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Technical Brief

Validation of Single C-Arm Fluoroscopic Technique for Measuring In Vivo Abdominal Wall Deformation

[+] Author and Article Information
Lindsey G. Kahan

Department of Surgery,
Washington University in St. Louis School of Medicine,
St. Louis, MO 63130
e-mail: l.kahan@wustl.edu

Charlotte Guertler

Department of Mechanical Engineering
and Materials Science,
Washington University in St. Louis,
St. Louis, MO 63130
e-mail: Charlotte.guertler@wustl.edu

Jeffrey A. Blatnik

Department of Surgery,
Washington University in St. Louis School of Medicine,
St. Louis, MO 63130
e-mail: jblatnik@wustl.edu

Spencer P. Lake

Mem. ASME
Department of Mechanical Engineering
and Materials Science,
Washington University in St. Louis,
1 Brookings Drive,
Campus Box 1185,
St. Louis, MO 63130;
Department of Orthopaedic Surgery,
Washington University in St. Louis,
1 Brookings Drive, Campus Box 1185,
St. Louis, MO 63130;
Department of Biomedical Engineering,
Washington University in St. Louis,
1 Brookings Drive, Campus Box 1185,
St. Louis, MO 63130
e-mail: Lake.s@wustl.edu

Manuscript received January 13, 2017; final manuscript received June 5, 2017; published online June 28, 2017. Assoc. Editor: Jeffrey Ruberti.

J Biomech Eng 139(8), 084502 (Jun 28, 2017) (7 pages) Paper No: BIO-17-1021; doi: 10.1115/1.4037073 History: Received January 13, 2017; Revised June 05, 2017

Hernia meshes significantly reduce the recurrence rates in hernia repair. It is known that they affect the abdominal wall postimplantation, yet the understanding of in vivo mechanics in the mesh placement area is lacking. We established a single C-arm biplane fluoroscopic system to study strains at the interface between the mesh and repaired abdominal tissues. We aimed to validate this system for future porcine hernia repair studies. Custom matlab programs were written to correct for pincushion distortion, and direct linear transformation (DLT) reconstructed objects in 3D. Using a custom biplane-trough setup, image sets were acquired throughout the calibrated volume to evaluate a radio-opaque test piece with known distances between adjacent beads. Distances were measured postprocessing and compared to known measurements. Repeatability testing was conducted by taking image sets of the test piece in a fixed location to determine system movement. The error in areal stretch tracking was evaluated by imaging a square plate with fixed radio-opaque beads and using matlab programs to compare the measured areal stretch to known bead positions. Minor differences between measured and known distances in the test piece were not statistically different, and the system yielded a 0.01 mm bias in the XY plane and a precision of 0.61 mm. The measured areal stretch was 0.996, which was not significantly different than the expected value of 1. In addition, preliminary stretch data for a hernia mesh in a porcine model demonstrated technique feasibility to measure in vivo porcine abdominal mechanics.

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References

Burger, J. W. , Luijendijk, R. W. , Hop, W. C. , Halm, J. A. , Verdaasdonk, E. G. , and Jeekel, J. , 2004, “Long-Term Follow-Up of a Randomized Controlled Trial of Suture Versus Mesh Repair of Incisional Hernia,” Ann. Surg., 240(4), pp. 578–583; discussion 583–575. [PubMed]
Deeken, C. R. , Thompson, D. M., Jr. , Castile, R. M. , and Lake, S. P. , 2014, “Biaxial Analysis of Synthetic Scaffolds for Hernia Repair Demonstrates Variability in Mechanical Anisotropy, Non-Linearity and Hysteresis,” J. Mech. Behav. Biomed. Mater., 38, pp. 6–16. [CrossRef] [PubMed]
Deeken, C. R. , Abdo, M. S. , Frisella, M. M. , and Matthews, B. D. , 2011, “Physicomechanical Evaluation of Absorbable and Nonabsorbable Barrier Composite Meshes for Laparoscopic Ventral Hernia Repair,” Surg. Endoscopy, 25(5), pp. 1541–1552. [CrossRef]
Est, S. , Roen, M. , Chi, T. , Simien, A. , Castile, R. M. , Thompson, D. M., Jr. , Blatnik, J. A. , Deeken, C. R. , and Lake, S. P. , 2017, “Multi-Directional Mechanical Analysis of Synthetic Scaffolds for Hernia Repair,” J. Mech. Behav. Biomed. Mater., 71, pp. 43–53. [CrossRef] [PubMed]
Hernandez-Gascon, B. , Pena, E. , Pascual, G. , Rodriguez, M. , Bellon, J. M. , and Calvo, B. , 2012, “Long-Term Anisotropic Mechanical Response of Surgical Meshes Used to Repair Abdominal Wall Defects,” J. Mech. Behav. Biomed. Mater., 5(1), pp. 257–271. [CrossRef] [PubMed]
Hansen, N. L. , Barabasch, A. , Distelmaier, M. , Ciritsis, A. , Kuehnert, N. , Otto, J. , Conze, J. , Klinge, U. , Hilgers, R. D. , Kuhl, C. K. , and Kraemer, N. A. , 2013, “First In-Human Magnetic Resonance Visualization of Surgical Mesh Implants for Inguinal Hernia Treatment,” Invest. Radiol., 48(11), pp. 770–778. [CrossRef] [PubMed]
Podwojewski, F. , Ottenio, M. , Beillas, P. , Guerin, G. , Turquier, F. , and Mitton, D. , 2013, “Mechanical Response of Animal Abdominal Walls In Vitro: Evaluation of the Influence of a Hernia Defect and a Repair With a Mesh Implanted Intraperitoneally,” J. Biomech., 46(3), pp. 561–566. [CrossRef] [PubMed]
Simon-Allue, R. , Montiel, J. M. , Bellon, J. M. , and Calvo, B. , 2015, “Developing a New Methodology to Characterize In Vivo the Passive Mechanical Behavior of Abdominal Wall on an Animal Model,” J. Mech. Behav. Biomed. Mater., 51, pp. 40–49. [CrossRef] [PubMed]
Podwojewski, F. , Ottenio, M. , Beillas, P. , Guerin, G. , Turquier, F. , and Mitton, D. , 2014, “Mechanical Response of Human Abdominal Walls Ex Vivo: Effect of an Incisional Hernia and a Mesh Repair,” J. Mech. Behav. Biomed. Mater., 38, pp. 126–133. [CrossRef] [PubMed]
Marzan, G. , 1976, “Rational Design for Close-Range Photogrammetry,” Ph.D. thesis, University of Illinois at Urbana-Champaign, Champaign, IL.
Bey, M. J. , Zauel, R. , Brock, S. K. , and Tashman, S. , 2006, “Validation of a New Model-Based Tracking Technique for Measuring Three-Dimensional, In Vivo Glenohumeral Joint Kinematics,” ASME J. Biomech. Eng., 128(4), pp. 604–609. [CrossRef]
Bey, M. J. , Kline, S. K. , Tashman, S. , and Zauel, R. , 2008, “Accuracy of Biplane X-Ray Imaging Combined With Model-Based Tracking for Measuring In-Vivo Patellofemoral Joint Motion,” J. Orthop. Surg. Res., 3(1), p. 38. [CrossRef] [PubMed]
Kapron, A. L. , Aoki, S. K. , Peters, C. L. , Maas, S. A. , Bey, M. J. , Zauel, R. , and Anderson, A. E. , 2014, “Accuracy and Feasibility of Dual Fluoroscopy and Model-Based Tracking to Quantify In Vivo Hip Kinematics During Clinical Exams,” J. Appl. Biomech., 30(3), pp. 461–470. [CrossRef] [PubMed]
Iaquinto, J. M. , Tsai, R. , Haynor, D. R. , Fassbind, M. J. , Sangeorzan, B. J. , and Ledoux, W. R. , 2014, “Marker-Based Validation of a Biplane Fluoroscopy System for Quantifying Foot Kinematics,” Med. Eng. Phys., 36(3), pp. 391–396. [CrossRef] [PubMed]
Amini, R. , Voycheck, C. A. , and Debski, R. E. , 2014, “A Method for Predicting Collagen Fiber Realignment in Non-Planar Tissue Surfaces as Applied to Glenohumeral Capsule During Clinically Relevant Deformation,” ASME J. Biomech. Eng., 136(3), p. 031003. [CrossRef]
Jenkins, E. D. , Melman, L. , Deeken, C. R. , Greco, S. C. , Frisella, M. M. , and Matthews, B. D. , 2010, “Evaluation of Fenestrated and Non-Fenestrated Biologic Grafts in a Porcine Model of Mature Ventral Incisional Hernia Repair,” Hernia, 14(6), pp. 599–610. [CrossRef] [PubMed]
Wang, J. , and Blackburn, T. J. , 2000, “The AAPM/RSNA Physics Tutorial for Residents: X-Ray Image Intensifiers for Fluoroscopy,” Radiographics, 20(5), pp. 1471–1477. [CrossRef] [PubMed]
Bouguet, J.-Y. , 2004, “Camera Calibration Toolbox for Matlab,” California Institute of Technology, Pasadena, CA.
Zhengyou, Z. , 1999, Flexible Camera Calibration by Viewing a Plane From Unknown Orientations, Vol. 661, Microsoft Research, Redmond, WA, pp. 666–673.
Heikkila, J. , and Silven, O. , 1997, “A Four-Step Camera Calibration Procedure With Implicit Image Correction,” Conference on Computer Vision and Pattern Recognition (CVPR '97), San Juan, Puerto Rico, June 17–19, pp. 1106–1112.
Sturm, P. F. , and Maybank, S. J. , 1999, “On Plane-Based Camera Calibration: A General Algorithm, Singularities, Applications,” IEEE Computer Society Conference on Computer Vision and Pattern Recognition (CVPR), Fort Collins, CO, June 23–25, p. 437.
Tsai, R. Y. , 1987, “A Versatile Camera Calibration Technique for High-Accuracy 3D Machine Vision Metrology Using Off-the-Shelf TV Cameras and Lenses,” IEEE J. Rob. Autom., 3(4), pp. 323–344.
Clarke, T. A. , and Fryer, J. G. , 1998, “The Development of Camera Calibration Methods and Models,” Photogramm. Rec., 16(91), pp. 51–66. [CrossRef]
Rossi, M. M. , Silvatti, A. P. , Dias, F. A. , and Barros, R. M. , 2015, “Improved Accuracy in 3D Analysis Using DLT After Lens Distortion Correction,” Comput. Methods Biomech. Biomed. Eng., 18(9), pp. 993–1002. [CrossRef]
Goktepe, A. , and Kocaman, E. , 2010, “Analysis of Camera Calibrations Using Direct Linear Transformation and Bundle Adjustment Methods,” Sci. Res. Essays, 5(9), pp. 869–872. http://www.academicjournals.org/article/article1380617995_Goktepe%20and%20Kocaman.pdf
ASTM, 2014, “Standard Practice for Use of the Terms Precision and Bias in ASTM Test Methods,” ASTM International, West Conshohocken, PA, Standard No. ASTM E177-13. https://www.astm.org/Standards/E177.htm
Filas, B. A. , Knutsen, A. K. , Bayly, P. V. , and Taber, L. A. , 2008, “A New Method for Measuring Deformation of Folding Surfaces During Morphogenesis,” ASME J. Biomech. Eng., 130(6), p. 061010. [CrossRef]
Amini Khoiy, K. , Biswas, D. , Decker, T. N. , Asgarian, K. T. , Loth, F. , and Amini, R. , 2016, “Surface Strains of Porcine Tricuspid Valve Septal Leaflets Measured in Ex Vivo Beating Hearts,” ASME J. Biomech. Eng., 138(11), p. 111006. [CrossRef]
Amini, R. , Eckert, C. E. , Koomalsingh, K. , McGarvey, J. , Minakawa, M. , Gorman, J. H. , Gorman, R. C. , and Sacks, M. S. , 2012, “On the In Vivo Deformation of the Mitral Valve Anterior Leaflet: Effects of Annular Geometry and Referential Configuration,” Ann. Biomed. Eng., 40(7), pp. 1455–1467. [CrossRef] [PubMed]
Tashman, S. , and Anderst, W. , 2003, “In-Vivo Measurement of Dynamic Joint Motion Using High Speed Biplane Radiography and CT: Application to Canine ACL Deficiency,” ASME J. Biomech. Eng., 125(2), pp. 238–245. [CrossRef]

Figures

Grahic Jump Location
Fig. 1

Computed-aided design setup of porcine trough and calibration planes (a) and actual setup with animal (b). The calibration planes were constructed of Plexiglas (61 × 46 × 0.9 cm), and bead distance was 25.4 mm between centroids.

Grahic Jump Location
Fig. 2

Computer-aided design model of test object constructed of Plexiglas and stainless steel beads (a). Radiographic images of test object and calibration planes at both angles of C-arm rotation (b). Triangles represent chosen calibration beads on top and bottom planes, and circles represent beads in test object. Three-dimensional reconstruction of all chosen calibration points and test object beads (c).

Grahic Jump Location
Fig. 3

Schematic of C-arm placement, calibration planes, and animal setup to acquire images at both angles in relation to the vertical axis

Grahic Jump Location
Fig. 4

Three-dimensional printed square plate with 16 beads used for strain tracking (a). Three-dimensional triangulation mesh plot of the square plate with 16 beads, where each triangle node represents a radio-opaque bead embedded in the square plate (b). Large circular (a) oriented in 3D (b).

Grahic Jump Location
Fig. 5

Overlay of binary radiographic images. Original grid positions are represented by white dots, and corrected grid positions are represented by black dots. Direct overlap at the center represents no correction needed. Distortion correction increased radially from the center.

Grahic Jump Location
Fig. 6

Application of technique to porcine ventral hernia repair model with implanted mesh. Mesh area expanded 5.23% with increased intra-abdominal pressure (IAP), as indicated by an areal stretch greater than 1 across the surface of the mesh.

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