Periodic Reporting for period 1 - MeDiTATe (The Medical Digital Twin for Aneurysm Prevention and Treatment)
Período documentado: 2020-01-01 hasta 2021-12-31
Cardiovascular diseases (CVDs) are the main cause of illness and premature death in the European Union. Personalized/individual medicine and the use of simulation technologies have been presented as the most promising areas where to address clinical research with high potential benefits for patients, citizens and economy. The use of scientific computing tools in medical practice is, nevertheless, still in its infancy. Three main causes can be identified to explain this limitation:
• the implementation of in-silico analysis into clinical practice requires a significant integration of knowledge and an elevated high-tech engineering know-how;
• the entire workflow requires computational facilities that are not typically hosted by healthcare institutions;
• the validation of numerical simulations through clinical studies remains challenging and scarce, or limited to small cohorts.
In this scenario, the MeDiTATe project ("the Medical Digital Twin for Aneurysm Prevention and Treatment") aims to deliver a comprehensive framework of simulation and imaging technologies, targeted at industrial and clinical-translation to accelerate the process of personalised cardiovascular medical procedure, validated through an integrated experimental programme to ultimately improve patient care. The strength of the concept lies within the multidisciplinary aspect given by the intense collaboration among different technical experts in the field of engineering, clinics, academics and industry. The core idea is to develop an image based medical Digital Twins of cardiovascular districts for a patient specific prevention and treatment of aneurysms and to make it available as "a service" for all in academia, hospital and industry.
The project involves 14 Individual Research Projects (IRP) defined across five research tracks:
1. High fidelity CAE multi-physics simulation with RBF mesh morphing (FEM, CFD, FSI, inverse FEM);
2. Real time interaction with the digital twin by Augmented Reality, Haptic Devices and Reduced Order Models;
3. HPC tools, including GPUs, and cloud-based paradigms for fast and automated CAE processing of clinical database;
4. Big Data management for population of patients imaging data and high-fidelity CAE twins;
5. Additive Manufacturing of physical mock-up for surgical planning and training to gain a comprehensive Industry 4.0 approach in a clinical scenario (Medicine 4.0).
The objectives of MeDiTATe are:
• to translate the well-known expertise specific of "traditional" engineering into a real clinical environment;
• to ensure the collaboration between research/academic organizations with industries to investigate cutting-edge issues for R&D in the aneurysms prevention and treatment by means of Digital Twin approach;
• to provide young researchers with an enviable skills mix, making them attractive to both academia and industry, preparing them for a competitive employment market and individually balancing technical and complementary skills training.
• the implementation of in-silico analysis into clinical practice requires a significant integration of knowledge and an elevated high-tech engineering know-how;
• the entire workflow requires computational facilities that are not typically hosted by healthcare institutions;
• the validation of numerical simulations through clinical studies remains challenging and scarce, or limited to small cohorts.
In this scenario, the MeDiTATe project ("the Medical Digital Twin for Aneurysm Prevention and Treatment") aims to deliver a comprehensive framework of simulation and imaging technologies, targeted at industrial and clinical-translation to accelerate the process of personalised cardiovascular medical procedure, validated through an integrated experimental programme to ultimately improve patient care. The strength of the concept lies within the multidisciplinary aspect given by the intense collaboration among different technical experts in the field of engineering, clinics, academics and industry. The core idea is to develop an image based medical Digital Twins of cardiovascular districts for a patient specific prevention and treatment of aneurysms and to make it available as "a service" for all in academia, hospital and industry.
The project involves 14 Individual Research Projects (IRP) defined across five research tracks:
1. High fidelity CAE multi-physics simulation with RBF mesh morphing (FEM, CFD, FSI, inverse FEM);
2. Real time interaction with the digital twin by Augmented Reality, Haptic Devices and Reduced Order Models;
3. HPC tools, including GPUs, and cloud-based paradigms for fast and automated CAE processing of clinical database;
4. Big Data management for population of patients imaging data and high-fidelity CAE twins;
5. Additive Manufacturing of physical mock-up for surgical planning and training to gain a comprehensive Industry 4.0 approach in a clinical scenario (Medicine 4.0).
The objectives of MeDiTATe are:
• to translate the well-known expertise specific of "traditional" engineering into a real clinical environment;
• to ensure the collaboration between research/academic organizations with industries to investigate cutting-edge issues for R&D in the aneurysms prevention and treatment by means of Digital Twin approach;
• to provide young researchers with an enviable skills mix, making them attractive to both academia and industry, preparing them for a competitive employment market and individually balancing technical and complementary skills training.
14 young researchers were selected within the first year of the action and enrolled in the PhD schools of three universities (University of Rome "Tor Vergata", National technical university of Athens and University of Lyon). The fellows are benefiting from the multisectoral Academic-Industrial hybrid high technological environment and are providing high quality research.
High Performance Computing (HPC) architectures were significantly adopted in most of the IRPs for several purposes as image processing, numerical solutions and both structural and fluid dynamic analyses. The complex physics involved in the aneurysm solicitations involve both biomechanical and fluid-dynamic aspects and require computationally expensive high fidelity (HiFi) analyses. Procedures aimed to investigate the Ascending Aorta Aneurism evolution and rupture are developing moving from the images of the vessel directly to the analysis of the simulation results. Numerical HiFi solutions were used to implement novel methodological approaches based on Reduced Order Models (ROM) and Uncertainty quantification (UQ) methods. A prototype, which the clinician himself will be able to use, is being developed. It allows to quickly obtain geometric measurements on the aortic model to monitor the progression of the pathology and exploit the full power of ROM to obtain real-time results, providing crucial information on the haemodynamic flow. With such tools, in addition to the diameter assessment, the risk of rupture can be estimated by combining metrics on the geometry and fluid-dynamic biomarkers, ensuring a more patient-specific understanding of the problem and a strong incentive for the revolution of the clinical practice.
Clinical data from CT-scans and 2D/3D flows have been used to validate the simulations and create patient-specific aorta geometries. Several Additive Manufacturing (AM) technique were explored for the development of 3D stent and patient specific geometries for the study of hemodynamic and structural behaviour in a bench test setup. An idealized AAA, provided by a partner, was used as a benchmark for exploring the fitting and positioning of a stent graft device within the aortic wall. Computational simulations were focused on the exploration of innovative stent designs able to improve key performance parameters of existing commercial products. An innovative manufacturing workflow to produce a high-fidelity tissue mimicking transparent phantom of AAA was investigated.
High Performance Computing (HPC) architectures were significantly adopted in most of the IRPs for several purposes as image processing, numerical solutions and both structural and fluid dynamic analyses. The complex physics involved in the aneurysm solicitations involve both biomechanical and fluid-dynamic aspects and require computationally expensive high fidelity (HiFi) analyses. Procedures aimed to investigate the Ascending Aorta Aneurism evolution and rupture are developing moving from the images of the vessel directly to the analysis of the simulation results. Numerical HiFi solutions were used to implement novel methodological approaches based on Reduced Order Models (ROM) and Uncertainty quantification (UQ) methods. A prototype, which the clinician himself will be able to use, is being developed. It allows to quickly obtain geometric measurements on the aortic model to monitor the progression of the pathology and exploit the full power of ROM to obtain real-time results, providing crucial information on the haemodynamic flow. With such tools, in addition to the diameter assessment, the risk of rupture can be estimated by combining metrics on the geometry and fluid-dynamic biomarkers, ensuring a more patient-specific understanding of the problem and a strong incentive for the revolution of the clinical practice.
Clinical data from CT-scans and 2D/3D flows have been used to validate the simulations and create patient-specific aorta geometries. Several Additive Manufacturing (AM) technique were explored for the development of 3D stent and patient specific geometries for the study of hemodynamic and structural behaviour in a bench test setup. An idealized AAA, provided by a partner, was used as a benchmark for exploring the fitting and positioning of a stent graft device within the aortic wall. Computational simulations were focused on the exploration of innovative stent designs able to improve key performance parameters of existing commercial products. An innovative manufacturing workflow to produce a high-fidelity tissue mimicking transparent phantom of AAA was investigated.
The innovative nature of the projects is expected to have a broader impact on the research environment of the beneficiaries, promoting best practice in research within institutions and enhancing engagement for industries and hospital research centres. The results of this research can be proposed as a guide for all companies wanting to implement the Medical Digital Twin (MDT) in cardiovascular application. The tools developed to predict the long-term evolution of a pathology and to assess the risk factors will allow translating this research into the clinical field, providing insights that can help clinicians in the evaluation and treatment planning, as part of medical digital twin and personalized medicine approaches.
With such results, MeDiTATe will contribute to the development of high quality care solutions for individual patients and sensible management for cardiovascular chronic diseases. The research work carried out will be a real guide especially for all those who want to develop market approved software from this example carried out exclusively for research purposes. It will open new markets in the neurovascular market, reduce costs associated with heavy numerical computations, and open new business model thanks to results being obtained real-time. The MeDiTATe research responds to a need from industrial partners, who depend on the guidance of clinical counterparts to direct R&D over the mid and long-term. Our clinical counterparts are at the forefront of translational research, thriving in innovation, being centres of excellence not only in their own countries but internationally, supportive of the use of novel technologies in healthcare.
From a societal point of view, the MeDiTATe research contributes to progress towards a reduction of overall mortality and surgery-related morbidity.
With such results, MeDiTATe will contribute to the development of high quality care solutions for individual patients and sensible management for cardiovascular chronic diseases. The research work carried out will be a real guide especially for all those who want to develop market approved software from this example carried out exclusively for research purposes. It will open new markets in the neurovascular market, reduce costs associated with heavy numerical computations, and open new business model thanks to results being obtained real-time. The MeDiTATe research responds to a need from industrial partners, who depend on the guidance of clinical counterparts to direct R&D over the mid and long-term. Our clinical counterparts are at the forefront of translational research, thriving in innovation, being centres of excellence not only in their own countries but internationally, supportive of the use of novel technologies in healthcare.
From a societal point of view, the MeDiTATe research contributes to progress towards a reduction of overall mortality and surgery-related morbidity.