Using High Performance Computing to enhance the

clinical decision making process in low back pain

Prof. Damien LacroixINSIGNEO Institute for in silico MedicineDepartment of Mechanical Engineering

University of Sheffield

The document is proprietary of the MySpine consortium members. No copy, distribution or use is allowed without the prior written agreement of the owner of the property rights

Low back pain impact

The document is proprietary of the MySpine consortium members. No copy, distribution or use is allowed without the prior written agreement of the owner of the property rights

Treatment decision

The document is proprietary of the MySpine consortium members. No copy, distribution or use is allowed without the prior written agreement of the owner of the property rights

IT Engineering into clinics

• Lumbar spine surgery leads to satisfactory short-term pain relief, but long/midterm outcomes are less positive in terms of incremental degeneration problems and pain resurgence

• We hypothesize that the lack of long term success is due to:- Incomplete understanding of the biomechanics of the lumbar

spine- Required specificity of the patient condition (geometry, disc

properties, loading, psychological profile, etc…)- A non-rationale engineering approach

The document is proprietary of the MySpine consortium members. No copy, distribution or use is allowed without the prior written agreement of the owner of the property rights

MySpine consortium

The document is proprietary of the MySpine consortium members. No copy, distribution or use is allowed without the prior written agreement of the owner of the property rights

MySpine objectives

• MySpine aims to create a clinical predictive tool to provide clinicians with patient-specific biomechanical and mechanobiological analysis.

• This tool will help to determine the best patient specific treatment for low back pain.

• The project will focus on disc degeneration pathology although the developed prototype system may be able to analyze other spinal pathologies as well.

The document is proprietary of the MySpine consortium members. No copy, distribution or use is allowed without the prior written agreement of the owner of the property rights

Patient-specific framework

Clinical software

Multiscale biomechanical analysis

The document is proprietary of the MySpine consortium members. No copy, distribution or use is allowed without the prior written agreement of the owner of the property rights

Subject-specific finite element model

Morphing FE models onto disc / vertebrae shape model

Generic FE model

Subject-specific shape model

Subject-specificFE model

MRI CT

+

The document is proprietary of the MySpine consortium members. No copy, distribution or use is allowed without the prior written agreement of the owner of the property rights

Patient-specific mesh

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Patient-specific 3D L1-S1 lumbar spine

Post-processing through ABAQUS

D7.3

The document is proprietary of the MySpine consortium members. No copy, distribution or use is allowed without the prior written agreement of the owner of the property rights

Patient-specific 3D L1-S1 lumbar spine

Post-processing through ABAQUS

VPH-Share: A secure web portal for the construction of personalised clinical workflows

VPH-Share Scientific Coordinator: Prof. Rod Hose, University of Sheffield

The document is proprietary of the MySpine consortium members. No copy, distribution or use is allowed without the prior written agreement of the owner of the property rights

MySpine Major Platform Components

VPH-Share

XNAT Database

MySpine

Image-based spine

reconstruction

HPC Server

Abaqus simulation:Short terms effects(+Matlab, Python)

Abaqus simulation:Ageing effect

(+Matlab, Python)

The document is proprietary of the MySpine consortium members. No copy, distribution or use is allowed without the prior written agreement of the owner of the property rights

Python Script

Pre-processing Computation Post-processing

The document is proprietary of the MySpine consortium members. No copy, distribution or use is allowed without the prior written agreement of the owner of the property rights

Python Script

Pre-processing Computation Post-processing

Generic Abaqus input filePersonalized inputs

The document is proprietary of the MySpine consortium members. No copy, distribution or use is allowed without the prior written agreement of the owner of the property rights

Python Script

Pre-processing Computation Post-processing

Patient-specific Abaqus input file

The document is proprietary of the MySpine consortium members. No copy, distribution or use is allowed without the prior written agreement of the owner of the property rights

Client Access to Visualisation Cluster

VirtualGL Client

Iceberg –Campus Compute Cloud

VirtualGL Server(NVIDIA Fermi M2070Q GPU)

The document is proprietary of the MySpine consortium members. No copy, distribution or use is allowed without the prior written agreement of the owner of the property rights P. 18

Time / Cost analysis per patient

Time Cost (without software cost)

Patient-specific comparison between 3 treatments (96 cores)

11 hours $65

Effect of fusion at 5 years (24 cores) 35 hours $27

• Patient specific model preparation (Gimias): 3h (1 core)

• Full lumbar simulation (Abaqus): 8h per loading & per treatment (16 cores)

• Bone remodelling and disc adaptation (Abaqus): 7h per year simulated

Based on Amazon c3.4xlarge (16C, 30GB RAM) = $1.366/h

The document is proprietary of the MySpine consortium members. No copy, distribution or use is allowed without the prior written agreement of the owner of the property rights P. 19

Time to complete clinical prospective study

• 200 patients have been treated and followed for 2 years

CPU hour DataPer patient 1,088 35 GB200 patients 217,600 7 TB

With 400 cores available (e.g. N8), need only 23 days to run

The document is proprietary of the MySpine consortium members. No copy, distribution or use is allowed without the prior written agreement of the owner of the property rights

Discussion

With additional resources, further analyses could investigate

• additional loadings• variability in surgery techniques• different types of screws

to provide an interval of confidence for the clinician.

The document is proprietary of the MySpine consortium members. No copy, distribution or use is allowed without the prior written agreement of the owner of the property rights

Conclusions

• A patient-specific platform to analyse the biomechanical load transfer between conservative treatment, discectomy and fusion was developed.

• Using VPH-Share cloud facilities and local or cloud HPC system, any clinician can have a patient-specific biomechanical analysis in less than 11 hours.

• Remote desktop visualization and cloud computing can provide a transformative change to NHS without hardware investment.

Acknowledgements

VPH-ShareProf. Rod HoseDr. Susheel VarmaDr. Steven Wood

Institute forin silico Medicine

Thank You!