title: Experimental Validation of ARFI Surveillance of Subcutaneous Hemorrhage (ASSH) Using Calibrated Infusions in a Tissue-Mimicking Model and Dogs.
abstract: Acoustic radiation force impulse (ARFI) Surveillance of Subcutaneous Hemorrhage (ASSH) has been previously demonstrated to differentiate bleeding phenotype and responses to therapy in dogs and humans, but to date, the method has lacked experimental validation. This work explores experimental validation of ASSH in a poroelastic tissue-mimic and in vivo in dogs. The experimental design exploits calibrated flow rates and infusion durations of evaporated milk in tofu or heparinized autologous blood in dogs. The validation approach enables controlled comparisons of ASSH-derived bleeding rate (BR) and time to hemostasis (TTH) metrics. In tissue-mimicking experiments, halving the calibrated flow rate yielded ASSH-derived BRs that decreased by 44% to 48%. Furthermore, for calibrated flow durations of 5.0 minutes and 7.0 minutes, average ASSH-derived TTH was 5.2 minutes and 7.0 minutes, respectively, with ASSH predicting the correct TTH in 78% of trials. In dogs undergoing calibrated autologous blood infusion, ASSH measured a 3-minute increase in TTH, corresponding to the same increase in the calibrated flow duration. For a measured 5% decrease in autologous infusion flow rate, ASSH detected a 7% decrease in BR. These tissue-mimicking and in vivo preclinical experimental validation studies suggest the ASSH BR and TTH measures reflect bleeding dynamics.
authors.affiliation: Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA and North Carolina State University, Raleigh, NC, USA.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Geist
authors.affiliation: Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA and North Carolina State University, Raleigh, NC, USA Cortical Metrics, LLC, Chapel Hill, NC, USA and North Carolina State University, Raleigh, NC USA.
authors.forename: Chase H
authors.initials: CH
authors.lastname: DuBois
authors.affiliation: Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Nichols
authors.affiliation: Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Caughey
authors.affiliation: Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Elizabeth P
authors.initials: EP
authors.lastname: Merricks
authors.affiliation: Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Raymer
authors.affiliation: Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA and North Carolina State University, Raleigh, NC, USA cmgallip@email.unc.edu.
authors.forename: Caterina M
authors.initials: CM
authors.lastname: Gallippi
mesh_terms: D000818:Animals; D002138:Calibration; D004195:Disease Models, Animal; D004285:Dogs; D054459:Elasticity Imaging Techniques / Q000379:methods*; D006470:Hemorrhage / Q000000981:diagnostic imaging*; D008954:Models, Biological; D015203:Reproducibility of Results; D040521:Subcutaneous Tissue / Q000000981:diagnostic imaging*
keywords: ARFI; ASSH; acoustic radiation force; bleeding; dog; hemorrhage; hemostasis; tofu; ultrasound