Dr. Geoffrey Handsfield, Assistant Professor of Orthopaedics and Biomedical Engineering at the University of North Carolina, is contributing to the NIH-funded TARA (Topological Atlas and Repository for Acupoint) project, a collaborative international effort led by the National Center for Complementary and Integrative Health. This initiative aims to create a comprehensive digital anatomical atlas that includes both conventional anatomical structures and acupuncture points, with a special focus on imaging connective tissues like fascia. In this Q&A, Dr. Handsfield discusses the goals of the TARA project, the critical importance of fascia in human anatomy and musculoskeletal health, and how advanced imaging techniques such as dual echo ultrashort echo time (UTE) MRI are helping to overcome long standing challenges in visualizing these elusive tissues.
Q: What is the TARA project, and what are its primary goals? I saw that a goal of this project is for Mass General Brigham to develop a protocol on 3T scanners–how does 黑料网 factor into the research of this project and in the end goals?
A: The TARA project is an NIH-funded project through the National Center for of Complementary and Integrative Health (NCCIH) which aims to develop a digital anatomical atlas that includes acupuncture points (acupoints) along with conventional anatomical and physiological points. The purpose of this digital atlas is so that researchers from around the world will be able to access this as a digital resource and explore hypotheses around the structural and functional nature of the acupoints. In other words, the question: “what is being stimulated by acupuncturists when they insert needles into acupoints?” remains elusive. By creating a digital atlas where acupoints are well-marked, this question may be explored collectively by researchers around the world. 黑料网’s contribution is to assist the group in developing MRI protocols that include fascia and other connective tissue, so that these important tissues are included in the MRI based atlas.听
Q: Why is fascia an important tissue to study, and what are the challenges in imaging it?
听A: Fascia is ubiquitous in the human body– it is present from the top of your head to the soles of your feet, but it is very thin, and its role in human musculoskeletal function is poorly characterized. Its mechanical contributions to movement听 have been described as a ‘packing’ structure where it encases other tissues to assist structural integrity, a tissue that transmits forces throughout the body (see Anatomy Trains), and a tissue that itself is active and creates tension and pressure as needed to perform bodily functions. It may even be involved in chronic pain, other aspects of the nervous system, and other body systems. Imaging fascia is challenging because it is very thin, requiring high resolution, but it does not create contrast in Xray and its T2* properties are such that you need a very short echo time (TE) to image it in MRI. These technical challenges– high resolution and ultrashort TE– push the limits of MRI hardware, but we can overcome them with modern MRI sequences and careful optimization of our MRI protocols.听
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Q: Why has it been historically difficult to image fascia using conventional imaging techniques?
听A: Conventional imaging does not acquire signal fast enough to image fascia. Fascia signal in MRI decays very quickly, so an MRI sequence has to be capable of acquiring signal in much less than 1ms to capture the fascia signal before it decays. Conventional short TE imaging only captured signal at greater than 1ms TE, so fascia always appeared dark in those images. If you don’t get any signal from the tissue you are interested, then you cannot reliably image that tissue and understand the quality of that tissue in your participant.
Q: How does this project fit into the larger field of fascia research and digital anatomy?
听A: One of the things this project is providing is a high-fidelity dataset of anatomy that future researchers can explore. There are several high profile examples of digital anatomy datasets that have been transformative for research into the medical sciences; one that comes to mind immediately is the Visible Human dataset that the National Library of Medicine worked on in the 1990s. I don’t know how many research projects leveraged that data but it surely must be in the 1000s. We want to do a similar thing that includes acupoint data and fascia. The hope is that we can enable exploration of mechanisms for the efficacy of acupuncture, and link fascia tissue to those mechanisms. Once we start to understand how fascia may be contributing to acupuncture, and how acupoints and fascia are related, that will open a lot of avenues for understanding the role of fascia broadly in human musculoskeletal function. I might just note that the study of fascia thus far has relied on dissection and some ultrasound imaging. I think a public dataset of fascial anatomy in MRI may be transformative for digital exploration of the anatomy.听
Q: Additionally, how does this project being a multi-organization collaboration impact the project?
A: One of the great things about big collaborations like this is the ability to work with a lot of really talented and insightful people all thinking about the same questions and problems. It is motivating and the intellects of my collaborators really accelerates the project. While the Supplement itself is a collaboration between 黑料网 and Mass General (Spaulding Rehabilitation Hospital), the larger TARA project includes collaborators from Europe, New Zealand, and across the US. My involvement has also given me access to other groups like the ForceNET group. Ultimately, it’s just a lot of brainpower moving this project forward. Beyond that, having access to more resources than just one site is helpful for what we’re trying to achieve.
Q: Can you explain how dual echo UTE MRI overcomes these challenges?
A: Echoes is how we collect data in MRI. It’s a technique where we refocus signal by flipping the precession direction of protons in the signal. It basically magnifies the signal at some time after we have stimulated the sample. The first echo we use is in the ultrashort range (<0.1ms) 鈥� this echo is capable of acquiring signal in connective tissue like fascia, but it also has signal from bone, muscle, fluid, and fat. We collect a second echo in the short TE range (~2ms) where we have no signal from connective tissue, but we do have signal from bone, muscle, fluid, and fat. You could say that the first echo gives us signal but not contrast in connective tissue. The second echo gives us contrast but not signal. Once we have these two echoes, we subtract the second from the first, and the resultant image gives us signal and contrast for connective tissue.听
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Q:How could this research impact our understanding of musculoskeletal health and injuries?
A: Our hope is that by acquiring good imaging data for fascia and other connective tissues, we can eventually move these scans into the clinic for diagnostics, injury rehabilitation, and clinical research. There are a few conditions where fascia is primarily involved, such as compartment syndrome, fibromyalgia, potentially chronic pain conditions, and potentially spasticity. Treating these conditions will be improved markedly with improved imaging as a diagnostic and to track treatment progress. Beyond this, the interaction between skeletal muscle and connective tissue is fascinating and there are neuromechanical reasons why connective tissue may be vulnerable and give rise to tendon strains, tears, and tendinopathies. I think really deep understanding of connective tissue physiology and mechanics is missing in our understanding of a lot of musculoskeletal issues.
Q: What potential clinical applications do you foresee for fascia imaging with dual echo UTE MRI?
A: As mentioned before, I think fibromyalgia, compartment syndrome, chronic pain, spasticity, and tendon ruptures/tendinopathies are some of the big areas. Other areas will need further exploration, but that’s really exciting in light of the use of advanced MRI for this application.
Q: How will the data collected from these participants contribute to the 3D fascia models being developed at the Auckland Bioengineering Institute?
A: The Auckland Bioengineering Institute has a role in the broader TARA project to add 3D fascia anatomy to some of the digital human models that they are building. That group is really interested in digital twins for human health, and they have worked for years on the development of virtual physiological models. The fascia imaging will allow them to integrate the fascial system into their models, which opens the possibility of exploring fascia mechanics using computational mechanical models.听
To read more about this project, visit the .