Body fat in adult man: semicentenary of fat density and skinfolds

Adjacent tissues modulate shear wave propagation in axially loaded tendons

Shear wave tensiometry is a noninvasive approach for gauging tendon loads based on shear wave speed. Transient shear waves are induced and tracked via sensors secured to the skin overlying a superficial tendon. Wave speeds measured in vivo via tensiometry modulate with tendon load but are lower than that predicted by a tensioned beam model of an isolated tendon, which may be due to the added inertia of adjacent tissues. The objective of this study was to investigate the effects of adjacent fat tissue on shear wave propagation measurements in axially loaded tendons. We created a layered, dynamic finite element model of an elliptical tendon surrounded by subcutaneous fat. Transient shear waves were generated via an impulsive excitation delivered across the tendon or through the subcutaneous fat. The layered models demonstrated dispersive behavior with phase velocity increasing with frequency. Group shear wave speed could be ascertained via dispersion analysis or time-to-peak measures at sequential spatial locations. Simulated wave speeds in the tendon and adjacent fat were similar and modulated with tendon loading. However, wave speed magnitudes were consistently lower in the layered models than in an isolated tendon. For all models, the wave speed-stress relationship was well described by a tensioned beam model after accounting for the added inertia of the adjacent tissues. These results support the premise that externally excited shear waves are measurable in subcutaneous fat and modulate with axial loading in the underlying tendon. The model suggests that adjacent tissues add inertia to the system, which in turn lowers shear wave speeds. This information must be considered when using tensiometry as a clinical or research tool to infer absolute tendon loading.

Vertical matrix perovskite X-ray detector for effective multi-energy discrimination

Multi-energy X-ray detection is sought after for a wide range of applications including medical imaging, security checking and industrial flaw inspection. Perovskite X-ray detectors are superior in terms of high sensitivity and low detection limit, which lays a foundation for multi-energy discrimination. However, the extended capability of the perovskite detector for multi-energy X-ray detection is challenging and has never been reported. Herein we report the design of vertical matrix perovskite X-ray detectors for multi-energy detection, based on the attenuation behavior of X-ray within the detector and machine learning algorithm. This platform is independent of the complex X-ray source components that constrain the energy discrimination capability. We show that the incident X-ray spectra could be accurately reconstructed from the conversion matrix and measured photocurrent response. Moreover, the detector could produce a set of images containing the density-graded information under single exposure, and locate the concealed position for all low-, medium- and high-density substances. Our findings suggest a new generation of X-ray detectors with features of multi-energy discrimination, density differentiation, and contrast-enhanced imaging.

Fracture behaviour of human skin in deep needle insertion can be captured using validated cohesive zone finite-element method

Medical needles have shown an appreciable contribution to the development of novel medical devices and surgical technologies. A better understanding of needle-skin interactions can advance the design of medical needles, modern surgical robots, and haptic devices. This study employed finite element (FE) modelling to explore the effect of different mechanical and geometrical parameters on the needle's force-displacement relationship, the required force for the skin puncture, and generated mechanical stress around the cutting zone. To this end, we established a cohesive FE model, and identified its parameters by a three-stage parameter identification algorithm to closely replicate the experimental data of needle insertion into the human skin available in the literature. We showed that a bilinear cohesive model with initial stiffness of 5000 MPa/mm, failure traction of 2 MPa, and separation length of 1.6 mm can lead to a model that can closely replicate experimental results. The FE results indicated that while the coefficient of friction between the needle and skin substantially changes the needle reaction force, the insertion velocity does not have a noticeable effect on the reaction force. Regarding the geometrical parameters, needle cutting angle is the prominent factor in terms of stress fields generated in the skin tissue. However, the needle diameter is more influential on the needle reaction force. We also presented an energy study on the frictional dissipation, damage dissipation, and strain energy throughout the insertion process.

Development of a CT number calibration audit phantom in photon radiation therapy: A pilot study

PURPOSE

In photon radiation therapy, computed tomography (CT) numbers are converted into values for mass density (MD) or relative electron density to water (RED). CT-MD or CT-RED calibration tables are relevant for human body dose calculation in an inhomogeneous medium. CT-MD or CT-RED calibration tables are influenced by patient imaging (CT scanner manufacturer, scanning parameters, and patient size), the calibration process (tissue-equivalent phantom manufacturer, and selection of tissue-equivalent material), differences between tissue-equivalent materials and standard tissues, and the dose calculation algorithm applied; however, a CT number calibration audit has not been established. The purposes of this study were to develop a postal audit phantom, and to establish a CT number calibration audit process.

METHODS

A conventional stoichiometric calibration conducts a least square fit of the relationships between the MD, material weight, and measured CT number, using two parameters. In this study, a new stoichiometric CT number calibration scheme has been empirically established, using three parameters to harmonize the calculated CT number with the measured CT number for air and lung tissue. In addition, the suitable material set and the minimal number of materials required for stoichiometric CT number calibration were determined. The MDs and elemental weights from the International Commission on Radiological Protection Publication 110 were used as standard tissue data, to generate the CT-MD and CT-RED calibration tables. A small-sized, CT number calibration phantom was developed for a postal audit, and stoichiometric CT number calibration with the phantom was compared to the CT number calibration tables registered in the radiotherapy treatment planning systems (RTPSs) associated with five radiotherapy institutions.

RESULTS

When a least square fit was performed for the stoichiometric CT number calibration with the three parameters, the calculated CT number showed better agreement with the measured CT number. We established stoichiometric CT number calibration using only two materials because the accuracy of the process was determined not by the number of used materials but by the number of elements contained. The stoichiometric CT number calibration was comparable to the tissue-substitute calibration, with a dose difference less than 1%. An outline of the CT number calibration audit was demonstrated through a multi-institutional study.

CONCLUSIONS

We established a new stoichiometric CT number calibration method for validating the CT number calibration tables registered in RTPSs. We also developed a CT number calibration phantom for a postal audit, which was verified by the performances of multiple CT scanners located at several institutions. The new stoichiometric CT number calibration has the advantages of being performed using only two materials, and decreasing the difference between the calculated and measured CT numbers for air and lung tissue. In the future, a postal CT number calibration audit might be achievable using a smaller phantom.

Modeling of body tissues for Monte Carlo simulation of radiotherapy treatments planned with conventional x-ray CT systems

In the conventional procedure for accurate Monte Carlo simulation of radiotherapy, a CT number given to each pixel of a patient image is directly converted to mass density and elemental composition using their respective functions that have been calibrated specifically for the relevant x-ray CT system. We propose an alternative approach that is a conversion in two steps: the first from CT number to density and the second from density to composition. Based on the latest compilation of standard tissues for reference adult male and female phantoms, we sorted the standard tissues into groups by mass density and defined the representative tissues by averaging the material properties per group. With these representative tissues, we formulated polyline relations between mass density and each of the following; electron density, stopping-power ratio and elemental densities. We also revised a procedure of stoichiometric calibration for CT-number conversion and demonstrated the two-step conversion method for a theoretically emulated CT system with hypothetical 80 keV photons. For the standard tissues, high correlation was generally observed between mass density and the other densities excluding those of C and O for the light spongiosa tissues between 1.0 g cm(-3) and 1.1 g cm(-3) occupying 1% of the human body mass. The polylines fitted to the dominant tissues were generally consistent with similar formulations in the literature. The two-step conversion procedure was demonstrated to be practical and will potentially facilitate Monte Carlo simulation for treatment planning and for retrospective analysis of treatment plans with little impact on the management of planning CT systems.

Electrical field and temperature model of nonthermal irreversible electroporation in heterogeneous tissues

Nonthermal irreversible electroporation (NTIRE) is a new minimally invasive surgical technique that is part of the emerging field of molecular surgery, which holds the potential to treat diseases with unprecedented accuracy. NTIRE utilizes electrical pulses delivered to a targeted area, producing irreversible damage to the cell membrane. Because NTIRE does not cause thermal damage, the integrity of all other molecules, collagen, and elastin in the targeted area is preserved. Previous theoretical studies have only examined NTIRE in homogeneous tissues; however, biological structures are complex collections of diverse tissues. In order to develop electroporation as a precise treatment in clinical applications, realistic models are necessary. Therefore, the purpose of this study was to refine electroporation as a treatment by examining the effect of NTIRE in heterogeneous tissues of the prostate and breast. This study uses a two-dimensional finite element solution of the Laplace and bioheat equations to examine the effects of heterogeneities on electric field and temperature distribution. Three different heterogeneous structures were taken into account: nerves, blood vessels, and ducts. The results of this study demonstrate that heterogeneities significantly impact both the temperature and electrical field distribution in surrounding tissues, indicating that heterogeneities should not be neglected. The results were promising. While the surrounding tissue experienced a high electrical field, the axon of the nerve, the interior of the blood vessel, and the ducts experienced no electrical field. This indicates that blood vessels, nerves, and lactiferous ducts adjacent to a tumor treated with electroporation will survive, while the cancerous lesion is ablated. This study clearly demonstrates the importance of considering heterogeneity in NTIRE applications.

Influence of age and position on the CT number of adipose tissues in pigs

The location of adipose tissue depots is important in determining their significance. Research into the physical and chemical differences between these depots is therefore of interest. Using image analysis, this paper examines the influence of location on the linear attenuation coefficient of adipose tissue for X-rays, in computed tomography (as indicated by CT number) at three time points. Nine pigs were CT scanned on three separate occasions approximately 1 month apart. The mean CT number was -78, -100, and -104 for visceral adipose tissue (VAT) from the first to the final scan, respectively. The corresponding CT numbers for subcutaneous adipose tissue (SAT) were -80, -101, and -106. There was a significant difference between the CT numbers at each location at each scan (P values from 0.025 to <0.001) and between the CT numbers for each location at different times (P < 0.05). In a separate analysis of the final scan session, the mean CT number of adipose tissue at increasing distances from a mathematically defined center of the animal was determined. Regression analysis showed that the CT number of adipose tissue decreases with increasing distance from the animal's center (y = -102.7 - 0.04 x, P < 0.001, where y is the predicted CT number for adipose tissue, from the animal center (x = 0) to the skin (x = 100)). It can thus be expected that the overall mean CT number for adipose tissue can be used as an indicator of the relative quantities of adipose tissue at each location if the mean for each is known.