Development and Testing of a Prototype Pregnant Abdomen for the Small-Female Hybrid III ATD

The ethics, applications, and contributions of cadaver testing in injury prevention research

OBJECTIVE

This study aims to establish best practices and guidelines to ensure that experimental research utilizing Postmortem Human Subjects (PMHS) for injury prevention adheres to relevant ethical principles, which are also commonly accepted in research involving human tissues and living subjects. Furthermore, it reviews existing literature to underscore the pivotal role of PMHS testing in evaluating the efficacy of safety systems, with a particular focus on airbag performance.

METHODS

This paper conducts an examination of the primary ethical principles governing human subject research as outlined in the Declaration of Helsinki (1965) and traces their evolution up to the latest framework proposed by the Council for International Organizations of Medical Sciences (CIOMS) in 2002. Input was solicited from international experts and laboratories experienced in PMHS testing to understand how these ethical principles are implemented in practice. This is complemented by a comprehensive review of literature that assesses the contribution of PMHS testing to airbag performance enhancements in frontal impacts.

RESULTS

The findings underscore the importance of informed consent from donors or their next-of-kin, as highlighted in CIOMS declarations, to ensure the ethical integrity of the donation process in line with international standards. The study also finds it customary for an independent review board to evaluate the research methodology and the necessity of employing PMHS tissue over alternative methods, such as computational models or crash test dummies. Despite various national regulations on human subject participation and living tissue research, no specific legal framework governing PMHS tissue use was identified. The systematic literature review revealed that PMHS testing has been crucial in identifying potential injury mechanisms not detected by Anthropomorphic Test Devices (ATD), significantly contributing to the enhancement of computer human body models and the biofidelity of crash test dummies.

CONCLUSION

The International Council on the Biomechanics of Injury (IRCOBI) recognizes the need to provide guidance for research involving human cadaveric tissue to be conducted with the highest ethical standards. This study proposes five recommendations to ensure adherence to these ethical principles in PMHS testing, highlighting the paramount importance of obtaining informed consent and securing independent committee approval. Moreover, IRCOBI emphasizes that until a thorough understanding of tissue damage tolerance levels is achieved and human surrogates, such as ATDs or Human Body Models (HBM), reach full biofidelity, the use of human cadavers remains indispensable for developing effective injury prevention strategies and measures.

Severity of Placental Abruption in Restrained Pregnant Vehicle Drivers: Correct Seat Belt Use Confirmed by Finite Element Model Analysis

Despite wearing a seat belt, pregnant drivers often suffer from negative fetal outcomes in the event of motor accidents. In order to maintain the safety of pregnant drivers and their fetuses, we assessed the severity of placental abruption caused by motor vehicle collisions using computer simulations. We employed a validated pregnant finite element model to determine the area of placental abruption. We investigated frontal vehicle collisions with a speed of 40 km/h or less involving restrained pregnant drivers with a gestational age of 30 weeks. For a crash speed of 40 km/h, the placental abruption area was 7.0% with a correctly positioned lap belt across the lower abdomen; it was 36.3% with the belt positioned at the umbilicus. The area of placental abruption depended on collision speed, but we found that with a correctly positioned belt it likely would not lead to negative fetal outcomes. We examined the effects on placental abruptions of reconfiguring seat belt width and force limiter setting. A wider lap belt and lower force limiter setting reduced the area of placental abruption to 3.5% and 1.1%, respectively; however, they allowed more forward movement upon collision. A 2.5 kN force limiter setting may be appropriate with respect to both forward movement and reduced placental abruption area. This study confirmed the importance of correctly using seat belts for pregnant drivers. It provides valuable evidence about improving safety equipment settings.

Factors Affecting the Severity of Placental Abruption in Pregnant Vehicle Drivers: Analysis with a Novel Finite Element Model

We clarified factors affecting the severity of placental abruption in motor vehicle collisions by quantitively analyzing the area of placental abruption in a numerical simulation of an unrestrained pregnant vehicle driver at collision velocities of 3 and 6 m/s. For the simulation, we constructed a novel finite element model of a small 30-week pregnant woman, which was validated anthropometrically using computed tomography data and biomechanically using previous examinations of post-mortem human subjects. In the simulation, stress in the elements of the utero–placental interface was computed, and those elements exceeding a failure criterion were considered to be abrupted. It was found that a doubling of the collision velocity increased the area of placental abruption 10-fold, and the abruption area was approximately 20% for a collision velocity of 6 m/s, which is lower than the speed limit for general roads. This result implies that even low-speed vehicle collisions have negative maternal and fetal outcomes owing to placental abruption without a seatbelt restraint. Additionally, contact to the abdomen, 30 mm below the umbilicus, led to a larger placental abruption area than contact at the umbilicus level when the placenta was located at the uterus fundus. The results support that a reduction in the collision speed and seatbelt restraint at a suitable position are important to decrease the placental abruption area and therefore protect a pregnant woman and her fetus in a motor vehicle collision.

Thoracoabdominal organ volumes for small women

OBJECTIVE

Thoracoabdominal injuries commonly occur as a result of motor vehicle crashes. In order to design occupant protection systems that reduce risk of injury, researchers are using a variety of tools, including computational human body models. Though research has been conducted to provide morphological and volumetric data for the thoracoabdominal cavity of the average male, there is currently an interest in developing models for a wider range of occupants. One particular cohort of interest is the small female by stature and weight because of their use in restraint system development. Geometric data on thoracoabdominal organs are needed to construct accurate representations of female occupants. This study aimed to gather information on organ volumes from clinical medical imaging studies of small females.

METHODS

Anonymized clinical computed tomography (CT) and magnetic resonance images were used to segment organs relevant to crash-induced injuries: namely, the liver, spleen, left kidney, right kidney, pancreas, gallbladder, lungs, and heart. Segmentations were conducted using semi-automatic techniques. Additionally, diametric measurements of the vena cava, aorta, trachea, and colon were obtained from the medical images at discrete locations using linear measurement tools.

RESULTS

A total of 14 adult scans were selected with stature and weight ranges of 145.0 to 162.6 cm and 43.7 to 65.5 kg, respectively. The following are the average thoracoabdominal organ volumes: liver (1,224.5 ± 220.7 mL), spleen (151.6 ± 42.1 mL), left kidney (123.7 ± 20.1 mL), right kidney (115.4 ± 20.9 mL), heart (417.8 ± 36.6 mL), pancreas (54.1 ± 11.8 mL), and gallbladder (20.6 ± 13.4 mL). The average diameters were 19.7 ± 3.2 mm and 17.7 ± 5.1 mm for the vena cava and aorta, respectively. The colon had an average diameter of 37.9 ± 7.1 mm.

CONCLUSION

Data characterizing the small female are important to validate the geometries used in computational models, including models derived from scaling techniques and those developed using subject-specific medical imaging. The goal of this study was to use a sample of subjects anthropometrically representative of small females to evaluate the average volume for organs commonly injured in motor vehicle crashes. Based on these data, the right and left lungs were strongly correlated with stature and the heart was strongly correlated with weight. Ultimately, these measurements will be useful for the validation of computational models of the small female.

Physics-Based Seated Posture Prediction for Pregnant Women and Validation Considering Ground and Seat Pan Contacts

An understanding of human seated posture is important across many fields of scientific research. Certain demographics, such as pregnant women, have special postural limitations that need to be considered. Physics-based posture prediction is a tool in which seated postures can be quickly and thoroughly analyzed, as long the predicted postures are realistic. This paper proposes and validates an optimization formulation to predict seated posture for pregnant women considering ground and seat pan contacts. For the optimization formulation, the design variables are joint angles (posture); the cost function is dependent on joint torques. Constraints include joint limits, joint torque limits, the distances from the end-effectors to target points, and self-collision avoidance constraints. Three different joint torque cost functions have been investigated to account for the special postural characteristics of pregnant women and consider the support reaction forces (SRFs) associated with seated posture. Postures are predicted for three different reaching tasks in common reaching directions using each of the objective function formulations. The predicted postures are validated against experimental postures obtained using motion capture. A linear regression analysis was used to evaluate the validity of the predicted postures and was the criteria for comparison between the different objective functions. A 56 degree of freedom model was used for the posture prediction. Use of the objective function minimizing the maximum normalized joint torque provided an R2 value of 0.828, proving superior to either of two alternative functions.

Biomechanical response of the pediatric abdomen, Part 2: injuries and their correlation with engineering parameters

This paper describes the injuries generated during dynamic belt loading to a porcine model of the 6-year-old human abdomen, and correlates injury outcomes with measurable parameters. The test fixture produced transverse, dynamic belt loading on the abdomen of 47 immediately post-mortem juvenile swine at two locations (upper/lower), with penetration magnitudes ranging from 23% - 65% of the undeformed abdominal depth, with and without muscle tensing, and over a belt penetration rate range of 2.9 m/s - 7.8 m/s. All thoracoabdominal injuries were documented in detail and then coded according to the Abbreviated Injury Scale (AIS). Observed injuries ranged from AIS 1 to AIS 4. The injury distribution matched well the pattern of injuries observed in a large sample of children exposed to seatbelt loading in the field, with most of the injuries in the lower abdomen. Univariate and multiple regression models were used to assess mechanical predictors as injury criteria for maximum AIS 2+ and 3+ outcomes, including peak belt tension and posterior reaction force, abdominal penetration, penetration rate, the viscous criterion, and a newly proposed criterion, FCmax, which is the maximum of the instantaneous product of loading rate and normalized penetration. The Goodman-Kruskal Gamma (gamma) was used to assess each parameter's ability to discriminate between injurious and non-injurious tests. Injury risk functions were generated for both outcomes by fitting a 2-parameter Weibull distribution to the injury data using survival analysis. The best discriminators were peak belt tension (gamma = 0.86 and 0.83, p < 0.01), the work done by the deforming thorax (gamma = 0.86 and 0.74, p < 0.01), and abdominal penetration (gamma = 0.89 and 0.66, p < 0.02). Penetration rate was not a good discriminator (gamma = 0.34 and 0.52), and the consideration of penetration rate decreased the discrimination of the viscous criterion (gamma = 0.67 and 0.58) relative to penetration alone. FCmax was a better discriminator of injury than the viscous criterion (gamma = 0.70 and 0.76, p < 0.01), indicating that the loading rate may be more related to injury outcome than the penetration rate.

Biomechanical response of the pediatric abdomen, part 1: development of an experimental model and quantification of structural response to dynamic belt loading

The abdomen is the second most commonly injured region in children using adult seat belts, but engineers are limited in their efforts to design systems that mitigate these injuries since no current pediatric dummy has the capability to quantify injury risk from loading to the abdomen. This paper develops a porcine (sus scrofa domestica) model of the 6-year-old human's abdomen, and then defines the biomechanical response of this abdominal model. First, a detailed abdominal necropsy study was undertaken, which involved collecting a series of anthropometric measurements and organ masses on 25 swine, ranging in age from 14 to 429 days (4-101 kg mass). These were then compared to the corresponding human quantities to identify the best porcine representation of a 6-year-old human's abdomen. This was determined to be a pig of age 77 days, and whole-body mass of 21.4 kg. The sub-injury, quasistatic response to belt loading of this porcine model compared well with pediatric human volunteer tests performed with a lap belt on the lower abdomen. A test fixture was designed to produce transverse, dynamic belt loading on the porcine abdomen. A detailed review of field cases identified the following test variables: loading location (upper/lower), penetration magnitude (23%-68% of initial abdominal depth), muscle tensing (yes/no), and belt penetration rate (quasistatic, dynamic 2.9 m/s - 7.8 m/s). Dynamic tests were performed on 47 post-mortem subjects. Belt tension and dorsal reaction force were cross-plotted with abdominal penetration to generate structural response corridors. Subcutaneous stimulation of the anterior abdominal muscle wall stiffened the quasistatic response significantly, but was of negligible importance in the dynamic tests. The upper abdomen exhibited stiffer response quasistatically, and also was more sensitive to penetration rate, with stiffness increasing significantly over the range of dynamic rates tested here. In contrast, the lower abdomen was relatively rate insensitive. To our knowledge, this is the only dynamic structural characterization study on a comprehensively developed experimental model of the 6-year-old human abdomen. The structural corridors developed here should lead to the development of both mechanical (i.e., crash dummies) and computational pediatric models that are more useful for assessing injurious levels of belt penetration into the abdomen.