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

Axial image at the upper torso demonstrating the projects full body imaging approach, provided by Dr. Handsfield.

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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

An image from the project dataset with some labels, provided by Dr. Handsfield.

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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 .

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Darrel S. Brodke, MD

April 9, 2025, at 6:30 am

Hybrid Conference

Darrel S. Brodke, MD

Chair of the Department of Orthopaedics
Jack and Hazel Robertson Presidential Endowed Professorship
University of Utah Health

Speaker Biography

Zoom Details

Meeting ID: 935 4985 2608

Passcode: 121212

In-Person Location

Bioinformatics 1131

Accreditation Statement
The School of Medicine of the University of North Carolina at Chapel Hill is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Statement
The School of Medicine of the University of North Carolina at Chapel Hill designates this live activity for a maximum of 0.5 AMA PRA Category 1 Credit(s). Physicians should claim only those hours of credit actually spent in the educational activity.

Disclosure statement
The presenter received consulting fees from CTL Amedica (ended July 2024) and Orthofix (ended Jan. 2024). 听These financial relationships have been mitigated through divestment.

Credit Limitation
Credit is only available to employees of 黑料网 or its affiliates. To claim credit please contact the Grand Rounds Coordinator.

Grand Rounds Coordinator
Chanelle Arsenault
Email: chanelle_arsenault@med.unc.edu

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Dr. Mitchell specializes in pediatric spinal surgery and uses to treat spinal deformities, such as scoliosis, and other spinal problems. 7D surgical technology is an image-guided spinal navigation system that utilizes machine vision technology similar to facial recognition in smart phone cameras instead of a CT scan or X-rays in the operating room to set up the system. This reduces the amount of radiation the surgical team is exposed to during spinal surgeries with navigation. 鈥淩adiation exposure is cumulative and can increase the risk of health problems such as cancer. This technology helps protect both our patients and the surgical team,” Dr. Mitchell explained.听

In addition to reducing radiation, the 7D system enhances surgical accuracy. The technology generates detailed 3D mapping of the patient鈥檚 anatomy with machine vision by projecting a light pattern and digitizing it into a cloud of nearly one million data points. This allows Dr. Mitchell to perform surgeries with higher precision, which not only improves outcomes but also reduces the amount of time patients are under anesthesia and the likelihood of needing follow-up surgeries due to errors. 鈥淭he process of learning is simple, and it greatly improves the overall experience for both surgeons and patients鈥揑 see no reason not to implement this technology,鈥� added Dr. Mitchell.听

Looking ahead, Dr. Mitchell is exploring the use of scans in place of CT scans to further minimize radiation exposure. “Many of our patients need frequent imaging throughout the course of their treatment, and MRI is a radiation-free option. We鈥檙e always looking for ways to improve care before, during, and after surgery, while also improving the patient experience,” he says. This shift would be especially beneficial for children who’s rapidly developing cells are much more sensitive to radiation than those of adults.听

Dr. Mitchell, who joined the department three years ago after a fellowship at the Children’s Hospital of Philadelphia, has been at the forefront of integrating advanced imaging technology into pediatric spinal surgery. His commitment to leveraging these innovations ensures that his patients receive the safest, most precise care possible.听

By incorporating technologies like 7D FLASH Navigation and BoneMRI, Dr. Mitchell is setting a new standard in pediatric spinal surgery, focused on minimizing risk, improving surgical outcomes, and enhancing the overall experience for young patients and their families.听

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Dr. Hart鈥檚 award brings 黑料网 Orthopaedics the first NIH R01 grant ever to the department. His research, 鈥楶redicting second injuries after ACL reconstruction using clinically accessible videography鈥� will work to utilize 3D markerless videography resulting in movement data that will be analyzed using advanced multi-joint approaches to derive specific and unique movement features.听These features听will enable the research team to develop predictive models to identify risk for second injuries after first-time knee surgeries in young patients. Movement data about lower body joint coordination will be combined with other features to provide a comprehensive and holistic approach to identifying risk for bad outcomes in our patients.听

The movement data will be captured using OpenCap, a free open-access technology that uses smart devices to capture 3D movement features. 鈥淲e selected this technology specifically because it is precise enough to characterize movement in the way that we need and it is accessible enough to enable clinical translation,鈥� Dr. Hart said on the choice to use new OpenCap technology versus other, more established, technologies. 鈥淭his study won鈥檛 require an expensive and complex motion capture system鈥搃t鈥檚 something that can be done by nearly anybody, anywhere,鈥� he continued.听

The project will combine motion capture, muscle strength, jumping performance听and patient surveys administered at the time of discharge from care after an ACL reconstruction surgery. The participants being studied fall within the most at-risk age range (13-25) and are monitored for 18 months, during which time they will periodically complete surveys about their recovery.听听

Dr. Hart鈥檚 study team hopes to find the safest, most effective way for patients to re-engage in exercise, physical activity and sports after ACL reconstruction since these patients suffer from unacceptably high rates of reinjury, reduced levels of exercise and early-onset knee osteoarthritis. Dr. Hart hopes to improve outcomes after ACL reconstructions by creating easily accessed indicators that will help physicians and rehab specialists target at-risk patients before they are discharged from care.听

When asked what this grant means to him, Dr. Hart noted 鈥淭his award is a great achievement for our department and a testament to the existing talents we have in our clinical and research faculty. It feels good to be a part of this initiative that helps to advance science and help the people we care for.鈥�听

Dr. Hart would like to recognize his collaborators and colleagues; Robin Queen, PhD, from Virginia Tech University, who is leading a complementary project as a part of the ACL-Clinically Assessed Re-Injury Evaluation (ACL-CARE) study; Kevin Ford, PhD, from High Point University; Adam Kiefer, PhD, from the 黑料网 Sports Medicine Institute (SMI); Devin Kelly, PhD, Postdoctoral Research Associate with the Department of Orthopaedics at 黑料网; and Jeff Spang, MD and Ganesh Kamath, MD, Clinical Faculty in the Department of Orthopaedics at 黑料网.听

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He, along with other members of the Department of Orthopaedics and the 黑料网 Sports Medicine Institute, are participating in the race to help raise money for the Arthritis Foundation. To join the team, view the roster, or donate, visit the team page .

Keep jingling this season for a great reason: CHANGE THE FUTURE OF ARTHRITIS TODAY. Arthritis is the nation鈥檚 #1 cause of disability, affecting nearly 60 million Americans, including 300,000 children. Join our team, raise funds, and help us make a difference in their quality of life today and help researchers ultimately discover a cure.

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For more information about the Special Issue, please read Dr. Handsfield’s letter listed below and visit the Bioengineering to find manuscript submission information.

Dear Colleagues,

Musculoskeletal bioengineering is a fascinating, multidisciplinary field that endeavors to apply engineering principles to advancing our understanding of musculoskeletal tissues. Musculoskeletal biomechanics鈥攖he study of the mechanical behavior of听 skeletal muscles, connective tissues, bones, joints, and their interaction鈥攈as benefitted tremendously from advances in medical imaging technology, progress in image processing routines, and computational modeling that takes advantage of these gains. Notably, the power of medical imaging has generally contributed to the rendering of anatomical structures in high fidelity and听in vivo, which has enhanced our understanding of mechanics. Advancements in acquisition frequency have strengthened our ability to conduct dynamic imaging, serving to validate our understanding of musculoskeletal dynamics.

This Special Issue of听Bioengineering听seeks to bring together researchers and experts to present recent progress in imaging, image processing, and image-based computational modeling in the study of musculoskeletal biomechanics. We aim to highlight key areas of rapid development, discuss techniques poised to further advance the field, and outline current challenges that require focused efforts to overcome. We invite contributions from experts working with MRI, CT, ultrasound, biplane radiography, and other imaging modalities, particularly those who have used these tools to enhance computational modeling in biomechanics. We also welcome applied research where the aforementioned techniques have been employed to gain a better understanding of musculoskeletal function, optimize treatments for musculoskeletal disorders, and design improved medical devices and interventions, among other applications.

Topics for this Special Issue include, but are not limited to the following:

• New imaging techniques for musculoskeletal analysis.
• Updates to conventional imaging for musculoskeletal biomechanics.
• Image-based computational modeling of musculoskeletal function and dysfunction.
• Novel technologies and methodologies in image processing and computational modeling.
• Image-based modeling to determine biomechanical factors in musculoskeletal injuries and rehabilitation.
• Applications of these techniques to aging, human performance, health, and disease.

We welcome original research, reviews, and perspectives from experts in bioengineering, biomechanics, biomedical imaging, orthopedics, and physical therapy. Through the sharing of the latest findings, innovations, and perspectives, contributors will help advance musculoskeletal bioengineering, particularly in the exciting intersection of imaging and computational modeling in biomechanics.

Dr. Geoffrey Handsfield
Guest Editor

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Featured speakers included providers from 黑料网, Duke, and UPMC, and included a range of multidisciplinary topics from sports medicine and sports psychology to performance nutrition and sleep medicine鈥搘ith the overall theme of the conference focusing on hip conditions.

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Learning objectives included:
– Utilize evidence-based management strategies to treat the following hip conditions: femoroacetabular impingement, labral tear, greater trochanteric pain syndrome, deep gluteal space syndrome, sports hernias, and chronic pain.
– Improve the care of active individuals by integrating publicly accessible, evidence-based resources for sleep, nutrition, and mental health.
– Treat athletes holistically by recognizing the need for and referring to specialized providers for sleep, nutrition, mental health, and strength & conditioning needs.
– Utilize a staged return to sport protocol to safely progress patients to return after injury or surgery

鈥淭his conference is unique because it offers presentations from multiple professions to provide different perspectives and equips attendees to improve their practice,鈥� said Carla Hill, DPT, and member of the conference planning committee. Attendees were given the opportunity to view posters, learn from a variety of perspectives to create best practices, and network with other professionals from the field.

鈥淚t has been great to see the conference grow every year and to see people come back from previous years, as well as welcome new people to 黑料网,鈥� added Anna Cochis, Admin Support Associate for the Sports Medicine Division at 黑料网 Orthopaedics and conference assistant.

Be on the lookout for 2025 Sports Medicine Institute Annual Conference information next year!

The SMI Annual Conference planning committee.

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Image of the Sports Medicine Center located at 6118 Farrington Road in Chapel Hill.

鈥淭he building represents the creation of an innovative comprehensive collaborative space that enriches the care we provide, enhances our ability to drive practice changing research and grows collaboration between all facets of care including medical, PT and more,鈥� said Dr. David Berkoff, MD, Director of the Sports Medicine Institute.听

The new 25,000 square foot clinic and research space includes:

• 1650 square feet for Radiology, featuring new ultrasound and x-ray machines
• 2900 square feet for Physical Therapy, featuring a full-service clinic
• 3150 square feet for research space used by Orthopaedics, EXSS, Physical Therapy, and TARC
• 7300 square feet for patient care, with 30+ exam rooms, and waiting areas

The SMC contains state-of-the-art equipment to bring quality care and research of the highest degree to patients. The innovative center also has two exam rooms dedicated exclusively to OrthoNow Urgent Care, which is now entirely housed at the center.

鈥淭his space provides us with a lot of ability to grow and to improve practice, in order to continue to create industry best practices,鈥� continued Berkoff.听

A grand opening for the building is set to take place in late November.

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In 2022, the department successfully recruited Dr. Joe Hart, a clinical musculoskeletal scientist, to lead the department鈥檚 research programs. Since then, Dr. Hart and his team have developed several strategic partnerships across the University centered around growing musculoskeletal science and innovation at 黑料网. The research programs began by developing a strong clinical research infrastructure intended to engage and support the ongoing research expertise in existing orthopaedic clinical faculty, staff, and collaborators. The research team engaged in partnerships with the Departments of Exercise and Sport Science, Biomedical Engineering, Cell Biology and Physiology, and the Thurston Arthritis Research Center as initial and essential steps toward growth of the research programs.听 These synergies allowed the research team in Orthopaedics to recruit two additional talented basic science faculty.

We are excited about the expertise and innovation that Dr. Handsfield and Dr. Hsueh bring to our department and look forward to their contributions to advancing orthopaedic research and patient care.

Dr. Ming-Feng Hsueh

Lab location: Thurston Building (Room 4103)

Dr. Ming-Feng Hsueh joined the department in April as an Assistant Professor in Orthopaedics. He comes from Duke University, where he held an Assistant Professor position and where he completed his PhD and post-doctoral research. Dr. Hsueh鈥檚 research focused on osteoarthritis and the protein components in cartilage using mass spectrometry-based proteomic methods.

Dr. Hsueh鈥檚 current research continues to explore osteoarthritis, with a focus on developing effective therapeutic strategies for degenerative diseases. His multidisciplinary approach has revealed increased cartilage anabolism in ankle cartilage compared to hip cartilage, suggesting a potential regenerative capacity that could be leveraged to enhance joint repair. These findings not only contribute to our understanding of OA pathogenesis but also provide a foundation for formulating novel therapeutic approaches.

Dr. Geoff Handsfield

Lab Location: Taylor Hall

Dr. Geoff Handsfield joined in May as an Assistant Professor in both the Department of Orthopaedics and the Department of Biomedical Engineering. He comes from the University of Auckland, where he completed his post-doctoral research at the Auckland Bioengineering Institute. Dr. Handsfield earned his PhD from the University of Virginia, where he conducted research in the Multiscale Muscle Mechanics (M3) lab.

An orthopaedic bioengineer by training, Dr. Handsfield is committed to collaborating with clinicians to address complex problems and deliver innovative solutions to patients. He aims to enhance medical imaging techniques to resolve connective tissues in greater detail and to develop improved mechanical models of force transmission in the musculoskeletal system. His passion for medical imaging, including MRI, drives his work in creating patient-specific models of the musculoskeletal system. These models are designed to identify sub-resolution areas and predict potential injury sites.

Welcome Dr. Hsueh and Dr. Handsfield!

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Mininder S. Kocher, MD, MPH, FAAOS, FAOA

February 21, 2024, at 6:30 am

Hybrid Conference

Mininder S. Kocher, MD, MPH, FAAOS, FAOA
Chief, Division of Sports Medicine
O’Donnell Family Endowed Chair
Director, Sports Medicine Fellowship
Boston Children’s Hospital
Professor of Orthopaedic Surgery
Harvard Medical School

Speaker Biography

Dr. Kocher is the Chief of the Division of Sports Medicine at Boston Children鈥檚 Hospital, O鈥橠onnell Family Endowed Chair, and Professor of Orthopaedic Surgery at Harvard Medical School. He is an internationally renowned expert in pediatric orthopaedics, sports medicine, and clinical epidemiology.

His clinical practice focuses on sports medicine and arthroscopic surgery of the knee, shoulder, hip, elbow, and ankle. He has treated pediatric and adult patients from around the world and many professional sports. He is the team physician for numerous high schools, Babson College, Northeastern University, US Ski Team, and USA Track & Field. He is recognized as Best of Boston by Boston Magazine, Best Doctors in America by Best Doctors, America鈥檚 Top Doctors by Castle Connelly, Top 17 Pediatric Orthopaedic Surgeons in North America by RY Ortho, and Who鈥檚 Who in the World by Strathmore.

His research focuses on clinical epidemiology and biostatistics. He has published over 250 scientific articles, 100 book chapters, 6 textbooks, and has been a visiting professor in over 20
countries. He has received numerous research awards including the Angela Kuo Award, the Arthur Heune Award, the Vernon Thompson Award, and the Kappa Delta Award (orthopaedic surgery鈥檚 highest honor).

He has been featured in the New York Times, Scientific American, San Francisco Chronicle, Boston Globe, Wall Street Journal, Chicago Herald, ABC World News, and Sports Illustrated. He has collaborated with the International Olympic Committee and the Aspen Institute. He is an invited member of IPOTT, Herodicus Society, and the 20th Century Orthopaedic Association. He has served in leadership positions with numerous organizations including President of POSNA, Founder of PRISM, and the Board of Directors of the AAOS and AOSSM.

Zoom Details

Meeting ID: 958 0070 2168

Passcode: 121212

In-Person Location

Bioinformatics 1131

Accreditation Statement
The School of Medicine of the University of North Carolina at Chapel Hill is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Statement
The School of Medicine of the University of North Carolina at Chapel Hill designates this live activity for a maximum of 0.5 AMA PRA Category 1 Credit(s). Physicians should claim only those hours of credit actually spent in the educational activity.

Other health professionals will receive a certificate of attendance from an AMA PRA Category 1 activity. These certificates are accepted by the NC Boards for physician assistants, nurse practitioners, nurses, and respiratory therapists. Other health care providers may also be able to use these certificates, depending on their particular license requirements. (License requirements are subject to change. Participants should check with their licensing boards for specific questions. 黑料网 and its partners are not responsible for changes in license requirements.)

Disclosure statement
This activity has been planned and implemented under the sole supervision of the course director and planning committee, in association with the 黑料网 Office of Continuing Professional Development (黑料网 CPD). The course director, planning committee, and CPD staff have no relevant financial relationships with commercial interests as defined by the ACCME. The speaker has no relevant financial relationships with ineligible companies as defined by the ACCME.

Credit Limitation
Credit is only available to employees of 黑料网 or its affiliates. To claim credit please contact the Grand Rounds Coordinator.

Grand Rounds Coordinator
Chi-Chi Harris
Email:听chania_harris@med.unc.edu

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