title: Comprehensive patient-specific information preprocessing for cardiac surgery simulations.
abstract: OBJECTIVE
  Patient-specific biomechanical simulations of the behavior of soft tissue gain importance in current surgery assistance systems as they can provide surgeons with valuable ancillary information for diagnosis and therapy. In this work, we aim at supporting minimally invasive mitral valve reconstruction (MVR) surgery by providing scenario setups for FEM-based soft tissue simulations, which simulate the behavior of the patient-individual mitral valve subject to natural forces during the cardiac cycle after an MVR. However, due to the complexity of these simulations and of their underlying mathematical models, it is difficult for non-engineers to sufficiently understand and adequately interpret all relevant modeling and simulation aspects. In particular, it is challenging to set up such simulations in automated preprocessing workflows such that they are both patient-specific and still maximally comprehensive with respect to the model.
  
  
  METHODS
  In this paper, we address this issue and present a fully automated chain of preprocessing operators for setting up comprehensive, patient-specific biomechanical models on the basis of patient-individual medical data. These models are suitable for FEM-based MVR surgery simulation. The preprocessing methods are integrated into the framework of the Medical Simulation Markup Language and allow for automated information processing in a data-driven pipeline.
  
  
  RESULTS
  We constructed a workflow for holistic, patient-individual information preprocessing for MVR surgery simulations. In particular, we show how simulation preprocessing can be both fully automated and still patient-specific, when using a series of dedicated MVR data analytics operators. The outcome of our operator chain is visualized in order to help the surgeon understand the model setup.
  
  
  CONCLUSIONS
  With this work, we expect to improve the usability of simulation-based MVR surgery assistance, through allowing for fully automated, patient-specific simulation setups. Combined visualization of the biomechanical model setup and of the corresponding surgery simulation results fosters the understandability and transparency of our assistance environment.
authors.affiliation: Engineering Mathematics and Computing Lab (EMCL), Heidelberg University, Heidelberg, Germany. nicolai.schoch@iwr.uni-heidelberg.de.
authors.forename: N
authors.initials: N
authors.lastname: Schoch
authors.affiliation: Engineering Mathematics and Computing Lab (EMCL), Heidelberg University, Heidelberg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Kißler
authors.affiliation: Medical Physics in Radiation Oncology, DKFZ Heidelberg, Heidelberg, Germany.|Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Stoll
authors.affiliation: Medical and Biological Informatics, DKFZ Heidelberg, Heidelberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Engelhardt
authors.affiliation: Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: R
authors.initials: R
authors.lastname: de Simone
authors.affiliation: Medical and Biological Informatics, DKFZ Heidelberg, Heidelberg, Germany.|Institut fuer Medizinische Informatik, Mannheim University of Applied Sciences, Mannheim, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Wolf
authors.affiliation: Medical Physics in Radiation Oncology, DKFZ Heidelberg, Heidelberg, Germany.|Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg, Germany.|Heilbronn University, Heilbronn, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Bendl
authors.affiliation: Engineering Mathematics and Computing Lab (EMCL), Heidelberg University, Heidelberg, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Heuveline
mesh_terms: D001696:Biomechanical Phenomena; D006348:Cardiac Surgical Procedures; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D008953:Models, Anatomic; D066230:Patient-Specific Modeling
keywords: Automated information processing; Cardiac surgery; Simulation preprocessing; Simulation-based surgery assistance; Treatment planning