Medical Robotics

The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not

Research on real-time physics-based deformation for haptic-enabled medical simulation

This study developed a multiple effective visuo-haptic surgical engine to handle a variety of surgical manipulations in real-time. Soft tissue models are based on biomechanical experiment and continuum mechanics for greater accuracy. Such models will increase the realism of future training systems and the VR/AR/MR implementations for the operating room

Embodied Interactions for Spatial Design Ideation: Symbolic, Geometric, and Tangible Approaches

Computer interfaces are evolving from mere aids for number crunching into active partners in creative processes such as art and design. This is, to a great extent, the result of mass availability of new interaction technology such as depth sensing, sensor integration in mobile devices, and increasing computational power. We are now witnessing the emergence of maker culture that can elevate art and design beyond the purview of enterprises and professionals such as trained engineers and artists. Materializing this transformation is not trivial; everyone has ideas but only a select few can bring them to reality. The challenge is the recognition and the subsequent interpretation of human actions into design intent

IMPROVING DAILY CLINICAL PRACTICE WITH ABDOMINAL PATIENT SPECIFIC 3D MODELS

This thesis proposes methods and procedures to proficiently introduce patient 3D models in the daily clinical practice for diagnosis and treatment of abdominal diseases. The objective of the work consists in providing and visualizing quantitative geometrical and topological information on the anatomy of interest, and to develop systems that allow to improve radiology and surgery. The 3D visualization drastically simplifies the interpretation process of medical images and provides benefits both in diagnosing and in surgical planning phases. Further advantages can be introduced registering virtual pre-operative information (3D models) with real intra-operative information (patient and surgical instruments). The surgeon can use mixed-reality systems that allow him/her to see covered structures before reaching them, surgical navigators for see the scene (anatomy and instruments) from different point of view and smart mechatronics devices, which, knowing the anatomy, assist him/her in an active way. All these aspects are useful in terms of safety, efficiency and financial resources for the physicians, for the patient and for the sanitary system too. The entire process, from volumetric radiological images acquisition up to the use of 3D anatomical models inside the surgical room, has been studied and specific applications have been developed. A segmentation procedure has been designed taking into account acquisition protocols commonly used in radiological departments, and a software tool, that allows to obtain efficient 3D models, have been implemented and tested. The alignment problem has been investigated examining the various sources of errors during the image acquisition, in the radiological department, and during to the execution of the intervention. A rigid body registration procedure compatible with the surgical environment has been defined and implemented. The procedure has been integrated in a surgical navigation system and is useful as starting initial registration for more accurate alignment methods based on deformable approaches. Monoscopic and stereoscopic 3D localization machine vision routines, using the laparoscopic and/or generic cameras images, have been implemented to obtain intra-operative information that can be used to model abdominal deformations. Further, the use of this information for fusion and registration purposes allows to enhance the potentialities of computer assisted surgery. In particular a precise alignment between virtual and real anatomies for mixed-reality purposes, and the development of tracker-free navigation systems, has been obtained elaborating video images and providing an analytical adaptation of the virtual camera to the real camera. Clinical tests, demonstrating the usability of the proposed solutions, are reported. Test results and appreciation of radiologists and surgeons, to the proposed prototypes, encourage their integration in the daily clinical practice and future developments

CT investigations of Australian Devonian fossil fishes, and the application of 3D segmentation and modelling in vertebrate morphology

This thesis by compilation covers four publications, which together demonstrate and apply computed tomography (CT) data, three-dimensional (3D) segmentation, and 3D printing, for the non-destructive high-resolution detection of internal structure in early vertebrate fossils. Paper 1 (published 2019) studied the tetrapodomorph fish, Gogonasus, a three dimensionally well-preserved acid etched Devonian sarcopterygian. 3D modelling and printing were used for the reconstruction of its shoulder girdle and opercular series. A close fit of the opercular series against the upper bones of the shoulder girdle required a more horizontally aligned anocleithrum, supracleithrum and post-temporal than in previous reconstructions. Subopercular bone 2 is partly covered the clavicle, and the ascending process of the clavicle, and the ventral process of the anocleithrum, do not fit closely inside the cleithrum, suggesting they may have functioned for ligamentous attachment. A rugose area on the anocleithral process has a similar relative position to muscle ligament attachements in the shoulder girdle of various living actinopterygians. The manipulation of 3D models demonstrates testing of morphological fit for extremely fragile acid-etched bones. Paper 2 (published 2017) dealt with an articulated Devonian placoderm. Micro CT, 3D segmentation, and enlarged 3D models of a buchanosteid arthrodire, demonstrated a double ethmoid and a palatobasal connection for the palatoquadrate, but no otic connection. A separately ossified cartilage behind the mandibular joint is comparable to the interhyal of osteichthyans. Two articular facets on the braincase associated with the hyomandibular nerve foramen supported a possible epihyal element and a separate opercular cartilage. Reassembling 3D printouts demonstrates the limits of jaw kinetics. New details on the hyoid arch will help to reformulate characters that are key in the heated debate of placoderm monophyly or paraphyly. Paper 3 (published 2019) describes the detailed morphology of the three gnathal elements of the same specimen as on the previous paper, giving insights into the morphology and organization of the dentition in arthrodires. Arthrodire placoderms, as a possible sister group of Chinese maxillate placoderms plus crown gnathostomes, provide important information regarding early evolution of jaws and teeth. In displaying numerous denticle rows, the gnathal element morphology is different from the much-reduced denticulation of higher brachythoracid arthrodires. Ossification centres are anterolateral on the anterior supragnathal (attached to the braincase), anteromesial on the posterior supragnathal (attached to the palatoquadrate), and in the central part of the biting portion of the infragnathal (attached to the meckelian cartilage). The infragnathal shows no evidence of two ossification centres, as has been interpreted for more advanced arthrodires. The new evidence gives insights into the primitive arthrodire condition for comparison with the dermal jaw bones of Chinese 'maxillate' placoderms that have been homologised with the premaxilla, maxilla, and dentary of osteichthyans. Paper 4 (published 2020) summarizes the relationship between different modules of Drishti, an open-source volume exploration, rendering and three-dimensional segmentation software program that was used in the previous three published papers. A new version (Drishti v2.7) is presented, with a new tool for thresholding volume data (i.e. gradient thresholding). A protocol is introduced for performing three-dimensional segmentation using the new 3D Freeform Painter tool. In Drishti Paint, these new tools and workflow enable more accurate and precise digital reconstruction, 3D modelling and three-dimensional printing/modelling results. Scan data from the buchanosteus arthrodire (Paper 2 and 3) was used as a case study but published procedure is widely applicable in biological, medical and industrial research

Development of a Body-powered Hand Prosthesis with Flexible Materials by Additive Manufacturing

The research on prostheses made by Additive Manufacturing (AM) has been increasing, as they solve some of the issues of the most common prostheses. However, despite their growth, these prostheses have a high rejection rate, especially in children, due to their low level of anthropomorphism. The main goal of this study was to develop an aesthetically appealing three-dimensional (3D) printed body-powered prosthesis for a four-year-old child with a transverse metacarpal total deficiency. The development of the prosthesis started through an assessment of the anatomical features of the extremities of patient’s both upper limbs, performed with body casting, simple measurements and 3D-scanning of the cast. The whole prosthesis was designed using the Fusion 360 CAD software and produced using The Original Prusa i3 MK3S and polylactic acid (PLA) and Filaflex filaments. The prosthesis was designed through an iterative process, whereby the prosthesis’ appearance and functionality were optimised. During the design stages, several design configurations and printing settings were tested. Some printed models were evaluated using pull tests. The developed prosthesis possessed a high level of anthropomorphism, consisting of a solution that is quite similar to a human hand. Despite all the generated concepts focused on increasing the performance of 3D-printed body-powered prostheses, the developed prosthesis presented a low functionality. However, the device was cheaper and lighter than the existing 3D-printed body-powered prostheses. Moreover, the performed tests revealed that a better printing quality implied higher forces to flex the prosthesis and consequently, lower functionality. The final prototype was presented to the child and his family, which provided their feedback using the System Usability Survey and a custom-made assessment questionnaire. The resulting scores classified the device as "Excellent". Despite being promising, further work is still required for this device to be used by children with upper limb defects.A investigação em próteses feitas através de Manufatura Aditiva tem aumentado, uma vez que as mesmas solucionam alguns dos problemas das próteses mais comuns. Porém, apesar deste crescimento, estas próteses apresentam uma elevada taxa de rejeição, principalmente em crianças, devido ao seu baixo nível de antropomorfismo. O objetivo principal deste estudo consistiu no desenvolvimento de uma prótese body-powered esteticamente apelativa, impressa a três dimensões, para uma criança de quatro anos com uma deficiência total transversal do metacarpo. O desenvolvimento da prótese começou com uma avaliação das características anatómicas das extremidades de ambos os membros superiores do paciente, realizada através de extração de moldes, medições simples e scanning tridimensional dos moldes. Toda a prótese foi desenhada com o software Fusion 360 CAD e produzida através da impressora The Original Prusa i3 MK3S com filamentos de ácido polilático (PLA) e Filaflex. A prótese foi desenvolvida através de um processo iterativo, em que a aparência e a funcionalidade da prótese foram otimizadas. Durante as fases de design, foram testadas várias configurações de design e impressão. Alguns modelos impressos foram avaliados através de testes de tração. A prótese desenvolvida possui um elevado nível de antropomorfismo, consistindo numa solução bastante semelhante a uma mão humana. Apesar de todos os conceitos gerados com o objetivo de aumentar o desempenho das próteses body-powered impressas a três dimensões, a prótese desenvolvida apresentou uma baixa funcionalidade. No entanto, o dispositivo é mais barato e mais leve do que outras próteses body-powered impressas a três dimensões. Além disso, os testes realizados revelaram que uma melhor qualidade de impressão implica maiores forças para flexionar a prótese e, consequentemente, uma menor funcionalidade. O protótipo final foi apresentado à criança e sua família, os quais forneceram feedback através do questionário de usabilidade "System Usability Survey" e de um questionário personalizado. As pontuações resultantes classificaram o dispositivo como "Excelente". Apesar de promissor, é necessário trabalho futuro para que este dispositivo seja utilizado por crianças com deficiências dos membros superiores

Three-dimensional morphanalysis of the face.

The aim of the work reported in this thesis was to determine the extent to which orthogonal two-dimensional morphanalytic (universally relatable) craniofacial imaging methods can be extended into the realm of computer-based three-dimensional imaging. New methods are presented for capturing universally relatable laser-video surface data, for inter-relating facial surface scans and for constructing probabilistic facial averages. Universally relatable surface scans are captured using the fixed relations principle com- bined with a new laser-video scanner calibration method. Inter- subject comparison of facial surface scans is achieved using inter- active feature labelling and warping methods. These methods have been extended to groups of subjects to allow the construction of three-dimensional probabilistic facial averages. The potential of universally relatable facial surface data for applications such as growth studies and patient assessment is demonstrated. In addition, new methods for scattered data interpolation, for controlling overlap in image warping and a fast, high-resolution method for simulating craniofacial surgery are described. The results demonstrate that it is not only possible to extend universally relatable imaging into three dimensions, but that the extension also enhances the established methods, providing a wide range of new applications

A gaze-contingent framework for perceptually-enabled applications in healthcare

Patient safety and quality of care remain the focus of the smart operating room of the future. Some of the most influential factors with a detrimental effect are related to suboptimal communication among the staff, poor flow of information, staff workload and fatigue, ergonomics and sterility in the operating room. While technological developments constantly transform the operating room layout and the interaction between surgical staff and machinery, a vast array of opportunities arise for the design of systems and approaches, that can enhance patient safety and improve workflow and efficiency. The aim of this research is to develop a real-time gaze-contingent framework towards a "smart" operating suite, that will enhance operator's ergonomics by allowing perceptually-enabled, touchless and natural interaction with the environment. The main feature of the proposed framework is the ability to acquire and utilise the plethora of information provided by the human visual system to allow touchless interaction with medical devices in the operating room. In this thesis, a gaze-guided robotic scrub nurse, a gaze-controlled robotised flexible endoscope and a gaze-guided assistive robotic system are proposed. Firstly, the gaze-guided robotic scrub nurse is presented; surgical teams performed a simulated surgical task with the assistance of a robot scrub nurse, which complements the human scrub nurse in delivery of surgical instruments, following gaze selection by the surgeon. Then, the gaze-controlled robotised flexible endoscope is introduced; experienced endoscopists and novice users performed a simulated examination of the upper gastrointestinal tract using predominately their natural gaze. Finally, a gaze-guided assistive robotic system is presented, which aims to facilitate activities of daily living. The results of this work provide valuable insights into the feasibility of integrating the developed gaze-contingent framework into clinical practice without significant workflow disruptions.Open Acces