Introduction: Implicit within spinal manipulative therapy is the assumption that treatment loads are effectively transcribed to actuate consistent mechanisms for expected clinical results. There is conflicting evidence between the mechanistic understandings and the physiologic responses from experimental evidence. Greater clarity on how loads are transferred through tissues to the target sites would be useful in enhancing utilization and efficacy of spinal manipulative procedures. Purpose: Directly monitor displacement of tissue in strata at sequential depths between the load application site and target articulation in the thoracic spine. Tissue displacement served as a surrogate for evidence of load transmission. Methods: Ultrasound elastography techniques monitored displacement in sequential strata while electromyographic signals, force, kinematic motions were monitored synchronously. Volunteers were placed prone on a treatment table, while a typical spinal manipulative pre-load maneuver was applied in the thoracic spine. Results: When applying a therapeutic load to the skin the results demonstrate with increasing depth of tissue there is a sequentially decreasing rank order in the mean cumulative displacement with each layer being significantly greater than the deeper adjacent layer. Superficial loose connective tissue layer (0.34 mm ± 0.15) vs. intermediate muscle layer (0.28 mm ± 0.11), p=0.004. Intermediate muscle layer (0.28 mm ± 0.11) vs. deep muscle layer (0.16 mm ± 0.6), p<0.0001. Filtered myoelectric signals were linearly correlated with tissue strata cumulative displacements, but the relationship was not strong (-0.23 < r < 0.46). Conversely, Pearson correlation analysis revealed strong and relatively stable correlations (0.74 < r < 0.90) for the association between displacement at the load application site and tissue layers. Conclusion: The sequential tissue motion demonstrates that some degree of load transfer through layers occurs. Both direct and indirect stimulation of tissues across both depth and breadth is feasible, to an extent consistent with the stimulation of mechanoreceptors. / Thesis / Master of Science (MSc)

The Achilles tendon is the largest tendon in the human body, which elastically stores and releases energy to facilitate walking and running. Tendons can suffer from a range of pathologies, most notably that of complete rupture, which affects athletes, physically active workers and the aged. There is a growing demand for in vivo methods of objectively measuring tendon health for aiding diagnosis, monitoring therapy and for assessment of new treatments. Knowledge of the changes in mechanical properties during the healing process is also limited and new methods to accurately and consistently estimate these could provide insights into the healing process and guide future research efforts. This thesis presents the development and use of 2D ultrasound elastography, a quantitative strain estimation imaging technique, as a tool to measure changes in the tensile mechanical properties of the Achilles tendon. This technique performs frame-to-frame block matching of image texture to track motion in an ultrasound signal sequence and create a strain estimation field from the spatial derivative of the motion. Elastography in the image-lateral direction of sagittal plane scans is of particular interest as this is in line with the longitudinal axis of the tendon, but presents extra accuracy issues from out of plane motion and lower image spatial resolution. Tendon rupture also presents unique problems to image acquisition and analysis- patient pain and safety are important considerations and disruption of the ultrasound texture can make 2D motion tracking more difficult. A new 2D elastography block matching algorithm, named `AutoQual', was developed to enable accurate tracking of motion in the image-lateral direction and reduce the impact of artefacts and errors common with damaged Achilles tendons image sequences. It was shown to outperform a multiscale block matching method when tested using ultrasound sequences from in vivo and gelatine phantom experiments. The input parameters of this algorithm were then optimised using the phantom data for benchmarking. The AutoQual algorithm was then used to analyse ultrasound sequences from a 24-week longitudinal study of 21 subjects with ruptured Achilles tendons to assess lateral, axial and principal strains during controlled passive motion of the foot or axial palpation of the ultrasound probe. Lateral and principal strains from controlled dorsiflexion were shown to be more repeatable and more sensitive to change than axial strains with manual palpation. This experience with lateral strain imaging from ruptured Achilles tendons gave an increased knowledge of the strain imaging artefacts and features that can occur. These are described in detail in order that they may be further mitigated in quantitative analysis by optimising acquisition protocols, further amendment of the block tracking algorithm, or exclusion of erroneous areas when selecting regions of interest. Regularisation is a potential solution to some common artefacts such as discontinuities from poor tracking in shadow regions. Regularisation of the lateral displacement fields is investigated using 2D bicubic smoothing splines. The regularisation parameters used are shown to have minimal effect on quantitative analysis and can aid visual clarity or reduce artefacts within certain settings. However, regularisation was also shown to cause large errors when parameters were set more aggressively. Finally, it is identified that cumulative lateral strain measurement of the Achilles and other tendons is feasible but that future work is needed to further improve the quality of force and cross sectional area measurements in order to infer mechanical properties accurately. Repeatable high force motion protocols also need to be developed to measure healthy tendons and to ensure comparable results between different patients and research groups.

Cette thèse concerne le développement d'un cadre de contrôle robotique pour l'élastographie ultrasonore quantitative. L'élastographie ultrasonore est une technique qui dévoile les paramètres élastiques du tissu qui sont généralement liés à une pathologie. Cette thèse propose trois nouvelles approches robotiques différentes pour pour assister la procédure d'élastographie. La première approche concerne le contrôle d'un robot actionnant une sonde à ultrasons pour effectuer un mouvement de palpation nécessaire pour l'élastographie par ultrasons. L'élasticité du tissu est utilisée pour concevoir une loi d'asservissement afin de maintenir un tissu d'intérêt rigide dans le champ de vision de la sonde ultrasonore. De plus, l'orientation de la sonde est contrôlée par un utilisateur humain pour explorer différentes vues du tissu pendant que l'élastographie est effectuée. La seconde approche exploite le recalage d'images déformables avec des images ultrasonores pour estimer l'élasticité tissulaire et aider à la compensation automatique par asservissement visuel ultrasonore d'un mouvement introduit dans le tissu. La troisième approche offre une méthodologie pour ressentir l'élasticité du tissu en déplaçant une sonde virtuelle dans l'image ultrasonore avec un dispositif haptique pendant que le robot effectue un mouvement de palpation. Les résultats expérimentaux des trois approches robotiques obtenus sur des fantômes constitués de tissus démontrent l'efficacité des méthodes proposées et ouvre des perspectives intéressantes pour l'élastographie ultrasonore assistée par robot. / This thesis concerns the development of a robotic control framework for quantitative ultrasound elastography. Ultrasound elastography is a technology that unveils elastic parameters of a tissue, which are commonly related with certain pathologies. This thesis proposes three novel robotic approaches to assist examiners with elastography. The first approach deals with the control of a robot actuating an ultrasound probe to perform palpation motion required for ultrasound elastography. The elasticity of the tissue is used to design a servo control law to keep a stiff tissue of interest in the field of view of the ultrasound probe. Additionally, the orientation of the probe is controlled by a human user to explore other tissue while elastography is performed. The second approach exploits deformable image registration of ultrasound images to estimate the tissue elasticity and to help in the automatic compensation by ultrasound visual servoing of a motion introduced into the tissue. The third approach offers a methodology to feel the elasticity of the tissue by moving a virtual probe in the ultrasound image with a haptic device while the robot is performing palpation motion. Experimental results of the three robotic approaches over phantoms with tissue-like offer an excellent perspective for robotic-assistance for ultrasound elastography.

Posterior tibial tendon dysfunction (PTTD) is a common degenerative condition leading to a severe impairment of gait. There is currently no effective method to determine whether a patient with advanced PTTD would benefit from several months of bracing and physical therapy or ultimately require surgery. Tendon degeneration is closely associated with irreversible degradation of its collagen structure, leading to changes to its mechanical properties. If these properties could be monitored in vivo, it could be used to quantify the severity of tendonosis and help determine the appropriate treatment. Ultrasound elasticity imaging (UEI) is a real-time, noninvasive technique to objectively measure mechanical properties in soft tissue. It consists of acquiring a sequence of ultrasound frames and applying speckle tracking to estimate displacement and strain at each pixel. The goals of my dissertation were to 1) use acoustic simulations to investigate the performance of UEI during tendon deformation with different geometries; 2) develop and validate UEI as a potentially noninvasive technique for quantifying tendon mechanical properties in human cadaver experiments; 3) design a platform for UEI to measure mechanical properties of the PTT in vivo and determine whether there are detectable and quantifiable differences between healthy and diseased tendons. First, ultrasound simulations of tendon deformation were performed using an acoustic modeling program. The effects of different tendon geometries (cylinder and curved cylinder) on the performance of UEI were investigated. Modeling results indicated that UEI accurately estimated the strain in the cylinder geometry, but underestimated in the curved cylinder. The simulation also predicted that the out-of-the-plane motion of the PTT would cause a non-uniform strain pattern within incompressible homogeneous isotropic material. However, to average within a small region of interest determined by principal component analysis (PCA) would improve the estimation. Next, UEI was performed on five human cadaver feet mounted in a materials testing system (MTS) while the PTT was attached to a force actuator. A portable ultrasound scanner collected 2D data during loading cycles. Young's modulus was calculated from the strain, loading force and cross sectional area of the PTT. Average Young's modulus for the five tendons was (0.45±0.16GPa) using UEI. This was consistent with simultaneous measurements made by the MTS across the whole tendon (0.52±0.18GPa). We also calculated the scaling factor (0.12±0.01) between the load on the PTT and the inversion force at the forefoot, a measurable quantity in vivo. This study suggests that UEI could be a reliable in vivo technique for estimating the mechanical properties of the human PTT. Finally, we built a custom ankle inversion platform for in vivo imaging of human subjects (eight healthy volunteers and nine advanced PTTD patients). We found non-linear elastic properties of the PTTD, which could be quantified by the slope between the elastic modulus (E) and the inversion force (F). This slope (ΔE/ΔF), or Non-linear Elasticity Parameter (NEP), was significantly different for the two groups: 0.16±0.20 MPa/N for healthy tendons and 0.45±0.43 MPa/N for PTTD tendons. A receiver operating characteristic (ROC) curve revealed an area under the curve (AUC) of 0.83±0.07, which indicated that the classifier system is valid. In summary, the acoustic modeling, cadaveric studies, and in vivo experiments together demonstrated that UEI accurately quantifies tendon mechanical properties. As a valuable clinical tool, UEI also has the potential to help guide treatment decisions for advanced PTTD and other tendinopathies.

Airway hyperresponsiveness (AHR) is a hallmark of asthma where constriction of airway smooth muscle (ASM) causes excessive airway narrowing. Asthmatics, unlike healthy subjects, cannot prevent or reverse this narrowing by stretching their airways with a deep inspiration (DI). Since stretching of isolated ASM causes dramatic reductions in force generation and asthmatics tend to have stiffer airways, researchers hypothesize that reduced ASM stretching during breathing and DIs results in hyperreactive airways. However, counterintuitively, excised measurement on intact airways show narrowing is minimally reversed by pressure oscillations simulating breathing and DIs. We hypothesized that AHR does not result from reduced capacity to stretch the airways; furthermore, each constituent of the airway wall experiences different strain magnitude during breathing and DIs. To test this, we used an intact airway system which controls transmural pressure (Ptm) to simulate breathing while measuring luminal diameter in response to ASM agonists. An ultrasound system and automated segmentation algorithm were implemented to quantify and compare the ability of Ptm fluctuations to reverse and prevent narrowing in larger (diameter=5.72±0.52mm) relative to smaller airways (diameter=2.92±0.29mm). We found the ability of Ptm oscillations to reverse airway narrowing was proportional to strain imposed on the airway wall. Further, tidal-like breathing Ptm oscillations (5-15cmH2O) after constriction imposed 196% more strain in smaller compared to larger airways (14.6% vs. 5.58%), resulting in 76% greater reversal of narrowing (41.2% vs. 23.4%). However, Ptm oscillations applied before and during constriction resulted in the same steady-state diameter as when Ptm oscillations were applied only after constriction. To better understand these results, we optimized an ultrasound elastography technique utilizing finite element-based image registration to estimate spatial distributions of displacements, strains, and material properties throughout an airway wall during breathing and bronchoconstriction. This required we formulate and solve an inverse elasticity problem to reconstruct the distribution of nonlinear material properties. Strains and material properties were radially and longitudinally heterogeneous, and patterns and magnitudes changed significantly after induced narrowing. Taken together, these data show AHR likely does not emerge due to reduced straining of airways prior to challenge, but remodeling that stiffens airway walls might serve to sustain constriction during an asthmatic-like attack.

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No description available.

Il est maintenant admis que la composition de la plaque athérosclérotique est un déterminant majeur de sa vulnérabilité à se rompre. Vu que la composition de la plaque affecte ses propriétés mécaniques, l'évaluation locale des propriétés mécaniques de la plaque d'athérome peut nous informer sur sa vulnérabilité. L'objectif est de comparer les techniques d’élastographie ultrasonores endovasculaire (EVE) et non-invasive (NIVE) en fonction de leur potentiel à identifier les composantes calcifiées et lipidiques de la plaque. Les acquisitions intravasculaire et extravasculaire ont été effectuées sur les artères carotidiennes de neuf porcs hypercholestérolémiques à l’aide d’un cathéter de 20 MHz et d'une sonde linéaire de 7.5 MHz, respectivement. Les valeurs de déformation radiale et axiale, rapportés par EVE et NIVE, ont été corrélées avec le pourcentage des zones histologiques calcifiées et lipidiques pour cinq plaques. Nos résultats démontrent une bonne corrélation positive entre les déformations et les composantes calcifiées (r2 = 0.82, P = 0.034 valeur par EVE et r2 = 0.80, P = 0.041 valeur par NIVE). Une forte corrélation entre les déformations axiales et les contenus lipidiques par NIVE (r2 = 0.92, P-value = 0.010) a été obtenue. En conclusion, NIVE et EVE sont des techniques potentielles pour identifier les composants de la plaque et aider les médecins à diagnostiquer précocement les plaques vulnérables. / It is now widely accepted that plaque composition is a major determinant of plaque’s vulnerability to rupture. Since composition of the plaque affects its mechanical properties, the local assessment of mechanical properties of atherosclerotic plaque may inform us about plaque’s vulnerability. The objective is to compare ultrasonic endovascular elastography (EVE) versus non-invasive vascular elastography (NIVE) according to their potential to identify plaque contents. Intravascular and extravascular acquisitions were performed on carotid arteries of nine hypercholesterolemic minipigs with a 20 MHz catheter and a 7.5 MHz standard probe, respectively. Radial and axial strain values, reported by EVE and NIVE respectively, were correlated with histological area of lipid and calcium for five plaques. Our results demonstrate a good positive correlation between strains and calcified contents (r2=0.82, P-value=0.034 by EVE and r2=0.80, P-value= 0.041 by NIVE). Additionally, there is a strong correlation between axial strains and lipid contents by NIVE (r2=0.92, P-value= 0.010). In conclusion, NIVE and EVE are the potential techniques to identify plaque components and to help physicians to early diagnose the vulnerable plaques.

Il est maintenant admis que la composition de la plaque athérosclérotique est un déterminant majeur de sa vulnérabilité à se rompre. Vu que la composition de la plaque affecte ses propriétés mécaniques, l'évaluation locale des propriétés mécaniques de la plaque d'athérome peut nous informer sur sa vulnérabilité. L'objectif est de comparer les techniques d’élastographie ultrasonores endovasculaire (EVE) et non-invasive (NIVE) en fonction de leur potentiel à identifier les composantes calcifiées et lipidiques de la plaque. Les acquisitions intravasculaire et extravasculaire ont été effectuées sur les artères carotidiennes de neuf porcs hypercholestérolémiques à l’aide d’un cathéter de 20 MHz et d'une sonde linéaire de 7.5 MHz, respectivement. Les valeurs de déformation radiale et axiale, rapportés par EVE et NIVE, ont été corrélées avec le pourcentage des zones histologiques calcifiées et lipidiques pour cinq plaques. Nos résultats démontrent une bonne corrélation positive entre les déformations et les composantes calcifiées (r2 = 0.82, P = 0.034 valeur par EVE et r2 = 0.80, P = 0.041 valeur par NIVE). Une forte corrélation entre les déformations axiales et les contenus lipidiques par NIVE (r2 = 0.92, P-value = 0.010) a été obtenue. En conclusion, NIVE et EVE sont des techniques potentielles pour identifier les composants de la plaque et aider les médecins à diagnostiquer précocement les plaques vulnérables. / It is now widely accepted that plaque composition is a major determinant of plaque’s vulnerability to rupture. Since composition of the plaque affects its mechanical properties, the local assessment of mechanical properties of atherosclerotic plaque may inform us about plaque’s vulnerability. The objective is to compare ultrasonic endovascular elastography (EVE) versus non-invasive vascular elastography (NIVE) according to their potential to identify plaque contents. Intravascular and extravascular acquisitions were performed on carotid arteries of nine hypercholesterolemic minipigs with a 20 MHz catheter and a 7.5 MHz standard probe, respectively. Radial and axial strain values, reported by EVE and NIVE respectively, were correlated with histological area of lipid and calcium for five plaques. Our results demonstrate a good positive correlation between strains and calcified contents (r2=0.82, P-value=0.034 by EVE and r2=0.80, P-value= 0.041 by NIVE). Additionally, there is a strong correlation between axial strains and lipid contents by NIVE (r2=0.92, P-value= 0.010). In conclusion, NIVE and EVE are the potential techniques to identify plaque components and to help physicians to early diagnose the vulnerable plaques.

Les muscles infraépineux et petit rond sont cruciaux sur le plan fonctionnel et sont altérés dans le cadre des pathologies de la coiffe des rotateurs. La proportion de tissu graisseux dans l’infraépineux est actuellement un critère pronostic du résultat fonctionnel des réparations des lésions tendineuses de la coiffe des rotateurs. Les buts de ce travail sont de caractériser ces muscles sur le plan anatomique, de proposer une meilleure exploration de leur morphologie par IRM, d’utiliser l’analyse de texture informatique pour objectiver leur composition et enfin, d’utiliser l’élastographie ultrasonore pour analyser leur comportement viscoélastique en contrainte. L’infraépineux et le petit rond sont respectivement de conformation tripennée et parallèle. Les critères d’acquisition IRM de routine peuvent être aisément optimisés pour analyser plus précisément les muscles rotateurs externes. L’analyse de texture semble prometteuse pour évaluer la proportion de tissu graisseux dans le muscle squelettique. L’élastographie ultrasonore permet d’appréhender le degré d’anisotropie musculaire, et donc l’état d’organisation du muscle infraépineux. / Infraspinatus and teres minor muscles are crucial functionally and are regularly impaired in the context of of the rotator cuff pathology. The proportion of fatty tissue in the infraspinatus is currently a strong prognosis criterion of functional outcomes of rotator cuff tendon repair. The goals of this work are to characterize these muscles anatomically, to provide a better exploration of their morphology by MRI, to use computer texture analysis to objectify their composition and finally to use the ultrasound elastography for analysing their viscoelastic behaviour under stress. Infraspinatus and teres minor muscles have a tripennate and parallel organization, respectively. Routine MRI acquisition criteria can be easily optimized to analyse more precisely the external rotator muscles. Texture analysis seems promising to assess the proportion of fatty tissue in the skeletal muscle. The ultrasound elastography allows us to estimate the degree of muscle anisotropy, and therefore the state of organization of the infraspinatus muscle.