TY - JOUR A1 - Birkenmaier, Clemens A1 - Dornia, Christian A1 - Lehle, Karla A1 - Müller, Thomas A1 - Gruber, Michael A1 - Philipp, Alois A1 - Krenkel, Lars T1 - Analysis of Thrombotic Deposits in Extracorporeal Membrane Oxygenators by High-resolution Microcomputed Tomography: A Feasibility Study JF - ASAIO Journal / American Society for Artificial Internal Organs N2 - Coagulative disorders, especially clotting during extracorporeal membrane oxygenation, are frequent complications. Direct visualization and analysis of deposits in membrane oxygenators using computed tomography (CT) may provide an insight into the underlying mechanisms causing thrombotic events. However, the already established multidetector CT1 (MDCT) method shows major limitations. Here, we demonstrate the feasibility of applying industrial micro-CT (μCT) to circumvent these restrictions. Three clinically used membrane oxygenators were investigated applying both MDCT and μCT. The scans were analyzed in terms of clot volume and local clot distribution. As validation, the clot volume was also determined from the fluid volume, which could be filled into the respective used oxygenator compared to a new device. In addition, cross-sectional CT images were compared with crosscut oxygenators. Based on the μCT findings, a morphological measure (sphericity) for assessing clot structures in membrane oxygenators is introduced. Furthermore, by comparing MDCT and μCT results, an augmentation of the MDCT method is proposed, which allows for improved clot volume determination in a clinical setting. Y1 - 2020 U6 - https://doi.org/10.1097/MAT.0000000000001089 SN - 1538-943X VL - 66 IS - 8 SP - 922 EP - 928 PB - Lippincott Williams & Wilkins ER - TY - GEN A1 - Singh, Max Diamond T1 - MDR - Die neuen rechtlichen Bedingungen für Händler und Hersteller: aus der Sicht einer benannten Stelle T2 - MEGRA Jahrestagung. - Wien, 18.05.2020 [Veranstalter: Mitteleuropäische Gesellschaft für Regulatory Affairs] Y1 - 2020 ER - TY - GEN A1 - Singh, Max Diamond T1 - Notified body feedback: PSUR Forms. Post Market Surveillance & Vigilance BT - [Vortrag gehalten am 24.06.2020] T2 - MedTech Summit 2020: EU MDR & IVDR: the end is in sight, Dublin/virtual, 20.-26.06.2020 Y1 - 2020 ER - TY - GEN A1 - Singh, Max Diamond T1 - Innovation challenges for orthopedic device manufacturers under the new EU MDR BT - a notified body perspective T2 - ORS (Orthopaedic Research Society) Annual Meeting. - Phoenix, Arizona, 08. - 11.02.2020 Y1 - 2020 ER - TY - GEN A1 - Singh, Max Diamond T1 - General Overview of the Medical Device Regulation T2 - MDR-Roadshow - TÜV SÜD MHS, India Y1 - 2020 ER - TY - GEN A1 - Singh, Max Diamond T1 - Conformity Assessment Procedure MDR BT - [Vortrag gehalten am 24.02.2020] T2 - MDR Training: Person Responsible for Regulatory Compliance Course, 24.-25.02.2020, Tel Aviv, Obelis Academy Y1 - 2020 ER - TY - GEN A1 - Singh, Max Diamond T1 - Stakeholder view on Post Market Surveillance under the EU MDR: Timelines, Compliance and Requirements ; Post Market Surveillance & Vigilance BT - [Vortrag gehalten am: 23.6.2020] T2 - MedTech summit 2020: EU MDR & IVDR: the end ist in sight, 22.-26.06.2020, Dublin/virtual Y1 - 2020 ER - TY - GEN A1 - Singh, Max Diamond T1 - Technical Documentation MDR / IVDR, including the Declaration of Conformity BT - [Vortrag gehalten am 24.02.2020] T2 - MDR Training: Person Responsible for Regulatory Compliance, 24.-25.02.2020, Tel Aviv, Obelis Academy Y1 - 2020 ER - TY - GEN A1 - Singh, Max Diamond T1 - Herausforderungen der Medizinprodukteindustrie bei der Internationalisierung T2 - Studienwoche an der HNU (Hochschule Neu-Ulm) 2020 Y1 - 2020 ER - TY - THES A1 - Maier, Johannes T1 - Entwicklung eines Haptisch und Visuell unterstützten Trainingssystems (HaptiVisT) für komplexe Knochenbohrungen in der minimalinvasiven Handchirurgie N2 - Eine gängige Operationsmethode, um Frakturen der menschlichen Hand nach einem Unfall zu korrigieren, ist eine Osteosynthese mit sogenannten Kirschnerdrähten (K-Drähten) zur Stabilisierung von Knochenfragmenten. Die Einführung dieser langen, dünnen und scharfen Drähte durch manuelles Bohren ist eine komplexe minimalinvasive Operation, bei der ein Chirurg nahezu ohne visuelle Orientierung und nur durch eine kleine Öffnung der Haut des Patienten arbeitet. Als Orientierungshilfe für die optimale Lage der K-Drähte bleibt dem Chirurgen lediglich eine zweidimensionale (2D)-Röntgendarstellung und das Ertasten von knöchernen Vorsprüngen auf der menschlichen Hand, um Verletzungen an Risikostrukturen (Nerven, Gefäße usw.), die im Weichteilgewebe der Hand eingebettet sind, zu vermeiden. Für eine sichere und fehlerfreie Durchführung einer K-Draht-Osteosynthese ist deswegen eine gründliche theoretische und praktische Ausbildung junger Chirurgen notwendig. Da traditionelle Trainingsmethoden zeitaufwendig, kostspielig, ethisch nicht korrekt und unzureichend realistisch sind, wird in dieser Arbeit ein innovativer, auf virtueller Realität (VR) basierender, Haptisch und Visuell unterstützter Trainingssimulator (HaptiVisT) für die Platzierung von K-Drähten entwickelt, der vor allem Handchirurgen mit Übungs- und Perfektionierungsbedarf dabei unterstützt, das Bohrverfahren in einer realistischen aber virtuellen Umgebung zu erlernen. Beim HaptiVisT-Prototypenaufbau werden reale Patientendaten segmentierter Volumendaten aus einer Computertomographie (CT) und einer Magnetresonanztomographie (MRT) im virtuellen, dreidimensionalen (3D) Raum auf einem 3D-Monitor visualisiert und für eine intuitive bimanuelle Haptik sowohl mit einem Kraftfeedback-Gerät für den Bohrprozess und einer 3D-gedruckten und optisch getrackten Phantomhand kombiniert. Die vorliegende Arbeit beschreibt zunächst alle verwendeten Hardwaregeräte, die C++-Softwareumgebung, aufgebaut auf Multithreading (gleichzeitige Ausführung mehrerer Anweisungsfolgen in einem Prozess), und die auf Oberflächen- und Volumenrendering basierte Visualisierung. Die Kollisionsdetektion zwischen Bohrer und Knochen im virtuellen Raum wird in zwei separate Ereignisse unterteilt: Kollisionen zwischen Objekten als Gesamtes (Simulation der Kollision über die gesamte Objektoberfläche) und Kollisionen zwischen einer K-Draht-Spitze und dem Knochenvolumen für die Entfernung kleiner Volumenelemente (Voxel). Das Herzstück des Trainingssystems bildet eine echtzeitfähige Bohrsimulation, die den gesamten Bohrprozess in eine endliche Anzahl logischer Unterprozesse gliedert und diese Zustände in einen endlichen Zustandsautomaten (FSM, engl.: Finite State Machine) zusammenfasst. Das Kraftfeedback während einer Bohrung wird mit sogenannten „Virtual Fixtures“ (abstrakten sensorischen Informationen) berechnet und über einen Haptikarm auf den Benutzer übertragen. Damit die Simulation der Realität entspricht, wird unter Zuhilfenahme eines experimentellen Aufbaus die reale Bohrgeschwindigkeit durch kortikale Knochen ermittelt. Anschließend werden ein Levelkonzept und alle im System verfügbaren Bohrunterstützungswerkzeuge, wie haptische Korridore als Goldstandard oder eine Röntgenbildsimulation, vorgestellt. Mit ihnen ist es möglich, ausgesuchte Operationsfälle in Level unterschiedlicher Schwierigkeit zu unterteilen und den Operationsvorgang qualitativ zu bewerten. Der 3D-Druck einer Phantomhand (realitätsnahe Nachbildung einer Patientenhand) mit realistischen haptischen Eigenschaften zum Ertasten von Knochenvorsprüngen wird über einen metamaterialbasierten Ansatz (Neuanordnung des Grundmaterials durch eine künstlich angelegte, sich wiederholende Struktur) realisiert, da das aktuell am Markt verfügbare 3D-Druckmaterial für den Druck menschlichen Weichteilgewebes zu hart ist. Die Echtzeitverfolgung der Phantomhand beruht auf einem mit einer Stereokamera optisch getrackten Marker in Form eines Dodekaeders (Körper mit zwölf Flächen). Abschließend wird das HaptiVisT-Gesamtsystem in drei und der 3D-Druck einer Phantomhand in zwei Expertenevaluationen ausführlich untersucht und ausgewertet. Das HaptiVisT-System versteht sich als notwendiges Komplement für den ersten und weltweit einzigen funktionsfähigen, kompakten Prototypen für virtuelle K-DrahtOsteosynthesen mit haptischen Kraftfeedback, der in Zukunft Chirurgen in Aus- und Weiterbildung an Kliniken oder Trainingszentren ein risikofreies, zeit- und ortsunabhängiges Training ermöglicht. Die Kernelemente dieser Arbeit sind: • Stereoskopische 3D-Darstellung von realen Patientendaten. • Bimanuelle Haptik aus haptischen Kraftfeedback des Bohrens verbunden mit einer optisch getrackten, haptisch korrekten und 3D-gedruckten Phantomhand. • Zuverlässige Kollisionsdetektion zwischen virtuellen Objekten als Grundlage für das Kraftfeedback und die Abtragung von Knochen. • Echtzeitfähige Bohrsimulation durch Reduzierung des Bohrprozesses auf logische Bohr-Teilprozesse kombiniert mit einer Virtual Fixtures basierten Kraftberechnung. Haptisch korrekte Phantome sind vor allem im medizinischen Training von hoher Relevanz und die Berechnung des Kraftfeedbacks beruht erstmals auf der performanten und stabilen Simulation von Bohr-Teilprozessen unter Verwendung von Virtual Fixtures. Der Prototyp wird von Experten durchgehend positiv bewertet und bietet nach deren Einschätzung einen hohen Mehrwert für das chirurgische Training. Zukünftige Arbeiten könnten den Lerneffekt durch das HaptiVisT-Trainingssystem in stichhaltigen Evaluationen mit jungen Medizinstudenten unter Vorhandensein einer Kontrollgruppe statistisch validieren. Bei Bestätigung dieses Lerneffekts ist eine Ausgründung als eigenständiges Unternehmen und Weiterentwicklung des Prototyps mit Ausweitung auf weitere chirurgische Bereiche wie Knie- oder Hüftchirurgie denkbar. Unter Zuhilfenahme von automatischer Segmentierung könnten in Zukunft akut zu behandelnde Brüche abgebildet, vorab einer tatsächlichen Operation geübt und anschließend komplikationslos unter reduzierter Operationszeit durchgeführt werden. KW - Medizinisches Trainingssystem KW - Virtual Reality KW - Minimalinvasive Handchirurgie Y1 - 2020 SN - 978-3-8440-7547-2 N1 - Titel verleihende Institution: Universität Regensburg PB - Shaker CY - Düren ER - TY - JOUR A1 - Huber, Michaela A1 - Schlosser, Daniela A1 - Stenzel, Susanne A1 - Maier, Johannes A1 - Pattappa, Girish A1 - Kujat, Richard A1 - Striegl, Birgit A1 - Docheva, Denitsa T1 - Quantitative Analysis of Surface Contouring with Pulsed Bipolar Radiofrequency on Thin Chondromalacic Cartilage JF - BioMed Research International N2 - The purpose of this study was to evaluate the quality of surface contouring of chondromalacic cartilage by bipolar radio frequency energy using different treatment patterns in an animal model, as well as examining the impact of the treatment onto chondrocyte viability by two different methods. Our experiments were conducted on 36 fresh osteochondral sections from the tibia plateau of slaughtered 6-month-old pigs, where the thickness of the cartilage is similar to that of human wrist cartilage. An area of 1 cm(2) was first treated with emery paper to simulate the chondromalacic cartilage. Then, the treatment with RFE followed in 6 different patterns. The osteochondral sections were assessed for cellular viability (live/dead assay, caspase (cell apoptosis marker) staining, and quantitative analysed images obtained by fluorescent microscopy). For a quantitative characterization of none or treated cartilage surfaces, various roughness parameters were measured using confocal laser scanning microscopy (Olympus LEXT OLS 4000 3D). To describe the roughness, the Root-Mean-Square parameter (Sq) was calculated. A smoothing effect of the cartilage surface was detectable upon each pattern of RFE treatment. The Sq for native cartilage was Sq=3.8 +/- 1.1 mu m. The best smoothing pattern was seen for two RFE passes and a 2-second pulsed mode (B2p2) with an Sq=27.3 +/- 4.9 mu m. However, with increased smoothing, an augmentation in chondrocyte death up to 95% was detected. Using bipolar RFE treatment in arthroscopy for small joints like the wrist or MCP joints should be used with caution. In the case of chondroplasty, there is a high chance to destroy the joint cartilage. KW - CHONDROCYTE DEATH KW - energy KW - HUMAN ARTICULAR-CARTILAGE KW - MONOPOLAR KW - THERMAL CHONDROPLASTY Y1 - 2020 U6 - https://doi.org/10.1155/2020/1242086 SP - 1 EP - 8 PB - HINDAWI ER - TY - JOUR A1 - Schecklmann, Martin A1 - Schmausser, Maximilian A1 - Klinger, Felix A1 - Kreuzer, Peter M. A1 - Krenkel, Lars A1 - Langguth, Berthold T1 - Resting motor threshold and magnetic field output of the figure-of-8 and the double-cone coil JF - scientific reports N2 - The use of the double-cone (DC) coil in transcranial magnetic stimulation (TMS) is promoted with the notion that the DC coil enables stimulation of deeper brain areas in contrast to conventional figure-of-8 (Fo8) coils. However, systematic comparisons of these two coil types with respect to the spatial distribution of the magnetic field output and also to the induced activity in superficial and deeper brain areas are limited. Resting motor thresholds of the left and right first dorsal interosseous (FDI) and tibialis anterior (TA) were determined with the DC and the Fo8 coil in 17 healthy subjects. Coils were orientated over the corresponding motor area in an angle of 45 degrees for the hand area with the handle pointing in posterior direction and in medio-lateral direction for the leg area. Physical measurements were done with an automatic gantry table using a Gaussmeter. Resting motor threshold was higher for the leg area in contrast to the hand area and for the Fo8 in contrast to the DC coil. Muscle by coil interaction was also significant providing higher differences between leg and hand area for the Fo8 (about 27%) in contrast to the DC coil (about 15%). Magnetic field strength was higher for the DC coil in contrast to the Fo8 coil. The DC coil produces a higher magnetic field with higher depth of penetration than the figure of eight coil. KW - ANTERIOR CINGULATE CORTEX KW - CONNECTIVITY KW - Depression KW - FRONTAL-CORTEX KW - PREDICTOR KW - RTMS KW - STIMULATION KW - TMS Y1 - 2020 U6 - https://doi.org/10.1038/s41598-020-58034-2 VL - 10 IS - 1 PB - Nature ER - TY - JOUR A1 - Monkman, Gareth J. A1 - Striegl, Birgit A1 - Prem, Nina A1 - Sindersberger, Dirk T1 - Electrical Properties of Magnetoactive Boron‐Organo‐Silicon Oxide Polymers JF - Macromolecular Chemistry and Physics N2 - The electrical properties of rheopectic magnetoactive composites comprising boron-organo-silicon oxide dielectric matrices containing carbonyl iron microparticles are presented for the first time. The increase in interfacial magnetocapacitance is seen to greatly exceed that experienced when using conventional elastomeric matrices such as polydimethylsiloxane. In addition to the increase in capacitance, a simultaneous and sharp decrease in the parallel electrical resistance over several orders of magnitude is also observed. The effects are time dependent but repeatable. Potential applications include magnetically controlled frequency dependent devices, magnetic sensor systems, weighting elements for neural networks, etc. Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:898-opus4-26488 N1 - Corresponding author: Gareth J. Monkman VL - 221 IS - 4 SP - 1 EP - 8 PB - Wiley ER - TY - JOUR A1 - Geith, Markus A. A1 - Nothdurfter, Laurenz A1 - Heiml, Manuel A1 - Agrafiotis, Emmanouil A1 - Gruber, Markus A1 - Sommer, Gerhard A1 - Schratzenstaller, Thomas A1 - Holzapfel, Gerhard A. T1 - Quantifying stent-induced damage in coronary arteries by investigating mechanical and structural alterations JF - Acta Biomaterialia N2 - Vascular damage develops with diverging severity during and after percutaneous coronary intervention with stent placement and is the prevailing stimulus for in-stent restenosis. Previous work has failed to link mechanical data obtained in a realistic in vivo or in vitro environment with data collected during imaging processes. We investigated whether specimens of porcine right coronary arteries soften when indented with a stent strut shaped structure, and if the softening results from damage mechanisms inside the fibrillar collagen structure. To simulate the multiaxial loading scenario of a stented coronary artery, we developed the testing device ‘LAESIO’ that can measure differences in the stress-stretch behavior of the arterial wall before and after the indentation of a strut-like stamp. The testing protocol was optimized according to preliminary experiments, more specifically equilibrium and relaxation tests. After chemical fixation of the specimens and subsequent tissue clearing, we performed three-dimensional surface and second-harmonic generation scans on the deformed specimens. We analyzed and correlated the mechanical response with structural parameters of high-affected tissue located next to the stamp indentation and low-affected tissue beyond the injured area. The results reveal that damage mechanisms, like tissue compression as well as softening, fiber dispersion, and the lesion extent, are direction-dependent, and the severity of them is linked to the strut orientation, indentation pressure, and position. The findings highlight the need for further investigations by applying the proposed methods to human coronary arteries. Additional data and insights might help to incorporate the observed damage mechanisms into material models for finite element analyses to perform more accurate simulations of stent-implantations. KW - Percutaneous coronary intervention KW - Stent KW - Mechanical properties KW - Damage mechanism KW - Vascular injury KW - Coronary artery KW - Indentation test KW - Softening KW - Second-harmonic generation imaging KW - Micro-structure Y1 - 2020 U6 - https://doi.org/10.1016/j.actbio.2020.08.016 VL - 116 IS - October SP - 285 EP - 301 PB - Elsevier ER - TY - JOUR A1 - Geith, Markus A. A1 - Eckmann, Jakob D. A1 - Haspinger, Daniel Ch. A1 - Agrafiotis, Emmanouil A1 - Maier, Dominik A1 - Szabo, Patrick A1 - Sommer, Gerhard A1 - Schratzenstaller, Thomas A1 - Holzapfel, Gerhard A. T1 - Experimental and mathematical characterization of coronary polyamide-12 balloon catheter membranes JF - PLoS One N2 - The experimental quantification and modeling of the multiaxial mechanical response of polymer membranes of coronary balloon catheters have not yet been carried out. Due to the lack of insights, it is not shown whether isotropic material models can describe the material response of balloon catheter membranes expanded with nominal or higher, supra-nominal pressures. Therefore, for the first time, specimens of commercial polyamide-12 balloon catheters membranes were investigated during uniaxial and biaxial loading scenarios. Furthermore, the influence of kinematic effects on the material response was observed by comparing results from quasi-static and dynamic biaxial extension tests. Novel clamping techniques are described, which allow to test even tiny specimens taken from the balloon membranes. The results of this study reveal the semi-compliant, nonlinear, and viscoelastic character of polyamide-12 balloon catheter membranes. Above nominal pressure, the membranes show a pronounced anisotropic mechanical behavior with a stiffer response in the circumferential direction. The anisotropic feature intensifies with an increasing strain-rate. A modified polynomial model was applied to represent the realistic mechanical response of the balloon catheter membranes during dynamic biaxial extension tests. This study also includes a compact set of constitutive model parameters for the use of the proposed model in future finite element analyses to perform more accurate simulations of expanding balloon catheters. KW - Catheters KW - Anisotropy KW - Polymers KW - Viscoelasticity KW - Coronary stenting KW - Finite element analysis KW - Deformation KW - Adhesives Y1 - 2020 U6 - https://doi.org/10.1371/journal.pone.0234340 VL - 15 IS - 6 SP - 1 EP - 22 PB - PLOS ER - TY - JOUR A1 - Prantl, Lukas A1 - Eigenberger, Andreas A1 - Klein, Silvan A1 - Limm, Katharina A1 - Oefner, Peter J. A1 - Schratzenstaller, Thomas A1 - Felthaus, Oliver T1 - Shear Force Processing of Lipoaspirates for Stem Cell Enrichment Does Not Affect Secretome of Human Cells Detected by Mass Spectrometry In Vitro JF - Plastic and Reconstructive Surgery N2 - Background: Lipofilling is one of the most often performed surgical procedures in plastic and reconstructive surgery. Lipoaspirates provide a ready source of stem cells and secreted factors that contribute to neoangiogenesis and fat graft survival. However, the regulations about the enrichment of these beneficial cells and factors are ambiguous. In this study, the authors tested whether a combination of centrifugation and homogenization allowed the enrichment of viable stem cells in lipoaspirates through the selective removal of tumescent solution, blood, and released lipids without significantly affecting the cell secretome. Methods: Human lipoaspirate was harvested from six different patients using water jet–assisted liposuction. Lipoaspirate was homogenized by first centrifugation (3584 rpm for 2 minutes), shear strain (10 times intersyringe processing), and second centrifugation (3584 rpm for 2 minutes). Stem cell enrichment was shown by cell counting after stem cell isolation. Lipoaspirate from different processing steps (unprocessed, after first centrifugation, after homogenization, after second centrifugation) was incubated in serum-free cell culture medium for mass spectrometric analysis of secreted proteins. Results: Lipoaspirate homogenization leads to a significant 2.6 ± 1.75-fold enrichment attributable to volume reduction without reducing the viability of the stem cells. Protein composition of the secretome did not change significantly after tissue homogenization. Considering the enrichment effects, there were no significant differences in the protein concentration of the 83 proteins found in all processing steps. Conclusions: Stem cells can be enriched mechanically without significantly affecting the composition of secreted proteins. Shear-assisted enrichment of lipoaspirate constitutes no substantial manipulation of the cells’ secretome. Y1 - 2020 U6 - https://doi.org/10.1097/PRS.0000000000007343 VL - 146 IS - 6 SP - 749e EP - 758e PB - American Society of Plastic Surgeons ER - TY - JOUR A1 - Wiesent, Lisa A1 - Schultheiß, Ulrich A1 - Lulla, Philipp A1 - Noster, Ulf A1 - Schratzenstaller, Thomas A1 - Schmid, Christof A1 - Nonn, Aida A1 - Spear, Ashley T1 - Computational analysis of the effects of geometric irregularities and post-processing steps on the mechanical behavior of additively manufactured 316L stainless steel stents JF - PLoS ONE N2 - Advances in additive manufacturing enable the production of tailored lattice structures and thus, in principle, coronary stents. This study investigates the effects of process-related irregularities, heat and surface treatment on the morphology, mechanical response, and expansion behavior of 316L stainless steel stents produced by laser powder bed fusion and provides a methodological approach for their numerical evaluation. A combined experimental and computational framework is used, based on both actual and computationally reconstructed laser powder bed fused stents. Process-related morphological deviations between the as-designed and actual laser powder bed fused stents were observed, resulting in a diameter increase by a factor of 2-2.6 for the stents without surface treatment and 1.3-2 for the electropolished stent compared to the as-designed stent. Thus, due to the increased geometrically induced stiffness, the laser powder bed fused stents in the as-built (7.11 ± 0.63 N) or the heat treated condition (5.87 ± 0.49 N) showed increased radial forces when compressed between two plates. After electropolishing, the heat treated stents exhibited radial forces (2.38 ± 0.23 N) comparable to conventional metallic stents. The laser powder bed fused stents were further affected by the size effect, resulting in a reduced yield strength by 41% in the as-built and by 59% in the heat treated condition compared to the bulk material obtained from tensile tests. The presented numerical approach was successful in predicting the macroscopic mechanical response of the stents under compression. During deformation, increased stiffness and local stress concentration were observed within the laser powder bed fused stents. Subsequent numerical expansion analysis of the derived stent models within a previously verified numerical model of stent expansion showed that electropolished and heat treated laser powder bed fused stents can exhibit comparable expansion behavior to conventional stents. The findings from this work motivate future experimental/numerical studies to quantify threshold values of critical geometric irregularities, which could be used to establish design guidelines for laser powder bed fused stents/lattice structures. KW - Heat treatment KW - Lasers KW - Surface treatments KW - Specimen preparation and treatment KW - Material properties KW - Stiffness KW - Deformation KW - Powders KW - Koronarendoprothese KW - Rapid prototyping KW - Numerische Methode Y1 - 2020 U6 - https://doi.org/10.1371/journal.pone.0244463 N1 - Corresponding author: Lisa Wiesent VL - 15 IS - 12 SP - 1 EP - 30 PB - PLOS ER - TY - VIDEO A1 - Auer, Simon A1 - Reinker, Lukas A1 - Süß, Franz A1 - Kubowitsch, Simone A1 - Krutsch, Werner A1 - Weber, Markus A1 - Renkawitz, Tobias A1 - Dendorfer, Sebastian T1 - Webcast: Effect of mental demand on leg loading in highly dynamic motion N2 - Football players have a high risk of leg muscle injuries, especially when exposed to mental stress. Injuries to muscles of the thigh are common in amateur and professional football, representing almost a third of all injuries. These injuries occur primarily in non-contact situations and from overuse. They can lead to a range of costs, including financial costs associated with treatment as well as those associated with long-term recovery, and absence from training and/or competition. Further, there is a high risk of injury recurrence and subsequent injury. KW - Webcast KW - AnyBody KW - Stress KW - Football KW - Speedcourt Y1 - 2020 UR - https://www.youtube.com/watch?v=uSc_9XlnkaA ER - TY - VIDEO A1 - Melzner, Maximilian A1 - Engelhardt, Lucas T1 - AnyBody Webcast - A new musculoskeletal AnyBody™ detailed hand model Y1 - 2020 UR - https://www.youtube.com/watch?v=E4xnbjRJYm8&t=631s ER - TY - JOUR A1 - Visscher, Rosa A1 - Wyss, C. A1 - Singh, Navrag B. A1 - Taylor, William R. A1 - Dendorfer, Sebastian A1 - Rutz, E. A1 - Brunner, Reinald T1 - Influence of TAL-TATS surgery on energy production of Tricepts Surae - A musculoskeletal modeling evaluation JF - Gait & Posture Y1 - 2020 U6 - https://doi.org/10.1016/j.gaitpost.2020.08.090 VL - 81 IS - Suppl. 1 SP - 381 EP - 382 PB - Elsevier ER - TY - JOUR A1 - Engelhardt, Lucas A1 - Melzner, Maximilian A1 - Havelkova, Linda A1 - Fiala, Pavel A1 - Christen, Patrik A1 - Dendorfer, Sebastian A1 - Simon, Ulrich T1 - A new musculoskeletal AnyBodyTM detailed hand model JF - Computer Methods in Biomechanics and Biomedical Engineering N2 - Musculoskeletal research questions regarding the prevention or rehabilitation of the hand can be addressed using inverse dynamics simulations when experiments are not possible. To date, no complete human hand model implemented in a holistic human body model has been fully developed. The aim of this work was to develop, implement, and validate a fully detailed hand model using the AnyBody Modelling System (AMS) (AnyBody, Aalborg, Denmark). To achieve this, a consistent multiple cadaver dataset, including all extrinsic and intrinsic muscles, served as a basis. Various obstacle methods were implemented to obtain with the correct alignment of the muscle paths together with the full range of motion of the fingers. These included tori, cylinders, and spherical ellipsoids. The origin points of the lumbrical muscles within the tendon of the flexor digitorum profundus added a unique feature to the model. Furthermore, the possibility of an entire patient-specific scaling based on the hand length and width were implemented in the model. For model validation, experimental datasets from the literature were used, which included the comparison of numerically calculated moment arms of the wrist, thumb, and index finger muscles. In general, the results displayed good comparability of the model and experimental data. However, the extrinsic muscles showed higher accordance than the intrinsic ones. Nevertheless, the results showed, that the proposed developed inverse dynamics hand model offers opportunities in a broad field of applications, where the muscles and joint forces of the forearm play a crucial role. KW - Musculoskeletal KW - hand KW - AnyBody KW - inverse dynamics KW - moment arm Y1 - 2020 U6 - https://doi.org/10.1080/10255842.2020.1851367 VL - 24 IS - 7 SP - 777 EP - 787 PB - Taylor & Francis ER - TY - JOUR A1 - Auer, Simon A1 - Kurbowitsch, Simone A1 - Süß, Franz A1 - Renkawitz, Tobias A1 - Krutsch, Werner A1 - Dendorfer, Sebastian T1 - Mental stress reduces performance and changes musculoskeletal loading in football-related movements JF - Science and Medicine in Football N2 - Purpose: Football players have a high risk of leg muscle injuries, especially when exposed to mental stress. Hence, this study investigated the musculoskeletal response of elite youth football players during highly dynamic movements under stress. The hypothesis is that mental stress reduces performance and changes the muscular forces exerted. Materials & methods: Twelve elite youth football players were subjected to mental stress while performing sports-specific change-of-direction movements. A modified version of the d2 attention test was used as stressor. The kinetics are computed using inverse dynamics. Running times and exerted forces of injury-prone muscles were analysed. Results: The stressor runs were rated more mentally demanding by the players (p = 0.006, rs = 0.37) with unchanged physical demand (p = 0.777, rs = 0.45). This resulted in 10% longer running times under stress (p < 0.001, d = −1.62). The musculoskeletal analysis revealed higher peak muscle forces under mental stress for some players but not for others. Discussion: The study shows that motion capture combined with musculoskeletal computation is suitable to analyse the effects of stress on athletes in highly dynamic movements. For the first time in football medicine, our data quantifies an association between mental stress with reduced football players’ performance and changes in muscle force. KW - Biomechanics KW - muscle injury KW - attention KW - musculoskeletal simulation Y1 - 2020 U6 - https://doi.org/10.1080/24733938.2020.1860253 VL - 5 IS - 4 SP - 323 EP - 329 PB - Taylor & Francis ER - TY - GEN A1 - Dendorfer, Sebastian T1 - The influence of mental stress on the musculoskeletal system Y1 - 2020 ER - TY - GEN A1 - Melzner, Maximilian A1 - Engelhardt, Leonard A1 - Süß, Friedrich A1 - Dendorfer, Sebastian T1 - Sensitivity evaluation of a musculoskeletal hand model using Latin hypercube sampling T2 - ESMAC 2020 Abstracts Y1 - 2020 U6 - https://doi.org/10.1016/j.gaitpost.2020.08.008 VL - 81 IS - Suppl. 1 PB - Elsevier ER - TY - JOUR A1 - Auer, Simon A1 - Krutsch, Werner A1 - Renkawitz, Tobias A1 - Kubowitsch, Simone A1 - Süß, Franz A1 - Dendorfer, Sebastian T1 - Kognitiver Stress führt zu unphysiologisch erhöhten Kniebelastungen im Profifußball JF - Sports Orthopaedics and Traumatology Y1 - 2020 U6 - https://doi.org/10.1016/j.orthtr.2020.04.122 VL - 36 IS - 2 SP - 202 EP - 203 PB - Elsevier ER - TY - GEN A1 - Auer, Simon A1 - Krutsch, Werner A1 - Renkawitz, Tobias A1 - Kubowitsch, Simone A1 - Süß, Franz A1 - Dendorfer, Sebastian T1 - Effect of mental demand on leg loading in highly dynamic motion T2 - AnyBody online Webinar, Oct 2020 N2 - Football players have a high risk of leg muscle injuries, especially when exposed to mental stress. Injuries to muscles of the thigh are common in amateur and professional football, representing almost a third of all injuries. These injuries occur primarily in non-contact situations and from overuse. They can lead to a range of costs, including financial costs associated with treatment as well as those associated with long-term recovery, and absence from training and/or competition. Further, there is a high risk of injury recurrence and subsequent injury. Y1 - 2020 ER - TY - GEN A1 - Melzner, Maximilian A1 - Pfeifer, Christian A1 - Alt, V. A1 - Süß, Franz A1 - Dendorfer, Sebastian T1 - Änderung der Gelenkreaktionskraft bei Schädigung des medialen Bandapparates im Ellenbogen T2 - Zeitschrift fur Orthopadie und Unfallchirurgie KW - Muskuloskelettale Simulation KW - Ellenbogenstabilität Y1 - 2020 U6 - https://doi.org/10.1055/s-0040-1717270 N1 - Poster VL - 158 IS - S01 PB - Thieme ER - TY - JOUR A1 - Weber, Markus A1 - Merle, Christian A1 - Nawabi, Danyal H. A1 - Dendorfer, Sebastian A1 - Grifka, Joachim A1 - Renkawitz, Tobias T1 - Inaccurate offset restoration in total hip arthroplasty results in reduced range of motion JF - Scientific Reports N2 - Offset restoration in total hip arthroplasty (THA) is associated with postoperative range of motion (ROM) and gait kinematics. We aimed to research into the impact of high offset (HO) and standard stems on postoperative ROM. 121 patients received cementless THA through a minimally-invasive anterolateral approach. A 360° hip ROM analysis software calculated impingement-free hip movement based on postoperative 3D-CTs compared to ROM values necessary for activities of daily living (ADL). The same model was then run a second time after changing the stem geometry between standard and HO configuration with the implants in the same position. HO stems showed higher ROM for all directions between 4.6 and 8.9° (p < 0.001) compared with standard stems but with high interindividual variability. In the subgroup with HO stems for intraoperative offset restoration, the increase in ROM was even higher for all ROM directions with values between 6.1 and 14.4° (p < 0.001) compared to offset underrestoration with standard stems. Avoiding offset underrestoration resulted in a higher amount of patients of over 20% for each ROM direction that fulfilled the criteria for ADL (p < 0.001). In contrast, in patients with standard stems for offset restoration ROM did increase but not clinically relevant by offset overcorrection for all directions between 3.1 and 6.1° (p < 0.001). Offset overcorrection by replacing standard with HO stems improved ROM for ADL in a low number of patients below 10% (p > 0.03). Patient-individual restoration of offset is crucial for free ROM in THA. Both over and underrestoration of offset should be avoided. KW - Adaptive clinical trial KW - Bone imaging Y1 - 2020 U6 - https://doi.org/10.1038/s41598-020-70059-1 VL - 10 IS - 13208 SP - 9 PB - Nature ER - TY - JOUR A1 - Aurbach, Maximilian A1 - Špička, Jan A1 - Süß, Franz A1 - Vychytil, J. A1 - Havelková, Leonard A1 - Ryba, T. A1 - Dendorfer, Sebastian T1 - Torus obstacle method as a wrapping approach of the deltoid muscle group for humeral abduction in musculoskeletal simulation JF - Journal of Biomechanics N2 - Musculoskeletal models of the shoulder complex are valuable research aids to investigate tears of the supraspinatus and the resulting mechanical impact during abduction of the humerus. One of the major contributors to this motion is the deltoid muscle group and for this, an accurate modeling of the lines of action is indispensable. The aim of this work was to utilize a torus obstacle wrapping approach for the deltoids of an existing shoulder model and assess the feasibility of the approach during humeral abduction. The shoulder model from the AnyBody™ modeling system was used as a platform. The size of the tori is based on a magnetic resonance imaging (MRI) approach and several kinematic couplings are implemented to determine the trajectories of the tori during abduction. To assess the model behavior, the moment arms of the virtual muscle elements and the resultant glenohumeral joint reaction force (GHJF) were compared with reference data from the literature during abduction of the humerus in the range 20°–120°. The root mean square error for the anterior, lateral and posterior part between the simulated muscle elements and reference data from the literature was 3.9, 1.7 and 5.8 mm, respectively. The largest deviation occurred on the outer elements of the muscle groups, with 12.6, 10.4 and 20.5 mm, respectively. During abduction, there is no overlapping of the muscle elements and these are in continuous contact with the torus obstacles, thus enabling a continuous force transmission. This results in a rising trend of the resultant GHJF. The torus obstacle approach as a wrapping method for the deltoid muscles provides a guided muscle pathing by simultaneously approximating the curvature of the deltoid muscle. The results from the comparison of the simulated moment arms and the resultant GHJF are in accordance with those in the literature in the range 20°–120° of abduction. Although this study shows the strength of the torus obstacle as a wrapping approach, the method of fitting the tori according to MRI data was not suitable. A cadaver study is recommended to better validate and mathematically describe the torus approach. KW - Muscoloskeletal model KW - AnyBody Modeling System KW - MRI KW - Shoulder joint complex KW - Muscle trajectory KW - Torus KW - Wrapping Y1 - 2020 U6 - https://doi.org/10.1016/j.jbiomech.2020.109864 VL - 109 IS - August PB - Elsevier ER - TY - CHAP A1 - Auer, Simon A1 - Kubowitsch, Simone A1 - Krutsch, Werner A1 - Renkawitz, Tobias A1 - Süß, Franz A1 - Dendorfer, Sebastian T1 - Effect of mental demand on knee forces in professional youth soccer players T2 - ISBS Proceedings Archive N2 - Soccer is one of the most popular sports all around the world. It is an injurious type of sport with a focus on lower extremities and high psychological pressure during matches. The stressor is linked with injuries and an increased musculoskeletal loading. This study investigates the influence of cognitive stress on the load profile of the knee joint. Twelve professional youth soccer players performed highly dynamic runs with and without additional cognitive stress. The runs were analysed with a musculoskeletal simulation software. The data analysis shows no difference in knee joint reaction loading under additional mental stress compared to the baseline. Yet running times are significantly lower in the baseline. While there is no increase in the joint loads, the running times indicate an altered movement behaviour when the subjects are exposed to additional mental demand. KW - Kniegelenk KW - Körperliche Belastung KW - Stress KW - Computersimulation Y1 - 2020 UR - https://commons.nmu.edu/isbs/vol38/iss1/28 VL - 38 IS - 1, Art. 28 ER - TY - JOUR A1 - Hartmann, Robin A1 - Weiherer, Maximilian A1 - Schiltz, Daniel A1 - Seitz, Stephan A1 - Lotter, Luisa A1 - Anker, Alexandra A1 - Palm, Christoph A1 - Prantl, Lukas A1 - Brébant, Vanessa T1 - A Novel Method of Outcome Assessment in Breast Reconstruction Surgery: Comparison of Autologous and Alloplastic Techniques Using Three-Dimensional Surface Imaging JF - Aesthetic Plastic Surgery N2 - Background Breast reconstruction is an important coping tool for patients undergoing a mastectomy. There are numerous surgical techniques in breast reconstruction surgery (BRS). Regardless of the technique used, creating a symmetric outcome is crucial for patients and plastic surgeons. Three-dimensional surface imaging enables surgeons and patients to assess the outcome’s symmetry in BRS. To discriminate between autologous and alloplastic techniques, we analyzed both techniques using objective optical computerized symmetry analysis. Software was developed that enables clinicians to assess optical breast symmetry using three-dimensional surface imaging. Methods Twenty-seven patients who had undergone autologous (n = 12) or alloplastic (n = 15) BRS received three-dimensional surface imaging. Anthropomorphic data were collected digitally using semiautomatic measurements and automatic measurements. Automatic measurements were taken using the newly developed software. To quantify symmetry, a Symmetry Index is proposed. Results Statistical analysis revealed that there is no dif- ference in the outcome symmetry between the two groups (t test for independent samples; p = 0.48, two-tailed). Conclusion This study’s findings provide a foundation for qualitative symmetry assessment in BRS using automatized digital anthropometry. In the present trial, no difference in the outcomes’ optical symmetry was detected between autologous and alloplastic approaches. KW - Breast reconstruction KW - Breast symmetry KW - Digital anthropometry KW - Mammoplastik KW - Dreidimensionale Bildverarbeitung KW - Autogene Transplantation KW - Alloplastik Y1 - 2020 U6 - https://doi.org/10.1007/s00266-020-01749-4 VL - 44 SP - 1980 EP - 1987 PB - Springer CY - Heidelberg ER - TY - JOUR A1 - De Pieri, Enrico A1 - Atzori, Federica A1 - Ferguson, Stephen J. A1 - Dendorfer, Sebastian A1 - Leunig, Michael A1 - Aepli, Martin T1 - Contact force path in total hip arthroplasty: effect of cup medialisation in a whole-body simulation JF - HIP International N2 - Background: Cup medialisation down to the true acetabular floor in total hip arthroplasty with a compensatory femoral offset increase seems to be mechanically advantageous for the abductor muscles due to the relocation of the lever arms (body weight lever arm decreased, abductor lever arm increased). However, limited information is currently available about the effects of this reconstruction type at the head cup interface, compared to an anatomical reconstruction that maintains the natural lever arms. Through a whole-body simulation analysis, we compared medialised versus anatomical reconstruction in THA to analyse the effects on: (1) contact force magnitude at the head cup interface; (2) contact force path in the cup; and (3) abductor activity. Methods: Musculoskeletal simulations were performed to calculate the above-mentioned parameters using inverse dynamics analysis. The differences between the virtually implanted THAs were calculated to compare the medialised versus anatomical reconstruction. Results: Cup medialisation with compensatory femoral offset increase led to: (1) a reduction in contact force magnitude at the head cup interface up to 6.6%; (2) a similar contact force path in the cup in terms of sliding distance and aspect ratio; and (3) a reduction in abductor activity up to 17.2% (gluteus medius). Conclusions: In our opinion, these potential biomechanical gains do not generally justify a fully medialised reconstruction, especially in younger patients that are more likely to undergo revision surgery in their lifetime. Cup medialisation should be performed until sufficient press fit and bony coverage of a properly sized and oriented cup can be achieved. KW - Cup medialisation KW - femoral offset KW - hip contact force KW - total hip anthroplasty KW - total hip replacement KW - Hüftgelenkprothese KW - Kontaktkraft KW - Biomechanische Analyse KW - Simulation Y1 - 2020 U6 - https://doi.org/10.1177/1120700020917321 VL - 31 IS - 5 SP - 624 EP - 631 PB - Sage ER - TY - JOUR A1 - Aurbach, Maximilian A1 - Spicka, Jan A1 - Süß, Franz A1 - Dendorfer, Sebastian T1 - Evaluation of musculoskeletal modelling parameters of the shoulder complex during humeral abduction above 90° JF - Journal of Biomechanics N2 - Based on electromyographic data and force measurements within the shoulder joint, there is an indication that muscle and resulting joint reaction forces keep increasing over an abduction angle of 90°. In inverse dynamics models, no single parameter could be attributed to simulate this force behaviour accordingly. The aim of this work is to implement kinematic, kinetic and muscle model modifications to an existing model of the shoulder (AnyBody™) and assess their single and combined effects during abduction up to 140° humeral elevation. The kinematics and the EMG activity of 10 test subjects were measured during humeral abduction. Six modifications were implemented in the model: alternative wrapping of the virtual deltoid muscle elements, utilization of a three element Hill model, strength scaling, motion capture driven clavicle elevation/protraction, translation of the GH joint in dependency of the acting forces and an alteration of the scapula/clavicle rhythm. From the six modifications, 16 different combinations were considered. Parameter combinations with the Hill model changed the resultant GH joint reaction force and led to an increase in force during abduction of the humerus above 90°. Under the premise of muscle activities and forces within the GH joint rising after 90° of humeral abduction, we propose that the Hill type muscle model is a crucial parameter for accurately modelling the shoulder. Furthermore, the outcome of this study indicates that the Hill model induces the co-contraction of the muscles of the shoulder without the need of an additional stability criterion for an inverse dynamics approach. KW - Shoulder joint KW - Musculoskeletal modelling KW - EMG KW - Glenohumeral joint reaction force KW - Muscle model KW - Schultergelenk KW - Bewegungsapparat KW - Biomechanik KW - Simulation Y1 - 2020 U6 - https://doi.org/10.1016/j.jbiomech.2020.109817 VL - 106 IS - June PB - Elsevier ER - TY - CHAP A1 - Raptis, Georgios ED - Marschner, Uwe ED - Clasbrummel, Bernhard ED - Dehm, Johannes T1 - Gewährleistung der IT-Sicherheit bei vernetzten Implantaten T2 - Biomedizinische Technik: Vernetzte und intelligente Implantate KW - Implantat KW - Vernetzung KW - Datenschutz KW - Datensicherung KW - Personenbezogene Daten Y1 - 2020 SN - 978-3-11-034927-6 SP - 182 EP - 192 PB - Walter de Gruyter ER - TY - CHAP A1 - Weiherer, Maximilian A1 - Zorn, Martin A1 - Wittenberg, Thomas A1 - Palm, Christoph ED - Tolxdorff, Thomas ED - Deserno, Thomas M. ED - Handels, Heinz ED - Maier, Andreas ED - Maier-Hein, Klaus H. ED - Palm, Christoph T1 - Retrospective Color Shading Correction for Endoscopic Images T2 - Bildverarbeitung für die Medizin 2020. Algorithmen - Systeme - Anwendungen. Proceedings des Workshops vom 15. bis 17. März 2020 in Berlin N2 - In this paper, we address the problem of retrospective color shading correction. An extension of the established gray-level shading correction algorithm based on signal envelope (SE) estimation to color images is developed using principal color components. Compared to the probably most general shading correction algorithm based on entropy minimization, SE estimation does not need any computationally expensive optimization and thus can be implemented more effciently. We tested our new shading correction scheme on artificial as well as real endoscopic images and observed promising results. Additionally, an indepth analysis of the stop criterion used in the SE estimation algorithm is provided leading to the conclusion that a fixed, user-defined threshold is generally not feasible. Thus, we present new ideas how to develop a non-parametric version of the SE estimation algorithm using entropy. KW - Endoskopie KW - Bildgebendes Verfahren KW - Farbenraum KW - Graustufe Y1 - 2020 SN - 978-3-658-29266-9 U6 - https://doi.org/10.1007/978-3-658-29267-6 SP - 14 EP - 19 PB - Springer Vieweg CY - Wiesbaden ER - TY - CHAP A1 - Chang, Ching-Sheng A1 - Lin, Jin-Fa A1 - Lee, Ming-Ching A1 - Palm, Christoph ED - Tolxdorff, Thomas ED - Deserno, Thomas M. ED - Handels, Heinz ED - Maier, Andreas ED - Maier-Hein, Klaus H. ED - Palm, Christoph T1 - Semantic Lung Segmentation Using Convolutional Neural Networks T2 - Bildverarbeitung für die Medizin 2020. Algorithmen - Systeme - Anwendungen. Proceedings des Workshops vom 15. bis 17. März 2020 in Berlin N2 - Chest X-Ray (CXR) images as part of a non-invasive diagnosis method are commonly used in today’s medical workflow. In traditional methods, physicians usually use their experience to interpret CXR images, however, there is a large interobserver variance. Computer vision may be used as a standard for assisted diagnosis. In this study, we applied an encoder-decoder neural network architecture for automatic lung region detection. We compared a three-class approach (left lung, right lung, background) and a two-class approach (lung, background). The differentiation of left and right lungs as direct result of a semantic segmentation on basis of neural nets rather than post-processing a lung-background segmentation is done here for the first time. Our evaluation was done on the NIH Chest X-ray dataset, from which 1736 images were extracted and manually annotated. We achieved 94:9% mIoU and 92% mIoU as segmentation quality measures for the two-class-model and the three-class-model, respectively. This result is very promising for the segmentation of lung regions having the simultaneous classification of left and right lung in mind. KW - Neuronales Netz KW - Segmentierung KW - Brustkorb KW - Deep Learning KW - Encoder-Decoder Network KW - Chest X-Ray Y1 - 2020 SN - 978-3-658-29266-9 U6 - https://doi.org/10.1007/978-3-658-29267-6_17 SP - 75 EP - 80 PB - Springer Vieweg CY - Wiesbaden ER - TY - JOUR A1 - Maier, Johannes A1 - Weiherer, Maximilian A1 - Huber, Michaela A1 - Palm, Christoph T1 - Optically tracked and 3D printed haptic phantom hand for surgical training system JF - Quantitative Imaging in Medicine and Surgery N2 - Background: For surgical fixation of bone fractures of the human hand, so-called Kirschner-wires (K-wires) are drilled through bone fragments. Due to the minimally invasive drilling procedures without a view of risk structures like vessels and nerves, a thorough training of young surgeons is necessary. For the development of a virtual reality (VR) based training system, a three-dimensional (3D) printed phantom hand is required. To ensure an intuitive operation, this phantom hand has to be realistic in both, its position relative to the driller as well as in its haptic features. The softest 3D printing material available on the market, however, is too hard to imitate human soft tissue. Therefore, a support-material (SUP) filled metamaterial is used to soften the raw material. Realistic haptic features are important to palpate protrusions of the bone to determine the drilling starting point and angle. An optical real-time tracking is used to transfer position and rotation to the training system. Methods: A metamaterial already developed in previous work is further improved by use of a new unit cell. Thus, the amount of SUP within the volume can be increased and the tissue is softened further. In addition, the human anatomy is transferred to the entire hand model. A subcutaneous fat layer and penetration of air through pores into the volume simulate shiftability of skin layers. For optical tracking, a rotationally symmetrical marker attached to the phantom hand with corresponding reference marker is developed. In order to ensure trouble-free position transmission, various types of marker point applications are tested. Results: Several cuboid and forearm sample prints lead to a final 30 centimeter long hand model. The whole haptic phantom could be printed faultless within about 17 hours. The metamaterial consisting of the new unit cell results in an increased SUP share of 4.32%. Validated by an expert surgeon study, this allows in combination with a displacement of the uppermost skin layer a good palpability of the bones. Tracking of the hand marker in dodecahedron design works trouble-free in conjunction with a reference marker attached to the worktop of the training system. Conclusions: In this work, an optically tracked and haptically correct phantom hand was developed using dual-material 3D printing, which can be easily integrated into a surgical training system. KW - Handchirurgie KW - 3D-Druck KW - Lernprogramm KW - Zielverfolgung KW - HaptiVisT KW - Dual-material 3D printing KW - hand surgery training KW - metamaterial KW - tissue imitating phantom hand Y1 - 2020 U6 - https://doi.org/10.21037/qims.2019.12.03 N1 - Corresponding author: Christoph Palm VL - 10 IS - 02 SP - 340 EP - 455 PB - AME Publishing Company CY - Hong Kong, China ER -