Project descriptions 2016 by Hightower

2016 Project Descriptions

Figure 7: Coronal (A), sagittal (B), axial (C), and isometric (D) views of ABM.

BME Summer Internship Program

Project List Project 1: Effect of Exercise During Weight Loss on Bone Structure and Strength Project 2: Advanced Radiation Therapy Technologies & Radiation-Induced Injury Assessment Project 3: Comparative Surgical Biomechanics in Ankle Fracture Fixation Project 4: Quantifying Postural Differences in Patients with Low Back Injury Project 5: Computational Human Body Modeling Heat Transfer Research for Burn Injuries Project 6: Biomechanical Evaluation of Sport-Related Head Impacts Project 7: Correlation of Crash Occupant Bone Mineral Density with Age and Fracture Incidence Project 8: The Biomechanics of Hemorrhagic Shock and Resuscitation Project 9: Computational Reconstructions of Real World Motor Vehicle Crashes Project 10: Advanced Automatic Crash Notification Algorithm for Occupant Triage Project 11: iTAKL- imaging Telemetry And Kinematic modeLing in Youth Football Project 12: Prevention of Radiation Therapy-Induced Fractures and Muscle Fibrosis Project 13: Human Body Model Development for Trauma Research Project 14: Multi-Modality Anthropometry Study for Computational Model Generation Project 15: Novel Research and Medical Device Development

Project 1 - Summer 2016 Effect of Exercise During Weight Loss on Bone Structure and Strength Weight loss improves many clinical consequences of obesity; yet despite its benefits, weight loss is not routinely recommended for older adults, partially due to loss of bone mass and the potential to worsen age-related risk of osteoporosis and fracture. This project explores whether the addition of exercise to weight loss preserves bone structure and strength compared to weight loss alone in obese, older adults participating in an 18-month lifestyle based intervention. The student will learn bone mineral density and cortical thickness mapping techniques and characterize bone quality of the femur and spine from medical images taken pre- and post-intervention. Finite element (FE) analysis will be performed to determine correlations between exercise, weight loss, and bone structure and strength.

Bone quality characterization and computational simulations will focus on clinically important sites of osteoporotic fracture. In addition to technical competencies, emphasis will also be placed on understanding and application of the research process â&#x20AC;&#x201C; specifically, reviewing the literature, hypothesis formation, and testing as it relates to the current project.

Location:

Kristen M. Beavers, PhD, MPH, RD Assistant Professor, Department of Health & Exercise Science Wake Forest University Winston-Salem, NC 27109 http://hes.wfu.edu/beavers.htm

Project 2 - Summer 2016 Advanced Radiation Therapy Technologies & Radiation-Induced Injury Assessment Modalities and techniques for image-guided radiation treatment in cancer therapy continue in development for quantitative assessment of the amount of radiation delivered to a target location. Biophysical models aid in the prediction of response to ionizing radiation, based on the delivered dose, including injury caused to normal tissues. This project investigates measurement techniques for confirming three-dimensional dose delivery for external beam or gamma radiosurgery under unique geometries where the dose certainty is not well-known or easily predicted. The student will be involved in assessment of dose in normal tissues and the analysis of radiation-induced injury. The student will be trained in radiation instrumentation and will learn mathematical and computational skills to analyze experimental and modeled data, including digital image data.

The student will be involved with literature review, hypothesis formation, experimental setup, and data analysis, and will contribute to the development of improved predictive models that will reduce radiation-induced injuries in cancer patients.

Location:

J. Daniel Bourland, PhD Professor, Radiation Oncology Wake Forest University School of Medicine Medical Center Boulevard Winston-Salem, NC 27157 http://www.wakehealth.edu/Faculty/Bourla nd-John-Daniel.htm

Project 3 - Summer 2016 Comparative Surgical Biomechanics in Ankle Fracture Fixation Ankle fractures involving the posterior malleolus are a common traumatic injury and may result in articular cartilage damage which can inhibit mobility in patients. Syndesmotic screws are often used to secure and stabilize ankle fractures, yet there are conflicting clinical studies and controversy as to the use of syndesmotic screws for posterior malleolar fractures as well as the timeframe for removal or whether they should be removed at all. This project seeks to use an industrial six axis robot to impart physiological forces and moments to measure stiffness, range of motion, and failure loading of cadaveric ankle joints with two current standards of fracture fixation

The student will review the literature on ankle fracture fixation techniques and physiological ankle loading, and will assist with hypothesis formation, experimental design, cadaveric testing, and data analysis. The student will receive training in mechanical testing and imaging techniques to measure specimen bone quality. Outcomes from their summer research experience will contribute to a recommendation for fixation of posterior malleolar fractures that reduces patient morbidity.

Location:

Philip Brown, PhD Research Assistant Professor, Biomedical Engineering VT-WFU Center for Injury Biomechanics School of Biomedical Engineering and Sciences 575 N. Patterson Ave, Suite 120 Winston-Salem, NC 27101 http://www.wakehealth.edu/CIB/CIB-People.htm

Project 4 - Summer 2016 Quantifying Postural Differences in Patients with Low Back Injury Lumbar spine disc herniation can lead to episodes of recurring back pain. As an alternative to surgery, postural training has been suggested as a method to treat some patients with lumbar disc injury. The goal of this project is to quantify existing postural differences between control subjects and those with low back injury. Study subjects will be monitored for up to 12 hours to insure the monitoring sessions accurately capture their posture as they conduct their normal activities. Activities in support of the project that the student will participate in are 1) Conduct a literature review to determine current posture sensing technology and postural interventions for low back injury, 2) Create a research question and hypothesis to address the goal of this study, 3) Evaluate the monitoring system selected, and 4) Analyze the monitoring results and identify key postural differences in patients with low back injury.

This research effort will be in the Department of Orthopaedic Surgery and you will have the opportunity to work on a range of projects in the field of orthopaedic biomechanics and military injury biomechanics.

Location:

Kerry Danelson, PhD Assistant Professor, Orthopaedic Surgery Medical Center Blvd. Winston-Salem, NC 27157 kdanelso@wakehealth.edu

Project 5 - Summer 2016 Computational Human Body Modeling Heat Transfer Research for Burn Injuries An emerging area of interest in computational modeling is the study of bio-heat transfer for modeling burn injuries. This project will focus on the study of heat transfer as it pertains to human body modeling, specifically quantifying thermal dose in the human body based on well-known bio-heat transfer experiments in the literature. The student will perform a literature survey of existing burn models and determine which are most applicable to the studyâ&#x20AC;&#x2122;s goal. Next, using an established finite difference model, the student will hypothesize how to best quantify the relationship between thermal dose and histological findings in the literature. In conjunction with this effort, the blood perfusion parameter will be varied across a range of values noted in the literature, to quantify the sensitivity of the dose calculation on this important, yet difficult to measure parameter. The student will determine the best fit injury assessment reference value for a given burn classification based on the calculated thermal dose and established risk models. This research will further the science of thermal burn modeling by bridging the insult and outcome via a quantifiable measure of thermal dose.

Location:

Scott Gayzik, PhD Assistant Professor, Biomedical Engineering VT-WFU Center for Injury Biomechanics School of Biomedical Engineering and Sciences 575 N. Patterson Ave, Suite 120 Winston-Salem, NC 27101 www.CIB.vt.edu

Project 6 - Summer 2016 Biomechanical Evaluation of Sport-Related Head Impacts Due to rising concern for head impact exposure and concussion in the 21 million kids involved in team sports, recent efforts have been made to collect and study real-time head impact data from youth and adolescent athletes. This project is obtaining on-field head impact data from adolescent football and soccer athletes using helmet-mounted and mouth guard-mounted sensors to better understand the biomechanical basis of sub-concussive and concussive head impacts. The student selected will perform literature review focused on cumulative head impact exposure and subconcussive head impacts. The student will work with a mentor to develop a hypothesis-driven project focused on the evaluation of analytically and computationally-based head impact exposure metrics that may be tested and verified.

This project will expose the student to data processing, application of statistical methods, and FE modeling with our high resolution, anatomically accurate brain model. The student's project will have a direct impact on the broader goals of the study which include characterization of cumulative head impact exposure and understanding the biomechanical basis of sub-concussive and concussive head impacts.

Location:

Figure 7: Coronal (A), sagittal (B), axial (C), and isometric (D) views of ABM.

Jillian Urban, PhD Research Assistant Professor, Biomedical Engineering VT-WFU Center for Injury Biomechanics School of Biomedical Engineering and Sciences 575 N. Patterson Ave, Suite 120 Winston-Salem, NC 27101 http://www.wakehealth.edu/CIB/CIB-People.htm

Project 7 - Summer 2016 Correlation of Crash Occupant Bone Mineral Density with Age and Fracture Incidence Low bone quality is a contributing factor to motor vehicle crash (MVC) fractures and quantification of an occupant's bone mineral density (BMD) is important from an injury causation standpoint. This project aims to quantify volumetric lumbar BMD in a dataset of over 1,000 seriously injured Crash Injury Research and Engineering Network (CIREN) MVC occupants from phantom-less computed tomography (CT) scans using a validated technique. The student will first perform a literature review on bone quality to learn BMD measurement techniques, factors affecting BMD, and BMD thresholds associated with osteopenia, osteoporosis, and thoracolumbar fracture incidence. Next, the student will form a hypothesis to test if lumbar BMD below particular thresholds is associated with thoracolumbar fracture incidence.

New CT-based and age-based thresholds for lumbar osteopenia/ osteoporosis will be established using occupant data including dual-energy X-ray absorptiometry scans and physician diagnoses of osteoporosis. Crash, occupant, and injury data from CIREN will be correlated with CT-measured lumbar BMD. While controlling for factors such as age and crash severity, the student will determine if lumbar BMD below the osteopenia/osteoporosis thresholds is associated with risk of particular thoracolumbar spine fractures, as well as osteopenia/osteoporosis diagnoses.

Fat

L1 L2 L3

Muscle

Location:

Anna N. Miller, MD Assistant Professor, Orthopaedics Office of Women in Medicine and Science Medical Center Boulevard Winston-Salem, NC 27157 http://www.wakehealth.edu/Faculty/Miller-Anna-N.htm

Bone

Project 8 - Summer 2016 The Biomechanics of Hemorrhagic Shock and Resuscitation Trauma is a leading cause of death in people under age 45, with hemorrhagic shock accounting for more than 80% of deaths in the operating room and nearly 50% of deaths within the first 24 hours from injury. While surgical interventions and transfusion practices have greatly advanced, we still have a rudimentary understanding of the underlying mechanisms of hemorrhagic shock, particularly the interplay between the changes in fluid mechanics, vascular permeability, and the physical and chemical properties of blood. In this project, the student will use intravital microscopy to image and record â&#x20AC;&#x153;real-timeâ&#x20AC;? changes in various rat microcirculatory tissue beds during hemorrhagic shock and resuscitation. Changes in arterial, venous and lymphatic flows will be quantified, along with changes in vascular permeability with varying degrees of shock/injury. The student will participate in literature review, formation of a hypothesis, and testing that will include working with rodents and microscopes. This includes learning valuable image acquisition and processing techniques and surgical skills on rats. Ultimately, this project should enhance our understanding of the acute mechanisms of shock and resuscitation, potentially elucidating key biomarkers for determining severity of shock and resuscitation efficacy.

Location:

Elaheh Rahbar, PhD Assistant Professor, Biomedical Engineering VT-WFU School of Biomedical Engineering and Sciences Wake Forest University School of Medicine 575 N Patterson Ave., Suite 120 Winston-Salem, NC 27101

Project 9 - Summer 2016 Computational Reconstructions of Real World Motor Vehicle Crashes Human body modeling has the potential to elucidate injury mechanisms for common injuries following MVCs. The focus of this project is to simulate well-documented MVCs involving seriously injured occupants from two national crash databases using computational vehicle and human body FE models. The student will perform a literature review focusing on a common injury, and will learn to reconstruct real world crashes with and without the chosen injury using a simplified vehicle model and a human body model. Additional injury metrics will be implemented into the human body model to predict the chosen injury.

A hypothesis will be formed to test if the injury metrics in the simulated crashes are predictive of the injuries sustained in the real world crashes. Sensitivity and specificity of the injury predictions will be assessed from the injury cases and non-injury cases reconstructed. Student contributions to this project will result in novel FE injury metrics and crash reconstruction methodology, along with an improved understanding of MVC injury mechanisms and FE injury predictions.

Location:

Joel Stitzel, PhD Professor, Biomedical Engineering Program Leader & Director, WFU Campus VT-WFU Center for Injury Biomechanics School of Biomedical Engineering and Sciences 575 N. Patterson Ave, Suite 120 Winston-Salem, NC 27101 www.CIB.vt.edu

Project 10 - Summer 2016 Advanced Automatic Crash Notification Algorithm for Occupant Triage An important future avenue for reducing the morbidity and mortality associated with MVCs is to improve the trauma triage process, ensuring that seriously injured occupants are transported to trauma centers. Advanced Automatic Crash Notification (AACN) has shown promise in improving trauma triage by predicting occupant injury severity using vehicle telemetry data to recommend a hospital transportation decision. The purpose of this project is to develop an AACN algorithm using an injury-based approach to identify injuries necessitating treatment at a Level I/II trauma center in order to reduce response times, increase triage efficiency, and improve overall patient outcomes. The student will conduct a literature review on current trauma triage practices and over- and under-triage. AACN Algorithm for Injury Prediction Vehicle Telemetry Data

Occupant Triage Recommendation

The student will be trained in big data techniques, to analyze large hospital and survey datasets containing information on injuries, mortality risk, treatment urgency, and hospital transfers in conjunction with large crash datasets with crash, vehicle, occupant, and injury data to develop the AACN algorithm. The student will form a hypothesis to test whether the developed AACN algorithmâ&#x20AC;&#x2122;s performance improves on existing triage rates for MVC occupants. To test the hypothesis and estimate the benefit of widespread AACN implementation, linked pre-hospital and hospital system data will be analyzed to examine current trends in trauma triage in comparison to the triage performance of the AACN algorithm.

Location:

Ashley Weaver, PhD Assistant Professor, Biomedical Engineering VT-WFU Center for Injury Biomechanics School of Biomedical Engineering and Sciences 575 N. Patterson Ave, Suite 120 Winston-Salem, NC 27101 www.CIB.vt.edu

Project 11 - Summer 2016 iTAKL- imaging Telemetry And Kinematic modeLing in Youth Football Sports-related head impacts are common and involve significant forces that can result in mild to severe traumatic brain injury (TBI). Football has the highest incidence of sports-related TBI and limited data is available for the millions of participants in youth and adolescent football leagues (8-18 years old) during this time of rapid brain development. We obtain magnetic resonance imaging (MRI), magnetoencephalography (MEG), cognitive measures, and detailed head impact data from sensors embedded within the helmets of youth and adolescent athletes to determine the effects of subconcussive impacts, and the true incidence of cognitive and objective imaging changes. The student selected will perform literature review focused on changes in the brain measureable from imaging and cognitive testing that are associated with cumulative head impact exposure and subconcussive head impacts. The student will work with a mentor to develop a hypothesis-driven project focused on relating quantitative medical imaging measures to biomechanical and neurocognitive measures. Lastly, the student will have the opportunity to help with pre-season data collection and will be trained to administer neurocognitive tests. These valuable experiences will allow the student to be actively engaged and exposed to human subjects research, statistical analysis, and multimodal medical imaging acquisition and analysis.

Location:

Christopher T. Whitlow, MD, PhD, MHA Associate Professor and Chief of Neuroradiology Director of Combined MD/PhD Program Advanced NeuroScience Imaging Research (ANSIR) Laboratory Departments of Radiology and Biomedical Engineering Wake Forest School of Medicine Medical Center Boulevard Winston-Salem, NC 27157-1088 http://fmri.wfubmc.edu/

Project 12 - Summer 2016 Prevention of Radiation Therapy-Induced Fractures and Muscle Fibrosis Cancer survivors increasingly experience long-term side effects of radiation therapy, including skeletal fractures and muscle fibrosis. This project seeks to identify novel compounds capable of suppressing these musculoskeletal disorders. Our data has shown over 2% loss of bone content per week in the proximal femur after radiation for gynecologic cancers, which is the equivalent of 3 years of bone loss during postmenopausal osteoporosis. This project will quantify bone and muscle damage in rats that do and do not receive administration of a therapeutic agent in conjunction with radiation therapy for pelvic cancers and sarcoma.

The student will use micro and nano-CT imaging with contrast agents to characterize how well bone and muscle tissues are spared from damage. Additionally, the student will biomechanically test bone and muscle samples to identify if the functional damage in these tissues that leads to fractures or joint stiffening can be prevented. The student will also perform molecular assays to characterize the precise mechanism(s) associated with prevention of musculoskeletal damage. Throughout this project, the student will gain experience in research techniques including literature review, hypothesis formation and experimental design, image acquisition and analysis techniques, biomechanical testing of bone and muscle, and molecular assays

Location:

Jeffrey Willey, PhD Assistant Professor , Radiation Oncology Wake Forest University School of Medicine Medical Center Boulevard Winston-Salem, NC 27157 http://www.wakehealth.edu/Faculty/Willey-Jeffrey-Scott.htm

Project 13 - Summer 2016 Human Body Model Development for Trauma Research Computational modeling is a growing component of injury biomechanics and trauma research. This project is a multi-center effort developing a next generation set of human body finite element (FE) models for enhanced injury prediction and prevention systems. The student will learn specific skills that are highly translatable to future graduate research experience including finite element volume meshing, high performance computing and morphometric operations such as scaling and medical image analysis. There will be a specific emphasis on applying the scientific process to these efforts. Students will review the literature in the subfield of modeling in which they are working. Computational efforts will focus on hypothesis driven activities, with simulations designed and conducted by the student to verify or refute their inquiries. These activities will be focused around model validation, studies related to injury risk predication in a given environment, or how best to scale results to match literature data from different body habitus. This research effort will be in the Center for Injury Biomechanics (CIB) and you will have the opportunity to work on a range of projects in the field of automobile safety, military restraints, and sports biomechanics. The CIB has two primary research facilities. The first is in the WFU School of Medicine in Winston-Salem, NC and the second is at Virginia Tech. The research at the CIB combines experimental testing, computational modeling, and case analysis to investigate human injury biomechanics.

Location:

Project 14 - Summer 2016 Multi-Modality Anthropometry Study for Computational Model Generation Computational models of the human body can be used to predict the relationship between a specific insult and the resulting tissue damage. These simulations require models with a high level of anatomic biofidelity that represent a population of interest. However, models in use today were developed with limited imaging data. The WFU CIB is collecting multi-modality medical image and anthropometry data from a targeted population to be used in the development of the next generation of wound prediction models. The student will be focused on developing models that capture normal anatomical variation in the thoracoabdominal region of the body based on data collected for this project. The student will begin with a literature review on current efforts to develop statistically based models in the region of interest. One aspect of this literature review will be to narrow the focus to a single organ or system that is both highly variable in terms of morphometry and location, but is also frequently injured and presents a high threat to life in such cases. The student will then propose a hypothesis of how best to capture morphometric variability in the organ. Finally a trial with a single organ to verify the process will be conducted. In addition to these focused research activities, the student will gain valuable research experience related to subject recruitment and institutional review board requirements as part of this project.

Location:

Project 15 - Summer 2016 Novel Research and Medical Device Development There are several opportunities within Biomedical Engineering and through collaborations with orthopedics, neurosurgery, the center for biomedical imaging, plastic surgery, and others for the development of novel medical and research devices. These include experimental fixtures, exercise/rehabilitation machines and instruments, as well as surgical tools and hardware. Students selected for this project will be heavily engaged in the design process, conceptualization, prototyping, and evaluation of multiple concurrent device development timelines. The CIB has two primary research facilities. The first is in the WFU School of Medicine in Winston-Salem, NC and the second is at Virginia Tech. The research at the CIB combines experimental testing, computational modeling, and case analysis to investigate human injury biomechanics.

Location: