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=== Introduction ===
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==Introduction==
  
Placement of  Implantable Cardiac Defibrillators(ICDs)is a unique and challenging problem for children due to the variety of shapes and sizes, ranging from neonate to adolescent.  As a result, a variety of novel implant techniques have been employed.  Although these have generally been successful inasmuch as they result in a clinically acceptable defibrillation threshold, nothing is known about the mechanisms by which this threshold is attained, the optimal geometries for defibrillation, and whether unsafe electric field strengths are a result of novel implant approaches.  Finite element modeling has been shown in adult torso models to correlate well with clinical results.  Our goal is to model defibrillation in child torso models to gain insight into this important problem.  We are also interested in developing new orientations in adults with the goal of lowering DFTs and providing options in patients with contraindications to standard techniques.
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Placement of  Implantable Cardiac Defibrillators(ICDs) is a unique and challenging problem for children due to the variety of shapes and sizes, ranging from neonate to adolescent.  As a result, a variety of novel implant techniques have been employed.  Although these have generally been successful inasmuch as they result in a clinically acceptable defibrillation threshold, nothing is known about the mechanisms by which this threshold is attained, the optimal geometries for defibrillation, and whether unsafe electric field strengths are a result of novel implant approaches.  Finite element modeling has been shown in adult torso models to correlate well with clinical results.  Our goal is to model defibrillation in child torso models to gain insight into this important problem.  We are also interested in developing new orientations in adults with the goal of lowering DFTs and providing options in patients with contraindications to standard techniques.
  
=== Goals of Project ===
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==Key Personnel==
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*Stanford: Matthew Jolley, Anne Dubin, Paul Wang
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*Children's Hospital Boston: John Triedman, Frank Cecchin
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*Scientific Computing Institute, Utah: Jeroen Stinstra, Rob Macleod
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*NorthEastern University: Dana Brooks
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*NA-MIC: Steve Pieper, Kilian Pohl
  
1.  Create 3D models of children based on CT and MRI datasets for modeling internal and external defibrillation in the SCIRun environment.  The processes required address the larger question of how to take any CT or MRI DICOM dataset, segment it into various label maps, combine those label maps in a hierarchical manner, then import and utilize them in the SCIRun/BioPSE environment.  This represents part of an expanding collaboration between [http://www.sci.utah.edu/ SCI] and [http://splweb.bwh.harvard.edu:8000/ SPL] to integrate open source tools to allow creation, visualization, and computational modeling of image based 3D models. 
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= Goals of Project =
  
2.  Create modules which allow insertion of electrode shapes into finite element models in in the SCIRun environment.
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==Segmentation==
  
3Utilize the above innovations to model the placement of internal defibrillator electrodes to maximize efficacy, minimize potential cardiac damage, and gain further insight into optimizing defibrillation in children of various sizes as shown above.
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Segmentation is currently done using tools within the open source tools 3D Slicer and Seg3D.  We are actively working with members of SCI and SPL on developing automated segmentation techniques for torso and cardiac modelingIn the future we would like to integrate DT-MRI fiber structure into our cardiac models.
  
=== Slicer and SPL Tools in the Project ===
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==Modeling==
  
[[Outline of Torso Segmentation Problem]]
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We have worked with members of the SCI Institute in Utah to develop a modeling framework within their SCIRun package which allows rapid placement of realistic electrodes within finite element models of adult and child torsos.  All tools to do so are available open source to download from the SCI website.  We continue to improve this platform, integrating new technology and insight as we progress.
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==Understanding Defibrillation==
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Ultimately this project is part of a larger goal of understanding defibrillation as a therapy.  Members of the group are also working with members of John Hopkins to further this goal.
  
[[Segmentation Tools Currently Utilized]]
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= Building and Running SCIRun on SPL Machines =
 
 
[[Tools In Development and Wishlist]]
 
 
 
=== Building and Running SCIRun on SPL Machines ===
 
 
[[SCRun on SPL Machines]]
 
[[SCRun on SPL Machines]]
  
=== Citations ===
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==Publications==
 
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*Jolley M, Stinstra J, Weinstein D, et al. Open-Source Environment for Interactive Finite Element Modeling of Optimal ICD Electrode Placement Functional Imaging and Modeling of the Heart, Lecture Notes in Computer Science. Berlin/Heidelberg: Springer, 2007:373-382.   
1. Jolley M, Stinstra J, Weinstein D, et al. Open-Source Environment for Interactive Finite Element Modeling of Optimal ICD Electrode Placement Functional Imaging and Modeling of the Heart, Lecture Notes in Computer Science. Berlin/Heidelberg: Springer, 2007:373-382.   
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*Jolley M, Stinstra J, Weinsten D, et al. Finite Element Modeling of Novel Defibrillation Approaches in Children and Adult Heart Rhythm Society. Denver, Colorado, 2007.  
 
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*Jolley M., Triedman J., Westin C-F., Weinstein D.M., MacLeod R., Brooks D.H.  [http://www.na-mic.org/publications/item/view/1240 Image Based Modeling of Defibrillation in Children.] Conf Proc IEEE Eng Med Biol Soc. 2006 Sep;1:2564-7. PMID: 17946966.
2. Jolley M, Stinstra J, Weinsten D, et al. Finite Element Modeling of Novel Defibrillation Approaches in Children and Adult Heart Rhythm Society. Denver, Colorado, 2007.  
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* Stinstra J.G., Jolley M., Callahan M., Weinstein D., Cole M., Brooks D.H., Triedman J.K., Macleod R.S.  [http://www.na-mic.org/publications/item/view/1241 Evaluation of Different Meshing Algorithms in the Computation of Defibrillation Thresholds in Children.] Conf Proc IEEE Eng Med Biol Soc. 2007 Aug;2007:1422-5. PMID: 18002232.
 
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*Jolley M., Stinstra J.G., Pieper S., Macleod R.S., Brooks D.H., Cecchin F., Triedman J.K.  [http://www.na-mic.org/publications/item/view/1277 A Computer Modeling Tool for Comparing Novel ICD Electrode Orientations in Children and Adults.] Heart Rhythm. 2008 Apr;5(4):565-72. PMID: 18362024. PMCID: PMC2745086.
3. Jolley M, Triedman J, Westin CF, et al. Image based modeling of defibrillation in children. Conf Proc IEEE Eng Med Biol Soc 2006;1:2564-7.  
 
 
 
4. Stinstra JG, Jolley M, Callahan M, et al. Evaluation of different meshing algorithms in the computation of defibrillator thresholds in children. Conf Proc IEEE Eng Med Biol Soc 2007;1:1422-5.  
 
 
 
5. Matthew Jolley, Jeroen Stinstra, Steve Pieper, Rob MacLeod, Dana H. Brooks, Frank Cecchin, John K. Triedman A Computer Modeling Tool for Comparing Novel ICD Electrode Orientations in Children and Adults. In Press Accepted Manuscript for Heart Rhythm, Available online 18 January 2008, http://www.heartrhythmjournal.com/inpress
 

Latest revision as of 17:18, 14 December 2016

Home < NA-MIC Childrens Collaboration

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Introduction

Placement of Implantable Cardiac Defibrillators(ICDs) is a unique and challenging problem for children due to the variety of shapes and sizes, ranging from neonate to adolescent. As a result, a variety of novel implant techniques have been employed. Although these have generally been successful inasmuch as they result in a clinically acceptable defibrillation threshold, nothing is known about the mechanisms by which this threshold is attained, the optimal geometries for defibrillation, and whether unsafe electric field strengths are a result of novel implant approaches. Finite element modeling has been shown in adult torso models to correlate well with clinical results. Our goal is to model defibrillation in child torso models to gain insight into this important problem. We are also interested in developing new orientations in adults with the goal of lowering DFTs and providing options in patients with contraindications to standard techniques.

Key Personnel

  • Stanford: Matthew Jolley, Anne Dubin, Paul Wang
  • Children's Hospital Boston: John Triedman, Frank Cecchin
  • Scientific Computing Institute, Utah: Jeroen Stinstra, Rob Macleod
  • NorthEastern University: Dana Brooks
  • NA-MIC: Steve Pieper, Kilian Pohl

Goals of Project

Segmentation

Segmentation is currently done using tools within the open source tools 3D Slicer and Seg3D. We are actively working with members of SCI and SPL on developing automated segmentation techniques for torso and cardiac modeling. In the future we would like to integrate DT-MRI fiber structure into our cardiac models.

Modeling

We have worked with members of the SCI Institute in Utah to develop a modeling framework within their SCIRun package which allows rapid placement of realistic electrodes within finite element models of adult and child torsos. All tools to do so are available open source to download from the SCI website. We continue to improve this platform, integrating new technology and insight as we progress.

Understanding Defibrillation

Ultimately this project is part of a larger goal of understanding defibrillation as a therapy. Members of the group are also working with members of John Hopkins to further this goal.

Building and Running SCIRun on SPL Machines

SCRun on SPL Machines

Publications