Soft Tissue Stiffness Research Articles

A digital viscoelastic liver phantom for investigation of elastographic measurements

To develop elastography imaging technologies and implement image reconstruction algorithms, testing is done with phantoms. Although the validation step is usually taken using real data and physical phantoms, their geometry as well as composition, biomechanical parameters, and details of applying stress cannot be modified readily. Such considerations have gained increasing importance with the growth of elastography techniques as one of the non-invasive medical imaging modalities, which can map the elastic properties and stiffness of soft tissues. In this article, we develop a digital viscoelastic phantom using computed tomography (CT) imaging data and several application software tools based on illustrations of normal liver anatomy so as to investigate the biomechanics of elastography via finite element modeling (FEM). Here we discuss how to create this phantom step by step, demonstrate typical shear wave elastography (SWE) experiments of applying transient stress to the liver model, and calculate quantitative measurements. In particular, shear wave velocities are investigated through a parametric study designed based on tissue stiffness and distance from the applied stress. According to the results of FEM analysis, low errors were obtained for shear wave velocity estimation for both mechanical stress (~2–5%) and acoustic radiation force (~3–7%). Results show that our model is a powerful framework and benchmark for simulating and implementing different algorithms in shear wave elastography, which can serve as a guide for upcoming researches and assist scientists to optimize their subsequent experiments in terms of design.

Diabetes Status is Associated With Plantar Soft Tissue Stiffness Measured Using Ultrasound Reverberant Shear Wave Elastography Approach.

The purpose of this study was to investigate the association between the mechanical properties of plantar soft tissue and diabetes status. 51 (M/F: 21/30) participants with prediabetes onset (fasting blood sugar [FBS] level > 100 mg/dL), age >18 years, and no lower limb amputation were recruited after ethical approval was granted from Pontificia Universidad Catolica del Peru ethical review board. Ultrasound reverberant shear wave elastography was used to assess the soft tissue stiffness at the 1st metatarsal head (MTH), 3rd MTH, and the heel at both feet. Spearman's rank-order correlation (rho) test indicated a significant (P < .05) positive correlations between FBS level and the plantar soft tissue shear wave speed at the 1st MTH: rho = 0.402 (@400 Hz), rho = 0.373 (@450 Hz), rho = 0.474 (@500 Hz), rho= 0.395 (@550 Hz), and rho = 0.326 (@600 Hz) in the left foot and rho = 0.364 (@450 Hz) in the right foot. Mann-Whitney U test indicated a significantly (P < .05) higher shear wave speed in the plantar soft tissue with the following effect sizes (r) at the 1st MTH of the left foot at all tested frequencies: r = 0.297 (@450 Hz), r = 0.345 (@500 Hz), r = 0.322 (@550 Hz), and r = 0.275 (@600 Hz), and at the 1st MTH of right foot r = 0.286 (@400 Hz) in diabetes as compared with the age and body mass index matched prediabetes group. An association between fasting blood sugar level and the stiffness of the plantar soft tissue with higher values of shear wave speed in diabetes versus prediabetes group was observed. This indicated that the proposed approach can improve the assessment of the severity of diabetic foot complications with potential implications in patient stratification.

A programmable and self-adaptive dynamic pressure delivery and feedback system for efficient intermittent pneumatic compression therapy

Controlled dynamic pressure delivery is essential for efficiently promoting hemodynamics of the lower extremities in pneumatic compression therapy. Pressure dosage control is challenging because of diverse influencing factors, such as irregular interface contact geometries, different stiffnesses of body tissues and pressure materials, and customized pressure recipes and individual patient demands. To address these challenges, a programmable and self-adaptive dynamic pressure delivery and feedback system for enhanced compression therapy were developed in this study. This system comprised a soft pneumatic actuator (SPA) unit in a stocking laminated with multi-bladder, a programmable pressure control unit for pneumatic and interface pressure control, matrix soft sensors for real-time interface pressure detection, and differential pressure sensors for pneumatic pressure monitoring as well as connective accessories (air tubes and valves). A fluid–structure interaction model was developed to analyse the interaction between the bladder and lower limb by considering essential factors (bladder and soft tissue stiffness, contact area, and bladder-lower limb interface characteristics). An improved proportional–integral–derivative controller was designed to regulate dynamic interface pressure and personalized pneumatic compression treatment. Dedicated software was developed to monitor, process, and display the tested pressure data. In vitro and in vivo experiments were performed to validate the developed system. This study integrated theoretical and experimental approaches to a novel solution for customized dynamic pressure therapy. The findings enhanced our understanding of the working mechanisms and characteristics of the SPA–lower limb system. Moreover, the results serve as a foundation for the design and innovation of advanced programmable units for efficient compression treatment in various applications in healthcare, medicine, and rehabilitation.

Ultrasound Elastography: Review of Techniques, Clinical Application, Technical Limitations, and Safety Considerations in Neonatology

Abstract Ultrasound elastography is a relatively new non-invasive diagnostic imaging technology that maps elastic properties and the stiffness of soft tissue. In general, these methods can be classified into strain imaging methods that use internal or external compression stimuli and a shear wave imaging that use ultrasound-generated travelling shear wave stimuli. In this review we describe the basics of ultrasound elastography, discuss differences between various ultrasound elastography techniques, and review advantages, limitations, and the safety of these techniques in clinical practice, especially in neonatology. Furthermore, we review the potential of application of elastography in revealing brain injury and characterizing age dependent differences in preterm and term infants.

A COMPARATIVE STUDY BETWEEN THE IMMEDIATE EFFECTS OF TENDINOUS PRESSURE TECHNIQUE VERSUS MYOFASCIAL RELEASE IN THE REDUCTION OF SPASTICITY: A CROSS OVER STUDY

Background- Spasticity following stroke is often associated with pain, soft tissue stiffness, decreased quality of life, increased treatment cost, and increased caregiver burden. Myofascial release is a new approach to relieve spasticity. It may act in the future as a facilitator and intensifier of treatment for a more consistent effect. Also, Inhibition techniques are used in spastic patients. In tendinous pressure, manual pressure is applied to the tendinous insertion of the muscle or across long tendons produces an inhibitory effect. AIM- To To find the immediate effect of tendinous pressure technique versus myofascial release in the reduction of spasticity. METHOD- The study was conducted in Vikhe Patil Hospital, Physiotherapy OPD, and Phuntamba Stroke Center. It was a cross over study conducted on spastic stroke patients using a purposive sampling method. Twenty-seven patients were included in the study. The duration of the study was of 6 months. Modified Tardieu scale was the outcome measure used at pre, and post-treatment measurement and the subject was treated with both the techniques with 2 hours of the interval to see which of the technique is more beneficial for reducing spasticity. RESULT-Result of within-group analysis of pre and post-treatment measurement of myofascial release showed clinical and statistical significance, but muscle reaction testing (X) showed no significant difference in MTS whereas the result of within-group analysis of pre and post-treatment measurement, and muscle reaction testing (X) of tendinous pressure showed clinical and statistically significant improvement in MTS. The result of between the post-treatment measurement and muscle reaction testing of myofascial release and tendinous pressure showed no significant difference. In contrast, muscle reaction testing showed a significant difference in MTS of both the techniques. CONCLUSION-So the conclusion can be made that tendinous pressure is more effective as compared to MFR in reducing the spasticity of stroke patients.

Immediate Effects of High-frequency Diathermy on Muscle Architecture and Flexibility in Subjects With Gastrocnemius Tightness

Background: The gastrocnemius (GCM) is one of the lower extremity muscles that tend to tighten easily. GCM tightness results in limited ankle dorsi-flexion (DF), especially when the knee joint is fully extended. Joint flexibility is determined by the morphological and physiological characteristics of joints, muscles, tendons, and ligaments. Impaired joint flexibility can be attributed to increased susceptibility to muscle injury. High-frequency diathermy is clinically used to reduce pain and muscle tightness and to improve limited range of motion. Objects: This study aimed to investigate the immediate effects of high-frequency therapy in subjects with GCM tightness. Methods: The study was designed as a one-group before–after trial. The subjects included 28 volunteers with GCM tightness (an active ankle DF angle of less than 12°) without any known neurological and musculoskeletal pathologies in the ankle and calf areas. WINBACK Transfer Electrode Capacitive and Resistive Therapy equipment was used to apply high-frequency therapy to the subjects’ GCMs for 10–15 minutes. The pennation angle and the fascicle length of the GCM were measured using ultrasonography. The flexibility of the ankle joint, peak torque to the passive ankle DF (Biodex), and soft tissue stiffness (MyotonPRO) were also measured. Results: The pennation angle was significantly decreased following the treatment; however, no significant difference in the fascicle length was found (p < 0.05). The flexibility was significantly increased and both the passive peak torque to passive ankle DF and the soft tissue stiffness significantly decreased (p < 0.05). Conclusion: High-frequency therapy is immediately effective for improving the muscle’s architectural properties and functional factors in subjects with GCM tightness. Further longitudinal clinical studies are required to investigate the long-term effects of high-frequency therapy on subjects with GCM tightness from various causes.

Acute effects of long-distance running on mechanical and morphological properties of the human plantar fascia.

Long‐distance running (LDR) can induce transient lowering of the foot arch, which may be associated with mechanical fatigue of the plantar fascia (PF). However, this has not been experimentally tested in vivo. The purpose of this study was to test our hypothesis that LDR induces transient and site‐specific changes in PF stiffness and morphology and that those changes are related to the lowering of the foot arch. Ten male recreational long‐distance runners and 10 untrained men were requested to run overground for 10 km. Before and after running, shear wave velocity (SWV: an index of soft tissue stiffness) and thickness of PF at three different sites from its proximal to distal end were measured using supersonic shear imaging and B‐mode ultrasonography. Foot dimensions including the navicular height were measured using a three‐dimensional foot scanner. SWV at the proximal site of PF and navicular height was significantly decreased in both groups after running, with a higher degree in untrained men (−21.9% and −14.1%, respectively) than in runners (−4.0% and −6.3%, respectively). The relative change (%Δ) in SWV was positively correlated with %Δnavicular height in both groups (r = .69 and r = .65, respectively). Multiple regression analysis revealed that %ΔSWV at the proximal site solely explained 72.7% of the total variance in %Δnavicular height. It is concluded that LDR induces transient and site‐specific decreases in PF stiffness. These results suggest that the majority of running‐induced lowering of the foot arch is attributable to the reduction of PF stiffness at the proximal site.

Mapping Tissue Properties in Trapezius with Ultrasound Shear Wave Elastography: A Pilot Study

Ultrasound shear wave elastography (SWE) is a relatively new technology in the field of sonography. Even more so, research into musculoskeletal applications of SWE is in its infancy. Despite challenges concerning the anisotropic nature of muscle tissue, the literature suggests that SWE is a promising medium with which to examine patterns of tissue properties in morphometrically complex muscles, like trapezius. Tissue properties can provide valuable insights into muscle function and dysfunction. In our laboratory, we have characterized and quantified the comprehensive architecture of the cadaveric trapezius at the fascicular level throughout the muscle volume. These 3D anatomic data are essential for improving current B‐mode ultrasound protocols and making necessary modifications for SWE compatibility.The primary aim of this study was to test a novel SWE‐adapted ultrasound protocol for trapezius—targeting regions of contractile and connective tissues—and establish baseline patterns of tissue properties throughout the muscle.Twenty healthy adults (10F, 10M) with no history of back or neck injury, surgery, or chronic pain participated in the pilot study. We performed all imaging using the Siemens ACUSON™ S3000 ultrasound system, equipped with Virtual Touch™ IQ for SWE, and a 4–9 MHz linear array transducer (9L4, Siemens Healthcare). B‐mode and SWE images were captured in both seated and prone positions from each functional partition of trapezius: descending, transverse, and ascending. We collected shear wave speed (SWS) values from regions of interest corresponding to contractile and connective tissues on each elastogram and co‐registered them with 3D models of trapezius rendered from cadaveric data. SWS data will also be analysed with respect to participant sex, age, height, weight, and hand dominance.Preliminary results show marked differences in SWS between regions of contractile and connective tissues in trapezius, consistent with the structural patterns observed during cadaveric dissection and modeling. Of particular interest were areas in the transverse and ascending partitions with extensive regions of musculoaponeurotic junction: we observed a gradual increase in SWS of up to 200% between contractile tissue and connective tissue across the musculoaponeurotic junction. Tissue properties in the descending partition of trapezius were challenging to characterize due to substantial changes in fascicle direction, limited muscle thickness, and proximity to underlying bone.To the best of our knowledge, this study is the first to investigate patterns of soft tissue stiffness in the healthy adult trapezius, including both contractile and connective tissues. These data, in combination with the novel SWS‐adapted ultrasound protocol, offer a strong foundation on which to conduct future studies of individuals with musculoskeletal disorder in trapezius.Support or Funding InformationSupported by a Vanier Canada Graduate Scholarship and a Michael Smith Foreign Study Supplement from the Canadian Institutes of Health Research (CIHR).

An analytical solution to the dispersion-by-inversion problem in magnetic resonance elastography.

Magnetic resonance elastography (MRE) measures stiffness of soft tissues by analyzing their spatial harmonic response to externally induced shear vibrations. Many MRE methods use inversion-based reconstruction approaches, which invoke first- or second-order derivatives by finite difference operators (first- and second-FDOs) and thus give rise to a biased frequency dispersion of stiffness estimates. We here demonstrate analytically, numerically, and experimentally that FDO-based stiffness estimates are affected by (1) noise-related underestimation of values in the range of high spatial wave support, that is, at lower vibration frequencies, and (2) overestimation of values due to wave discretization at low spatial support, that is, at higher vibration frequencies. Our results further demonstrate that second-FDOs are more susceptible to noise than first-FDOs and that FDO dispersion depends both on signal-to-noise ratio (SNR) and on a lumped parameter A, which is defined as wavelength over pixel size and over a number of pixels per stencil of the FDO. Analytical FDO dispersion functions are derived for optimizing A parameters at a given SNR. As a simple rule of thumb, we show that FDO artifacts are minimized when A/2 is in the range of the square root of 2SNR for the first-FDO or cubic root of 5SNR for the second-FDO. Taken together, the results of our study provide an analytical solution to a long-standing, well-recognized, yet unsolved problem in MRE postprocessing and might thus contribute to the ongoing quest for minimizing inversion artifacts in MRE.

Design and Simulation of Micro Tactile Sensor for Stiffness Detection of Soft Tissue with Irregular Surface

Tactile sensors become an essential part of many applications in our life. Integrating tactile sensors with surgical tools used in MIS is significant to compensate for the shortage of touch feeling of soft tissues and organs comparing with traditional surgeries. This paper presents a detailed design of a micro tactile sensor for measuring the stiffness of soft tissue with an irregular surface. The sensor consists of five cantilever springs with different stiffness. A spring in the middle has a relatively low stiffness surrounded by 4 springs have relatively equal high stiffness to compensate for the soft tissue contact error in the longitudinal and lateral directions. Sensor parameters are selected to ensure high sensitivity and linearity with taking into consideration the cross-talk effect among the sensor springs tips. A detailed design of the sensor structure in the microscale is conducted based on some constraints related to MEMS fabrication. A finite element analysis (FEA) of the sensor structure is conducted to evaluate sensor structure performance using CoventorWare software. Then, an FEA for the piezo-resistors, as a signal transduction method, is conducted which maps the sensor output to an electrical signal. The results prove that the sensor can differentiate among different soft-tissue stiffness within the selected range independent of the applied distance between the sensor and the tissue with an error below 3% even with inclination angle between the sensor and the tissue ±3°. Furthermore, a linear performance has been achieved between the soft-tissue stiffness and the sensor output.

Impact of sleeping position, gravitational force & effective tissue stiffness on obstructive sleep apnoea

Accurate prediction of deformation and collapse of the upper airway during breathing is required for effective and personalised treatment of obstructive sleep apnoea (OSA). While numerical modelling techniques such as fluid–structure interaction (FSI) are promising, an outstanding challenge is to accurately predict the deformation of the airway during breathing and thus the occurrence of OSA. These difficulties arise because the effective stiffness of the soft tissue in the human upper airway varies due to neuromuscular effects on the stiffness of the underlying muscles. In addition, both the elasticity and anisotropy of the soft tissues along the upper airway are poorly characterised. Finally, gravitational effects on anatomic features are yet to be considered. In this study, a validated FSI technique is introduced that allows prediction of the extent and position of the major deformation in the upper airway. This technique is used to analyse the behaviour of the upper airway in the two most common sleeping positions and for a range of effective tissue stiffnesses. The results demonstrate that sleeping position, gravity and soft tissue stiffness (used here as a proxy for neuromuscular effects) are the main factors that affect upper airway collapse. Therefore, this study provides new insights into the mechanisms of OSA and a new methodology that significantly advances the patient-specific treatment of OSA.

Preclinical Imaging Using Single Track Location Shear Wave Elastography: Monitoring the Progression of Murine Pancreatic Tumor Liver Metastasis In Vivo.

Recently, researchers have discovered the direct impact of the tumor mechanical environment on the growth, drug uptake and prognosis of tumors. While estimating the mechanical parameters (solid stress, fluid pressure, stiffness) can aid in the treatment planning and monitoring, most of these parameters cannot be quantified noninvasively. Shear wave elastography (SWE) has shown promise as a means of noninvasively measuring the stiffness of soft tissue. However, stiffness is still not a recognized imaging biomarker. While SWE has been shown to be capable of measuring tumor stiffness in humans, much important research is done in small animal preclinical models, where tumors are often too small for the resolution of traditional SWE tools. Single-track location SWE (STL-SWE) has previously been shown to overcome the fundamental resolution limit of SWE imposed by ultrasound speckle, which may make it suitable for preclinical imaging. Using STL-SWE, in this work, we demonstrate, for the first time, that the stiffness changes occurring inside metastatic murine pancreatic tumors can be monitored over long time scales (up to 9 weeks). To prevent the respiration motion from degrading the STL-SWE estimates, we developed a real-time software-based respiration gating scheme that we implemented on a Verasonics ultrasound imaging system. By imaging the liver of three healthy mice and performing correlation analysis, we confirmed that the respiration-gated STL-SWE data was free from motion corruption. By performing coregistered power-doppler imaging, we found that the local variability in liver shear wave speed (SWS) measurements increased from 5.4% to 9.9% due to blood flow. We performed a longitudinal study using a murine model of pancreatic cancer liver metastasis to assess the temporal changes (over nine weeks) in SWS in two groups: a controlled group receiving no treatment (n=8), and an experimental group (n=6) treated with Gemcitabine, a chemotherapy agent. We independently evaluated tumor burden using bioluminescence imaging (BLI). The initial and endpoint SWS measurements were statistically different (p<0.05). Additionally, when the liver SWS exceeded 2.5 ± 0.3 and 2.73 ± 0.34 m/s in untreated and treated mice, respectively, the death of the mice was imminent within approximately 10 days. The time taken for the SWS to exceed the thresholds was 17 days (on average) longer in Gemcitabine treated mice compared to the untreated ones. The survival statistics corroborated the effectiveness of Gemcitabine. Spearman correlation analysis revealed a monotonic relationship between SWE measurements (SWS) and BLI measurements (radiance) for tumors whose radiance exceeded 1×107 photons/s/cm2/sr. Longitudinal measurements on the liver of four healthy mice revealed a maximum coefficient of variation of 11.4%. The results of this investigation demonstrate that with appropriate gating, researchers can use STL-SWE for small animal imaging and perform longitudinal studies using preclinical cancer models.

Real-time shear wave ultrasound elastography: a new tool for the evaluation of diaphragm and limb muscle stiffness in critically ill patients

BackgroundMuscle weakness following critical illness is the consequence of loss of muscle mass and alteration of muscle quality. It is associated with long-term disability. Ultrasonography is a reliable tool to quantify muscle mass, but studies that evaluate muscle quality at the critically ill bedside are lacking. Shear wave ultrasound elastography (SWE) provides spatial representation of soft tissue stiffness and measures of muscle quality. The reliability and reproducibility of SWE in critically ill patients has never been evaluated.MethodsTwo operators tested in healthy controls and in critically ill patients the intra- and inter-operator reliability of the SWE using transversal and longitudinal views of the diaphragm and limb muscles. Reliability was calculated using the intra-class correlation coefficient and a bootstrap sampling method assessed their consistency.ResultsWe collected 560 images. Longitudinal views of the diaphragm (ICC 0.83 [0.50–0.94]), the biceps brachii (ICC 0.88 [0.67–0.96]) and the rectus femoris (ICC 0.76 [0.34–0.91]) were the most reliable views in a training set of healthy controls. Intra-class correlation coefficient for inter-operator reproducibility and intra-operator reliability was above 0.9 for all muscles in a validation set of healthy controls. In critically ill patients, inter-operator reproducibility and intra-operator 1 and 2 reliability ICCs were respectively 0.92 [0.71–0.98], 0.93 [0.82–0.98] and 0.92 [0.81–0.98] for the diaphragm; 0.96 [0.86–0.99], 0.98 [0.94–0.99] and 0.99 [0.96–1] for the biceps brachii and 0.91 [0.51–0.98], 0.97 [0.93–0.99] and 0.99 [0.97–1] for the rectus femoris. The probability to reach intra-class correlation coefficient greater than 0.8 in a 10,000 bootstrap sampling for inter-operator reproducibility was respectively 81%, 84% and 78% for the diaphragm, the biceps brachii and the rectus femoris respectively.ConclusionsSWE is a reliable technique to evaluate limb muscles and the diaphragm in both healthy controls and in critically ill patients.Trial registrationThe study was registered (ClinicalTrial NCT03550222).

Identification of potential plantar ulceration among diabetes patients using plantar soft tissue stiffness

This study investigates the relationship between plantar tissue stiffness and selected parameters, including age, diabetes mellitus (DM) duration, body mass index (BMI), and HbA1c level. 70 diabetes patients with no foot problems were recruited. The plantar soft tissue at the 2nd sub-metatarsal head (MTH) pad was examined using the novel indentation system developed. The stiffness constant, K, was used to describe the tissue stiffness. The four factors (age, DM duration, BMI, and HbA1c level) were plotted against the plantar tissue stiffness. The scatter plots revealed that a higher plantar tissue stiffness was usually associated with (1) BMI>25 kgm−2, (2) HbA1c score >10% (86 mmol/mol), and (3) DM duration >10 years. The three risk criteria were further evaluated using the binary classification test. The predictions were reported to be fairly accurate and reliable in detecting stiffened tissues. The study has successfully identified the strong association of BMI, HbA1c, and DM duration with the plantar tissue properties. Special attention should be given to the high risk group with BMI>25 kgm−2, HbA1c score >10% (86 mmol/mol), and DM duration >10 years. The high diagnostic odds ratio attained suggests its potential usefulness in helping clinicians to diagnose diabetic foot more efficiently.

Lumbar muscle stiffness is different in individuals with low back pain than asymptomatic controls and is associated with pain and disability, but not common physical examination findings

BackgroundLumbar muscle dysfunction is commonly implicated in low back pain (LBP). Shear-wave elastography (SWE) uses ultrasound technology to quantify absolute soft tissue stiffness (shear modulus), thereby allowing for estimation of individual muscle contraction and function. ObjectivesTo compare resting and contracted stiffness of lumbar spine musculature in individuals with and without LBP using SWE. A secondary aim was to explore for relationships between common self-report and physical examination measures and resting and contracted muscle stiffness in individuals with LBP. DesignCross-sectional. MethodsShear modulus of the lumbar musculature was measured in 60 participants with LBP and 60 asymptomatic controls (120 total) using SWE. The lumbar erector spinae were imaged at rest only, while the lumbar multifidus was imaged at rest and during contraction. Before imaging, participants with LBP underwent a standardized clinical examination including a brief history, self-report questionnaires, and a physical examination. Lumbar muscle shear modulus was compared between participants with LBP and asymptomatic controls using ANCOVA. Potential associations between shear modulus and selected self-report and physical examination measures were assessed using correlation analysis. ResultsStiffness of the erector spinae and lumbar multifidus at rest (but not during contraction) was greater in participants with LBP than in asymptomatic controls (p < 0.05). Many of the self-report measures, but none of the physical examination findings were associated with muscle stiffness. ConclusionResting lumbar muscle stiffness is greater in individuals with LBP than asymptomatic controls and is associated with self-reported pain and disability, but not physical exam findings.

Comparison between 2D and 3D Simulation of Contact of Two Deformable Axisymmetric Bodies

Abstract A portable pneumatic video-tactile sensor for determining the local stiffness of soft tissue and the methodology for its application are considered. The expected range of local elastic modulus that can be estimated by the sensor is 100 kPa–1 MPa. The current version of the device is designed to determine the characteristics of tissues that are close in mechanical properties to the skin with subcutis and muscles. A numerical simulation of the contact between the sensor head and the soft tissue was performed using the finite-element method. Both 2D and 3D models were developed. Results of experiments with device prototype are used for approval of adequacy of mathematical modelling in case of large deformations. Simulation results can be used to create soft tissue databases, which will be required to determine the local stiffness of soft tissues by the sensor. 2D model proved to be more efficient for the chosen range of values of local stiffness of soft tissues.

Radiation-Induced Skin Fibrosis: Pathogenesis, Current Treatment Options, and Emerging Therapeutics.

Radiotherapy (RT) has become an indispensable part of oncologic treatment protocols for a range of malignancies. However, a serious adverse effect of RT is radiodermatitis; almost 95% of patients develop moderate to severe skin reactions following radiation treatment. In the acute setting, these can be erythema, desquamation, ulceration, and pain. Chronically, soft tissue atrophy, alopecia, and stiffness can be noted. Radiodermatitis can delay oncologic treatment protocols and significantly impair quality of life. There is currently a paucity of effective treatment options and prevention strategies for radiodermatitis. Importantly, recent preclinical and clinical studies have suggested that fat grafting may be of therapeutic benefit, reversing detrimental changes to soft tissue following RT. This review outlines the damaging effects of RT on the skin and soft tissue as well as discusses available treatment options for radiodermatitis. Emerging strategies to mitigate detrimental, chronic radiation-induced changes are also presented.

Stiffness and echogenicity: Development of a stiffness-echogenicity matrix for clinical problem solving.

The assessment of soft tissue stiffness is important to evaluate many neuromusculoskeletal conditions. Several tools have been proposed for the assessment of stiffness, but ultrasonography appears to be most practical. The reflection of ultrasound waves as it travels through tissue enables assessment of tissue echogenicity, which is influenced by the characteristics of the sound wave as well as the characteristics of the tissue through which it passes, such as the amount of fat and fibrous tissue. However, tissue stiffness is not directly proportional to its echogenicity. Hence evaluation of echogenicity, as a stand-alone technique, is inadequate to describe its mechanical properties. The aim of this manuscript is to present a method of combining echogenicity evaluation by ultrasound and stiffness evaluation by palpation to better describe the mechanical properties of muscle using a stiffness-echogenicity matrix.

Regional variations of in vivo surface stiffness of soft tissue layers of musculoskeletal extremities

Surface stiffness of bulk soft tissue in musculoskeletal extremities is important to consider in the design of prosthetics, exoskeletons, and protective gear. This knowledge is also foundational for surgical simulation and clinical interventions leveraging manipulation of the musculoskeletal surfaces. Injuries to musculoskeletal extremities are common and surgical and preventive interventions require interactions between various objects such as surgical tools and support surfaces with tissue boundaries. While a handful of investigations examined the variations in indentation mechanics due to pathology or injury specific sites, a comprehensive analysis across the surfaces of musculoskeletal extremities has not been completed. In this study we examine variations of surface stiffness across 8 sites of the upper and lower arms and legs for 95 subjects using an instrumented ultrasound device. Differences in surface stiffness were observed between gender, activity level, and indentation location groups. The lower arm posterior location had the highest average stiffness (3.89 × 10−3 MPa/mm), while the lowest stiffness was observed at the upper leg posterior location (0.98 × 10−3 MPa/mm). The differences between indentation sites were larger in magnitude when compared to differences due to demographics (gender and activity level). However the large ranges of the 95% confidence intervals suggest that an aggregated metric based on population or sub-group may not capture individual variations. This study implicates the motivation to explore tissue composition variations within the indentation sites as well as the potential importance to include variations in surface stiffness during surgical simulations.

Study of age-related changes in Middle ear transfer function

Osteoporosis (OP) is common with advancing age. Several studies have shown a strong correlation between OP and otosclerosis. However, no studies have investigated OP of the malleus, incus or stapes in the human middle ear, its effect on middle ear transfer function. Here, we investigate whether these three ossicles develop OP, and how this affects middle ear transfer function. The effect of OP on middle ear transfer function was investigated in simulations based on a finite element (FE) method. First, the FE model used in our previous study was refined, and optimized by introducing viscoelastic properties to selected soft tissues of the middle ear. Then, the FE model was used to simulate OP of the three ossicles and assess its influence on middle ear transfer function. Other possible age-related changes, such as stiffness of the joints or ligaments in the middle ear, were also investigated. The results indicated that OP of the ossicles could increase the high frequency displacement of both the umbo and stapes footplate (FP). However, the stiffness of the middle ear soft tissue can lead to the decrease of middle ear gain at lower frequencies. Furthermore, loosening of these joints or ligaments could increase displacement of the umbo and stapes FP. In conclusion, although age-related hearing loss is most commonly conceived of as sensorineural hearing loss (SNHL), we found that age-related changes may also include OP and changes in joint stiffness, but these will have little effect on middle ear transfer function in elderly people.