para el análisis de FE. El método tiene en cuenta la evolución de la línea central del vaso en el espacio tridimensional y genera la malla directamente a partir de las imágenes segmentadas, sin necesidad de reconstruir superficies triangulares. Con el fin de reducir la intervención del usuario en el proceso de generación de las mallas, es también objetivo de esta tesis desarrollar un método de segmentación semiautomática de las distintas estructuras de interés. Las principales contribuciones de esta tesis doctoral son: 1. El diseño, implementación y evaluación de un algoritmo de generación de mallas hexaédricas conformadas de la pared y el TIL a partir de los contornos segmentados en imágenes de RM. Se ha llevado a cabo una evaluación de calidad que determine su aplicabilidad a métodos de FE. Los resultados demuestran que el algoritmo desarrollado genera mallas conformadas de alta calidad incluso en la región de la bifurcación, que son adecuadas para su uso en métodos de análisis de FE. 2. El diseño, implementación y evaluación de un método de segmentación automático de las estructuras de interés. La luz arterial se segmenta de manera semiautomática utilizando un software disponible a partir de imágenes de RM con contraste. Los resultados de este proceso sirven de inicialización para la segmentación automática de las caras interna y externa de la pared aórtica utilizando métodos basado en modelos de textura y forma a partir de imágenes de RM sin contraste. Los resultados demuestran que el algoritmo desarrollado proporciona segmentaciones fieles de las distintas estructuras de interés. En conclusión, el trabajo realizado en esta tesis doctoral corrobora las hipótesis de investigación postuladas, y pretende servir como aportación para futuros avances en la generación de modelos físicos de geometrías biológicas. ABSTRACT The frame of this PhD Thesis is the biomedical engineering applied to the treatment of cardiovascular diseases, which cause around 1.9 million deaths per year in the European Union and suppose about 40% of deaths per year. In this context appears the European project SCATh-Smart Catheterization. The main objective of this project is creating a platform which improves the navigation of catheters in aortic catheterization minimizing the use of fluoroscopy. In the framework of this project, the specific field of this PhD Thesis is the diagnosis and modeling of abdominal aortic aneurysm (AAAs) and the intraluminal thrombus (ILT) whenever it is present. Patient-specific physical models built from preoperative imaging are becoming increasingly important in the area of minimally invasive surgery. These models can be employed for different purposes, such as the preoperatory evaluation of anatomic structures or the surgical planning for catheter guidance. In the specific case of AAA diagnosis and treatment, physical models are especially useful for evaluating pressures over vascular structures. There are multiple techniques that require the generation of physical models which represent the target anatomy. Finite element (FE) analysis is one the principal applications for physical models. FE simulations for AAA may be patient-specific and allow modeling biomechanical and physiological variables including those produced by ILT, and also the segmentation of those anatomical structures in preoperative MR images. Applying numeric methods requires the generation of a proper computational mesh. These meshes represent the patient anatomy using a set of polyhedral elements, with hexahedral elements providing better results. In the specific case of vascular structures, generating hexahedral meshes is a challenging task due to the complex 3D branching anatomy. Each patient’s aneurysm is unique, characterized by its location and shape, and must be accurately represented for subsequent analyses to be meaningful. Most AAAs are located in the region where the aorta bifurcates into the iliac arteries and it is necessary to model this bifurcation precisely and reliably. If blood stagnates in the aneurysm and forms an ILT, it exists as a conforming structure with the aortic wall, i.e. the ILT’s outer contour is the same as the wall’s inner contour. Therefore, resulting meshes must also be conforming. The main objective of this PhD Thesis is designing a novel and robust method for generating conforming hexahedral meshes for the aortic wall and the thrombus. These meshes are built using largely high-quality elements, especially at the bifurcation, that are suitable for FE analysis of tissue stresses. The method accounts for the evolution of the vessel’s centerline which may develop outside a single plane, and generates the mesh directly from segmented images without the requirement to reconstruct triangular surfaces. In order to reduce the user intervention in the mesh generation process is also a goal of this PhD. Thesis to develop a semiautomatic segmentation method for the structures of interest. The segmentation is performed from magnetic resonance image (MRI) sequences that have tuned to provide high contrast for the arterial tissue against the surrounding soft tissue, so that we determine the required information reliably. The main contributions of this PhD Thesis are: 1. The design, implementation and evaluation of an algorithm for generating hexahedral conforming meshes of the arterial wall and the ILT from the segmented contours. A quality inspection has been applied to the meshes in order to determine their suitability for FE methods. Results show that the developed algorithm generates high quality conforming hexahedral meshes even at the bifurcation region. Thus, these meshes are suitable for FE analysis. 2. The design, implementation and evaluation of a semiautomatic segmentation method for the structures of interest. The lumen is segmented in a semiautomatic way from contrast filled MRI using an available software. The results obtained from this process are used to initialize the automatic segmentation of the internal and external faces of the aortic wall. These segmentations are performed by methods based on texture and shape models from MRI with no contrast. The results show that the algorithm provides faithful segmentations of the structures of interest requiring minimal user intervention. In conclusion, the work undertaken in this PhD. Thesis verifies the investigation hypotheses. It intends to serve as basis for future physical model generation of proper biological anatomies used by numerical methods.

Two-dimensional mesh optimization in the finite element method

The solution to the problem of finding the optimum mesh design in the finite element method with the restriction of a given number of degrees of freedom, is an interesting problem, particularly in the applications method. At present, the usual procedures introduce new degrees of freedom (remeshing) in a given mesh in order to obtain a more adequate one, from the point of view of the calculation results (errors uniformity). However, from the solution of the optimum mesh problem with a specific number of degrees of freedom some useful recommendations and criteria for the mesh construction may be drawn. For 1-D problems, namely for the simple truss and beam elements, analytical solutions have been found and they are given in this paper. For the more complex 2-D problems (plane stress and plane strain) numerical methods to obtain the optimum mesh, based on optimization procedures have to be used. The objective function, used in the minimization process, has been the total potential energy. Some examples are presented. Finally some conclusions and hints about the possible new developments of these techniques are also given.

High-quality conforming hexahedral meshes of patient-specific abdominal aortic aneurysms including their intraluminal thrombi

In order to perform finite element (FE) analyses of patient-specific abdominal aortic aneurysms, geometries derived from medical images must be meshed with suitable elements. We propose a semi-automatic method for generating conforming hexahedral meshes directly from contours segmented from medical images. Magnetic resonance images are generated using a protocol developed to give the abdominal aorta high contrast against the surrounding soft tissue. These data allow us to distinguish between the different structures of interest. We build novel quadrilateral meshes for each surface of the sectioned geometry and generate conforming hexahedral meshes by combining the quadrilateral meshes. The three-layered morphology of both the arterial wall and thrombus is incorporated using parameters determined from experiments. We demonstrate the quality of our patient-specific meshes using the element Scaled Jacobian. The method efficiently generates high-quality elements suitable for FE analysis, even in the bifurcation region of the aorta into the iliac arteries. For example, hexahedral meshes of up to 125,000 elements are generated in less than 130 s, with 94.8 % of elements well suited for FE analysis. We provide novel input for simulations by independently meshing both the arterial wall and intraluminal thrombus of the aneurysm, and their respective layered morphologies.

Development of AMREM: a Maxwell's equations solver with Adaptive Mesh Refinement

El principal objetivo de la presente tesis es el de desarrollar y probar un código capaz de resolver las ecuaciones de Maxwell en el dominio del tiempo con Malla Refinada Adaptativa (AMR por sus siglas en inglés). AMR es una técnica de cálculo basada en dividir el dominio físico del problema en distintas mallas rectangulares paralelas a las direcciones cartesianas. Cada una de las mallas tendrá distinta resolución y aquellas con mayor resolución se sitúan allí dónde las ondas electromagnéticas se propagan o interaccionan con los materiales, es decir, dónde mayor precisión es requerida. Como las ondas van desplazándose por todo el dominio, las mayas deberán seguirlas. El principal problema al utilizar esta metodología se puede encontrar en las fronteras internas, dónde las distintas mallas se unen. Ya que el método más corrientemente utilizado para resolver las ecuaciones de Maxwell es el de las diferencias finitas en el dominio del tiempo (FDTD por sus siglas en inglés) , el trabajo comenzó tratando de adaptar AMR a FDTD. Tras descubrirse que esta interacción resultaba en problemas de inestabilidades en las fronteras internas antes citadas, se decidió cambiar a un método basado en volúmenes finitos en el dominio del tiempo (FVTD por sus siglas en inglés). Este se basa en considerar la forma en ecuaciones de conservación de las ecuaciones de Maxwell y aplicar a su resolución un esquema de Godunov. Se ha probado que es clave para el correcto funcionamiento del código la elección de un limitador de flujo que proteja los extremos de la onda de la disipación típica de los métodos de este tipo. Otro problema clásico a la hora de resolver las ecuaciones de Maxwell es el de tratar con las condiciones de frontera física cuando se simulan dominios no acotados, es decir, dónde las ondas deben salir del sistema sin producir ninguna reflexión. Normalmente la solución es la de disponer una banda absorbente en las fronteras físicas. En AMREM se ha desarrollado un nuevo método basado en los campos característicos que con menor requisito de CPU funcina suficientemente bien incluso en los casos más desfaborables. El código ha sido contrastado con soluciones analíticas de diferentes problemas y también su velocidad ha sido comparada con la de Meep, uno de los programas más conocidos del ámbito. También algunas aplicaciones han sido simuladas con el fin de demostrar el amplio espectro de campos en los que AMREM puede funcionar como una útil herramienta.

Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost

Objective: To compare tension-free open mesh hernioplasty under local anaesthetic with transabdominal preperitoneal laparoscopic hernia repair under general anaesthetic.

Evaluating approximations generated by the GNG3D method for mesh simplification

In this paper we present different error measurements with the aim to evaluate the quality of the approximations generated by the GNG3D method for mesh simplification. The first phase of this method consists on the execution of the GNG3D algorithm, described in the paper. The primary goal of this phase is to obtain a simplified set of vertices representing the best approximation of the original 3D object. In the reconstruction phase we use the information provided by the optimization algorithm to reconstruct the faces thus obtaining the optimized mesh. The implementation of three error functions, named Eavg, Emax, Esur, permitts us to control the error of the simplified model, as it is shown in the examples studied.

Computational cost of GNG3D algorithm for mesh simplification

In this paper we present a study of the computational cost of the GNG3D algorithm for mesh optimization. This algorithm has been implemented taking as a basis a new method which is based on neural networks and consists on two differentiated phases: an optimization phase and a reconstruction phase. The optimization phase is developed applying an optimization algorithm based on the Growing Neural Gas model, which constitutes an unsupervised incremental clustering algorithm. The primary goal of this phase is to obtain a simplified set of vertices representing the best approximation of the original 3D object. In the reconstruction phase we use the information provided by the optimization algorithm to reconstruct the faces thus obtaining the optimized mesh. The computational cost of both phases is calculated, showing some examples.

The effect of variable mesh size on the stability of multistep methods /

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Fish screen head loss, perforated 16-gage steel plate (5/32-inch holes staggered on 7/32-inch centers) versus 5-mesh, 19-gage galvanized wire, Tracy Pumping Plant intake, Central Valley Project /

Mode of access: Internet.

Housing finance : implications of alternative methods of adjusting the conforming loan limit : report to Congressional requesters /

"B-257364"--P. 1.

An apology for conforming to the Protestant Episcopal Church contained in a series of letters addressed to the Right Rev. Benjamin T. Onderdonk

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A socio-psychological study of conforming and deviating behavior among adolescents; a final report of research under contract project 507 (8133) a cooperative research project of the United States Office of Education and the State University of Iowa. Project staff: Albert J. Reiss, Jr., project director [and] Albert Lewis Rhodes, research associate.

"The first two years of this three year project were undertaken as Cooperative Research Project 6399, by Vanderbilt University and the U.S. Office of Education."

Listed Construction Materials and Equipment and Methods of Construction and of Installation of Equipment Conforming to the Fire and Panic Safety Standards

Mode of access: Internet.

Reacting to an assumed situation vs. conforming to an assumed reaction: The role of perceived speaker attitude in vicarious dissonance

Witnessing an ingroup member acting against his or her belief can lead individuals who identify with that group to change their own attitude in the direction of that counterattitudinal behavior. Two studies demonstrate this vicarious dissonance effect among high ingroup identifiers and show that this attitude change is not attributable to conformity to a perceived change in speaker attitude. Study I shows that the effect occurs-indeed, is stronger-even when it is clear that the speaker disagrees with the position espoused, and Study 2 shows that foreseeable aversive consequences bring about attitude change in the observer without any parallel impact on the perceived attitude of the speaker. Furthermore, the assumption that vicarious dissonance is at heart a group phenomenon is supported by the results indicating that attitude change is not impacted either by individual differences in dispositional empathy or measures of interpersonal affinity.