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Wagner MG, Whitehead JF, Periyasamy S, Laeseke PF, Speidel MA. Spatiotemporal frequency domain analysis for blood velocity measurement during embolization procedures. Med Phys 2024; 51:1726-1737. [PMID: 37665770 PMCID: PMC10909916 DOI: 10.1002/mp.16715] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Currently, determining procedural endpoints and treatment efficacy of vascular interventions is largely qualitative and relies on subjective visual assessment of digital subtraction angiography (DSA) images leading to large interobserver variabilities and poor reproducibility. Quantitative metrics such as the residual blood velocity in embolized vessel branches could help establish objective and reproducible endpoints. Recently, velocity quantification techniques based on a contrast enhanced X-ray sequence such as qDSA and 4D DSA have been proposed. These techniques must be robust, and, to avoid radiation dose concerns, they should be compatible with low dose per frame image acquisition. PURPOSE To develop and evaluate a technique for robust blood velocity quantification from low dose contrast enhanced X-ray image sequences that leverages the oscillating signal created by pulsatile blood flow. METHODS The proposed spatiotemporal frequency domain (STF) approach quantifies velocities from time attenuation maps (TAMs) representing the oscillating signal over time for all points along a vessel centerline. Due to the time it takes a contrast bolus to travel along the vessel centerline, the resulting TAM resembles a sheared sine wave. The shear angle is related to the velocity and can be determined in the spatiotemporal frequency domain after applying the 2D Fourier transform to the TAM. The approach was evaluated in a straight tube phantom using three different radiation dose levels and compared to ultrasound transit-time-based measurements. The STF velocity results were also compared to previously published approaches for the measurement of blood velocity from contrast enhanced X-ray sequences including shifted least squared (SLS) and phase shift (PHS). Additionally, an in vivo porcine study (n = 8) was performed where increasing amounts of embolic particles were injected into a hepatic or splenic artery with intermittent velocity measurements after each injection to monitor the resulting reduction in velocity. RESULTS At the lowest evaluated dose level (average air kerma rate 1.3 mGy/s at the interventional reference point), the Pearson correlation between ultrasound and STF velocity measurements was99 % $99\%$ . This was significantly higher (p < 0.0001 $p < 0.0001$ ) than corresponding correlation results between ultrasound and the previously published SLS and PHS approaches (91 $\hskip.001pt 91$ and93 % $93\%$ , respectively). In the in vivo study, a reduction in velocity was observed in85.7 % $85.7\%$ of cases after injection of 1 mL,96.4 % $96.4\%$ after 3 mL, and100.0 % $100.0\%$ after 4 mL of embolic particles. CONCLUSIONS The results show good agreement of the spatiotemporal frequency domain approach with ultrasound even in low dose per frame image sequences. Additionally, the in vivo study demonstrates the ability to monitor the physiological changes due to embolization. This could provide quantitative metrics during vascular procedures to establish objective and reproducible endpoints.
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Affiliation(s)
- Martin G Wagner
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
| | - Joseph F Whitehead
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
| | - Sarvesh Periyasamy
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Paul F Laeseke
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Michael A Speidel
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
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2
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Wancura M, Nkansah A, Chwatko M, Robinson A, Fairley A, Cosgriff-Hernandez E. Interpenetrating network design of bioactive hydrogel coatings with enhanced damage resistance. J Mater Chem B 2023; 11:5416-5428. [PMID: 36825927 PMCID: PMC10682960 DOI: 10.1039/d2tb02825e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/20/2023] [Indexed: 02/22/2023]
Abstract
Bioactive hydrogel coatings offer a promising route to introduce sustained thromboresistance to cardiovascular devices without compromising bulk mechanical properties. Poly(ethylene glycol)-based hydrogels provide antifouling properties to limit acute thromobosis and incorporation of adhesive ligands can be used to promote endothelialization. However, conventional PEG-based hydrogels at stiffnesses that promote cell attachment can be brittle and prone to damage in a surgical setting, limiting their utility in clinical applications. In this work, we developed a durable hydrogel coating using interpenetrating networks of polyether urethane diacrylamide (PEUDAm) and poly(N-acryloyl glycinamide) (pNAGA). First, diffusion-mediated redox initiation of PEUDAm was used to coat electrospun polyurethane fiber meshes with coating thickness controlled by the immersion time. The second network of pNAGA was then introduced to enhance damage resistance of the hydrogel coating. The durability, thromboresistance, and bioactivity of the resulting multilayer grafts were then assessed. The IPN hydrogel coatings displayed resistance to surgically-associated damage mechanisms and retained the anti-fouling nature of PEG-based hydrogels as indicated by reduced protein adsorption and platelet attachment. Moreover, incorporation of functionalized collagen into the IPN hydrogel coating conferred bioactivity that supported endothelial cell adhesion. Overall, this conformable and durable hydrogel coating provides an improved approach for cardiovascular device fabrication with targeted biological activity.
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Affiliation(s)
- Megan Wancura
- Department of Chemistry, The University of Texas at Austin, Austin, TX 78712, USA
| | - Abbey Nkansah
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA.
| | - Malgorzata Chwatko
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA.
| | - Andrew Robinson
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA.
| | - Ashauntee Fairley
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA.
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3
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A method for matching the refractive index and dynamic viscosity of transparent replicas of rock for flow visualization. J Vis (Tokyo) 2022. [DOI: 10.1007/s12650-022-00875-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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4
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A Review on Novel Channel Materials for Particle Image Velocimetry Measurements-Usability of Hydrogels in Cardiovascular Applications. Gels 2022; 8:gels8080502. [PMID: 36005103 PMCID: PMC9407631 DOI: 10.3390/gels8080502] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 12/02/2022] Open
Abstract
Particle image velocimetry (PIV) is an optical and contactless measurement method for analyzing fluid blood dynamics in cardiovascular research. The main challenge to visualization investigated in the current research was matching the channel material’s index of refraction (IOR) to that of the fluid. Silicone is typically used as a channel material for these applications, so optical matching cannot be proven. This review considers hydrogel as a new PIV channel material for IOR matching. The advantages of hydrogels are their optical and mechanical properties. Hydrogels swell more than 90 vol% when hydrated in an aqueous solution and have an elastic behavior. This paper aimed to review single, double, and triple networks and nanocomposite hydrogels with suitable optical and mechanical properties to be used as PIV channel material, with a focus on cardiovascular applications. The properties are summarized in seven hydrogel groups: PAMPS, PAA, PVA, PAAm, PEG and PEO, PSA, and PNIPA. The reliability of the optical properties is related to low IORs, which allow higher light transmission. On the other hand, elastic modulus, tensile/compressive stress, and nominal tensile/compressive strain are higher for multiple-cross-linked and nanocomposite hydrogels than single mono-cross-linked gels. This review describes methods for measuring optical and mechanical properties, e.g., refractometry and mechanical testing.
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5
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Engineering characterization of the novel Bach impeller for bioprocessing applications requiring low power inputs. Chem Eng Sci 2022. [DOI: 10.1016/j.ces.2021.117263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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6
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Sadek SH, Rubio M, Lima R, Vega EJ. Blood Particulate Analogue Fluids: A Review. MATERIALS (BASEL, SWITZERLAND) 2021; 14:2451. [PMID: 34065125 PMCID: PMC8126041 DOI: 10.3390/ma14092451] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 04/30/2021] [Accepted: 05/01/2021] [Indexed: 11/16/2022]
Abstract
Microfluidics has proven to be an extraordinary working platform to mimic and study blood flow phenomena and the dynamics of components of the human microcirculatory system. However, the use of real blood increases the complexity to perform these kinds of in vitro blood experiments due to diverse problems such as coagulation, sample storage, and handling problems. For this reason, interest in the development of fluids with rheological properties similar to those of real blood has grown over the last years. The inclusion of microparticles in blood analogue fluids is essential to reproduce multiphase effects taking place in a microcirculatory system, such as the cell-free layer (CFL) and Fähraeus-Lindqvist effect. In this review, we summarize the progress made in the last twenty years. Size, shape, mechanical properties, and even biological functionalities of microparticles produced/used to mimic red blood cells (RBCs) are critically exposed and analyzed. The methods developed to fabricate these RBC templates are also shown. The dynamic flow/rheology of blood particulate analogue fluids proposed in the literature (with different particle concentrations, in most of the cases, relatively low) is shown and discussed in-depth. Although there have been many advances, the development of a reliable blood particulate analogue fluid, with around 45% by volume of microparticles, continues to be a big challenge.
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Affiliation(s)
- Samir Hassan Sadek
- Departamento de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Científica Avanzada (ICCAEx), Universidad de Extremadura, E-06006 Badajoz, Spain; (S.H.S.); (M.R.)
| | - Manuel Rubio
- Departamento de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Científica Avanzada (ICCAEx), Universidad de Extremadura, E-06006 Badajoz, Spain; (S.H.S.); (M.R.)
| | - Rui Lima
- MEtRICs, Mechanical Engineering Department, Campus de Azurém, University of Minho, 4800-058 Guimarães, Portugal;
- Transport Phenomena Research Center, Department of Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Emilio José Vega
- Departamento de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Científica Avanzada (ICCAEx), Universidad de Extremadura, E-06006 Badajoz, Spain; (S.H.S.); (M.R.)
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Griffiths RL, Berg JD. Automation of the Whole-Blood Thiopurine S-Methyltransferase (TPMT) Phenotyping Assay Using the Biomek NX P and Biomek i5 Liquid-Handling Workstations. SLAS Technol 2021; 26:488-497. [PMID: 33913342 DOI: 10.1177/24726303211008856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Assessment of thiopurine S-methyltransferase (TPMT) status is required before commencing thiopurine treatment to reduce the potential for adverse drug reactions. Our laboratory has provided a national TPMT phenotyping service since 2003. Our assay uses 6-thioguanine as substrate and detection of 6-methylthioguanine via high-performance liquid chromatography (HPLC) fluorescence. Here, we report the automation of this complex, labor-intensive, manual assay using the Biomek NXP and Biomek i5 liquid-handling workstations. We optimized assay performance and validated for precision, linearity, and lower limit of quantitation. We also compared results from the manual and automated methods. Primary sample mixing and aliquoting were performed on the Biomek NXP. On-board inversions (n = 10) replaced offline mixing. No carryover was observed. Eleven percent of primary sample tubes were incompatible with the Biomek NXP, and these were assayed manually. The Biomek i5 was used to automate the enzyme assay. Optimum vortex mixing was achieved at 2500 rpm for 60 s, and the temperature was set to 37.0 °C for the 60 min enzyme incubation. Intra- and inter-assay precision were excellent, with coefficients of variation (CVs) of ≤2.3% and ≤7.4%, respectively, for patient samples. Linearity was demonstrated up to 199 mIU/L (R2 = 0.992), with a lower limit of quantitation of 3.9 mIU/L. Correlation between the manual and automated methods was good (R2 = 0.979, n = 405), with results being interchangeable. We have successfully developed and validated a novel automated method for the TPMT phenotyping enzyme assay. The two methods are cost-neutral. Automation of other complex enzyme assays may be possible using this approach.
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Affiliation(s)
- Rachel L Griffiths
- Department of Clinical Biochemistry, Sandwell & West Birmingham NHS Trust, part of the Black Country Pathology Services, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, UK
| | - Jonathan D Berg
- Department of Clinical Biochemistry, Sandwell & West Birmingham NHS Trust, part of the Black Country Pathology Services, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, UK
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Carvalho V, Maia I, Souza A, Ribeiro J, Costa P, Puga H, Teixeira S, Lima RA. In vitro
Biomodels in Stenotic Arteries to Perform Blood Analogues Flow Visualizations and Measurements: A Review. Open Biomed Eng J 2020. [DOI: 10.2174/1874120702014010087] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular diseases are one of the leading causes of death globally and the most common pathological process is atherosclerosis. Over the years, these cardiovascular complications have been extensively studied by applying in vivo, in vitro and numerical methods (in silico). In vivo studies represent more accurately the physiological conditions and provide the most realistic data. Nevertheless, these approaches are expensive, and it is complex to control several physiological variables. Hence, the continuous effort to find reliable alternative methods has been growing. In the last decades, numerical simulations have been widely used to assess the blood flow behavior in stenotic arteries and, consequently, providing insights into the cardiovascular disease condition, its progression and therapeutic optimization. However, it is necessary to ensure its accuracy and reliability by comparing the numerical simulations with clinical and experimental data. For this reason, with the progress of the in vitro flow measurement techniques and rapid prototyping, experimental investigation of hemodynamics has gained widespread attention. The present work reviews state-of-the-art in vitro macro-scale arterial stenotic biomodels for flow measurements, summarizing the different fabrication methods, blood analogues and highlighting advantages and limitations of the most used techniques.
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Amabili M, Balasubramanian P, Ferrari G, Franchini G, Giovanniello F, Tubaldi E. Identification of viscoelastic properties of Dacron aortic grafts subjected to physiological pulsatile flow. J Mech Behav Biomed Mater 2020; 110:103804. [DOI: 10.1016/j.jmbbm.2020.103804] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/12/2020] [Accepted: 04/15/2020] [Indexed: 11/26/2022]
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10
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Hong H, Song JM, Yeom E. Variations in pulsatile flow around stenosed microchannel depending on viscosity. PLoS One 2019; 14:e0210993. [PMID: 30677055 PMCID: PMC6345426 DOI: 10.1371/journal.pone.0210993] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/04/2019] [Indexed: 12/17/2022] Open
Abstract
In studying blood flow in the vessels, the characteristics of non-Newtonian fluid are important, considering the role of viscosity in rheology. Stenosis, which is an abnormal narrowing of the vessel, has an influence on flow behavior. Therefore, analysis of blood flow in stenosed vessels is essential. However, most of them exist as simulation outcomes. In this study, non-Newtonian fluid was observed in stenosed microchannels under the pulsatile flow condition. A polydimethylsiloxane channel with 60% stenosis was fabricated by combining an optic fiber and a petri dish, resembling a mold. Three types of samples were prepared by changing the concentrations of xanthan gum, which induces a shear thinning effect (phosphate buffered saline (PBS) solution as the Newtonian fluid and two non-Newtonian fluids mimicking normal blood and highly viscous blood analog). The viscosity of the samples was measured using a Y-shaped microfluidic viscometer. Thereafter, velocity profiles were analyzed under the pulsatile flow condition using the micro-particle image velocimetry (PIV) method. For the Newtonian fluid, the streamline was skewed more to the wall of the channel. The velocity profile of the non-Newtonian fluid was generally blunter than that of the Newtonian fluid. A highly oscillating wall shear stress (WSS) during the pulsatile phase may be attributed to such a bluntness of flow under the same wall shear rate condition with the Newtonian fluid. In addition, a highly viscous flow contributes to the variation in the WSS after passing through the stenosed structures. A similar tendency was observed in simulation results. Such a variation in the WSS was associated with plaque instability or rupture and damage of the tissue layer. These results, related to the influence on the damage to the endothelium or stenotic lesion, may help clinicians understand relevant mechanisms.
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Affiliation(s)
- Hyeonji Hong
- School of Mechanical Engineering, Pusan National University, Busan, South Korea
| | - Jae Min Song
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Busan, South Korea
| | - Eunseop Yeom
- School of Mechanical Engineering, Pusan National University, Busan, South Korea
- * E-mail:
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11
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Microfluidic Deformability Study of an Innovative Blood Analogue Fluid Based on Giant Unilamellar Vesicles. J Funct Biomater 2018; 9:jfb9040070. [PMID: 30518160 PMCID: PMC6306889 DOI: 10.3390/jfb9040070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 11/12/2018] [Accepted: 11/27/2018] [Indexed: 11/16/2022] Open
Abstract
Blood analogues have long been a topic of interest in biofluid mechanics due to the safety and ethical issues involved in the collection and handling of blood samples. Although the current blood analogue fluids can adequately mimic the rheological properties of blood from a macroscopic point of view, at the microscopic level blood analogues need further development and improvement. In this work, an innovative blood analogue containing giant unilamellar vesicles (GUVs) was developed to mimic the flow behavior of red blood cells (RBCs). A natural lipid mixture, soybean lecithin, was used for the GUVs preparation, and three different lipid concentrations were tested (1 × 10-3 M, 2 × 10-3 M and 4 × 10-3 M). GUV solutions were prepared by thin film hydration with a buffer, followed by extrusion. It was found that GUVs present diameters between 5 and 7 µm which are close to the size of human RBCs. Experimental flow studies of three different GUV solutions were performed in a hyperbolic-shaped microchannel in order to measure the GUVs deformability when subjected to a homogeneous extensional flow. The result of the deformation index (DI) of the GUVs was about 0.5, which is in good agreement with the human RBC's DI. Hence, the GUVs developed in this study are a promising way to mimic the mechanical properties of the RBCs and to further develop particulate blood analogues with flow properties closer to those of real blood.
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12
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Brindise MC, Busse MM, Vlachos PP. Density and Viscosity Matched Newtonian and non-Newtonian Blood-Analog Solutions with PDMS Refractive Index. EXPERIMENTS IN FLUIDS 2018; 59:173. [PMID: 31745378 PMCID: PMC6863344 DOI: 10.1007/s00348-018-2629-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/03/2018] [Accepted: 10/13/2018] [Indexed: 05/31/2023]
Abstract
Optical imaging is commonly used to investigate biological flows and cardiovascular disease using compliant silicone polydimethysiloxane (PDMS) Sylgard 184 geometries. However, selecting the working fluid with blood density and viscosity, and PDMS index of refraction (RI) for such experiments is challenging. Currently, water-glycerol is commonly used and sodium iodide (NaI) often added to increase the index of refraction without changing fluid viscosity. But the resulting fluid density is well above blood. Moreover, NaI is expensive, has safety and material discoloration concerns, and has been reported to affect non-Newtonian fluid behavior. Here, we present a new blood analog alternative based on urea. Urea is approximately five to fifteen times less expensive than NaI, safe and easy to handle, optically clear, and causes no discoloration. Water-glycerol-urea solutions, unlike those with NaI, simultaneously matched the density and viscosity of blood and RI of PDMS. Water-xylitol and water-xylitol-urea solutions are also possible blood analog solutions. Xanthan gum (XG)-water-glycerol non-Newtonian solutions maintained similar viscoelastic properties throughout the range of weight percent (about 15-25%) of urea and NaI used here. The results showed that the XG weight percent affected viscoelastic properties more than the weight percent of urea or NaI tested in this study. Overall, we demonstrate urea is useful for PDMS blood analog experiments and should also be considered as an inexpensive additive, and an alternative to NaI.
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Affiliation(s)
| | - Margaret M. Busse
- Lyles School of Civil Engineering, Purdue University, West Lafayette, IN
| | - Pavlos P. Vlachos
- School of Mechanical Engineering, Purdue University, West Lafayette, IN
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13
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Inter-Laboratory Characterization of the Velocity Field in the FDA Blood Pump Model Using Particle Image Velocimetry (PIV). Cardiovasc Eng Technol 2018; 9:623-640. [DOI: 10.1007/s13239-018-00378-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/08/2018] [Indexed: 12/12/2022]
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14
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Pinho D, Campo-Deaño L, Lima R, Pinho FT. In vitro particulate analogue fluids for experimental studies of rheological and hemorheological behavior of glucose-rich RBC suspensions. BIOMICROFLUIDICS 2017; 11:054105. [PMID: 28966701 PMCID: PMC5608610 DOI: 10.1063/1.4998190] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 07/28/2017] [Indexed: 05/09/2023]
Abstract
Suspensions of healthy and pathological red blood cells (RBC) flowing in microfluidic devices are frequently used to perform in vitro blood experiments for a better understanding of human microcirculation hemodynamic phenomena. This work reports the development of particulate viscoelastic analogue fluids able to mimic the rheological and hemorheological behavior of pathological RBC suspensions flowing in microfluidic systems. The pathological RBCs were obtained by an incubation of healthy RBCs at a high concentration of glucose, representing the pathological stage of hyperglycaemia in diabetic complications, and analyses of their deformability and aggregation were carried out. Overall, the developed in vitro analogue fluids were composed of a suspension of semi-rigid microbeads in a carrier viscoelastic fluid made of dextran 40 and xanthan gum. All suspensions of healthy and pathological RBCs, as well as their particulate analogue fluids, were extensively characterized in steady shear flow, as well as in small and large amplitude oscillatory shear flow. In addition, the well-known cell-free layer (CFL) phenomenon occurring in microchannels was investigated in detail to provide comparisons between healthy and pathological in vitro RBC suspensions and their corresponding analogue fluids at different volume concentrations (5% and 20%). The experimental results have shown a similar rheological behavior between the samples containing a suspension of pathological RBCs and the proposed analogue fluids. Moreover, this work shows that the particulate in vitro analogue fluids used have the ability to mimic well the CFL phenomenon occurring downstream of a microchannel contraction for pathological RBC suspensions. The proposed particulate fluids provide a more realistic behavior of the flow properties of suspended RBCs when compared with existing non-particulate blood analogues, and consequently, they are advantageous for detailed investigations of microcirculation.
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Affiliation(s)
| | - Laura Campo-Deaño
- CEFT, DEMec, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | | | - Fernando T Pinho
- CEFT, DEMec, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
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15
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Development of an In Vitro PIV Setup for Preliminary Investigation of the Effects of Aortic Compliance on Flow Patterns and Hemodynamics. Cardiovasc Eng Technol 2017; 8:368-377. [PMID: 28597231 DOI: 10.1007/s13239-017-0309-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Abstract
The aorta with its compliance plays a major role in hemodynamics as it saves a portion of ejected blood during systole which is then released in diastole. The aortic compliance decreases with increasing age, which is related to several cardiovascular imparities and diseases. Changes in flow patterns and pressure curves, due to varying aortic compliance, are difficult to investigate in vivo. As a result, the aim of the present work was to develop an in vitro setup enabling standardized investigations on the effect of compliance changes on flow patterns and pressure curves. Therefore an experimental setup with an anatomically correct silicone phantom of the aortic arch was developed, suitable for optical flow measurements under pulsatile inflow conditions. The setup was developed for precise adjustments of different compliances and optical flow measurements. Particle image velocimetry measurements were carried out downstream of the aortic valve in the center plane perpendicular to the valve with compliance adjusted between 0.62 × 10-3 to 1.82 × 10-3 mmHg-1. Preliminary results of the in vitro investigations showed that decreases in compliance results in significant increases in pressure changes with respect to time (dp/dt) and altered pressure curves in the aortic arch. In terms of flow, an increased aortic stiffness lead to higher mean velocities and decreased vortex development in the aortic sinuses. As in vivo validation and translation remains difficult, the results have to be considered as preliminary in vitro insights into the mechanisms of (age-related) compliance changes.
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Born F, Khaladj N, Pichlmaier M, Schramm R, Hagl C, Guenther SP. Potential impact of oxygenators with venous air trap on air embolism in veno-arterial Extracorporeal Life Support. Technol Health Care 2017; 25:111-121. [DOI: 10.3233/thc-161248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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17
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Landsman TL, Bush RL, Glowczwski A, Horn J, Jessen SL, Ungchusri E, Diguette K, Smith HR, Hasan SM, Nash D, Clubb FJ, Maitland DJ. Design and verification of a shape memory polymer peripheral occlusion device. J Mech Behav Biomed Mater 2016; 63:195-206. [PMID: 27419615 PMCID: PMC5508979 DOI: 10.1016/j.jmbbm.2016.06.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/17/2016] [Accepted: 06/18/2016] [Indexed: 10/21/2022]
Abstract
Shape memory polymer foams have been previously investigated for their safety and efficacy in treating a porcine aneurysm model. Their biocompatibility, rapid thrombus formation, and ability for endovascular catheter-based delivery to a variety of vascular beds makes these foams ideal candidates for use in numerous embolic applications, particularly within the peripheral vasculature. This study sought to investigate the material properties, safety, and efficacy of a shape memory polymer peripheral embolization device in vitro. The material characteristics of the device were analyzed to show tunability of the glass transition temperature (Tg) and the expansion rate of the polymer to ensure adequate time to deliver the device through a catheter prior to excessive foam expansion. Mechanical analysis and flow migration studies were performed to ensure minimal risk of vessel perforation and undesired thromboembolism upon device deployment. The efficacy of the device was verified by performing blood flow studies that established affinity for thrombus formation and blood penetration throughout the foam and by delivery of the device in an ultrasound phantom that demonstrated flow stagnation and diversion of flow to collateral pathways.
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Affiliation(s)
- Todd L Landsman
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843-3120, USA
| | - Ruth L Bush
- College of Medicine, Texas A&M University Health Science Center, MS 1359, 8447 State Highway 47, HPEB 3060, Bryan, TX 77807-3260, USA
| | - Alan Glowczwski
- Texas A&M Institute for Preclinical Studies, Texas A&M University, MS 4478, College Station, TX 77845-4478, USA
| | - John Horn
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843-3120, USA
| | - Staci L Jessen
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843-3120, USA
| | - Ethan Ungchusri
- College of Medicine, Texas A&M University Health Science Center, MS 1359, 8447 State Highway 47, HPEB 3060, Bryan, TX 77807-3260, USA
| | - Katelin Diguette
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843-3120, USA
| | - Harrison R Smith
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843-3120, USA
| | - Sayyeda M Hasan
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843-3120, USA
| | - Daniel Nash
- Maverick Regional Anesthesia Education, LLC, 10592 County Road 175, Iola, TX 77861, USA
| | - Fred J Clubb
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843-3120, USA; Department of Veterinary Pathobiology, Cardiovascular Pathology Laboratory, College of Veterinary Medicine, Texas A&M University, MS 4467, College Station, TX 77843-4467, USA
| | - Duncan J Maitland
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843-3120, USA.
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18
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Particulate Blood Analogues Reproducing the Erythrocytes Cell-Free Layer in a Microfluidic Device Containing a Hyperbolic Contraction. MICROMACHINES 2015; 7:mi7010004. [PMID: 30407376 PMCID: PMC6189708 DOI: 10.3390/mi7010004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 11/17/2022]
Abstract
The interest in the development of blood analogues has been increasing recently as a consequence of the increment in the number of experimental hemodynamic studies and the difficulties associated with the manipulation of real blood in vitro because of ethical, economical or hazardous issues. Although one-phase Newtonian and non-Newtonian blood analogues can be found in the literature, there are very few studies related to the use of particulate solutions in which the particles mimic the behaviour of the red blood cells (RBCs) or erythrocytes. One of the most relevant effects related with the behaviour of the erythrocytes is a cell-free layer (CFL) formation, which consists in the migration of the RBCs towards the center of the vessel forming a cell depleted plasma region near the vessel walls, which is known to happen in in vitro microcirculatory environments. Recent studies have shown that the CFL enhancement is possible with an insertion of contraction and expansion region in a straight microchannel. These effects are useful for cell manipulation or sorting in lab-on-chip studies. In this experimental study we present particulate Newtonian and non-Newtonian solutions which resulted in a rheological blood analogue able to form a CFL, downstream of a microfluidic hyperbolic contraction, in a similar way of the one formed by healthy RBCs.
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19
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Chopski SG, Rangus OM, Downs EA, Moskowitz WB, Throckmorton AL. Three-Dimensional Laser Flow Measurements of a Patient-Specific Fontan Physiology With Mechanical Circulatory Assistance. Artif Organs 2015; 39:E67-78. [DOI: 10.1111/aor.12426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Steven G. Chopski
- Department of Mechanical and Nuclear Engineering; School of Engineering; Virginia Commonwealth University; Richmond VA USA
| | - Owen M. Rangus
- Department of Mechanical and Nuclear Engineering; School of Engineering; Virginia Commonwealth University; Richmond VA USA
| | - Emily A. Downs
- Department of Mechanical and Nuclear Engineering; School of Engineering; Virginia Commonwealth University; Richmond VA USA
| | - William B. Moskowitz
- Division of Pediatric Cardiology; Children's Hospital of Richmond; Virginia Commonwealth University; Richmond VA USA
- School of Medicine; Virginia Commonwealth University; Richmond VA USA
| | - Amy L. Throckmorton
- Department of Mechanical and Nuclear Engineering; School of Engineering; Virginia Commonwealth University; Richmond VA USA
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20
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Chopski SG, Rangus OM, Fox CS, Moskowitz WB, Throckmorton AL. Stereo-Particle Image Velocimetry Measurements of a Patient-Specific Fontan Physiology Utilizing Novel Pressure Augmentation Stents. Artif Organs 2015; 39:228-36. [DOI: 10.1111/aor.12364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Steven G. Chopski
- Department of Mechanical and Nuclear Engineering; School of Engineering; Virginia Commonwealth University; Richmond VA
| | - Owen M. Rangus
- Department of Mechanical and Nuclear Engineering; School of Engineering; Virginia Commonwealth University; Richmond VA
| | - Carson S. Fox
- Department of Mechanical and Nuclear Engineering; School of Engineering; Virginia Commonwealth University; Richmond VA
| | - William B. Moskowitz
- Division of Pediatric Cardiology; Children's Hospital of Richmond and School of Medicine; Virginia Commonwealth University; Richmond VA
| | - Amy L. Throckmorton
- School of Biomedical Engineering, Science and Health Systems; Drexel University; Philadelphia PA USA
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21
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Giurgea C, Bode F, Ioan Budiu O, Nascutiu L, Banyai D, Damian M. Experimental investigations of the steady flow through an idealized model of a femoral artery bypass. EPJ WEB OF CONFERENCES 2014. [DOI: 10.1051/epjconf/20146702031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Campo-Deaño L, Dullens RPA, Aarts DGAL, Pinho FT, Oliveira MSN. Viscoelasticity of blood and viscoelastic blood analogues for use in polydymethylsiloxane in vitro models of the circulatory system. BIOMICROFLUIDICS 2013; 7:34102. [PMID: 24404022 PMCID: PMC3669138 DOI: 10.1063/1.4804649] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 04/29/2013] [Indexed: 05/07/2023]
Abstract
The non-Newtonian properties of blood are of great importance since they are closely related with incident cardiovascular diseases. A good understanding of the hemodynamics through the main vessels of the human circulatory system is thus fundamental in the detection and especially in the treatment of these diseases. Very often such studies take place in vitro for convenience and better flow control and these generally require blood analogue solutions that not only adequately mimic the viscoelastic properties of blood but also minimize undesirable optical distortions arising from vessel curvature that could interfere in flow visualizations or particle image velocimetry measurements. In this work, we present the viscoelastic moduli of whole human blood obtained by means of passive microrheology experiments. These results and existing shear and extensional rheological data for whole human blood in the literature enabled us to develop solutions with rheological behavior analogous to real whole blood and with a refractive index suited for PDMS (polydymethylsiloxane) micro- and milli-channels. In addition, these blood analogues can be modified in order to obtain a larger range of refractive indices from 1.38 to 1.43 to match the refractive index of several materials other than PDMS.
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Affiliation(s)
- Laura Campo-Deaño
- Centro de Estudos de Fenómenos de Transporte, Faculdade de Engenharia da Universidade do Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Roel P A Dullens
- Department of Chemistry, Physical and Theoretical Chemistry Laboratory, University of Oxford, South Parks Road, Oxford OX1 3QZ, United Kingdom
| | - Dirk G A L Aarts
- Department of Chemistry, Physical and Theoretical Chemistry Laboratory, University of Oxford, South Parks Road, Oxford OX1 3QZ, United Kingdom
| | - Fernando T Pinho
- Centro de Estudos de Fenómenos de Transporte, Faculdade de Engenharia da Universidade do Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Mónica S N Oliveira
- Department of Mechanical and Aerospace Engineering, University of Strathclyde, Glasgow G1 1XJ, United Kingdom
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23
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Yeung JCY, de Lannoy I, Gien B, Vuckovic D, Yang Y, Bojko B, Pawliszyn J. Semi-automated in vivo solid-phase microextraction sampling and the diffusion-based interface calibration model to determine the pharmacokinetics of methoxyfenoterol and fenoterol in rats. Anal Chim Acta 2012; 742:37-44. [DOI: 10.1016/j.aca.2012.01.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Revised: 01/18/2012] [Accepted: 01/19/2012] [Indexed: 11/26/2022]
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24
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Lara M, Chen CY, Mannor P, Dur O, Menon PG, Yoganathan AP, Pekkan K. Hemodynamics of the Hepatic Venous Three-Vessel Confluences Using Particle Image Velocimetry. Ann Biomed Eng 2011; 39:2398-416. [DOI: 10.1007/s10439-011-0326-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 05/10/2011] [Indexed: 11/27/2022]
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25
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Høgetveit J, Saatvedt K, Norum H, Kristiansen F, Elvebakk O, Dahle G, Geiran O. Central venous catheters may be a potential source of massive air emboli during vascular procedures involving extracorporeal circulation: an experimental study. Perfusion 2011; 26:341-6. [DOI: 10.1177/0267659111403644] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Central venous catheters are mandatory during every major procedure involving extracorporeal circulation. Air emboli potentially could enter the circulation through this device when negative pressure is applied in the venous cannula. The following experimental study was initiated by a fatal massive air embolus during a vascular procedure involving cardiopulmonary bypass. An experimental setup was established, simulating a real scenario. The experiment was performed with a 40% glycerol/water mixture which exhibits properties and fluid dynamics close to blood. A heart-lung machine provided circulation of the fluid. The flow was adjusted according to the gravitational status. A triple-lumen central venous catheter with one line open to air was lowered into the liquid. The disconnected lumen of the central venous catheter was manipulated so it approached and was located in close proximity to the venous cannula. An air flow of up to 300 ml/min could be obtained from the central venous catheter with a flow in the cardiopulmonary bypass circuit of 2.3 L/min. A linear relationship was observed between flow in the circuit and air flow. Consecutive measurements proved consistent with acceptable results, proving that a disconnected central venous catheter might, under certain circumstances, be a source of massive air emboli during cardiopulmonary bypass.
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Affiliation(s)
- J.O. Høgetveit
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, Rikshospitalet, Norway, Department of Physics, University of Oslo
| | - K. Saatvedt
- Department of Cardiothoracic Surgery, University Hospital, Rikshospitalet, Norway,
| | - H. Norum
- Department of Anesthesiology, Oslo University Hospital, Rikshospitalet, Norway
| | - F. Kristiansen
- Department of Cardiothoracic Surgery, University Hospital, Rikshospitalet, Norway
| | - O. Elvebakk
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, Rikshospitalet, Norway
| | - G. Dahle
- Department of Cardiothoracic Surgery, University Hospital, Rikshospitalet, Norway
| | - O.R. Geiran
- Department of Cardiothoracic Surgery, University Hospital, Rikshospitalet, Norway
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26
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Yeung JCY, Vuckovic D, Pawliszyn J. Comparison and validation of calibration methods for in vivo SPME determinations using an artificial vein system. Anal Chim Acta 2010; 665:160-6. [DOI: 10.1016/j.aca.2010.03.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 03/02/2010] [Accepted: 03/02/2010] [Indexed: 11/25/2022]
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27
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Blake JR, Easson WJ, Hoskins PR. A dual-phantom system for validation of velocity measurements in stenosis models under steady flow. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:1510-1524. [PMID: 19540655 DOI: 10.1016/j.ultrasmedbio.2009.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 03/01/2009] [Accepted: 03/29/2009] [Indexed: 05/27/2023]
Abstract
A dual-phantom system is developed for validation of velocity measurements in stenosis models. Pairs of phantoms with identical geometry and flow conditions are manufactured, one for ultrasound and one for particle image velocimetry (PIV). The PIV model is made from silicone rubber, and a new PIV fluid is made that matches the refractive index of 1.41 of silicone. Dynamic scaling was performed to correct for the increased viscosity of the PIV fluid compared with that of the ultrasound blood mimic. The degree of stenosis in the models pairs agreed to less than 1%. The velocities in the laminar flow region up to the peak velocity location agreed to within 15%, and the difference could be explained by errors in ultrasound velocity estimation. At low flow rates and in mild stenoses, good agreement was observed in the distal flow fields, excepting the maximum velocities. At high flow rates, there was considerable difference in velocities in the poststenosis flow field (maximum centreline differences of 30%), which would seem to represent real differences in hydrodynamic behavior between the two models. Sources of error included: variation of viscosity because of temperature (random error, which could account for differences of up to 7%); ultrasound velocity estimation errors (systematic errors); and geometry effects in each model, particularly because of imperfect connectors and corners (systematic errors, potentially affecting the inlet length and flow stability). The current system is best placed to investigate measurement errors in the laminar flow region rather than the poststenosis turbulent flow region.
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Affiliation(s)
- James R Blake
- Department of Medical Physics, University of Edinburgh, UK
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28
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Yousif MY, Holdsworth DW, Poepping TL. Deriving a blood-mimicking fluid for particle image velocimetry in Sylgard-184 vascular models. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2009:1412-1415. [PMID: 19964526 DOI: 10.1109/iembs.2009.5334175] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A new blood-mimicking fluid (BMF) has been developed for particle image velocimetry (PIV), which enables flow studies in vascular models (phantoms). A major difficulty in PIV that affects measurement accuracy is the refraction and distortion of light passing through the interface between the model and the fluid, due to the difference in refractive index (n) between the two materials. The problem can be eliminated by using a fluid with a refractive index matching that of the model. Such fluids are not commonly available, especially for vascular research where the fluid should also have a viscosity similar to human blood. In this work, a blood-mimicking fluid, composed of water (47.38% by weight), glycerol (36.94% by weight) and sodium iodide salt (15.68% by weight), was developed for compatibility with our silicone (Sylgard 184; n = 1.414) phantoms. The fluid exhibits a dynamic viscosity of 4.31+/-0.03 cP which lies within the range of human blood viscosity (4.4+/-0.6 cP). Both refractive index and viscosity were attained at 22.2+/-0.2 degrees C, which is a feasible room temperature, thus eliminating the need for a temperature-control system. The fluid will be used to study hemodynamics in vascular flow models fabricated from Sylgard 184.
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Affiliation(s)
- Majid Y Yousif
- Biomedical Engineering Graduate Program, The University of Western Ontario, London, ON N6A 3K7, Canada.
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Frakes DH, Pekkan K, Dasi LP, Kitajima HD, de Zelicourt D, Leo HL, Carberry J, Sundareswaran K, Simon H, Yoganathan AP. Modified control grid interpolation for the volumetric reconstruction of fluid flows. EXPERIMENTS IN FLUIDS 2008; 45:987-997. [PMID: 22997481 PMCID: PMC3445410 DOI: 10.1007/s00348-008-0517-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Complex applications in fluid dynamics research often require more highly resolved velocity data than direct measurements or simulations provide. The advent of stereo PIV and PCMR techniques has advanced the state-of-the-art in flow velocity measurement, but 3D spatial resolution remains limited. Here a new technique is proposed for velocity data interpolation to address this problem. The new method performs with higher quality than competing solutions from the literature in terms of accurately interpolating velocities, maintaining fluid structure and domain boundaries, and preserving coherent structures.
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30
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3D flow study in a mildly stenotic coronary artery phantom using a whole volume PIV method. Med Eng Phys 2008; 30:1193-200. [DOI: 10.1016/j.medengphy.2008.02.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Revised: 02/26/2008] [Accepted: 02/26/2008] [Indexed: 11/15/2022]
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31
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