京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第24097号 / 人健博第104号 / 新制||人健||7(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 黒木 裕士, 教授 青山 朋樹, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

L'analyse biomécanique du geste sportif vise à mieux comprendre les mécanismes de la performance, en vue de l'améliorer tout en limitant le risque de blessures. Dans le sport de haut niveau, les appuis constituent une des clés de la performance. Couramment utilisée pour l'analyse de la marche, la dynamique inverse permet de quantifier les actions inter-segmentaires, potentiellement traumatiques, au cours du mouvement. Cette méthode comporte toutefois certains biais, dont deux peuvent être particulièrement importants au cours de mouvements sportifs à fortes accélérations : l'artefact des tissus mous et la précision du torseur dynamique. Ce travail a pour premier objectif de proposer des adaptations méthodologiques pour l'analyse par dynamique inverse d'appuis sportifs. D'abord, l'intérêt de la méthode des « centres articulaires moyens », basée sur l'utilisation de clusters rigides, est montré pour l'acquisition de la cinématique segmentaire. Ensuite, l'influence de la fréquence d'échantillonnage et de la méthode de dérivation discrète sur le calcul des accélérations est évaluée. Enfin, la validation d'un modèle volumique personnalisé permettant une meilleure estimation des paramètres inertiels que les modèles proportionnels couramment utilisés est présentée. Le second objectif de ce travail consiste en l'application des méthodes ainsi développées à l'analyse du comportement mécanique de la cheville au cours de sauts de type pliométrique et à l'évaluation personnalisée du risque de blessures du membre inférieur chez des athlètes d'élite en kungfu wushu. Ces analyses seront faites en parallèle de la mesure de caractéristiques spécifiques de l'athlète, telles que l'amplitude articulaire de la cheville et les modules d'élasticité de différentes structures du triceps sural obtenus par élastographie. Les perspectives pour l'application à l'entraînement seront abordées, en termes d'évolution des pratiques et de prévention personnalisée des blessures. / Sports biomechanics aims at better understanding performance mechanisms, to improve them while limiting injury risk. At elite level, stances are a key aspect of performance. Often used in gait analysis, inverse dynamics enables quantification of mechanical actions during motion. However, there are some limits to this method, two of which can become important when studying sports stances: soft tissue artifact and accuracy of dynamic wrenches. The first objective of this work is to propose methodological adaptations for inverse dynamics analysis of sports stances. Firstly, the benefit of the “mean joint centers” method, based on the use of rigid clusters, is shown for segment kinematics acquisition. Secondly, the influences of the sampling frequency and the differentiation method on the calculation of accelerations are evaluated. Thirdly, the validation of a personalized volumetric model enabling better estimation of segment inertial parameters than common proportional models is presented. The second objective of this work is the application of the methods proposed to the analysis of the ankle joint mechanical behavior during plyometric jumps, and to personalized evaluation of the lower limb injury risk in elite wushu athletes. These analyses have been performed in parallel to specific measures of athletes' characteristics, such as the ankle range of motion and the shear modulii of different structures of the triceps surae, using shear wave elastography. Perspectives for training application will be discussed, to address the evolution of training habits and personalized injury prevention.

Arterial stiffness is an important biometric in predicting cardiovascular diseases, since mechanical properties serve as indicators of several pathologies such as e.g. atherosclerosis. Shear Wave Elastography (SWE) could serve as a valuable non-invasive diagnostic tool for assessing arterial stiffness, with the technique proven efficient in large homogeneous tissue. However the accuracy within arterial applications is still uncertain, following the lack of proper validation. Therefore, the aim of this study was to assess the accuracy of SWE in arterial phantoms of poly(vinyl alcohol) cryogel by developing an experimental setup with an additional mechanical testing setup as a reference method. The two setups were developed to generate identical stress states on the mounted phantoms, with a combination of axial loads and static intraluminal pressures. The acquired radiofrequency-data was analysed in the frequency domain with retrieved dispersion curves fitted to a Lamb-wave based wave propagation model. The results indicated a significant correlation between SWE and mechanical measurements for the arterial phantoms, with an average relative error of 10 % for elastic shear moduli in the range of 23 to 108 kPa. The performed accuracy quantification implies a satisfactory performance level and as well as a general feasibility of SWE in arterial vessels, indicating the potential of SWE as a future cardiovascular diagnostic tool.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第19970号 / 人健博第38号 / 新制||人健||3(附属図書館) / 33066 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 杉本 直三, 教授 精山 明敏, 教授 黒田 知宏 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Genom att generera mer information om hälsenan i form av dess elasticitet kan förhoppningsvis fler slutsater nås gällande diagnostik och behandling. Elastografi med hjälp av ultraljud skulle kunna vara en metod för att bidra med denna information. För att utföra detta anpassades en mjukvara utifrån ett grundläggande basprogram för elastografimätningar, utvecklat av företaget Verasonics, för att kunna utföra elastografi av hälsenan genom programmering i matlab. Tidigare undersökningsmetoder för elastografi är utvecklade för större organ, varför anpassningen innebar att använda metoder som även ger tillförlitlig information för mindre organ. För att göra detta anpassades först mjukvaran för en mindre fantom med liknande djup som hälsenan. När det konstaterats att skjuvningsvågor genererats på rätt avstånd kunde sedan mätningar göras på hälsenan. Genom att bestämma hastigheten av de genererade skjuvningsvågorna kunde sedan skjuvmodulen, följt av elasticitetsmodulen, beräknas för vävnaden. Denna bestämdes först genom grupphastigheten av skjuvningsvågorna, vilket är den metod som används vid större organ, följt av fashastigheten av skjuvningsvågorna vilket tar hänsyn till vågens dispersion. Detta gav då hälsenans elasticitetsmodul enligt grupphastighet samt fashastighet som sedan kunde jämföras. Slutligen gick det att konstatera att elasticitetsmodulen kommer att variera beroende på vilken typ av hastighet denna härleds från. Detta indikerar då på att sjuvningsvågen interagerar med organets gränsyta vilket orsakar dispersion. / Generating more information about the achilles tendon, such as its elasticity, will hopefully lead to more conclusions and results within both diagnostics as well as treatment. Elastography by ultrasound could be a method to contribute with this information. To do so, a basic software,provided and developed by the company Verasonics for elastography was specialized to fit the achilles tendon by programing in matlab. Earlier methods to perform elastography are developed for larger organs, hence the adjustment will include methods that acquire trustworthy information from smaller organs. To do so the adjustment of the software was first made to work on a smaller phantom with similar symmetry as the achilles tendon. When it was confirmed that shear waves were generated at the correct distance this enabled further measurements on the achilles tendon. By deciding the speed of the generated shear waves the shear modulus, followed by the elastic modulus, could then be estimated for the tissue. This was first decided by the group velocity of the shear waves, as the usual method done on larger organs, followed by the phase velocity that also takes dispersion in mind. The result could then be used to obtain the elastic modulus of the achilles tendon based on group and phase velocity for further comparison.The conclusion was then that the elastic modulus will depend on what kind of velocity it is derived from. This indicates that the shear wave interacts with the organ's boundaries which causes dispersion.

This thesis is comprised of two studies. The objective of the first study was to find the frequency response and stiffness of the biceps brachii muscle group during recovery from exercise induced damage and to determine whether these data could be used to track muscle recovery by correlating changes in the frequency response with changes in muscle stiffness. Stiffness moduli were collected using Shear Wave Elastography (SWE) which were then applied to a proportional first mode frequency analysis. Data were collected for the muscle stiffness and frequency response for fifteen subjects (25.6 +- 4.5). By comparing the proportion of the square root of the SWE results, the variation in stiffness showed a less than 2 Hz change in first mode resonance for the control group. Frequency response results for the control group agreed with the modified SWE results and the proportion analysis. SWE results for the damage protocol group showed an average increase of 4 Hz. Frequency response results for the damage protocol group were sorted into three categories: three subjects had a change in frequency of peaks of at least 4 Hz in the positive direction; four subjects had an increase in amplitude, but no change in frequency of peaks; three subjects showed mixed responses like fewer resonance peaks, variable amplitudes, changes in peak bandwidth. This research allowed for the documentation of the in-vivo frequency response of the biceps brachii muscle. We believe that the frequency response of a muscle group may be used in the future to evaluate recovery from exercise induced damage. Lessons learned were also recorded for helping future studies in their efforts using an SLDV with human body testing.The second study focused on finding the effects on the surface velocity of tissue above and below a region of the lower leg wrapped in an elastic band when excited by an external source. Ten male subjects between the ages of 18-25 were seated in a chair with one foot placed on a vibrating platform. Two excitation frequencies were separately applied while three points along the leg were measured. A repeatability analysis, using results without the leg wrap, showed a 6.5%, 2.5%, and 10.5% variance in the x-, y-, and z-directions respectively, applying a 20 Hz frequency. With a 40 Hz frequency, the variations were 24%, 23.8%, and 28.4% respectively. A change in displacement of +38% and +10% occurred above the knee in the x-direction with 40 Hz and in the y-direction with 20 Hz, respectively. A change in displacement of -20% occurred below the knee in the x-direction with 20 Hz. A change in displacement of -24% occurred below the wrap location in the y-direction with 40Hz. With a confidence interval of 93%, surface velocity of the tissue located above the wrap increased, while the surface velocity of the tissue below the wrap decreased.

Cardiovascular diseases are the leading causes of death worldwide and improved diagnostic methods are needed for early intervention and to select the most suitable treatment for patients. Currently, carotid artery plaque vulnerability is typically determined by visually assessing ultrasound B-mode images, which is influenced by user-subjectivity. Since plaque vulnerability is correlated to the mechanical properties of the plaque, quantitative techniques are needed to estimate plaque stiffness as a surrogate for plaque vulnerability, which would reduce subjectivity during plaque assessment. The work in this thesis focused on three noninvasive ultrasound-based techniques to quantitatively assess plaque vulnerability and measure arterial stiffness. In Study I, a speckle tracking algorithm was validated in vitro to assess strain in common carotid artery (CCA) phantom plaques and thereafter applied in vivo to carotid atherosclerotic plaques where the strain results were compared to visual assessments by experienced physicians. In Study II, hard and soft CCA phantom plaques were characterized with shear wave elastography (SWE) by using phase and group velocity analysis while being hydrostatically pressurized followed by validating the results with mechanical tensile testing. In Study III, feasibility of assessing the stiffness of simulated plaques and the arterial wall with SWE was demonstrated in an ex vivo setup in small porcine aortas used as a human CCA model. In Study IV, SWE and pulse wave imaging (PWI) were compared when characterizing homogeneous CCA soft phantom plaques. The techniques developed in this thesis have demonstrated potential to characterize carotid artery plaques. The results show that the techniques have the ability to noninvasively evaluate the mechanical properties of carotid artery plaques, provide additional data when visually assessing B-mode images, and potentially provide improved diagnoses for patients suffering from cerebrovascular diseases. / <p>Doctoral thesis in medical technology and medical sciences</p><p>QC 20160921</p>

La fibrillation atriale (FA) est l’arythmie cardiaque la plus fréquente. Elle touche près de 750 000 personnes en France. La technique de traitement la plus courante est l’ablation intracardiaque par radiofréquence (RF). Son principe consiste à isoler électriquement les veines pulmonaires du reste de l’oreillette. Cependant cette technique est invasive et a une efficacité limitée. Les Ultrasons Focalisés de Haute Intensité (HIFU) permettent de léser à distance de façon précise les tissus biologiques. Un traitement de la FA par HIFU transoesophagiens aurait l’avantage d’être mini-invasif et plus efficace qu’un traitement par RF intracardiaque de par la possibilité de générer des lésions transmurales sans nécessiter de contact entre la sonde et la zone à traiter. Un applicateur HIFU transoesophagien à guidage échographique intégré a donc été développé pour le traitement de la FA. Le transducteur peut focaliser le faisceau ultrasonore de 17 mm à 55 mm de profondeur avec une intensité acoustique maximale à sa surface de 12 W•cm-2. Une procédure de traitement HIFU préservant les tissus adjacents a été simulée numériquement sur un modèle anatomique réaliste. Des lésions HIFU transoesophagiennes ont été obtenues ex vivo dans du myocarde dans des conditions anatomiques et physiologiques proches de l’in vivo. Des essais préliminaires d’élastographie par ondes de cisaillement ont permis d’évaluer la faisabilité d’un contrôle de la formation des lésions à l’aide du transducteur d’imagerie intégré. Une première série d’expérimentations in vivo sur le modèle porcin a finalement permis de valider la procédure de traitement et d’induire des dommages biologiques dans le tissu cardiaque / Atrial fibrillation (AF) is the most frequent cardiac arrhythmia. This pathology affects more than 750,000 persons in France. Radiofrequency (RF) endocardial ablation is performed to treat this disease and involves the generation of transmural thermal lesions, to isolate electrically the pulmonary veins (PV) from the left atrium. The technique is, however, invasive and has a limited efficiency, especially for ensuring transmurality which requires a perfect contact between the RF probe and cardiac tissues. High Intensity Focused Ultrasound (HIFU) allows the creation of precise thermal lesions, deep within biological tissues. A transesophageal HIFU approach could provide a minimally-invasive alternative for AF treatment, since deep transmural lesions could be generated at distance from the HIFU probe. In this work, an ultrasound-guided transesophageal applicator has been developed for AF treatment. The HIFU transducer, embedding a transesophageal echocardiography (TEE) probe, can focus the acoustic beam from 17 to 55 mm axially and generate a surface acoustic intensity up to 12 W•cm-2. A complex treatment plan, the HIFU Mini-Maze (HIFUMM), was successfully simulated on a realistic anatomical human model. Transesophageal HIFU lesions were induced experimentally in static myocardium, under ex vivo configurations reflecting an increasing complexity in anatomical and physiological conditions. Investigations conducted on shear wave elastography confirmed the feasibility of using TEE to control the formation of HIFU lesions. Finally, in vivo experiments in a porcine model allowed validating the treatment procedure by inducing biological damages in beating heart

Chronic liver diseases are the eighth leading cause of death in Brazil and a major public health problem in the world. Liver biopsy is the best available reference standard for evaluating and classifying stages of liver diseases, but it presents limitations and complications that are common in invasive methods. In recent years, elasticity imaging methods have been the focus of intense research activity with the ability to measure mechanical properties of soft tissues in a non-invasive way. Shear wave elastography is one of the most promising methods because it enables to quantitatively assess tissue elasticity. However, the current depth range of shear wave elastography impedes its application in obese patients, which have a great risk of developing liver disease. The aim of this study is to investigate the use of shear wave elastography in deeper tissues using a two-dimensional ultrasound transducer array. An efficient transducer array arrangement was simulated, fabricated and characterized. The results show that the proposed transducer configuration presents enhanced transmitting capabilities for generating tissue displacement in deeper tissues. In addition, numerical simulations were performed in order to track the tissue deformation and reconstruct its elastic properties. / Doenças crônicas do fígado são a oitava causa de morte no Brasil e um dos principais problemas de saúde pública do mundo. A biópsia do fígado é o melhor padrão de referência disponível para avaliação e classificação dos estágios das doenças hepáticas, mas apresenta limitações e complicações que são comuns nos métodos invasivos. Nos últimos anos, métodos de imagem por elasticidade têm sido o foco de intensa atividade de pesquisa, pois têm a capacidade de medir propriedades mecânicas dos tecidos moles de maneira não invasiva. A elastografia por ondas de cisalhamento é um dos métodos mais promissores, pois permite avaliar quantitativamente a elasticidade do tecido. No entanto, a atual faixa de profundidade da elastografia por ondas de cisalhamento impede sua aplicação em pacientes obesos, que apresentam grande risco de desenvolver doença hepática. O objetivo deste estudo é investigar o uso da elastografia por onda de cisalhamento em tecidos mais profundos usando um transdutor de ultrassom bidimensional. Uma configuração eficiente de transdutores matriciais foi simulada, fabricada e caracterizada. Os resultados mostram que o transdutor proposto possui capacidade de transmissão melhorada para gerar deslocamento em tecidos profundos. Além disso, simulações numéricas foram realizadas para monitorar a deformação do tecido e reconstruir suas propriedades elásticas.

Chronic liver diseases are the eighth leading cause of death in Brazil and a major public health problem in the world. Liver biopsy is the best available reference standard for evaluating and classifying stages of liver diseases, but it presents limitations and complications that are common in invasive methods. In recent years, elasticity imaging methods have been the focus of intense research activity with the ability to measure mechanical properties of soft tissues in a non-invasive way. Shear wave elastography is one of the most promising methods because it enables to quantitatively assess tissue elasticity. However, the current depth range of shear wave elastography impedes its application in obese patients, which have a great risk of developing liver disease. The aim of this study is to investigate the use of shear wave elastography in deeper tissues using a two-dimensional ultrasound transducer array. An efficient transducer array arrangement was simulated, fabricated and characterized. The results show that the proposed transducer configuration presents enhanced transmitting capabilities for generating tissue displacement in deeper tissues. In addition, numerical simulations were performed in order to track the tissue deformation and reconstruct its elastic properties. / Doenças crônicas do fígado são a oitava causa de morte no Brasil e um dos principais problemas de saúde pública do mundo. A biópsia do fígado é o melhor padrão de referência disponível para avaliação e classificação dos estágios das doenças hepáticas, mas apresenta limitações e complicações que são comuns nos métodos invasivos. Nos últimos anos, métodos de imagem por elasticidade têm sido o foco de intensa atividade de pesquisa, pois têm a capacidade de medir propriedades mecânicas dos tecidos moles de maneira não invasiva. A elastografia por ondas de cisalhamento é um dos métodos mais promissores, pois permite avaliar quantitativamente a elasticidade do tecido. No entanto, a atual faixa de profundidade da elastografia por ondas de cisalhamento impede sua aplicação em pacientes obesos, que apresentam grande risco de desenvolver doença hepática. O objetivo deste estudo é investigar o uso da elastografia por onda de cisalhamento em tecidos mais profundos usando um transdutor de ultrassom bidimensional. Uma configuração eficiente de transdutores matriciais foi simulada, fabricada e caracterizada. Os resultados mostram que o transdutor proposto possui capacidade de transmissão melhorada para gerar deslocamento em tecidos profundos. Além disso, simulações numéricas foram realizadas para monitorar a deformação do tecido e reconstruir suas propriedades elásticas.