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Michael Sutcliffe - Biomedical Engineering Research

Decompressive craniectomy - Active
Decompressive craniectomy
Decompressive craniectomy (DC) is a surgical procedure in which the neurosurgeon removes a section of skull in order to reduce uncontrolled raised intra-cranial pressure (ICP) post traumatic brain injury. DC has seen renewed interest in recent years; however there remains doubt as to the efficacy of the procedure. Engineering models of DC can aid the surgeon in furthering their understanding of the procedure and its likely effects on the brain during surgery. Image analysis has been used to quantify deformation associated with DC and a parametric finite element study of the procedure has addressed clinical issues such as the optimum location and size of the craniectomy. Current work examines modelling of the brain deformation associated with physiological and mechanical factors and examines how deformation in the brain can be characterised. The project is in collaboration with Peter Hutchinson, Hadie Adams and Angelos Kolias at the Department of Clinical Neurosciences, Addenbrooke's Hospital.
Key publications:
Fletcher TL, Wirthl B, Kolias AG, Adams H, Hutchinson PJA, Sutcliffe MPF. Modelling of brain deformation after decompressive craniectomy. Annals of Biomedical Engineering (2016)
Fletcher TL, Kolias AG, Hutchinson PJ, Sutcliffe MPF. A new improved method for assessing brain deformation after decompressive craniectomy. PLoS ONE (2014)
Fletcher TL, Kolias AG, Hutchinson PJA, Sutcliffe MPF. Development of a finite element model of decompressive craniectomy. PLoS ONE (2014)

Artery modelling - Active
Cardiovascular disease is a major cause of death. Rupture of diseased atherosclerotic plaque leads to stroke, while the benefits of lowering high blood pressure using drugs are well established. Work by Graeham Douglas and Aziz Tokgoz considers measurement and modelling of material properties of diseased arteries, with funding from EPSRC, the Canadian Government and the Armstrong Trust and in collaboration with Jonathan Gillard and Zhongzhao Teng at the Department of Radiology. Secondary harmonic imaging, in conjunction with Jeremy Skepper and the Cambridge Advanced Imaging Centre, is being used to explore the way that the collagen network structure affects deformation and failure. In another tack, Chen Yen Ooi has investigated the mechanical and pharmacological aspects of arteries to describe plaque rupture and arterial response to drugs, in collaboration with Anthony Davenport and Janet Maguire at the Department of Clinical Parmacology.
Key publications:
Barrett SRH, Sutcliffe MPF, Howarth S, Li Z-Y, Gillard JH. Experimental measurement of the mechanical properties of carotid atherosclerotic plaque fibrous cap. J. Biomechanics (2009)
Li ZY, Tang T, U-King-Im J, Graves M, Sutcliffe MPF, Gillard JH. Assessment of carotid plaque vulnerability using structural and geometric determinants. Circ J (2008)
Teng Z, Feng J, Zhang Y, Huang Y, Sutcliffe MPF, Brown AJ, Jing Z, Gillard JH, Lu Q. Layer- and direction-specific material properties, extreme extensibility and ultimate material strength of human abdominal aorta and aneurysm: a uniaxial extension study. Annals of Biomedical Engineering (2015)

Radiotherapy - Active
Radiotherapy remains one of the most potent curative treatments for cancer. For many common cancers, up to half of patients treated experience some degree of toxicity. Current dose escalation strategies are based on static models of the patient anatomy, and do not take into account variation in patient position, shape and location of mobile internal organs. This research project aims to provide bio-engineering models and analysis tools to predict tissue-tracked dosage mapping and hence guide development of appropriate patient-specific radiotherapy protocols. The work is part of a collaboration with colleagues in the Departments of Oncology and Physics within the Voxtox project. The picture shows a still from an animation of the rectum during radiotherapy treatment.
Key publications:
Thomas SJ, Romanchikova M, Harrison K, Parker MA, Bates AM, Scaife JE, Sutcliffe MPF, Burnet NG. Recalculation of dose for each fraction of treatment on TomoTherapy. British J of Radiology (2015)
Scaife JE, Thomas SJ, Harrison K, Romanchikova M, Sutcliffe, MPF, Forman JR, Bates AM, Jena R, Parker MA, Burnet NG. Accumulated dose to the rectum, measured using dose-volume histograms and dose-surface maps, is different from planned dose in all patients treated with radiotherapy for prostate cancer. British Journal of Radiology (2015)
Scaife J, Harrison K, Romanchikova M, Parker A, Sutcliffe M, Bond S, Thomas S, Freeman S, Jena R, Bates A, Burnet N. Random variation in rectal position during radiotherapy for prostate cancer is two to three times greater than that predicted from prostate motion. British Journal of Radiology (2014)

Biomechanics testing in clinical and veterinary medicine - Active
Veterinary Medicine
I have been involved with various projects in collaboration with colleagues at Addenbrooke's Hospital and the Department of Veterinary Medicine, predominantly working on mechanical and materials testing, with help from Alan Heaver and Anne Bahnweg in the Department. Projects include: (i) testing of suture configurations for use in repairing cruciate disease in canine stifle joints, (ii) strength of hand tendon repairs, (iii) assessment of different techniques for treating feline talocrural luxation using suture prostheses and bone tunnels, (iv) assessment of different fixation plate configurations for stabilising canine tibia fracture. Currently I am working with Matthew Allen in Veterinary Medicine on biomechanical modelling of diseased dog joints and associated ways to treat such patients.
Key publications:
De Sousa R, Sutcliffe M, Rousset N, Holmes M, Langley-Hobbs SJ. Treatment of cranial cruciate ligament rupture in feline stifles. Veterinary and Comparative Orthopaedics and Traumatology (2015)
Henderson J, Sutcliffe M, Gillespie P. Epitendinous suture techniques in extensor tendon repairs - an experimental evaluation. J Hand Surgery (2011)
Nicholson I, Langley-Hobbs S, Sutcliffe M, Jeffery N, Radke H. Feline talocrural luxation: A cadaveric study of repair using ligament prostheses. Veterinary and Comparative Orthopaedics and Traumatology (2012)

Eustachian tube dysfunction - Active
Eustachian tube
The Eustachian tube is a narrow structure running between the air-filled middle ear space and the back of the nose. It is designed to allow ventilation of the middle ear, but in around 5% of the adult population, the tube fails to open adequately, causing many different types of ear disease. Balloon Eustachian Tuboplasty (BET) is a new minimally-invasive technique using a narrow balloon to stretch the Eustachian tube and has recently been used in patients. The aim of this project is to study the biomechanics of balloon inflation within human Eustachian tube tissue. In parallel, physical and 3D computer-based models will be created to add to our clinical observations, and provide methods of testing innovative adaptations to the procedure, and new equipment modifications. The project is a collaboration with Matt Smith and James Tysome in the ENT Department at Addenbrooke's Hospital, with the help of a Engineering for Clinical Practice grant undertaken by MEng students Daisy Prior and Anna Weir.

Hydrocephalus - Complete
This project investigated brain compliance and deformation associated with various neuro-pathologies (head injury and hydrocephalus), focussing on two different modelling approaches: global and structural. In the global approach, the relationship between added volume and pressure response was analysed in terms of cerebrospinal volume-pressure compensatory reserve or brain compartmental compliances. For the structural approach, magnetic resonance imaging data were processed to generate meshes for finite element analysis. For hydrocephalus, the resulting models can be used to help define the degree of pathogenesis by considering the size of ventricles and the extent of cerebral oedema and to discriminate between hydrocephalus and other neurological disorders. These hold the potential to improve treatment outcomes for individual patients by making pragmatic treatment decisions in clinical practice. The PhD project was undertaken undertaken by DongJoo Kim, co-supervised by Marek Czosnyka at the Department of Neurosurgery and in collaboration with colleagues there.
Key publications:
Kim DJ, Czosnyka Z, Keong N Radolovich DK,. Smielewski P, Sutcliffe MPF, Pickard JD, Czosnyka M. Index of cerebrospinal compensatory reserve in hydrocephalus. Neurosurgery (2009)
Kim DJ, Kasprowicz M, Carrera E, Castellani G, Zweifel C, Lavinio A, Smielewski P, Sutcliffe MPF, Pickard JD, Czosnyka M. The monitoring of relative changes in compartmental compliances of brain. Physiological Measurement (2009)
Kim H, Min B-K, Park D-H, Hawi S, Kim B-J, Czosnyka Z, Czosnyka M, Sutcliffe MP, Kim D-J. Porohyperelastic anatomical models for hydrocephalus and idiopathic intracranial hypertension. Journal of Neurosurgery. (2015)

© 2016 Cambridge University Engineering Dept and Michael Sutcliffe.
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