BackgroundComputational modeling of cardiovascular flow is a growing and useful field, but such simulations usually require the researcher to guess the flow’s inlet and outlet conditions since they are difficult and expensive to measure. It is critical to determine the amount of uncertainty introduced by these assumptions in order to evaluate the degree to which cardiovascular flow simulations are accurate. Our work begins to address this question by examining the sensitivity of flow to several different assumed velocity inlet and outlet conditions in a patient-specific aorta model.MethodsWe examined the differences between plug flow, parabolic flow, linear shear flows, skewed cubic flow profiles, and Womersley flow at the inlet. Only the shape of the inlet velocity profile was varied—all other parameters were identical among these simulations. Secondary flow in the form of a counter-rotating pair of vortices was also added to parabolic axial flow to study its effect on the solution. In addition, we examined the differences between two-element Windkessel, three element Windkessel and the outflow boundary conditions. In these simulations, only the outlet boundary condition was varied.ResultsThe results show axial and in-plane velocities are considerably different close to the inlet for the cases with different inlet velocity profile shapes. However, the solutions are qualitatively similar beyond 1.75D, where D is the inlet diameter. This trend is also observed in other quantities such as pressure and wall shear stress. Normalized root-mean-square deviation, a measure of axial velocity magnitude differences between the different cases, generally decreases along the streamwise coordinate. The linear shear inlet velocity boundary condition and plug velocity boundary condition solution exhibit the highest time-averaged wall shear stress, approximately higher than the parabolic inlet velocity boundary condition. Upstream of 1D from the inlet, adding secondary flow has a significant impact on temporal wall shear stress distributions. This is especially observable during diastole, when integrated wall shear stress magnitude varies about between simulations with and without secondary flow. The results from the outlet boundary condition study show the Windkessel models differ from the outflow boundary condition by as much as in terms of time-averaged wall shear stress. Furthermore, normalized root-mean-square deviation of axial velocity magnitude, a measure of deviation between Windkessel and the outflow boundary condition, increases along the streamwise coordinate indicating larger variations near outlets.ConclusionIt was found that the selection of inlet velocity conditions significantly affects only the flow region close to the inlet of the aorta. Beyond two diameters distal to the inlet, differences in flow solution are small. Although additional studies must be performed to verify this result, the data suggest that it is important to use patient-specific inlet conditions primarily if the researcher is concerned wit...

Background and aims: Endothelial surface glycocalyx shedding plays a role in endothelial dysfunction and increases vessel wall permeability, which can lead to inflammation and atherogenesis. We sought to elucidate whether a high fat diet (HFD) or disturbed blood flow conditions, both of which are atherogenic risk factors, would contribute more detrimentally to pre-atherosclerotic loss of endothelial glycocalyx integrity and vascular inflammation. Methods: Six to seven week-old C57BL/6-background apolipoprotein-E-knockout (ApoE-KO) male mice were either fed a chow diet, fed a modified Western HFD, and/or subjected to a partial left carotid artery (LCA) ligation procedure to induce disturbed blood flow patterns in the LCA. Mice were sacrificed after 1 week of experimental conditions. Both LCA and right carotid artery (RCA) vessels were dissected and preserved to compare glycocalyx coverage and thickness as well as macrophage accumulation in carotid arterial walls amongst and between cohorts. Results: Glycocalyx coverage of the endothelium was significantly reduced in the LCAs of HFD fed mice when compared to the control. More significant reduction in glycocalyx coverage occurred in the LCAs of mice exposed to disturbed flow by partial LCA ligation when compared to the control. No differences were found in glycocalyx coverage of RCAs from all cohorts. Regarding inflammation, no difference in macrophage accumulation in carotid arterial walls was observed when comparing the LCAs and RCAs of control and HFD fed mice. However, macrophage infiltration in vessel walls showed a 20-fold increase in the LCAs exposed to disturbed flow following ligation, when compared to control LCAs, while no such statistical difference was observed between the RCAs of the group. Conclusions: In our mouse model, endothelial glycocalyx integrity was compromised more by disturbed blood flow patterns than by exposure of the carotid vessel to HFD conditions. The pathophysiological implications include endothelial dysfunction, which correlates to macrophage infiltration in vessel walls and promotes atherogenesis.

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In this study, we develop a physiologic internal pressure and wall stress analysis procedure and apply it to a patient-specific abdominal aortic aneurysm model. Timedependent pressure loading of the inner vessel wall was experimentally measured in a 3D printed aneurysm phantom. The results were used as boundary conditions for finite element calculations of von Mises stresses throughout the AAA model over the cardiac cycle. A nonlinear hyperelastic constitutive law with parameters based on biaxial stress-deformation data from aneurysmal tissue samples was used to describe the mechanical behavior of the aneurysm wall. The internal pressure was found to be fairly spatially uniform (within 10%) over most of the cardiac cycle, but average internal pressure varied by more than a factor of two between systole and diastole. The aneurysm wall stress was highly spatially nonuniform. The highest value of von Mises stress was localized in a small area within the aneurysm bulge and remained in the same place throughout the cardiac cycle, suggesting that this area was the most likely point of rupture. Large variations in wall stress over the cardiac cycle suggest calculations that assume steady flow are a poor approximation for physiological stresses. K E Y W O R D SAAA, abdominal aortic aneurysm, finite element analysis, flow field measurements 2258

Purpose: Next-generation extremely rapid radiation therapy systems could mitigate the need for motion management, improve patient comfort during the treatment, and increase patient throughput for cost effectiveness. Such systems require an on-board imaging system that is competitively priced, fast, and of sufficiently high quality to allow good registration between the image taken on the day of treatment and the image taken the day of treatment planning. In this study, three different detectors for a custom on-board CT system were investigated to select the best design for integration with an extremely rapid radiation therapy system. Methods: Three different CT detectors are proposed: low-resolution (all 4 × 4 mm pixels), mediumresolution (a combination of 4 × 4 mm pixels and 2 × 2 mm pixels), and high-resolution (all 1 × 1 mm pixels). An in-house program was used to generate projection images of a numerical anthropomorphic phantom and to reconstruct the projections into CT datasets, henceforth called "realistic" images. Scatter was calculated using a separate Monte Carlo simulation, and the model included an antiscatter grid and bowtie filter. Diagnostic-quality images of the phantom were generated to represent the patient scan at the time of treatment planning. Commercial deformable registration software was used to register the diagnostic-quality scan to images produced by the various on-board detector configurations. The deformation fields were compared against a "gold standard" deformation field generated by registering initial and deformed images of the numerical phantoms that were used to make the diagnostic and treatment-day images. Registrations of on-board imaging system data were judged by the amount their deformation fields differed from the corresponding gold standard deformation fields-the smaller the difference, the better the system. To evaluate the registrations, the pointwise distance between gold standard and realistic registration deformation fields was computed. Results: By most global metrics (e.g., mean, median, and maximum pointwise distance), the highresolution detector had the best performance but the medium-resolution detector was comparable. For all medium-and high-resolution detector registrations, mean error between the realistic and gold standard deformation fields was less than 4 mm. By pointwise metrics (e.g., tracking a small lesion), the high-and medium-resolution detectors performed similarly. For these detectors, the smallest error between the realistic and gold standard registrations was 0.6 mm and the largest error was 3.6 mm. Conclusions: The medium-resolution CT detector was selected as the best for an extremely rapid radiation therapy system. In essentially all test cases, data from this detector produced a significantly better registration than data from the low-resolution detector and a comparable registration to data from the high-resolution detector. The medium-resolution detector provides an appropriate compromise between registration accuracy and system cost. C 201...