CIBC:Collab:Triedman

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Modeling Internal Defibrillators in Children

Department of Cardiology, Children's Hospital Boston

Matthew Jolley, MD

John Triedman, MD

Scientific Computing and Imaging Institute

Dana Brooks, PhD, NorthEastern University

Robert MacLeod, PhD, Utah

Jeroen Stinstra, PhD, Utah

Joshua Cates, Utah

McKay Davis, Utah

David Weinstein, PhD, Utah

Surgical Planning Laboratory

Carl-Fredrik Westin, PhD

Raul San-Jose Estepar, PhD

Steve Pieper, PhD

Gordon Kindlmann, PhD

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.

Goals of Project

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 SCI and SPL to integrate open source tools to allow creation, visualization, and computational modeling of image based 3D models.

2. Create modules which allow insertion of electrode shapes into finite element models in SCIRun/BioPSE. This requires advanced local remeshing to remove "tissue" elements and insert the "electrode elements" for which electrical properties can be independently and adaptively set.

3. Utilize 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.