A statistical human rib cage geometry model accounting for variations by age, sex, stature and body mass index

Mechanical chest compression increases intrathoracic hemorrhage complications in patients receiving extracorporeal cardiopulmonary resuscitation

Background

Mechanical cardiopulmonary resuscitation (CPR) devices address the limitations of manual CPR, but their impact on intrathoracic injuries during extracorporeal CPR (ECPR) remains unclear. This study investigated the relationship between mechanical CPR and severe intrathoracic hemorrhage during ECPR compared to manual CPR.

Methods

We conducted a single-center retrospective study of consecutive patients who underwent ECPR from April 2017 to March 2024 according to a standard institutional protocol. Patients were divided into a mechanical CPR group (piston-driven compressions before veno-arterial extracorporeal membrane oxygenation [VA-ECMO]) and a manual CPR group. The primary outcome was intrathoracic hemorrhage requiring transcatheter arterial embolization (TAE). Secondary outcomes included other intrathoracic injuries and 180-day survival.

Results

A total of 91 patients were enrolled (mechanical n = 48, manual n = 43). Intrathoracic hemorrhage requiring TAE occurred more frequently in the mechanical CPR group (18.8% vs. 2.3%, p = 0.030). On multivariate analysis, mechanical CPR was independently associated with this outcome (adjusted odds ratio 6.29; 95% confidence interval 1.20-65.10). In the mechanical group, older age and larger thoracic transverse diameter were significantly related to intrathoracic hemorrhage requiring TAE. Mediastinal hematoma (18.8% vs. 2.3%, p = 0.030) and hemothorax (20.8% vs. 4.7%, p = 0.049) were also more frequent in the mechanical group. The 180-day survival rates did not differ significantly between groups (27.7% vs. 25.0%, log-rank p = 0.540).

Conclusions

Mechanical CPR during ECPR is associated with an increased risk of severe intrathoracic hemorrhage. While mechanical CPR devices may provide benefits in certain scenarios, clinicians should carefully consider individual patient characteristics and closely monitor for complications.

The effect of Scheuermann's kyphosis on rib cage morphology: A skeletal study

BACKGROUND

Evolutionary changes in human rib cage morphology rendered it prone to pathologies like Scheuermann's kyphosis (SK). However, the impact of SK on rib cage morphology is unclear.

PURPOSE

This study aimed to examine differences in rib cage morphology (e.g., ribs and sternum) between SK patients and a control group.

METHODS

Measurements of the vertebral body, transverse process angle, sternum, and rib size were taken from the skeletons of SK patients (76) and a control group (96). Statistical tests were carried out to examine differences between the study and control groups and between the right and left sides. Correlations were obtained to examine the associations between the extent of the kyphosis (kyphosis angle) and rib cage variables.

RESULTS

The SK group yielded significantly longer and flatter ribs than the control group in both sexes. However, males had the largest differences in the 9th rib and females in the upper ribs (5-7). Inconsistency in symmetry results was found between the sexes. In summary, SK patients had a larger anteroposterior diameter in relation to the transverse diameter than the control group.

DISCUSSION AND CONCLUSIONS

SK affects the morphology of the entire thorax and changes rib proportions similarly in males and females. These changes might have a role in bipedal stability and locomotion efficiency. Moreover, understanding the unique anatomy of SK patients is essential when performing an anterior release and anterior fusion operative approach. Finally, it provides insights into respiratory complications and poor prognosis related to individuals suffering from severe hyperkyphosis.

Gender-Based Differences in the Biomechanical Behavior of the Thorax During CPR Maneuvers

In this study, 18 rib cages (8 males and 10 females) were segmented from computer tomography (CT) images. In order to analyze the potential differences in thoracic biomechanics during cardiopulmonary resuscitation (CPR), a set of numerical experiments was conducted using finite elements (FE). Compression forces were applied at different points on the rib cage. Results indicated that the optimal compression area for both sexes is the sternum at the 5th rib level, requiring the least force to achieve the desired compression depth. Males required greater force than females. Among females, those with lower width/depth ratios (more rounded thoracic shape) required less force compared to those with higher ratios (more oval-shaped thorax).

Development of bone surrogates by material extrusion-based additive manufacturing to mimic flexural mechanical behaviour and fracture prediction via phase-field approach

BACKGROUND AND OBJECTIVE

The limited availability of human bone samples for investigation leads to the demand for alternatives. Bone surrogates are crucial in promoting research on the intricate mechanics of osseous tissue. However, solutions are restricted to commercial brands, which frequently fail to faithfully replicate the mechanical response of bone, or oversimplified customised simulants designed for a specific application. The manufacturing and assessment of reliable bone surrogates made of polylactic acid via material extrusion-based additive manufacturing are presented in this work.

METHODS

An experimental and numerical study with 3D-printed dog-bone and prismatic specimens was carried out to characterise the polymeric feedstock and analyse the influence of process parameters under three-point bending and quasi-static conditions. Besides, three porcine rib samples were considered as a reference for the development of the artificial bones. Bone surrogates were manufactured from the 3D-scanned real bone geometries. In order to reproduce the trabecular and cortical bone, a lattice structure for the infill and a compact shell surrounding the core were employed. Infill density and shell thickness were evaluated through different printing configurations. Additionally, a computational analysis based on the phase-field approach was conducted to simulate the experimental tests and predict fracture. The modelling considered homogenisation of the infill material.

RESULTS

Outcomes demonstrated the potential of the presented methodology. Maximum force and flexural stiffness were compared to real bone properties to find the optimal printing configuration, replicating the flexural mechanical behaviour of bone tissue. Certain configurations accurately reproduce the studied properties. Regarding the numerical model, strength and stiffness prediction was validated with experimental results.

CONCLUSIONS

The presented methodology enables the manufacturing of artificial bones with accurate geometries and tailored mechanical properties. Furthermore, the described modelling strategy offers a powerful tool for designing bone surrogates.

Simulative investigation of the required level of geometrical individualization of the lumbar spines to predict fractures

Injury mechanisms of the lumbar spine under dynamic loading are dependent on spine curvature and anatomical variation. Impact simulation with finite element (FE) models can assist the reconstruction and prediction of injuries. The objective of this study was to determine which level of individualization of a baseline FE lumbar spine model is necessary to replicate experimental responses and fracture locations in a dynamic experiment.Experimental X-rays from 26 dynamic drop tower tests were used to create three configurations of a lumbar spine model (T12 to L5): baseline, with aligned vertebrae (positioned), and with aligned and morphed vertebrae (morphed). Each model was simulated with the corresponding loading and boundary conditions from dynamic lumbar spine experiments. Force, moment, and kinematic responses were compared to the experimental data. Cosine similarity was computed to assess how well simulation responses match the experimental data. The pressure distribution within the vertebrae was used to compare fracture risk and fracture location between the different models.The positioned models replicated the injured spinal level and the fracture patterns quite well, though the morphed models provided slightly more accuracy. However, for impact reconstruction or injury prediction, the authors recommend pure positioning for whole-body models, as the gain in accuracy was relatively small, while the morphing modifications of the model require considerably higher efforts. These results improve the understanding of the application of human body models to investigate lumbar injury mechanisms with FE models.

A deep learning-based pipeline for developing multi-rib shape generative model with populational percentiles or anthropometrics as predictors

Rib cross-sectional shapes (characterized by the outer contour and cortical bone thickness) affect the rib mechanical response under impact loading, thereby influence the rib injury pattern and risk. A statistical description of the rib shapes or their correlations to anthropometrics is a prerequisite to the development of numerical human body models representing target demographics. Variational autoencoders (VAE) as anatomical shape generators remain to be explored in terms of utilizing the latent vectors to control or interpret the representativeness of the generated results. In this paper, we propose a pipeline for developing a multi-rib cross-sectional shape generative model from CT images, which consists of the achievement of rib cross-sectional shape data from CT images using an anatomical indexing system and regular grids, and a unified framework to fit shape distributions and associate shapes to anthropometrics for different rib categories. Specifically, we collected CT images including 3193 ribs, surface regular grid is generated for each rib based on anatomical coordinates, the rib cross-sectional shapes are characterized by nodal coordinates and cortical bone thickness. The tensor structure of shape data based on regular grids enable the implementation of CNNs in the conditional variational autoencoder (CVAE). The CVAE is trained against an auxiliary classifier to decouple the low-dimensional representations of the inter- and intra- variations and fit each intra-variation by a Gaussian distribution simultaneously. Random tree regressors are further leveraged to associate each continuous intra-class space with the corresponding anthropometrics of the subjects, i.e., age, height and weight. As a result, with the rib class labels and the latent vectors sampled from Gaussian distributions or predicted from anthropometrics as the inputs, the decoder can generate valid rib cross-sectional shapes of given class labels (male/female, 2nd to 11th ribs) for arbitrary populational percentiles or specific age, height and weight, which paves the road for future biomedical and biomechanical studies considering the diversity of rib shapes across the population.

Population trends in human rib cross-sectional shapes

Rib fractures remain the most frequent thoracic injury in motor vehicle crashes. Computational human body models (HBMs) can be used to simulate these injuries and design mitigation strategies, but they require adequately detailed geometry to replicate such fractures. Due to a lack of rib cross-sectional shape data availability, most commercial HBMs use highly simplified rib sections extracted from a single individual during original HBM development. This study provides human rib shape data collected from chest CT scans of 240 females and males across the full adult age range. A cortical bone mapping algorithm extracted cross-sectional geometry from scans in terms of local periosteal position with respect to the central rib axis and local cortex thickness. Principal component analysis was used to reduce the dimensionality of these cross-sectional shape data. Linear regression found significant associations between principal component scores and subject demographics (sex, age, height, and weight) at all rib levels, and predicted scores were used to explore the expected rib cross-sectional shapes across a wide range of subject demographics. The resulting detailed rib cross-sectional shapes were quantified in terms of their total cross-sectional area and their cortical bone cross-sectional area. Average-sized female ribs were smaller in total cross-sectional area than average-sized male ribs by between 20% and 36% across the rib cage, with the greatest differences seen in the central portions of rib 6. This trend persisted although to smaller differences of 14%-29% when comparing females and males of equal intermediate weight and stature. Cortical bone cross-sectional areas were up to 18% smaller in females than males of equivalent height and weight but also reached parity in certain regions of the rib cage. Increased age from 25 to 80 years was associated with reductions in cortical bone cross-sectional area (up to 37% in females and 26% in males at mid-rib levels). Total cross-sectional area was also seen to reduce with age in females but to a lesser degree (of up to 17% in mid-rib regions). Similar regions saw marginal increases in total cross-sectional area for male ribs, indicating age affects rib cortex thickness moreso than overall rib cross-sectional size. Increased subject height was associated with increased rib total and cortical bone cross-sectional areas by approximately 25% and 15% increases, respectively, in mid-rib sections for a given 30 cm increase in height, although the magnitudes of these associations varied by sex and rib location. Increased weight was associated with approximately equal changes in both cortical bone and total cross-sectional areas in males. These effects were most prominent (around 25% increases for an addition of 50 kg) toward lower ribs in the rib cage and had only modest effects (less than 12% change) in ribs 2-4. Females saw greater increases with weight in total rib area compared to cortical bone area, of up to 21% at the eighth rib level. Results from this study show the expected shapes of rib cross-sections across the adult rib cage and across a broad range of demographics. This detailed geometry can be used to produce accurate rib models representing widely varying populations.

Characterizing thoracic morphology variation to develop representative 3D models for applications in chest trauma

BACKGROUND

Rib fracture(s) occurs in 85% of blunt chest trauma cases. Increasing evidence supports that surgical intervention, particularly for multiple fractures, may improve outcomes. Thoracic morphology diversity across ages and sexes is important to consider in the design and use of surgical intervention devices in chest trauma. However, research on non-average thoracic morphology is lacking.

METHODS

The rib cage was segmented from patient computed tomography (CT) scans to create 3D point clouds. These point clouds were uniformly oriented and chest height, width, and depth were measured. Size categorization was determined by grouping each dimension into small, medium, and large tertiles. From small and large size combinations, subgroups were extracted to develop thoracic 3D models of the rib cage and surrounding soft tissue.

RESULTS

The study population included 141 subjects (48% male) ranging from age 10-80 with ∼20 subjects/age decade. Mean chest volume increased with age by 26% from the age groups 10-20 to 60-70, with 11% of this increase occurring between the youngest groups of 10-20 and 20-30. Across all ages, chest dimensions were ∼10% smaller in females and chest volume was highly variable (SD: ±3936.5 cm3). Representative thoracic models of four males (ages 16, 24, 44, 48) and three females (ages 19, 50, 53) were developed to characterize morphology associated with combinations of small and large chest dimensions.

CONCLUSIONS

The seven models developed cover a broad range of non-average thoracic morphologies and can serve as a basis for informing device design, surgical planning, and injury risk assessments.

Development and preliminary validation of computationally efficient and detailed 50th percentile female human body models

OBJECTIVE

No vehicle testing standard (physical or computational) employs a mid-sized female human surrogate, despite discrepancies related to injury outcomes for female occupants amongst all vehicle users. We detail the design and preliminary validation of 50th percentile female (F50) computational human body models (HBMs) based on Global Human Body Models Consortium (GHBMC) models.

METHOD

Data for the target geometry was collected as part of the initial generation of GHBMC models. Imaging, surface data, and 15 anthropomorphic measures from a living female subject (60.8 kg and 1.61 m) served as the baseline for model development. Due to the role rib cage geometry plays in biomechanical loading, rib cage morphology from secondary retrospective data was leveraged to identify an average female rib cage based on gross anatomical features. A female rib cage was selected from an existing dataset closest to the mean depth, height, and width of the set, considering only those aged 20 - 50 years. The selected subject among this secondary set also exhibited a 7th rib angle and sternum angle within 5% of the mean measurements, and within the range of previously reported studies. The GHBMC 5th percentile, small female detailed (high biofidelity) and simplified (computationally efficient) models were morphed to match the F50 subject body surface, selected bones, and mean rib cage using established thin plate spline techniques. The models were validated vs. previously published literature studies with an emphasis on rib cage response. Model data was compared to 47 channels of experimental data across four biomechanical hub simulations, two sled test simulations (one of which included all female PMHS), and two robustness simulations to test stability. Model results were mass scaled to the average of the reported corridors. Objective evaluation was conducted using CORA. IRB approval was obtained for all prospective and retrospective data collected or used. The target rib cage was selected from retrospective image data used in prior studies (n = 339 chest CT scans).

RESULTS

The morphed HBMs closely matched the target geometry. The detailed and simplified models had masses and element counts of 61.2 kg and 61.8 kg, and 2.8 million and 0.3 million, respectively. The mass difference is due to a coarser mesh in the simplified model. The simplified model ran 23 times faster than the detailed model on the same hardware. Each model exhibited stability in robustness tests, and the average CORA scores were 0.80 and 0.72 in the detailed and simplified models, respectively. The models performed well in frontal impacts against PMHS corridors after mass scaling.

CONCLUSIONS

Numerous recent studies underscore poorer injury outcomes for female vehicle occupants compared to males. While such outcomes are multifactorial, the average female models introduced in this work offer a novel tool within a widely used family of HBMs to reduce the outcome gap in terms of injury for all drivers. HBMs can be deployed in safety studies or in future regulatory requirements faster and more economically than a resized or newly designed ATDs aimed at the same target population.

Assessment of the sensitivity of thoracic injury criteria to subject-specific characteristics using human body models

Introduction: Chest deformation has been proposed as the best predictor of thoracic injury risk in frontal impacts. Finite Element Human Body Models (FE-HBM) can enhance the results obtained in physical crash tests with Anthropometric Test Devices (ATD) since they can be exposed to omnidirectional impacts and their geometry can be modified to reflect specific population groups. This study aims to assess the sensitivity of two thoracic injury risk criteria (PC Score and Cmax) to several personalization techniques of FE-HBMs. Methods: Three 30° nearside oblique sled tests were reproduced using the SAFER HBM v8 and three personalization techniques were applied to this model to evaluate the influence on the risk of thoracic injuries. First, the overall mass of the model was adjusted to represent the weight of the subjects. Second, the model anthropometry and mass were modified to represent the characteristics of the post-mortem human subjects (PMHS). Finally, the spine alignment of the model was adapted to the PMHS posture at t = 0 ms, to conform to the angles between spinal landmarks measured in the PMHS. The following two metrics were used to predict three or more fractured ribs (AIS3+) of the SAFER HBM v8 and the effect of personalization techniques: the maximum posterior displacement of any studied chest point (Cmax), and the sum of the upper and lower deformation of selected rib points (PC score). Results: Despite having led to statistically significant differences in the probability of AIS3+ calculations, the mass-scaled and morphed version provided, in general, lower values for injury risk than the baseline model and the postured version being the latter, which exhibited the better approximation to the PMHS tests in terms of probability of injury. Additionally, this study found that the prediction of AIS3+ chest injuries based on PC Score resulted in higher probability values than the prediction based on Cmax for the loading conditions and personalization techniques analyzed within this study. Discussion: This study could demonstrate that the personalization techniques do not lead to linear trends when they are used in combination. Furthermore, the results included here suggest that these two criteria will result in significantly different predictions if the chest is loaded more asymmetrically.

Approximating subject-specific brain injury models via scaling based on head-brain morphological relationships

Most human head/brain models represent a generic adult male head/brain. They may suffer in accuracy when investigating traumatic brain injury (TBI) on a subject-specific basis. Subject-specific models can be developed from neuroimages; however, neuroimages are not typically available in practice. In this study, we establish simple and elegant regression models between brain outer surface morphology and head dimensions measured from neuroimages along with age and sex information (N = 191; 141 males and 50 females with age ranging 14-25 years). The regression models are then used to approximate subject-specific brain models by scaling a generic counterpart, without using neuroimages. Model geometrical accuracy is assessed using adjusted [Formula: see text] and absolute percentage error (e.g., 0.720 and 3.09 ± 2.38%, respectively, for brain volume when incorporating tragion-to-top). For a subset of 11 subjects (from smallest to largest in brain volume), impact-induced brain strains are compared with those from "morphed models" derived from neuroimage-based mesh warping. We find that regional peak strains from the scaled subject-specific models are comparable to those of the morphed counterparts but could be considerably different from those of the generic model (e.g., linear regression slope of 1.01-1.03 for gray and white matter regions versus 1.16-1.19, or up to ~ 20% overestimation for the smallest brain studied). These results highlight the importance of incorporating brain morphological variations in impact simulation and demonstrate the feasibility of approximating subject-specific brain models without neuroimages using age, sex, and easily measurable head dimensions. The scaled models may improve subject specificity for future TBI investigations.

The anatomical growth of the thoracic cage in adolescents with specific reference to axial growth comparing the right and left hemithorax

This study has demonstrated the changing volume of both the anterior and posterior thorax in normal adolescents (without spinal or thoracic deformity), differentiating for both sex and age, to further understand how the thorax grows, along with the differences in growth between the anterior and posterior thorax. The thorax was measured on axial CT slices at every vertebral level from T3 to T12 in a series of scans previous taken for routine clinical care. Measurements taken were the anteroposterior thoracic distance and the area of the anterior and posterior rib prominences on either side of the thorax. Data was analyzed per vertebral level, differentiating for age and sex. There were 486 CT scans analyzed (257 males and 229 females) between the ages of 8 and 18 years. The analysis identified that for the anterior thorax, there are three phases of growth with an initial slow increase in volume, followed by a stabilization of little growth, followed by another phase of a more rapid increase in volume. For the posterior thorax, there was a gradual increase in area with increasing age. This study demonstrates that the shape of the thorax is age and sex dependent, with males having both a greater width and depth of thorax compared to females. Of particular note is the difference in patterns of growth between the anterior and posterior thorax. This information will add to the understanding of normal growth, which will aid in the management of conditions where that growth is disturbed.

Rib cortical bone thickness variation in adults by age and sex

Rib fractures are a common and serious outcome of blunt thoracic trauma and their likelihood is greater in older individuals. Osteoporotic bone loss is a well-documented aging phenomenon with sex-specific characteristics, but within rib bones, neither baseline maps of regional thickness nor the rates of bone thinning with age have been quantified across whole ribs. This study presents such data from 4014 ribs of 240 adult subjects aged 20-90. A validated cortical bone mapping technique was applied to clinical computed tomography scans to obtain local rib cortical bone thickness measurements over the surfaces of ribs 2 through 11. Regression models to age and sex gave rates of cortex thinning in local zones and aggregated across whole ribs. The statistical parametric mapping provided these relationships regionally as a function of rib surface location. All models showed significant reductions in bone thickness with age (p < 0.01). Average whole-rib thinning occurred at between 0.011 to 0.032 mm/decade (males) and 0.035 to 0.043 mm/decade (females), with sex and age accounting for up to 37% of population variability (R2 ). Rates of thinning differed regionally and by rib, with the highest bone loss of up to 0.074 mm/decade occurring in mid-rib cutaneous and superior regions of ribs 2-6. Rates were consistently higher in females than males (significantly so across whole ribs but not all local regions) and were more pronounced in cutaneous, superior, and inferior rib aspects (average 0.025 mm/decade difference in ribs 4-8) compared to pleural aspects which had the thickest cortices but saw only minor differences in thinning rates by sex (0.045 mm/decade for females and 0.040 mm/decade for males). Regional analysis showed male and female bone thickness differences that were not statistically significant at 20 years of age (p > 0.05 across practically all regions) but subsequent cortex thinning meant that substantial pleural and cutaneous regions were thinner (p < 0.05) in females than males by 55 years of age. The techniques and results from this study can be applied to assess rib bone content loss in clinical settings across wide populations. Additionally, average cortex thickness results can be mapped directly to finite element models of the thorax, and regression results are used to modify such models to represent the ribs of men and women across their full adult lifespan.

Effect of thoracic stiffness on chest compression performance - A prospective randomized crossover observational manikin study

Introduction

Human thoracic stiffness varies and may affect the performance during external chest compression (ECC). The Extra Compression Spring Resusci® QCPR Anne manikin is a high-fidelity training model developed for ECC training that can account for varying levels of thoracic stiffness. The aim of this study was to use this training model to investigate the effects of thoracic stiffness on ECC biomechanics and qualities.

Methods

Fifty-two participants performed standard ECC on the manikin with different thoracic springs to simulate varying levels of thoracic stiffness. The MatScan Pressure Measurement system was used to investigate the ECC pressure and force distribution.

Results

The hard spring group’s performance had a better complete recoil ratio (90.06 ± 24.84% vs. 79.75 ± 32.17% vs. 56.42 ± 40.15%, p < 0.001 at second minute), but was more inferior than the standard and soft spring groups in overall quality, ECC depth (34.17 ± 11.45 mm vs. 41.25 ± 11.42 mm vs. 51.88 ± 7.56, p < 0.001 at second minutes), corrected depth ratio, and corrected rate ratio. The hard spring group had less radial-ulnar peak pressure difference (kgf/cm²) than the other two groups (−0.28 ± 0.38 vs. −0.30 ± 0.43 vs. −0.47 ± 0.34, p = 0.01), demonstrating that more symmetrical pressure was applied in the hard spring group. The soft spring group had better ECC depth, corrected depth ratio, corrected rate ratio, and overall quality, but its performance in complete recoil was inferior, and unbalanced pressure was more liable to cause injury. Hard springs caused operator fatigue easily.

Conclusion

The thoracic stiffness greatly affected the performance of ECC. Our findings provided information for more effective ECC practices and training.

Hello, world! VIVA+: A human body model lineup to evaluate sex-differences in crash protection

Finite element Human Body Models are increasingly becoming vital tools for injury assessment and are expected to play an important role in virtual vehicle safety testing. With the aim of realizing models to study sex-differences seen in the injury- and fatality-risks from epidemiology, we developed models that represent an average female and an average male. The models were developed with an objective to allow tissue-based skeletal injury assessment, and thus non-skeletal organs and joints were defined with simplified characterizations to enhance computational efficiency and robustness. The model lineup comprises female and male representations of (seated) vehicle occupants and (standing) vulnerable road users, enabling the safety assessment of broader segments of the road user population. In addition, a new workflow utilized in the model development is presented. In this workflow, one model (the seated female) served as the base model while all the other models were generated as closely-linked derivative models, differing only in terms of node coordinates and mass distribution. This approach opens new possibilities to develop and maintain further models as part of the model lineup, representing different types of road users to reflect the ongoing transitions in mobility patterns (like bicyclists and e-scooter users). In this paper, we evaluate the kinetic and kinematic responses of the occupant and standing models to blunt impacts, mainly on the torso, in different directions (front, lateral, and back). The front and lateral impacts to the thorax showed responses comparable to the experiments, while the back impact varied with the location of impact (T1 and T8). Abdomen bar impact showed a stiffer load-deflection response at higher intrusions beyond 40 mm, because of simplified representation of internal organs. The lateral shoulder impact responses were also slightly stiffer, presumably from the simplified shoulder joint definition. This paper is the first in a series describing the development and validation of the new Human Body Model lineup, VIVA+. With the inclusion of an average-sized female model as a standard model in the lineup, we seek to foster an equitable injury evaluation in future virtual safety assessments.

Development and Evaluation of a Rib Statistical Shape Model for Thoracic Surgery

Patients with advanced cancer undergoing chest wall resection may require reconstruction. Currently, rib prostheses are created by segmenting computed tomography images, which is time-consuming and labour intensive. The aim was to optimise the production of digital rib models based on a patient's age, weight, height and gender. A statistical shape model of human ribs was created and used to synthetise rib models, which were compared to the ones produced by segmentation and mirroring. The segmentation took 11.56±1.60 min compared to 0.027 ±0.009 min using the new technique. The average mesh error between the mirroring technique and segmentation was 0.58±0.25 mm (right ribs), and 0.87±0.18 mm (left ribs), compared to 1.37±0.66 mm ( ) and 1.68 ±0.77 mm ( ), respectively, for the new technique. The new technique is promising for the efficiency and ease-of-use in the clinical environment. Clinical Relevance- This is an optimised 3D modelling method providing clinicians with a time-efficient technique to create patient-specific rib prostheses, without any expertise or software knowledge required.

Aerosol Transport Modeling: The Key Link Between Lung Infections of Individuals and Populations

The recent COVID-19 pandemic has propelled the field of aerosol science to the forefront, particularly the central role of virus-laden respiratory droplets and aerosols. The pandemic has also highlighted the critical need, and value for, an information bridge between epidemiological models (that inform policymakers to develop public health responses) and within-host models (that inform the public and health care providers how individuals develop respiratory infections). Here, we review existing data and models of generation of respiratory droplets and aerosols, their exhalation and inhalation, and the fate of infectious droplet transport and deposition throughout the respiratory tract. We then articulate how aerosol transport modeling can serve as a bridge between and guide calibration of within-host and epidemiological models, forming a comprehensive tool to formulate and test hypotheses about respiratory tract exposure and infection within and between individuals.

A parametric head geometry model accounting for variation among adolescent and young adult populations

BACKGROUND AND OBJECTIVE

Modeling the size and shape of human skull and scalp is essential for head injury assessment, design of helmets and head-borne equipment, and many other safety applications. Finite element (FE) head models are important tools to assess injury risks and design personal protective equipment. However, current FE head models are mainly developed based on the midsize male, failing to account for the significant morphological variation that exists in the skull and brain. The objective of this study was to develop a statistical head geometry model that accounts for size and shape variations among the adolescent and young adult population.

METHODS

To represent subject-specific geometry using a homologous mesh, threshold-based segmentation of head CT scans of 101 subjects between 14 and 25 years of age was performed, followed by landmarking, mesh morphing, and projection. Skull and scalp statistical geometry models were then developed as functions of age, sex, stature, BMI, head length, head breadth, and tragion-to-top of head using generalized Procrustes analysis (GPA), principal component analysis (PCA) and multivariate regression analysis.

RESULTS

The statistical geometry models account for a high percentage of morphological variations in scalp geometry (R²=0.63), outer skull geometry (R²=0.66), inner skull geometry (R²=0.55), and skull thickness (error < 1 mm) CONCLUSIONS: Skull and scalp statistical geometry models accounts for size and shape variations among the adolescent and young adult population were developed as functions of subject covariates. These models may serve as the geometric basis to develop individualized head FE models for injury assessment and design of head-borne equipment.

Sexual dimorphism in the first rib of Homo sapiens

This work aimed to study sexual dimorphism in the first rib of modern humans, with a special focus on whether differences in shape are due to divergent allometric growth in males and females. Also, we compare the accuracy of sex classification using different approaches based on two methodologies, traditional morphometry based on linear measurements and geometric morphometric analysis based on 2D landmark coordinates. The sample studied here comprised 121 right and left first ribs from 65 female and male adult recent Euro-American Homo sapiens individuals. For traditional morphometrics, 12 metric variables were collected from each rib using a digital caliper, and for geometric morphometrics, six landmarks and 31 semilandmarks were captured from photographs using digital software. Both geometric morphometric and metric data were analyzed to calculate the index of sexual dimorphism, variation related to lateral asymmetry, variation in size and shape, and allometric trends between males and females. Finally, a linear discriminant analysis (LDA) was performed comparing both methodologies to test the best approach for sex classification. Results indicated that there are significant sex differences in the size and shape of the first ribs of recent Euro-American Homo sapiens. Regression analysis revealed different allometric patterns for males and females, and this could partially explain shape differences between sexes. Additionally, traditional morphometrics showed that all characteristics analyzed are significantly dimorphic, with the midshaft minimum craniocaudal diameter, the sternal end minimum diameter, and the neck minimum craniocaudal diameter displaying the most dimorphic scores. Similarly, geometric morphometrics results indicated that males have more curved and interno-exteriorly wider first ribs. Finally, analysis of sex classification using LDA yielded slightly better accuracy for traditional morphometry (83.8%) than the geometric morphometrics approach (81.3%) based on form Procrustes coordinates. This study demonstrates the usefulness of applying two different morphometric approaches to obtain more comprehensive results.

Biomechanical response of human rib cage to cardiopulmonary resuscitation maneuvers: Effects of the compression location

The biomechanical response of a human rib cage to cardiopulmonary resuscitation maneuvers was investigated by means of finite element simulations. We analyzed the effect of the location where the force was applied on the achieved compression depths and stress levels experienced by the breastbone and ribs. For compression locations on the breastbone, a caudal shift of the application area toward the breastbone tip resulted in a 17% reduction of the force required to achieve a target 5 cm compression depth. We found that the use of compression regions located on the costal cartilages would involve higher risk of rib fractures.

Assessment of in situ chest deflection of post mortem human subjects (PMHS) and personalized human body models (HBM) in nearside oblique impacts

OBJECTIVE

The present study has three objectives: First, to analyze the chest deflection measured in nearside oblique tests performed with three post mortem human subjects (PMHS). Second, to assess the capability of a HBM to predict the chest deflection sustained by the PMHS. Third to evaluate the influence on chest deflection prediction of subject-specific HBM.

METHODS

Three dimensional chest deformation of five anterior chest landmarks was extracted from three PMHS (A-C) in three sled tests. The sled test configurations corresponded to a 30 degree nearside oblique impact at 35 km/h. Two different restraint system versions (RSv) were used. RSv1 was used for PMHS A and B while RSv2 was used for PMHS C. The capability of the SAFER HBM (called baseline model) to predict PMHS chest deflection was benchmarked by means of the PMHS test results. In a second step, the anthropometry, mass and pre-impact posture of the baseline HBM were modified to the PMHS-specific characteristics to develop a model to assess the influence of personalization techniques in the capability of the human body model to predict PMHS chest deflection.

RESULTS

In the sled tests, the measured sternum compression relative to the eighth thoracic vertebra in the PMHS tests was 49, 54 and 55 millimeters respectively. The HBM baseline model predicted 48%, 43% and 34% of the deflections measured in the PMHS tests, while the personalized version predicted 38%, 34% and 28%. When chest deflection was analyzed in x-, y- and z-direction for the five chest landmarks it was found that neither the baseline HBM nor the personalized model predicted x, y and z axis deflections.

CONCLUSIONS

The PMHS in situ chest deflection was found to be sensitive to the variation in restraint system and the three PMHS exhibited greater values of lower right chest deflection compared to what was found in available literature. The baseline HBM underpredicted peak chest deflection obtained in the PMHS test. The personalized model was not capable of predicting the chest deflection sustained by the PMHS. Hence, further biofidelity investigations have to be carried out on the human body thorax model for oblique loading.

Effects of obesity on pulmonary function considering the transition from obstructive to restrictive pattern from childhood to young adulthood

Adults with obesity exhibit a restrictive pattern, whereas children with obesity exhibit an obstructive pattern. However, the transition process remains unclear. We performed a systematic search for studies reporting on body mass index and pulmonary function in children. The main outcomes were forced expiratory volume in 1 s (FEV₁ ), forced vital capacity (FVC), and their ratio (FEV₁ /FVC). We compared individuals with overweight or with obesity with individuals with normal weight. Random-effects models were used to calculate pooled estimates. A total of 17 studies were included. Individuals with obesity had a lower FEV₁ /FVC ratio (mean difference [MD] = -3.61%; 95% confidence interval [CI] = -4.58%, -2.64%) and a higher percent-predicted FVC (MD = 3.33%; 95% CI = 0.79%, 5.88%) than those with normal weight. Obesity impaired pulmonary function in the obstructive pattern during childhood to young adulthood, and the maximum obstruction was observed at the age of 16 years in boys and 20 years in girls. The effects attenuated at approximately 30 years and then shifted to the restrictive pattern after 35 years of age in men and 40 years in women. The effects of obesity on pulmonary function change from the obstructive pattern in childhood to the restrictive pattern in adulthood.

Evaluating stability of human spine in static tasks: a combined in vivo-computational study

Various interpretations and parameters have been proposed to assess spinal stability such as antagonist muscle coactivity, trunk stiffness and spinal buckling load; however, the correlation between these parameters remains unknown. We evaluated spinal stability during different tasks while changing the external moment and load height and investigated likely relationships between different EMG- and model-based parameters (e.g., EMG coactivity ratio, trunk stiffness, force coactivity ratio) and stability margins. EMG and kinematics of 40 young healthy subjects were recorded during various quasi-static tasks. Muscle forces, trunk stiffness and stability margins were calculated by a nonlinear subject-specific EMG-assisted-optimization musculoskeletal model of the trunk. The load elevation and external moment increased muscle activities and trunk stiffness while all stability margins (i.e., buckling loads) decreased. The force coactivity ratio was strongly correlated with the hand-load stability margin (i.e., additional weight in hands to initiate instability; R² = 0.54) demonstrating the stabilizing role of abdominal muscles. The total trunk stiffness (Pearson's r = 0.96) and the sum of EMGs of back muscles (Pearson's r = 0.65) contributed the most to the T1 stability margin (i.e., additional required load at T1 for instability/buckling). Force coactivity ratio and trunk stiffness can be used as alternative spinal stability metrics.

A statistical lumbar spine geometry model accounting for variations by Age, Sex, Stature, and body mass index

The objective of this study was to develop a statistical lumbar spine geometry model accounting for morphological variations among the adult population. Five lumber vertebrae and lumber spine curvature were collected from CT scans of 82 adult subjects through CT segmentation, landmark identification, and template mesh mapping. Generalized Procrustes Analysis (GPA), Principal Component Analysis (PCA), and multivariate regression analysis were conducted to develop the statistical lumbar spine model. Two statistical models were established to predict the vertebrae geometry and lumbar curvature respectively. Using the statistical models, a lumbar spine finite element (FE) model could be rapidly generated with a given set of age, sex, stature, and body mass index (BMI). The results showed that the lumbar spine vertebral size was significantly affected by stature, sex and age, and the lumbar spine curvature was significantly affected by stature and age. This statistical lumbar spine model could serve as the geometric basis for quantifying effects of human characteristics on lumbar spine injury risks in impact conditions.

Predicting pelvis geometry using a morphometric model with overall anthropometric variables

Pelvic fractures have been identified as the second most common AIS2+ injury in motor vehicle crashes, with the highest early mortality rate compared to other orthopaedic injuries. Further, the risk is associated with occupant sex, age, stature and body mass index (BMI). In this study, clinical pelvic CT scans from 132 adults (75 females, 57 males) were extracted from a patient database. The population shape variance in pelvis bone geometry was studied by Sparse Principal Component Analysis (SPCA) and a morphometric model was developed by multivariate linear regression using overall anthropometric variables (sex, age, stature, BMI). In the analysis, SPCA identified 15 principal components (PCs) describing 83.6% of the shape variations. Eight of these were significantly captured (α < 0.05) by the morphometric model, which predicted 29% of the total variance in pelvis geometry. The overall anthropometric variables were significantly related to geometrical features primarily in the inferior-anterior regions while being unable to significantly capture local sacrum features, shape and position of ASIS and lateral tilt of the iliac wings. In conclusion, a new detailed morphometric model of the pelvis bone demonstrated that overall anthropometric variables account for only 29% of the variance in pelvis geometry. Furthermore, variations in the superior-anterior region of the pelvis, with which the lap belt is intended to interact, were not captured. Depending on the scenario, shape variations not captured by overall anthropometry could have important implications for injury prediction in traffic safety analysis.

Morphology and growth of the pediatric lumbar vertebrae

BACKGROUND CONTEXT

The majority of existing literature describing pediatric lumbar vertebral morphology are limited to characterization of the vertebral bodies, pedicles, and spinal canal and no study has described the rates of growth for any lumbar vertebral structure. While it is known that growth of the lumbar vertebrae results in changes in vertebral shape, the dimension ratios used to quantify these shape changes do not represent the 3D morphology of the vertebral structures. Additionally, many of the previous evaluations of growth and shape are purely descriptive and do not investigate sexual dimorphism or variations across vertebral levels.

PURPOSE

This study aims to establish a database of pediatric lumbar vertebra dimension, growth, and shape data for subjects between and ages of 1 and 19 years.

STUDY DESIGN

A retrospective study of computed tomography (CT) data.

METHODS

Retrospective, abdominal, CT scans of 102 skeletally normal pediatric subjects (54 males, 48 females) between the ages of 1 and 19 years were digitally reconstructed and manually segmented. Thirty surface landmark points (LMPs), 30 vertebral measurements, the centroid size, centroid location, and the local orientation were collected for each lumbar vertebra along with the centroid size of the LMPs comprising each subject's full lumbar spine and their intervertebral disc (IVD) heights. Nonparametric statistics were used to compare dimension values across vertebral levels and between sexes. Linear models with age as the independent variable were used to characterize dimension growth for each sex and vertebral level. Age-dependent quadratic equations were fit to LMP distributions resulting from a generalized Procrustes analysis (GPA) of the vertebrae and fixed effects models were used to investigate differences in model coefficients across levels and between sexes.

RESULTS

Intervertebral level dimension differences were observed across all vertebral structures in both sexes while pedicle widths and IVDs heights were the only measurements found to be sexually dimorphic. Dimension growth rates generally varied across vertebral levels and the growth rates of males were typically larger than those of females. Differences between male and female vertebral shapes were also found for all lumbar vertebral structures.

CONCLUSIONS

To the authors' knowledge, this is the first study to report growth rates for the majority of pediatric lumbar vertebral structures and the first to describe the 3D age-dependent shapes of the pediatric lumbar spine and vertebrae. In addition to providing a quantitative database, the dimension, growth, and shape data reported here would have applications in medical device design, surgical planning, surgical training, and biomechanical modeling.

Subject-specific rib finite element models with material data derived from coupon tests under bending loading

Rib fractures are common thoracic injuries in motor vehicle crashes. Several human finite element (FE) human models have been created to numerically assess thoracic injury risks. However, the accurate prediction of rib biomechanical response has shown to be challenging due to human variation and modeling approaches. The main objective of this study was to better understand the role of modeling approaches on the biomechanical response of human ribs in anterior-posterior bending. Since the development of subject specific rib models is a time-consuming process, the second objective of this study was to develop an accurate morphing approach to quickly generate high quality subject specific rib meshes. The exterior geometries and cortical-trabecular boundaries of five human 6th-level ribs were extracted from CT-images. One rib mesh was developed in a parametric fashion and the other four ribs were developed with an in-house morphing algorithm. The morphing algorithm automatically defined landmarks on both the periosteal and endosteal boundaries of the cortical layer, which were used to morph the template nodes to target geometries. Three different cortical bone material models were defined based on the stress-strain data obtained from subject-specific tensile coupon tests for each rib. Full rib anterior-posterior bending tests were simulated based on data recorded in testing. The results showed similar trends to test data with some sensitivity relative to the material modeling approach. Additionally, the FE models were substantially more resistant to failure, highlighting the need for better techniques to model rib fracture. Overall, the results of this work can be used to improve the biofidelity of human rib finite element models.

Obesity effects on pedestrian lower extremity injuries in vehicle-to-pedestrian impacts: A numerical investigation using human body models

OBJECTIVE

The objectives of this study were to develop a method for modeling obese pedestrians and to investigate effects of obesity on pedestrian impact responses and injury outcomes.

METHODS

The GHBMC (Global Human Body Model Consortium) 50th percentile male pedestrian model was morphed into geometries with 4 body mass index (BMI) levels (25/30/35/40 kg/m²) predicted by statistical body shape models. Each of the 4 morphed models was further morphed from a standing posture into 2 other gaits (toe-off and mid-swing), which resulted in a total of 12 (4 BMIs × 3 postures) models. Each model was used to simulate vehicle-to-pedestrian impact under 2 impact velocities. Pedestrian kinematics and injury measures were analyzed focusing on lower extremities. Statistical analyses were performed to examine significance of obesity on concerned injury measures.

RESULTS

Peak values of the bending moment at tibia, force at medial collateral ligament (MCL), bending angle at knee joint, and contact force between vehicle and pedestrian increased significantly (P < .05) with increased BMI. By analyzing kinematics of the lower extremity, the overall vehicle-to-pedestrian impact was divided into 2 phases: "initial contact" and "tibia rebound." For obese pedestrians, the added mass caused a higher tibia bending moment in the initial contact phase, and the greater moment of inertia led to greater bending angle and MCL force in the tibia rebound phase. Statistical analyses also revealed that pre-impact posture and impact velocity had significant effects on all injury measures.

CONCLUSIONS

Obesity could significantly increase the risk of pedestrian lower extremity injuries due to the inertial effect from the added mass. Pre-impact posture and impact velocity also significantly affect pedestrian injury measures. Future vehicle designs for pedestrian protection should consider populations with obesity. This study demonstrated the feasibility of using parametric human modeling to account for population diversity in injury prediction.

Lung and fissure shape is associated with age in healthy never-smoking adults aged 20-90 years

Lung shape could hold prognostic information for age-related diseases that affect lung tissue mechanics. We sought to quantify mean lung shape, its modes of variation, and shape associations with lung size, age, sex, and Body Mass Index (BMI) in healthy subjects across a seven-decade age span. Volumetric computed tomography from 83 subjects (49 M/34 F, BMI [Formula: see text]) was used to derive two statistical shape models using a principal component analysis. One model included, and the other controlled for, lung volume. Volume made the strongest contribution to shape when it was included. Shape had a strong relationship with age but not sex when volume was controlled for, and BMI had only a small but significant association with shape. The first principal shape mode was associated with decrease in the antero-posterior dimension from base to apex. In older subjects this was rapid and obvious, whereas younger subjects had relatively more constant dimension. A shift of the fissures of both lungs in the basal direction was apparent for the older subjects, consistent with a change in tissue elasticity with age. This study suggests a quantifiable structure-function relationship for the healthy adult lung that can potentially be exploited as a normative description against which abnormal can be compared.

Biomechanical Response Targets of Adult Human Ribs in Frontal Impacts

Thorax injuries mainly due to rib fractures have been associated with high rates of morbidity and mortality in motor vehicle crashes. Thoracic biomechanics has been studied extensively, but there are no robust biomechanical response targets for ribs that consider age, sex, body size, and vulnerability factors. The objective of this study was to generate biomechanical targets for human rib response with respect to age, sex, and body size. Two-hundred sixty-one ribs from 171 individuals were dynamically loaded to failure in anterior-posterior bending. Force and displacement at the time of fracture in young adults were greater than in older adults (p < 0.0001). Sex differences were found in those over 40 years old (p < 0.0001). Fracture force from 5th percentile female ribs was lower than 50th and 95th male (p < 0.005). Vulnerable ribs were successfully identified by examining the percentile of both force and displacement at the time of fracture in the proposed samples. The biomechanical targets generated in this study will have useful applications to computational thorax and rib models to aid in injury prevention measures.

Late subadult ontogeny and adult aging of the human thorax reveals divergent growth trajectories between sexes

Sexual dimorphism is an important feature of adult thorax morphology, but when and how sex-related differences in the ribcage arise during ontogeny is poorly known. Previous research proposed that sex-related size differences in the nasal region arise during puberty. Therefore, we explore whether ribcage sexual dimorphism also arises at that time and whether this sexual dimorphism is maintained until old age. We measured 526 (semi)landmarks on 80 CT-based human ribcage reconstructions, on individuals ranging from 7 to 65 year-old. The 3D coordinates were submitted to the Procrustes superimposition and analyzed. Our results show that the trajectories of thorax size and shape between sexes diverge at around 12 years of age, and continue slightly diverging until old age. The differential ontogenetic trends cause adult male ribcages to become deeper, shorter, and wider than female. Our results are consistent with the evidence from the cranial respiratory system, with the development of sexual dimorphism probably related to changes in body composition during puberty combined with changes in the reproductive system.

Dynamic 3D Reconstruction of Thoracic Cage and Abdomen in Children and Adolescents With Scoliosis: Preliminary Results of Optical Reflective Motion Analysis Assessment

BACKGROUND

In patients with untreated scoliosis or in those with posterior spinal instrumented fusion (PSF), the movements of neither the thoracic cage (ThC) nor the abdomen (ABD) during quiet and deep breathing have been well defined in the literature. The purpose of this study was to evaluate kinematic variations in the ThC and ABD during quiet and deep breathing by optical reflective motion analysis (ORMA) in children with scoliosis.

METHODS

The study included 6 healthy children (group A), 7 subjects with untreated scoliosis over 50 degrees (group B), and 8 patients with scoliosis treated by PSF (group C). After anthropometric measurements (standing height, sitting height, arm span, chest perimeter, body weight, body mass index, T1-T12, and L1-L5 length) were obtained, the movements of subjects during quiet and deep breathing were measured with a 10-camera 3-dimensional ORMA system (82 markers) with the subjects in a standard standing position.

RESULTS

No significant differences were observed in sex, age, weight, height, or arm span (P>0.05). Significant differences were observed in the chest perimeter, Cobb angle, and body mass index (P<0.05). ThC and ABD movements during quiet and deep breathing decreased significantly in group B and C when compared with group A (P<0.05). Group B showed decreased expansion of the ThC (-52.4% to -58.3%) and relatively increased motion of the ABD compared with groups A and C (P<0.001). However, ABD expansion remained lower in group B than in groups A and C (-32.8% and -5.7%). PSF does not completely eliminate transverse plane kinematics, although a greater reduction was observed at instrumented than noninstrumented levels (-60.8% vs. -35.1%; P<0.05).

CONCLUSIONS

ORMA is a useful tool for assessing alterations in the kinematics of the ThC and ABD caused by severe scoliosis and/or PSF. Compared with normal subjects, patients with severe scoliosis had poorer and less effective kinematics of the ThC and ABD. In contrast, operated subjects had better and more effective kinematics of the ThC and ABD, breathing curves, thoracic expansion, and abdominal movements closer to normal compared with patients with severe, untreated deformity.

LEVEL OF EVIDENCE

Level III.

Understanding the Adverse Hemodynamic Effects of Serious Thoracic Injuries During Cardiopulmonary Resuscitation: A Review and Approach Based on the Campbell Diagram

Chest compressions during cardiopulmonary resuscitation (CPR) generate cardiac output during cardiac arrest. Their quality performance is key to achieving the return of spontaneous circulation. Serious thoracic injuries (STIs) are common during CPR, and they can change the shape and mechanics of the thorax. Little is known about their hemodynamic effects, so a review of this emerging concept is necessary. The Campbell diagram (CD) is a theoretical framework that integrates the lung and chest wall pressure-volume curves, allowing us to assess the consequences of STIs on respiratory mechanics and hemodynamics. STIs produce a decrease in the compliance of the chest wall and lung. The representation of STIs on the CD shows a decrease in the intrathoracic negative pressure and a functional residual capacity decrease during the thoracic decompression, leading to a venous return impairment. The thorax with STIs is more vulnerable to the adverse hemodynamic effects of leaning, hyperventilation, and left ventricular outflow tract obstruction during CPR. A better understanding of the effects of STIs during CPR, and the study of avoidable injuries, can help to improve the effectiveness of chest compressions and the survival in cardiac arrest.

A Novel Approach to Scaling Age-, Sex-, and Body Size-Dependent Thoracic Responses using Structural Properties of Human Ribs

Thoracic injuries are frequently observed in motor vehicle crashes, and rib fractures are the most common of those injuries. Thoracic response targets have previously been developed from data obtained from post-mortem human subject (PMHS) tests in frontal loading conditions, most commonly of mid-size males. Traditional scaling methods are employed to identify differences in thoracic response for various demographic groups, but it is often unknown if these applications are appropriate, especially considering the limited number of tested PMHS from which those scaling factors originate. Therefore, the objective of this study was to establish a new scaling approach for generating age-, sex-, and body size- dependent thoracic responses utilizing structural properties of human ribs from direct testing of various demographics. One-hundred forty-seven human ribs (140 adult; 7 pediatric) from 132 individuals (76 male; 52 female; 4 pediatric) ranging in age from 6 to 99 years were included in this study. Ribs were tested at 2 m/s to failure in a frontal impact scenario. Force and displacement for individual ribs were used to develop new scaling factors, with a traditional mid-size biomechanical target as a baseline response. This novel use of a large, varied dataset of dynamic whole rib responses offers vast possibilities to utilize existing biomechanical data in creative ways to reduce thoracic injuries in diverse vehicle occupants.

Validating diverse human body models against side impact tests with post-mortem human subjects

This study aimed at evaluating the ability of morphed finite element (FE) human body models (HBMs) to reproduce the impact responses of post-mortem human subjects (PMHS) with various stature and shape. Ten side impact tests previously performed using seven PMHS under 3 m/s and 8 m/s impact velocities were selected for model evaluation. With weight, stature, sex, and age of PMHS, seven FE HBMs were developed by morphing the midsize male THUMS model into the target geometries predicted by the statistical skeleton and external body shape models. The model-predicted force histories, accelerations along the spine, and deflections in the chest and abdomen were compared to the test data. For comparison, simulations in all testing conditions were also conducted with the original midsize male THUMS, and the results from the THUMS simulations were scaled to the weight and stature from each PMHS. The CORrelation and Analysis (CORA) was used to evaluate the model accuracy, with CORA scores close to one indicating excellent agreement. Ten simulations using the morphed models exhibited 0.80 ± 0.01, 0.80 ± 0.01, 0.78 ± 0.02, and 0.78 ± 0.02 CORA scores for the impact forces to the thorax, abdomen, iliac-wings, and greater-trochanter, respectively; the corresponding CORA scores with the original THUMS were markedly lower at 0.60 ± 0.06, 0.69 ± 0.05, 0.71 ± 0.05, and 0.69 ± 0.04; while those for the scaled THUMS were 0.65 ± 0.05, 0.71 ± 0.05, 0.73 ± 0.05, and 0.72 ± 0.02, also lower than the morphed models. Across all simulations, the morphed HBMs demonstrated significantly higher accuracy than the THUMS with or without scaling. These results suggested the necessity of accounting for size and shape effects on predicting human responses in side impacts.

Defining the shape of the scapulothoracic gliding surface

PURPOSE

The aim of the study is to evaluate the difference in shape of the upper part and lower part of the Scapulothoracic Gliding Surface (STGS).

METHODS

3D-CT images of the thoracic cage of 50 patients were created in MIMICS ^®. Three anatomical landmarks (insertion m. serratus anterior on 5th rib; transverse process of 2th and 7th vertebra) were used as an anteroposterior cutting plane to define the STGS. The upper part of the STG was defined as rib 2-5 and the lower part as 5-8. Next, in MATLAB ^®, a script was used to create the sphere with best fit for upper and lower parts of STGS. The Root-Square-Mean Error (RSME) (mm) between two closest points on the fitted sphere and the STGS of both parts were calculated to determine the goodness-of-fit.

RESULTS

The RSME was found to be significantly lower for the area ribs 2-5 (mean 7.85 mm, SD 1.86) compared the area of ribs 5-8 (mean 10.08 mm, SD 1.90).

CONCLUSION

The STGS of the upper thoracic wall (2-5) is more spherical shaped than the STGS of the lower thoracic wall (rib 5-8).

Development and validation of a semi-automatic landmark extraction method for mesh morphing

Currently, landmark-based mesh morphing technology is widely used to rapidly obtain meshes with specific geometry, which is suitable to develop parametric human finite element (FE) models. However it takes too much time for landmark extraction to obtain high geometric accuracy. The purpose of this study is to develop and validate a semi-automatic landmark extraction method to reduce the time of manual selection of landmarks without sacrificing the accuracy of identifying landmarks in the process of mesh morphing. A few contour edge landmarks were extracted manually. Mathematical landmarks and pseudo-landmarks were extracted automatically by user-defined algorithm. The radial basis function (RBF) was used to morph the baseline FE model into the target geometry based on these landmarks. The cervical vertebra (C5), rib (R7) and femur were selected as the target geometries to verify the effectiveness of the method. The maximum mean geometric error of the three types of target geometries was less than 1 mm. The mesh quality of the morphed FE model was similar to that of the baseline FE model. Compared to the traditional manual method, 2/3 to 3/4 of the time for landmark extraction was saved by the semi-automatic method.

Three-dimensional analysis of sexual dimorphism in ribcage kinematics of modern humans

OBJECTIVES

Sexual dimorphism is an important biological factor underlying morphological variation in the human skeleton. Previous research found sex-related differences in the static ribcage, with males having more horizontally oriented ribs and a wider lower ribcage than females. Furthermore, a recent study found sex-related differences in the kinematics of the human lungs, with cranio-caudal movements of the caudal part of the lungs accounting for most of the differences between sexes. However, these movements cannot be quantified in the skeletal ribcage, so we do not know if the differences observed in the lungs are also reflected in sex differences in the motion of the skeletal thorax.

MATERIALS AND METHODS

To address this issue, we quantified the morphological variation of 42 contemporary human ribcages (sex-balanced) in both maximal inspiration and expiration using 526 landmarks and semilandmarks. Thoracic centroid size differences between sexes were assessed using a t test, and shape differences were assessed using Procrustes shape coordinates, through mean comparisons and dummy regressions of shape on kinematic status. A principal components analysis was used to explore the full range of morphological variation.

RESULTS

Our results show significant size differences between males and females both in inspiration and expiration (p < .01) as well as significant shape differences, with males deforming more than females during inspiration, especially in the mediolateral dimension of the lower ribcage. Finally, dummy regressions of shape on kinematic status showed a small but statistically significant difference in vectors of breathing kinematics between males and females (14.78°; p < .01).

DISCUSSION

We support that sex-related differences in skeletal ribcage kinematics are discernible, even when soft tissues are not analyzed. We hypothesize that this differential breathing pattern is primarily a result of more pronounced diaphragmatic breathing in males, which might relate to differences in body composition, metabolism, and ultimately greater oxygen demand in males compared to females. Future research should further explore the links between ribcage morphological variation and basal metabolic rate.

Effect of gender on the biodynamic responses to vibration induced by a whole-body vibration training machine

Whole-body vibration training machines are used by both male and female users. However, studies investigating the biodynamic responses to vibration during training have used either mixed-gender subjects or male subjects. No study has investigated the effect of gender on the biodynamic responses under vibration training conditions. The objective of this study is to investigate the effect of gender on the apparent mass and the vibration of the head of standing people during exposure to vibration. A total of 40 subjects (20 females and 20 males) were exposed to vertical vibration at six frequencies in the range 20-45 Hz and vibration acceleration in the range 10.8-20.9 m/s² (peak). The subjects stood on a force platform mounted on the vibrating plate of the machine adopting an upright standing posture with their knees unlocked and their arms straight along their bodies. The vertical acceleration and force at the interface between the vibrating plate and the feet were measured and used to calculate the apparent mass. The accelerations of the head in the x-, y- and z-directions were also measured and used to calculate the transmissibility to the head. The apparent mass of males was found higher than that of females. The transmissibility to the head in all directions was found higher in females than males. The differences in the biodynamic responses between males and females were attributed to the differences in body properties and structure of the two genders. The results of this study imply the need for gender-specific vibration training programmes.

Frontal crash simulations using parametric human models representing a diverse population

Objective: Analyses of crash data have shown that older, obese, and/or female occupants have a higher risk of injury in frontal crashes compared to the rest of the population. The objective of this study was to use parametric finite element (FE) human models to assess the increased injury risks and identify safety concerns for these vulnerable populations. Methods: We sampled 100 occupants based on age, sex, stature, and body mass index (BMI) to span a wide range of the U.S. adult population. The target anatomical geometry for each of the 100 models was predicted by the statistical geometry models for the rib cage, pelvis, femur, tibia, and external body surface developed previously. A regional landmark-based mesh morphing method was used to morph the Global Human Body Models Consortium (GHBMC) M50-OS model into the target geometries. The morphed human models were then positioned in a validated generic vehicle driver compartment model using a statistical driving posture model. Frontal crash simulations based on U.S. New Car Assessment Program (U.S. NCAP) were conducted. Body region injury risks were calculated based on the risk curves used in the US NCAP, except that scaling was used for the neck, chest, and knee-thigh-hip injury risk curves based on the sizes of the bony structures in the corresponding body regions. Age effects were also considered for predicting chest injury risk. Results: The simulations demonstrated that driver stature and body shape affect occupant interactions with the restraints and consequently affect occupant kinematics and injury risks in severe frontal crashes. U-shaped relations between occupant stature/weight and head injury risk were observed. Chest injury risk was strongly affected by age and sex, with older female occupants having the highest risk. A strong correlation was also observed between BMI and knee-thigh-hip injury risk, whereas none of the occupant parameters meaningfully affected neck injury risks. Conclusions: This study is the first to use a large set of diverse FE human models to investigate the combined effects of age, sex, stature, and BMI on injury risks in frontal crashes. The study demonstrated that parametric human models can effectively predict the injury trends for the population and may now be used to optimize restraint systems for people who are not similar in size and shape to the available anthropomorphic test devices (ATDs). New restraints that adapt to occupant age, sex, stature, and body shape may improve crash safety for all occupants.

Thoracic cage volume and dimension assessment by optoelectronic molding in normal children and adolescents during growth

PURPOSE

The thoracic spine, the chondral and osseous ribs, and the sternum together make up the thoracic cage. These elements are strictly correlated, although their growth is not synchronous. The purpose of this study is to provide a comprehensive data set of thoracic dimensions and non-invasive volumetric assessment in a large cohort of males and females from early childhood to young adult age.

METHODS

In all, 622 healthy individuals (406 girls, 216 boys) aged 6-18 years were consecutively enrolled between 2006 and 2016. All had to be healthy with no history of spinal deformity, or any lung, cardiovascular, systemic or neuromuscular disease. The optical ORTEN system for trunk surface data acquisition was used to calculate thoracic cage volume (V) and perimeter (Pe), anterior-posterior depth (AP) and transverse diameter (TD), AP/TD ratio, sternal length (St), and T1-T12 distance (Tle) in all patients.

RESULTS

The overall average age was 11.1 ± 2.5 years (4-18) for girls and 11.0 ± 3.1 years (4-18) for boys. Average growth parameters were: standing height 146.2 ± 14.6 cm (103-172) for girls and 146.4 ± 20.0 cm (94-192) for boys, sitting height 75.4 ± 8.6 cm (61-91) for girls and 75.5 ± 10.3 cm (60-99) for boys, weight 37.6 ± 10.4 kg (16-65) for girls and 38.3 ± 14.3 kg (13.7-104) for boys, BMI 16.7 ± 3.7 (18.5-26) for girls and 17.0 ± 3.3 (18.7-34.3) for boys. At age 6-8 years: V was 52.5% of its final size in girls and 44.9% in boys; Pe was 80.2% its final length in girls and 76.8% in boys; St reached 68% of its final size in girls and 66.9% in boys; Tle reached 73.3% of its final length in girls and 71.2% in boys. At skeletal maturity, thoracic cage volume in boys was 19.4% greater than in girls (p < 0.05). AP/TD ratio remained < 1 in all age groups and did not differ between genders (p > 0.05).

CONCLUSION

Growth of the thoracic cage is shown to be a gradual process that is more linear than previously reported. Only small increases in annual growth rates were observed during the pubertal growth spurt. The most important events characterizing thoracic cage development occurred during the first few years of postnatal growth. The circular cross-section of the very young child's thorax reached adult-like proportions together with its ovoid shape before age 6 years.

Sources of Variability in Structural Bending Response of Pediatric and Adult Human Ribs in Dynamic Frontal Impacts

Despite safety advances, thoracic injuries in motor vehicle crashes remain a significant source of morbidity and mortality, and rib fractures are the most prevalent of thoracic injuries. The objective of this study was to explore sources of variation in rib structural properties in order to identify sources of differential risk of rib fracture between vehicle occupants. A hierarchical model was employed to quantify the effects of demographic differences and rib geometry on structural properties including stiffness, force, displacement, and energy at failure and yield. Three-hundred forty-seven mid-level ribs from 182 individual anatomical donors were dynamically (~2 m/s) tested to failure in a simplified bending scenario mimicking a frontal thoracic impact. Individuals ranged in age from 4 - 108 years (mean 53 ± 23 years) and included 59 females and 123 males of diverse body sizes. Age, sex, body size, aBMD, whole rib geometry and cross-sectional geometry were explored as predictors of rib structural properties. Measures of cross-sectional rib size (Tt.Ar), bone quantity (Ct.Ar), and bone distribution (Z) generally explained more variation than any other predictors, and were further improved when normalized by rib length (e.g., robustness and WBSI). Cortical thickness (Ct.Th) was not found to be a useful predictor. Rib level predictors performed better than individual level predictors. These findings moderately explain differential risk for rib fracture and with additional exploration of the rib's role in thoracic response, may be able contribute to ATD and HBM development and alterations in addition to improvements to thoracic injury criteria and scaling methods.

Sex differences in respiratory function

Men Are from Mars, Women Are from Venus. John Gray used this provocative title for his book to describe the fundamental psychological differences between the sexes. Many other controlled studies and brain scans demonstrate that men and women are physically and mentally different. The purpose of this physiology masterclass is to illustrate how sex-related differences are present in respiratory function and their possible clinical implications.

An overview of sex-related differences in respiratory function and their possible clinical implicationshttp://ow.ly/106m30jqOSW

Trunk musculoskeletal response in maximum voluntary exertions: A combined measurement-modeling investigation

Maximum voluntary exertion (MVE) tasks quantify trunk strength and maximal muscle electromyography (EMG) activities with both clinical and biomechanical implications. The aims here are to evaluate the performance of an existing trunk musculoskeletal model, estimate maximum muscle stresses and spinal forces, and explore likely differences between males and females in maximum voluntary exertions. We, therefore, measured trunk strength and EMG activities of 19 healthy right-handed subjects (9 females and 10 males) in flexion, extension, lateral and axial directions. MVEs for all subjects were then simulated in a subject-specific trunk musculoskeletal model, and estimated muscle activities were compared with EMGs. Analysis of variance was used to compare measured moments and estimated spinal loads at the L5-S1 level between females and males. MVE moments in both sexes were greatest in extension (means of 236 Nm in males and 190 Nm in females) and least in left axial torque (97 Nm in males and 64 Nm in females). Being much greater in lateral and axial MVEs, coupled moments reached ∼50% of primary moments in average. Females exerted less moments in all directions reaching significance except in flexion. Muscle activity estimations were strongly correlated with measurements in flexion and extension (Pearson's r = 0.69 and 0.76), but the correlations were very weak in lateral and axial MVEs (Pearson's r = 0.27 and 0.13). Maximum muscle stress was in average 0.80 ± 0.42 MPa but varied among muscles from 0.40 ± 0.22  MPa in rectus abdominis to 0.99 ± 0.29 MPa in external oblique. To estimate maximum muscle stresses and evaluate validity of a musculoskeletal model, MVEs in all directions with all coupled moments should be considered.

Altered Thoracic Cage Dimensions in Patients with Chronic Obstructive Pulmonary Disease

Background

Chronic obstructive pulmonary disease (COPD) may cause changes in the shape of the thoracic cage by increasing lung volume and hyperinflation. This study investigated changes in thoracic cage dimensions and related factors in patients with COPD.

Methods

We enrolled 85 patients with COPD (76 males, 9 females; mean age, 70.6±7.1 years) and 30 normal controls. Thoracic cage dimensions were measured using chest computed tomography at levels 3, 6, and 9 of the thoracic spine. We measured the maximal transverse diameter, mid-sagittal anteroposterior (AP) diameter, and maximal AP diameter of the right and left hemithorax.

Results

The average AP diameter was significantly greater in patients with COPD compared with normal controls (13.1±2.8 cm vs. 12.2±1.13 cm, respectively; p=0.001). The ratio of AP/transverse diameter of the thoracic cage was also significantly greater in patients with COPD compared with normal controls (0.66±0.061 vs. 0.61±0.86; p=0.002). In COPD patients, the AP diameter of the thoracic cage was positively correlated with body mass index (BMI) and 6-minute walk test distance (r=0.395, p<0.001 and r=0.238, p=0.028) and negatively correlated with increasing age (r=−0.231, p=0.034). Multiple regression analysis revealed independent correlation only between BMI and increased ratio of AP/transverse diameter of the thoracic cage (p<0.001).

Conclusion

Patients with COPD exhibited an increased AP diameter of the thoracic cage compared with normal controls. BMI was associated with increased AP diameter in these patients.

Eco-geographic adaptations in the human ribcage throughout a 3D geometric morphometric approach

OBJECTIVES

According to eco-geographic rules, humans from high latitude areas present larger and wider trunks than their low-latitude areas counterparts. This issue has been traditionally addressed on the pelvis but information on the thorax is largely lacking. We test whether ribcages are larger in individuals inhabiting high latitudes than in those from low latitudes and explored the correlation of rib size with latitude. We also test whether a common morphological pattern is exhibited in the thorax of different cold-adapted populations, contributing to their hypothetical widening of the trunk.

MATERIALS AND METHODS

We used 3D geometric morphometrics to quantify rib morphology of three hypothetically cold-adapted populations, viz. Greenland (11 individuals), Alaskan Inuit (8 individuals) and people from Tierra del Fuego (8 individuals), in a comparative framework with European (Spain, Portugal and Austria; 24 individuals) and African populations (South African and sub-Saharan African; 20 individuals).

RESULTS

Populations inhabiting high latitudes present longer ribs than individuals inhabiting areas closer to the equator, but a correlation (p < 0.05) between costal size and latitude is only found in ribs 7-11. Regarding shape, the only cold adapted population that was different from the non-cold-adapted populations were the Greenland Inuit, who presented ribs with less curvature and torsion.

CONCLUSIONS

Size results from the lower ribcage are consistent with the hypothesis of larger trunks in cold-adapted populations. The fact that only Greenland Inuit present a differential morphological pattern, linked to a widening of their ribcage, could be caused by differences in latitude. However, other factors such as genetic drift or specific cultural adaptations cannot be excluded and should be tested in future studies.