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Pressure ulcers are a severe disease affecting patients that are bedridden orin a wheelchair bound for long periods of time. These wounds can develop in thedeep layers of the skin of specific parts of the body, mostly on heels orsacrum, making them hard to detect in their early stages. Strain levels havebeen identified as a direct danger indicator for triggering pressure ulcers.Prevention could be possible with the implementation of subject-specific FiniteElement (FE) models. However, generation and validation of such FE models is acomplex task, and the current implemented techniques offer only a partialsolution of the entire problem considering only external displacements andpressures, or cadaveric samples. In this paper, we propose an in vivo solutionbased on the 3D non-rigid registration between two Magnetic Resonance (MR)images, one in an unloaded configuration and the other deformed by means of aplate or an indenter. From the results of the image registration, thedisplacement field and subsequent strain maps for the soft tissues werecomputed. An extensive study, considering different cases (on heel pad andsacrum regions) was performed to evaluate the reproducibility and accuracy ofthe results obtained with this methodology.The implemented technique can giveinsight for several applications. It adds a useful tool for betterunderstanding the propagation of deformations in the heel soft tissues thatcould generate pressure ulcers. This methodology can be used to obtain data onthe material properties of the soft tissues to define constitutive laws for FEsimulations and finally it offers a promising technique for validating FEmodels.

MR-based quantitative measurement of human soft tissue internal strains for pressure ulcer prevention