Subject-Specific Ligament Models: Towards Real-Time Simulation of the Knee Joint

International audienceWe present an efficient finite element method to simulate a transversely isotropic non-linear material for ligaments. The approach relies on tetrahedral elements and exploits the geometry to optimize computation of the derivatives of the strain energy. To better support incompressibilty, deviatoric and dilational responses are uncoupled and a penalty term controls volume preservation. We derive stress and elasticity tensors required for implicit solvers and verify our model against the FEBio software using a variety of load scenarios with synthetic shapes. The maximum node positioning error for ligament materials is < 5% for strains under physiological conditions. To generate subject-specific ligament models, we propose a novel technique to estimate fiber orientation from segmented ligament geometry. The approach is based on an automatic centerline extraction and generation of the corresponding diffusion field. We present results for a medial collateral ligament segmented from standard MRI data. Results show the general viability of the method, but also the limitations of current MRI acquisitions. In the future, we hope to employ the presented techniques for real-time simulation of knee surgery

Determination of critical factors for fast and accurate 2D medical image deformation

The advent of medical imaging technology enabled physicians to study patient anatomy non-invasively and revolutionized the medical community. As medical images have become digitized and the resolution of these images has increased, software has been developed to allow physicians to explore their patients\u27 image studies in an increasing number of ways by allowing viewing and exploration of reconstructed three-dimensional models. Although this has been a boon to radiologists, who specialize in interpreting medical images, few software packages exist that provide fast and intuitive interaction for other physicians. In addition, although the users of these applications can view their patient data at the time the scan was taken, the placement of the tissues during a surgical intervention is often different due to the position of the patient and methods used to provide a better view of the surgical field. None of the commonly available medical image packages allow users to predict the deformation of the patient\u27s tissues under those surgical conditions. This thesis analyzes the performance and accuracy of a less computationally intensive yet physically-based deformation algorithm- the extended ChainMail algorithm. The proposed method allows users to load DICOM images from medical image studies, interactively classify the tissues in those images according to their properties under deformation, deform the tissues in two dimensions, and visualize the result. The method was evaluated using data provided by the Truth Cube experiment, where a phantom made of material with properties similar to liver under deformation was placed under varying amounts of uniaxial strain. CT scans were before and after the deformations. The deformation was performed on a single DICOM image from the study that had been manually classified as well as on data sets generated from that original image. These generated data sets were ideally segmented versions of the phantom images that had been scaled to varying fidelities in order to evaluate the effect of image size on the algorithm\u27s accuracy and execution time. Two variations of the extended ChainMail algorithm parameters were also implemented for each of the generated data sets in order to examine the effect of the parameters. The resultant deformations were compared with the actual deformations as determined by the Truth Cube experimenters. For both variations of the algorithm parameters, the predicted deformations at 5% uniaxial strain had an RMS error of a similar order of magnitude to the errors in a finite element analysis performed by the truth cube experimenters for the deformations at 18.25% strain. The average error was able to be reduced by approximately between 10-20% for the lower fidelity data sets through the use of one of the parameter schemes, although the benefit decreased as the image size increased. When the algorithm was evaluated under 18.25% strain, the average errors were more than 8 y times that of the errors in the finite element analysis. Qualitative analysis of the deformed images indicated differing degrees of accuracy across the ideal image set, with the largest displacements estimated closer to the initial point of deformation. This is hypothesized to be a result of the order in which deformation was processed for points in the image. The algorithm execution time was examined for the varying generated image fidelities. For a generated image that was approximately 18.5% of the size of the tissue in the original image, the execution time was less than 15 seconds. In comparison, the algorithm processing time for the full-scale image was over 3 y hours. The analysis of the extended ChainMail algorithm for use in medical image deformation emphasizes the importance of the choice of algorithm parameters on the accuracy of the deformations and of data set size on the processing time

Realistic tool-tissue interaction models for surgical simulation and planning

Surgical simulators present a safe and potentially effective method for surgical training, and can also be used in pre- and intra-operative surgical planning. Realistic modeling of medical interventions involving tool-tissue interactions has been considered to be a key requirement in the development of high-fidelity simulators and planners. The soft-tissue constitutive laws, organ geometry and boundary conditions imposed by the connective tissues surrounding the organ, and the shape of the surgical tool interacting with the organ are some of the factors that govern the accuracy of medical intervention planning.\ud \ud This thesis is divided into three parts. First, we compare the accuracy of linear and nonlinear constitutive laws for tissue. An important consequence of nonlinear models is the Poynting effect, in which shearing of tissue results in normal force; this effect is not seen in a linear elastic model. The magnitude of the normal force for myocardial tissue is shown to be larger than the human contact force discrimination threshold. Further, in order to investigate and quantify the role of the Poynting effect on material discrimination, we perform a multidimensional scaling study. Second, we consider the effects of organ geometry and boundary constraints in needle path planning. Using medical images and tissue mechanical properties, we develop a model of the prostate and surrounding organs. We show that, for needle procedures such as biopsy or brachytherapy, organ geometry and boundary constraints have more impact on target motion than tissue material parameters. Finally, we investigate the effects surgical tool shape on the accuracy of medical intervention planning. We consider the specific case of robotic needle steering, in which asymmetry of a bevel-tip needle results in the needle naturally bending when it is inserted into soft tissue. We present an analytical and finite element (FE) model for the loads developed at the bevel tip during needle-tissue interaction. The analytical model explains trends observed in the experiments. We incorporated physical parameters (rupture toughness and nonlinear material elasticity) into the FE model that included both contact and cohesive zone models to simulate tissue cleavage. The model shows that the tip forces are sensitive to the rupture toughness. In order to model the mechanics of deflection of the needle, we use an energy-based formulation that incorporates tissue-specific parameters such as rupture toughness, nonlinear material elasticity, and interaction stiffness, and needle geometric and material properties. Simulation results follow similar trends (deflection and radius of curvature) to those observed in macroscopic experimental studies of a robot-driven needle interacting with gels

セイタイ ナンソシキ ノ ネンダンセイ ヒョウカホウ ト ケイソク システム カイハツ

博士（工学）東京農工大

Real-time simulation of soft tissue deformation for surgical simulation

Surgical simulation plays an important role in the training, planning and evaluation of many surgical procedures. It requires realistic and real-time simulation of soft tissue deformation under interaction with surgical tools. However, it is challenging to satisfy both of these conflicting requirements. On one hand, biological soft tissues are complex in terms of material compositions, structural formations, and mechanical behaviours, resulting in nonlinear deformation characteristics under an external load. Due to the involvement of both material and geometric nonlinearities, the use of nonlinear elasticity causes a highly expensive computational load, leading to the difficulty to achieve the real-time computational performance required by surgical simulation. On the other hand, in order to satisfy the real-time computational requirement, most of the existing methods are mainly based on linear elasticity under the assumptions of small deformation and homogeneity to describe deformation of soft tissues. Such simplifications allow reduced runtime computation; however, they are inadequate for modelling nonlinear material properties such as anisotropy, heterogeneity and large deformation of soft tissues. In general, the two conflicting requirements of surgical simulation raise immense complexity in modelling of soft tissue deformation. This thesis focuses on establishment of new methodologies for modelling of soft tissue deformation for surgical simulation. Due to geometric and material nonlinearities in soft tissue deformation, the existing methods have only limited capabilities in achieving nonlinear soft tissue deformation in real-time. In this thesis, the main focus is devoted to the real-time and realistic modelling of nonlinear soft tissue deformation for surgical simulation. New methodologies, namely new ChainMail algorithms, energy propagation method, and energy balance method, are proposed to address soft tissue deformation. Results demonstrate that the proposed methods can simulate the typical soft tissue mechanical properties, accommodate isotropic and homogeneous, anisotropic and heterogeneous materials, handle incompressibility and viscoelastic behaviours, conserve system energy, and achieve realistic, real-time and stable deformation. In the future, it is projected to extend the proposed methodologies to handle surgical operations, such as cutting, joining and suturing, for topology changes occurred in surgical simulation

Frictional Contact in Interactive Deformable Environments

L\u2019uso di simulazioni garantisce notevoli vantaggi in termini di economia, realismo e di flessibilit\ue0 in molte aree di ricerca e in ambito dello sviluppo tecnologico. Per questo motivo le simulazioni vengono usate spesso in ambiti quali la prototipazione di parti meccaniche, nella pianificazione e nell\u2019addestramento di procedure di assemblaggio e disassemblaggio inoltre, di recente, le simulazioni si sono dimostrate validi strumenti anche nell\u2019assistenza e nell\u2019addestramento ai chirurghi, in particolare nel caso della chirurgia laparoscopica. La chirurgia laparoscopica, infatti, \ue8 considerata lo standard per molte procedure chirurgiche. La principale differenza rispetto alla chirurgia tradizionale risiede nella notevole limitazione che ha il chirurgo nell\u2019interagire e nel percepire l\u2019ambiente in lavora, sia nella vista che nel tatto. Questo rappresenta una forte limitazione per il chirurgo a cui \ue8 richiesta una lunga fase di addestramento prima di poter ottenere la necessaria destrezza per intervenire in laparoscopia con profitto. Queste limitazioni, d\u2019altra parte, rendono la laparoscopia il candidato ideale per l\u2019introduzione della simulazione nell\u2019addestramento. Attualmente sono disponibili in commercio dei software per l\u2019addestramento alla laparoscopia, tuttavia essi sono in genere basati su modelli rigidi, o modelli che comunque mancano del necessario realismo fisico. L\u2019introduzione di modelli deformabili migliorerebbe notevolmente l\u2019accuratezza e il realismo delle simulazioni. Nel caso dell\u2019addestramento il maggior realismo permetterebbe all\u2019utente di acquisire non solo le conoscenze motorie basilari ma anche capacit\ue0 e conoscenze di pi\uf9 alto livello. I corpi rigidi, infatti, rappresentano una buona approssimazione della realt\ue0 solo in situazioni particolari ed entro intervalli di sollecitazioni molto ristretti. Quando si considerano materiali non ingegneristici, come accade nelle simulazioni chirurgiche, le deformazioni non possono essere trascurate senza compromettere irrimediabilmente il realismo dei risultati. L\u2019uso di modelli deformabili tuttavia introduce notevole complessit\ue0 computazionale per il calcolo della fisica che regola le deformazioni e limita fortemente l\u2019uso di dati precalcolati, spesso utilizzati per velocizzare la fase di identificazione delle collisioni tra i corpi. I ritardi dovuti all\u2019uso di modelli deformabili rappresentano un grosso limite soprattutto nelle applicazioni interattive che, per consentire all\u2019utente di interagire con l\u2019ambiente, richiedono il calcolo della simulazione entro intervalli di tempo molto ridotti. In questa tesi viene affrontato il tema della simulazione di ambienti interattivi composti da corpi deformabili che interagiscono con attrito. Vengono analizzati e sviluppati differenti tecniche e metodi per le diverse componenti della simulazione: dalla simulazione di modelli deformabili, agli algoritmi di identificazione e soluzione delle collisioni e alla modellazione e integrazione dell\u2019attrito nella simulazione. In particolare vengono valutati i principali metodi che rappresentano lo stato dell\u2019arte nella modellazione di materiali deformabili. L\u2019analisi considera i fondamenti fisici su cui i modelli si basano e quindi sul grado di realismo che possono garantire in termini di deformazioni modellabili e la semplicit\ue0 d\u2019uso degli stessi (ovvero la facilit\ue0 di comprensione del metodo, la calibrazione del modello e la possibilit\ue0 di adattare il modello a situazioni differenti) ma viene considerata anche la complessit\ue0 computazionale di ciascun metodo in quanto essa rappresenta un fattore estremamente importante nella scelta e nell\u2019uso dei modelli deformabili nelle simulazioni. Il confronto dei differenti modelli e le caratteristiche identificate hanno motivato lo sviluppo di un metodo innovativo per fornire un\u2019interfaccia comune ai vari metodi di simulazione dei tessuti deformabili. Tale interfaccia ha il vantaggio di fornire dei metodi omogenei per la manipolazione dei diversi modelli deformabili. Ci\uf2 garantisce la possibilit\ue0 di scambiare il modello usato per la simulazione delle deformazioni mantenendo inalterati le altre strutture dati e i metodi della simulazione. L\u2019introduzione di tale interfaccia unificata si dimostra particolarmente vantaggiosa in quanto permette l\u2019uso di un solo metodo per l\u2019identificazione delle collisioni per tutti i differenti modelli deformabili. Ci\uf2 semplifica molto l\u2019analisi e la definizione dei requisiti di tale modulo software. L\u2019identificazione delle collisioni tra modelli rigidi generalmente precalcola delle partizioni dello spazio in cui i corpi sono definiti oppure sfrutta la suddivisione del corpo analizzato in parti convesse per velocizzare la simulazione. Nel caso di modelli deformabili non \ue8 possibile applicare tali tecniche a causa dei continui cambiamenti nella configurazione dei corpi. Dopo che le collisioni tra i corpi sono state riconosciute e che i punti di contatto sono stati identificati e necessario risolvere le collisioni tenendo conto della fisica sottostante i contatti. Per garantire il realismo \ue8 necessario assicurare che i corpi non si compenetrino mai e che nella simulazione delle collisioni tutti i fenomeni fisici di interesse coinvolti nel contatto tra i corpi vengano considerati: questi includono le forze elastiche che si esercitano tra i corpi e le forze di attrito che si generano lungo le superfici di contatto. L\u2019innovativo metodo proposto per la soluzione delle collisioni garantisce il realismo della simulazione e l\u2019integrazione con l\u2019interfaccia proposta per la gestione unificata dei modelli. Una caratteristica importante dei tessuti biologici \ue8 il comportamento anisotropico, dovuto, in genere, alla loro struttura fibrosa. In questa tesi viene proposto un nuovo metodo per aggiungere l\u2019anisotropia al comportamento dei modelli massa molla. Il metodo ha il vantaggio di mantenere la velocit\ue0 computazionale e la semplicit\ue0 di implementazione dei modelli massa molla classici e riesce a differenziare efficacemente la risposta del modello alle sollecitazioni lungo le differenti direzioni. Le tecniche descritte sono state integrate in due applicazioni che forniscono la simulazione della fisica di ambienti con corpi deformabili. La prima delle due implementa tutti i metodi descritti per la simulazione dei modelli deformabili, identifica le collisioni con precisione e le risolve fornendo la possibilit\ue0 di scegliere il modello di attrito pi\uf9 adatto, dimostrando cos\uec la fattibilit\ue0 dell\u2019approccio proposto. La limitazione principale di tale simulatore risiede nell\u2019alto tempo di calcolo richiesto per la simulazione dei singoli passi di simulazione. Tale limitazione \ue8 stata superata in una seconda implementazione che sfrutta il parallelismo intrinseco delle simulazioni fisiche per ottimizzare gli algoritmi e che, quindi, riesce a sfruttare al meglio la potenza computazionale delle architetture hardware parallele. Al fine di ottenere le prestazioni richieste per la simulazione di ambienti interattivi con ritorno di forza, la simulazione \ue8 basata su un algoritmo di identificazione delle collisioni semplificato, ma implementa gli altri metodi descritti in questa tesi. L\u2019implementazione parallela sfrutta le capacit\ue0 di calcolo delle moderne schede video munite di processori altamente paralleli e ci\uf2 permette di aggiornare la scena ogni millisecondo. Questo elimina ogni discontinuit\ue0 nel ritorno di forza reso all\u2019utente e nell\u2019aggiornamento della grafica della scena, inoltre garantisce il realismo necessario alla simulazione fisica sottostante. Le applicazioni implementate provano la fattibilit\ue0 della simulazione della fisica di interazioni complesse tra corpi deformabili. Inoltre, l\u2019implementazione parallela della simulazione rappresenta un promettente punto di partenza per la realizzazione di simulazioni interattive che potr\ue0 essere utilizzato in ambiti di ricerca differenti, quali l\u2019addestramento di chirurghi o la prototipazione rapida.The use of simulations provides great advantages in term of economy, realism, and adaptability to user requirements in many research and technological fields. For this reason simulations are currently exploited, for example, in prototyping of machinery parts, in assembly-disassembly test or training and, recently, simulations have also allowed the development of many useful and promising tools for the assistance and learning of surgical procedures. This is particularly true for laparoscopic intervention. Laparoscopy, in fact, represents the gold standard for many surgical procedures. The principal difference from standard surgery is the reduction of the surgeon ability to perceive the surgical scenario, both from visual and tactile point of view. This represents a great limitation for surgeons who undergo long training before being able to perform laparoscopic intervention with proficiency. This, on the other hand, makes laparoscopy an excellent candidate for the use of simulations for training. Some commercial training softwares are already available on the market, but they are usually based on rigid body models that completely lack the physical realism. The introduction of deformable models may leads to a great increment in terms of realism and accuracy. And, in the case of laparoscopy trainer it may allow the user to learn not only basic motor skills, but also higher level capabilities and knowledge. Rigid bodies, in fact, represents a good approximation of reality only in some situations and in very restricted ranges of solicitations. In particular, when non engineering materials are involved, as happens in surgical simulations, deformations cannot be neglected without completely loosing the realism of the environment. The use of deformable models, however, is limited for the high computational costs involved in the computation of the physics undergoing the deformations and because of the reduction in pre computable data in particular for collision detection between bodies. This represents a very limiting factor in interactive environments where, to allow the user to interactively control the virtual bodies, the simulation should be performed in real time. In this thesis we address the simulation of interactive environment populated with deformable models that interact with frictional contacts. This includes the analysis and the development of different techniques which implement the various parts of the simulation: mainly the methods for the simulation of deformable models, the collision detection and collision solution techniques but also the modelling and the integration of suitable friction models in the simulation. In particular we evaluated the principal methods that represent the state of the art in soft tissue modeling. Our analysis is based on the physical background of each method and thus on its realism in terms of deformations that the method can mimic and on the ease of use (i.e. method understanding, calibration and ability to adapt to different scenarios) but we also compared the computational complexity of different models, as it represents an extremely important factor in the choice and in the use of models in simulations. The comparison of different features in analyzed methods motivated us to the development of an innovative method to wrap in a common representation framework different methodologies of soft tissue simulation. This framework has the advantage of providing a unified interface for all the deformable models and thus it provides the ability to switch between deformable model keeping unchanged all other data structures and methods of the simulation. The use of this unique interface allows us to use one single method to perform the collision detection phase for all the analyzed deformable models, this greatly helped during the identification of requirements and features of such software module. Collision detection phase, when applied to rigid bodies, usually takes advantage of pre computation to subdivide body shapes in convex elements or to construct partitions of the space in which the body is defined to speed up the computation. When handling deformable models this is not possible because of the continuous changes in bodies shape. The collision detection method used in this work takes into account this problem and regularly adapt the data structures to the body configuration. After collisions have been detected and contact points have been identified on colliding bodies, it is necessary to solve the collision in a physics based way. To this extent we have to ensure that objects never compenetrate during the simulation and that, when solving collisions, all the physical phenomena involved in the contact of real bodies are taken into account: this include the elastic response of bodies during the contact and the frictional force exerted between each pair of colliding bodies. The innovative method for solving collision that we describe in this thesis ensures the realism of the simulation and the seamless interaction with the common framework used to integrate deformable models. One important feature of biologic tissues is their anisotropic behavior that usually comes from the fibrous structure of these tissues. In this thesis we propose a new method to introduce anisotropy in mass spring model. The method has the advantages of preserving the speed and ease of implementation of the model and it effectively introduces differentiation of the model behavior along the chosen directions. The described techniques have been integrated in two applications that allows the physical simulation of environments populated with deformable models. The first application implements all the described methods to simulate deformable models, it performs precise collision detection and solution with the possibility to chose the most suitable friction model for the simulation. It demonstrates the effectiveness of the proposed framework. The main limitation of this simulator, i.e. its high computation time, is tackled and solved in a second application that exploits the intrinsic parallelism of physical simulations to optimize the implementation and to exploit parallel architecture computational power. To obtain the performances required for an interactive environment the simulation is based on a simplified collision detection algorithm, but it features all the other techniques described in this thesis. The parallel implementation exploits graphic cards processor, a highly parallel architecture that update the scene every milliseconds. This allows the rendering of smooth haptic feedback to the user and ensures the realism of the physics simulation. The implemented applications prove the feasibility of the simulation of complex interactions between deformable models with physics realism. In addition, the parallel implementation of the simulator represents a promising starting point for the development of interactive simulations that can be used in different fields of research, such as surgeon training or fast prototyping