2 research outputs found
Personalized medicine in surgical treatment combining tracking systems, augmented reality and 3D printing
Mención Internacional en el tÃtulo de doctorIn the last twenty years, a new way of practicing medicine has been focusing on the problems and needs of each patient as an individual thanks to the significant advances in healthcare technology, the so-called personalized medicine. In surgical treatments, personalization has been possible thanks to key technologies adapted to the specific anatomy of each patient and the needs of the physicians. Tracking systems, augmented reality (AR), three-dimensional (3D) printing and artificial intelligence (AI) have previously supported this individualized medicine in many ways. However, their independent contributions show several limitations in terms of patient-to-image registration, lack of flexibility to adapt to the requirements of each case, large preoperative planning times, and navigation complexity.
The main objective of this thesis is to increase patient personalization in surgical treatments by combining these technologies to bring surgical navigation to new complex cases by developing new patient registration methods, designing patient-specific tools, facilitating access to augmented reality by the medical community, and automating surgical workflows.
In the first part of this dissertation, we present a novel framework for acral tumor resection combining intraoperative open-source navigation software, based on an optical tracking system, and desktop 3D printing. We used additive manufacturing to create a patient-specific mold that maintained the same position of the distal extremity during image-guided surgery as in the preoperative images. The feasibility of the proposed workflow was evaluated in two clinical cases (soft-tissue sarcomas in hand and foot). We achieved an overall accuracy of the system of 1.88 mm evaluated on the patient-specific 3D printed phantoms. Surgical navigation was feasible during both surgeries, allowing surgeons to verify the tumor resection margin.
Then, we propose and augmented reality navigation system that uses 3D printed surgical guides with a tracking pattern enabling automatic patient-to-image registration in orthopedic oncology. This specific tool fits on the patient only in a pre-designed location, in this case bone tissue. This solution has been developed as a software application running on Microsoft HoloLens. The workflow was validated on a 3D printed phantom replicating the anatomy of a patient presenting an extraosseous Ewing’s sarcoma, and then tested during the actual surgical intervention. The results showed that the surgical guide with the reference marker can be placed precisely with an accuracy of 2 mm and a visualization error lower than 3 mm. The application allowed physicians to visualize the skin, bone, tumor and medical images overlaid on the phantom and patient.
To enable the use of AR and 3D printing by inexperienced users without broad technical knowledge, we designed a step-by-step methodology. The proposed protocol describes how to develop an AR smartphone application that allows superimposing any patient-based 3D model onto a real-world environment using a 3D printed marker tracked by the smartphone camera. Our solution brings AR solutions closer to the final clinical user, combining free and open-source software with an open-access protocol. The proposed guide is already helping to accelerate the adoption of these technologies by medical professionals and researchers.
In the next section of the thesis, we wanted to show the benefits of combining these technologies during different stages of the surgical workflow in orthopedic oncology. We designed a novel AR-based smartphone application that can display the patient’s anatomy and the tumor’s location. A 3D printed reference marker, designed to fit in a unique position of the affected bone tissue, enables automatic registration. The system has been evaluated in terms of visualization accuracy and usability during the whole surgical workflow on six realistic phantoms achieving a visualization error below 3 mm. The AR system was tested in two clinical cases during surgical planning, patient communication, and surgical intervention. These results and the positive feedback obtained from surgeons and patients suggest that the combination of AR and 3D printing can improve efficacy, accuracy, and patients’ experience
In the final section, two surgical navigation systems have been developed and evaluated to guide electrode placement in sacral neurostimulation procedures based on optical tracking and augmented reality. Our results show that both systems could minimize patient discomfort and improve surgical outcomes by reducing needle insertion time and number of punctures. Additionally, we proposed a feasible clinical workflow for guiding SNS interventions with both navigation methodologies, including automatically creating sacral virtual 3D models for trajectory definition using artificial intelligence and intraoperative patient-to-image registration.
To conclude, in this thesis we have demonstrated that the combination of technologies such as tracking systems, augmented reality, 3D printing, and artificial intelligence overcomes many current limitations in surgical treatments. Our results encourage the medical community to combine these technologies to improve surgical workflows and outcomes in more clinical scenarios.Programa de Doctorado en Ciencia y TecnologÃa Biomédica por la Universidad Carlos III de MadridPresidenta: MarÃa Jesús Ledesma Carbayo.- Secretaria: MarÃa Arrate Muñoz Barrutia.- Vocal: Csaba Pinte
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Mobile depth sensing technology and algorithms with application to occupational therapy healthcare
This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonThe UK government is striving to shift its current healthcare delivery model from clini-cian–oriented services, to that of patient and self–care–oriented intervention strategies. It seeks to do so through Information Communication (ICT) and Computer Mediated Re-ality Technologies (CMRT) as a key strategy to overcome the ever–increasing scarcity of healthcare resources and costs. To this end, in the UK the use of paper–based information systems have exhibited their limitations in providing apposite care. At the national level, The Royal College of Occupational Therapists (RCOT) identify home visits and modifica-tions as key levers in a multifactorial health programme to evaluate interventions for older people with a history of falling or are identified as being prone to falling. Prescribing Assistive Equipment (AE) is one such mechanism that seeks to reduce the risk of falling whilst promoting the continued independence of physical dexterity and mobility in older adults at home. In the UK, the yearly cost of falls is estimated at £2.3 billion. Further evidence places a 30% to 60% abandonment rate on prescribed AE by and large due to a ‘poor fit’ and measurement inaccuracies.
To remain aligned with the national strategy, and assist in the eradication of measurement inaccuracies, this thesis employs Mobile Depth Sensing and Motion Track-ing Devices (MDSMTDs) to assist OTs in in the process of digitally measuring the extrin-sic fall–risk factors for the provision of AE. The quintessential component in this assess-ment lies in the measurement of fittings and furniture items in the home. To digitise and aid in this process, the artefact presented in this thesis employs stereo computer–vision and camera calibration algorithms to extract edges in 3D space. It modifies the Sobel–Feldman convolution filter by reducing the magnitude response and employs the camera intrinsic parameters as a mechanism to calculate the distortion matrix for interpolation between the edges and the 3D point cloud. Further Augmented Reality User Experience (AR-UX) facets are provided to digitise current state of the art clinical guidance and over-lay its instructions onto the real world (i.e., 3D space).
Empirical mixed methods assessment revealed that in terms of accuracy, the arte-fact exhibited enhanced performance gains over current paper–based guidance. In terms of accuracy consistency, the artefact can rectify measurement consistency inaccuracies, but there are still a wide range of factors that can influence the integrity of the point-cloud in respect of the device’s point-of-view, holding positions and measurement speed. To this end, OTs usability, and adoption preferences materialise in favour of the artefact. In conclusion, this thesis demonstrates that MDSMTDs are a promising alterna-tive to existing paper–based measurement practices as OTs appear to prefer the digital–based system and that they can take measurements more efficiently and accurately