Development of a Surgical Assistance System for Guiding Transcatheter Aortic Valve Implantation

Development of image-guided interventional systems is growing up rapidly in the recent years. These new systems become an essential part of the modern minimally invasive surgical procedures, especially for the cardiac surgery. Transcatheter aortic valve implantation (TAVI) is a recently developed surgical technique to treat severe aortic valve stenosis in elderly and high-risk patients. The placement of stented aortic valve prosthesis is crucial and typically performed under live 2D fluoroscopy guidance. To assist the placement of the prosthesis during the surgical procedure, a new fluoroscopy-based TAVI assistance system has been developed. The developed assistance system integrates a 3D geometrical aortic mesh model and anatomical valve landmarks with live 2D fluoroscopic images. The 3D aortic mesh model and landmarks are reconstructed from interventional angiographic and fluoroscopic C-arm CT system, and a target area of valve implantation is automatically estimated using these aortic mesh models. Based on template-based tracking approach, the overlay of visualized 3D aortic mesh model, landmarks and target area of implantation onto fluoroscopic images is updated by approximating the aortic root motion from a pigtail catheter motion without contrast agent. A rigid intensity-based registration method is also used to track continuously the aortic root motion in the presence of contrast agent. Moreover, the aortic valve prosthesis is tracked in fluoroscopic images to guide the surgeon to perform the appropriate placement of prosthesis into the estimated target area of implantation. An interactive graphical user interface for the surgeon is developed to initialize the system algorithms, control the visualization view of the guidance results, and correct manually overlay errors if needed. Retrospective experiments were carried out on several patient datasets from the clinical routine of the TAVI in a hybrid operating room. The maximum displacement errors were small for both the dynamic overlay of aortic mesh models and tracking the prosthesis, and within the clinically accepted ranges. High success rates of the developed assistance system were obtained for all tested patient datasets. The results show that the developed surgical assistance system provides a helpful tool for the surgeon by automatically defining the desired placement position of the prosthesis during the surgical procedure of the TAVI.Die Entwicklung bildgeführter interventioneller Systeme wächst rasant in den letzten Jahren. Diese neuen Systeme werden zunehmend ein wesentlicher Bestandteil der technischen Ausstattung bei modernen minimal-invasiven chirurgischen Eingriffen. Diese Entwicklung gilt besonders für die Herzchirurgie. Transkatheter Aortenklappen-Implantation (TAKI) ist eine neue entwickelte Operationstechnik zur Behandlung der schweren Aortenklappen-Stenose bei alten und Hochrisiko-Patienten. Die Platzierung der Aortenklappenprothese ist entscheidend und wird in der Regel unter live-2D-fluoroskopischen Bildgebung durchgeführt. Zur Unterstützung der Platzierung der Prothese während des chirurgischen Eingriffs wurde in dieser Arbeit ein neues Fluoroskopie-basiertes TAKI Assistenzsystem entwickelt. Das entwickelte Assistenzsystem überlagert eine 3D-Geometrie des Aorten-Netzmodells und anatomischen Landmarken auf live-2D-fluoroskopische Bilder. Das 3D-Aorten-Netzmodell und die Landmarken werden auf Basis der interventionellen Angiographie und Fluoroskopie mittels eines C-Arm-CT-Systems rekonstruiert. Unter Verwendung dieser Aorten-Netzmodelle wird das Zielgebiet der Klappen-Implantation automatisch geschätzt. Mit Hilfe eines auf Template Matching basierenden Tracking-Ansatzes wird die Überlagerung des visualisierten 3D-Aorten-Netzmodells, der berechneten Landmarken und der Zielbereich der Implantation auf fluoroskopischen Bildern korrekt überlagert. Eine kompensation der Aortenwurzelbewegung erfolgt durch Bewegungsverfolgung eines Pigtail-Katheters in Bildsequenzen ohne Kontrastmittel. Eine starrere Intensitätsbasierte Registrierungsmethode wurde verwendet, um kontinuierlich die Aortenwurzelbewegung in Bildsequenzen mit Kontrastmittelgabe zu detektieren. Die Aortenklappenprothese wird in die fluoroskopischen Bilder eingeblendet und dient dem Chirurg als Leitfaden für die richtige Platzierung der realen Prothese. Eine interaktive Benutzerschnittstelle für den Chirurg wurde zur Initialisierung der Systemsalgorithmen, zur Steuerung der Visualisierung und für manuelle Korrektur eventueller Überlagerungsfehler entwickelt. Retrospektive Experimente wurden an mehreren Patienten-Datensätze aus der klinischen Routine der TAKI in einem Hybrid-OP durchgeführt. Hohe Erfolgsraten des entwickelten Assistenzsystems wurden für alle getesteten Patienten-Datensätze erzielt. Die Ergebnisse zeigen, dass das entwickelte chirurgische Assistenzsystem ein hilfreiches Werkzeug für den Chirurg bei der Platzierung Position der Prothese während des chirurgischen Eingriffs der TAKI bietet

An easy-to-use 2D-3D registration process

This report describes the work carried out during the project representing the final part of the Professional Doctorate in Engineering (PDEng) degree pro-gram in Software Technology provided by the Eindhoven University of Technology and Stan Ackermans Institute. The project name is "An Easy-to-use 2D-3D Registration Process". This project consists of the design and development of an easy-to-use inter-face for image registration for the VesselNavigator prototype developed in Philips Healthcare. The report is addressed to a technical audience that has a general knowledge about software design and medical imaging. Readers that are interested in the clinical background and the goals of the project should refer to Chapters 2-5. Details about the software architecture design and implementation are provid-ed in Chapters 6-8. For the result of the project and the software process used readers must address Chapters 9 and 10

Structure-Property Relationships in Aluminum-Copper alloys using Transmission X-Ray Microscopy (TXM) and Micromechanical Testing

abstract: Aluminum alloys are ubiquitously used in almost all structural applications due to their high strength-to-weight ratio. Their superior mechanical performance can be attributed to complex dispersions of nanoscale intermetallic particles that precipitate out from the alloy’s solid solution and offer resistance to deformation. Although they have been extensively investigated in the last century, the traditional approaches employed in the past haven’t rendered an authoritative microstructural understanding in such materials. The effect of the precipitates’ inherent complex morphology and their three-dimensional (3D) spatial distribution on evolution and deformation behavior have often been precluded. In this study, for the first time, synchrotron-based hard X-ray nano-tomography has been implemented in Al-Cu alloys to measure growth kinetics of different nanoscale phases in 3D and reveal mechanistic insights behind some of the observed novel phase transformation reactions occurring at high temperatures. The experimental results were reconciled with coarsening models from the LSW theory to an unprecedented extent, thereby establishing a new paradigm for thermodynamic analysis of precipitate assemblies. By using a unique correlative approach, a non-destructive means of estimating precipitation-strengthening in such alloys has been introduced. Limitations of using existing mechanical strengthening models in such alloys have been discussed and a means to quantify individual contributions from different strengthening mechanisms has been established. The current rapid pace of technological progress necessitates the demand for more resilient and high-performance alloys. To achieve this, a thorough understanding of the relationships between material properties and its structure is indispensable. To establish this correlation and achieve desired properties from structural alloys, microstructural response to mechanical stimuli needs to be understood in three-dimensions (3D). To that effect, in situ tests were conducted at the synchrotron (Advanced Photon Source) using Transmission X-Ray Microscopy as well as in a scanning electron microscope (SEM) to study real-time damage evolution in such alloys. Findings of precipitate size-dependent transition in deformation behavior from these tests have inspired a novel resilient aluminum alloy design.Dissertation/ThesisDoctoral Dissertation Materials Science and Engineering 201

The inertial properties of the German Shepherd

Previously held under moratorium from 30th November 2016 until 30th November 2021The police service dog has a long history stretching as far back as the 1400’s. One of the most popular dog breeds deployed by both the police and military has been the German Shepherd yet little is known about the morphology or body segment parameters of this breed. Knowledge of these measures is essential for developing biomechanical models that can guide clinicians in developing surgical interventions, injury treatment and prevention procedures. The aim of this thesis was to provide a complete set of body segment parameters and inertial properties for the German Shepherd. In addition, a canine motion capture suit and marker model was proposed for use with this dog population. Morphometric measures and 3-dimensional inertial properties, including mass, centre of mass, moment of inertia and volume, were measured from 17 segments from each of 6 German Shepherd police service dog cadavers. Measurements were performed with frozen segments similar to the procedure on primates described by Reynolds (1974), on humans by Chandler et al. (1975) and on horses by Buchner et al. (1997). Using whole body mass and geometric modelling, multiple linear regression equations were developed from the collected data so that they may be used to estimate segment masses and inertial tensors in living dogs. Using a custom Lycra suit and 44-marker full-body marker set, kinematic data were collected to assess the practicality of the model, to observe the dogs’ acceptance of the motion capture suit and to ensure fore and hind limb flexion/extension angles were comparable to those of other canine studies. Using frozen cadavers, tissue loss was minimal at an average loss of 0.49% of total body mass. Hind limbs, at 6.8% of body mass, were 2.3% heavier than the forelimbs. Of the over 100 morphometric measures analysed, 33 were kept for inclusion in the linear regression equations and joint centre estimations. Analyses of body mass alone, found that, except for the abdominal segment (r = .845, p≤.05), body mass did not correlate well with segmental masses. Similarly for moments of inertia, only the manus and pes produced predictive results using body mass alone. 11 regression equations were developed for predicting segment masses, and 33 equations were developed for predicting moments of inertia about the three primary axes of each segment. Regression correlation analyses were summarized for each segment and a table of normalised average segment masses, centres of mass, radii of gyration and segment densities was produced. Five police service dogs took part in the evaluation of the motion capture suit. Overall the marker set and suit performed well and was well-received by dog/handler teams. The markers took very little time to apply, remained in place for the majority of trials and the suit itself did not visibly affect the dog’s natural movement. An analysis of the kinematic data produced outputs showing characteristic patterns of flexion/extension similar to those found in other canine research. With the development of regression equations for predicting segment mass and moments of inertia combined with the proposed marker model and novel method of marker attachment, inverse dynamic analyses may be applied in future investigations of canine mechanics, potentially guiding surgical procedures, rehabilitation and training for the German Shepherd breed. Key Words: Canine, German Shepherd, morphometry, kinematics, kinetics, inertial properties, body segment parameter, segment model, moment of inertia, mass distribution.The police service dog has a long history stretching as far back as the 1400’s. One of the most popular dog breeds deployed by both the police and military has been the German Shepherd yet little is known about the morphology or body segment parameters of this breed. Knowledge of these measures is essential for developing biomechanical models that can guide clinicians in developing surgical interventions, injury treatment and prevention procedures. The aim of this thesis was to provide a complete set of body segment parameters and inertial properties for the German Shepherd. In addition, a canine motion capture suit and marker model was proposed for use with this dog population. Morphometric measures and 3-dimensional inertial properties, including mass, centre of mass, moment of inertia and volume, were measured from 17 segments from each of 6 German Shepherd police service dog cadavers. Measurements were performed with frozen segments similar to the procedure on primates described by Reynolds (1974), on humans by Chandler et al. (1975) and on horses by Buchner et al. (1997). Using whole body mass and geometric modelling, multiple linear regression equations were developed from the collected data so that they may be used to estimate segment masses and inertial tensors in living dogs. Using a custom Lycra suit and 44-marker full-body marker set, kinematic data were collected to assess the practicality of the model, to observe the dogs’ acceptance of the motion capture suit and to ensure fore and hind limb flexion/extension angles were comparable to those of other canine studies. Using frozen cadavers, tissue loss was minimal at an average loss of 0.49% of total body mass. Hind limbs, at 6.8% of body mass, were 2.3% heavier than the forelimbs. Of the over 100 morphometric measures analysed, 33 were kept for inclusion in the linear regression equations and joint centre estimations. Analyses of body mass alone, found that, except for the abdominal segment (r = .845, p≤.05), body mass did not correlate well with segmental masses. Similarly for moments of inertia, only the manus and pes produced predictive results using body mass alone. 11 regression equations were developed for predicting segment masses, and 33 equations were developed for predicting moments of inertia about the three primary axes of each segment. Regression correlation analyses were summarized for each segment and a table of normalised average segment masses, centres of mass, radii of gyration and segment densities was produced. Five police service dogs took part in the evaluation of the motion capture suit. Overall the marker set and suit performed well and was well-received by dog/handler teams. The markers took very little time to apply, remained in place for the majority of trials and the suit itself did not visibly affect the dog’s natural movement. An analysis of the kinematic data produced outputs showing characteristic patterns of flexion/extension similar to those found in other canine research. With the development of regression equations for predicting segment mass and moments of inertia combined with the proposed marker model and novel method of marker attachment, inverse dynamic analyses may be applied in future investigations of canine mechanics, potentially guiding surgical procedures, rehabilitation and training for the German Shepherd breed. Key Words: Canine, German Shepherd, morphometry, kinematics, kinetics, inertial properties, body segment parameter, segment model, moment of inertia, mass distribution

Automated catheter navigation with electromagnetic image guidance

This paper describes a novel method of controlling an endoscopic catheter by using an automated catheter tensioning system with the objective of providing clinicians with improved manipulation capabilities within the patient. Catheters are used in many clinical procedures to provide access to the cardiopulmonary system. Control of such catheters is performed manually by the clinicians using a handle, typically actuating a single or opposing set of pull wires. Such catheters are generally actuated in a single plane, requiring the clinician to rotate the catheter handle to navigate the system. The automation system described here allows closed-loop control of a custom bronchial catheter in tandem with an electromagnetic tracking of the catheter tip and image guidance by using a 3D Slicer. An electromechanical drive train applies tension to four pull wires to steer the catheter tip, with the applied force constantly monitored through force sensing load cells. The applied tension is controlled through a PC connected joystick. An electromagnetic sensor embedded in the catheter tip enables constant real-time position tracking, whereas a working channel provides a route for endoscopic instruments. The system is demonstrated and tested in both a breathing lung model and a preclinical animal study. Navigation to predefined targets in the subject's airways by using the joystick while using virtual image guidance and electromagnetic tracking was demonstrated. Average targeting times were 29 and 10 s, respectively, for the breathing lung and live animal studies. This paper presents the first reported remote controlled bronchial working channel catheter utilizing electromagnetic tracking and has many implications for future development in endoscopic and catheter-based procedures