Neurosurgical Ultrasound Pose Estimation Using Image-Based Registration and Sensor Fusion - A Feasibility Study

Modern neurosurgical procedures often rely on computer-assisted real-time guidance using multiple medical imaging modalities. State-of-the-art commercial products enable the fusion of pre-operative with intra-operative images (e.g., magnetic resonance [MR] with ultrasound [US] images), as well as the on-screen visualization of procedures in progress. In so doing, US images can be employed as a template to which pre-operative images can be registered, to correct for anatomical changes, to provide live-image feedback, and consequently to improve confidence when making resection margin decisions near eloquent regions during tumour surgery. In spite of the potential for tracked ultrasound to improve many neurosurgical procedures, it is not widely used. State-of-the-art systems are handicapped by optical tracking’s need for consistent line-of-sight, keeping tracked rigid bodies clean and rigidly fixed, and requiring a calibration workflow. The goal of this work is to improve the value offered by co-registered ultrasound images without the workflow drawbacks of conventional systems. The novel work in this thesis includes: the exploration and development of a GPU-enabled 2D-3D multi-modal registration algorithm based on the existing LC2 metric; and the use of this registration algorithm in the context of a sensor and image-fusion algorithm. The work presented here is a motivating step in a vision towards a heterogeneous tracking framework for image-guided interventions where the knowledge from intraoperative imaging, pre-operative imaging, and (potentially disjoint) wireless sensors in the surgical field are seamlessly integrated for the benefit of the surgeon. The technology described in this thesis, inspired by advances in robot localization demonstrate how inaccurate pose data from disjoint sources can produce a localization system greater than the sum of its parts

Hip joint centre position estimation using a dual unscented Kalman filter for computer-assisted orthopaedic surgery

In computer-assisted knee surgery, the accuracy of the localization of the femur centre of rotation relative to the hip-bone (hip joint centre) is affected by the unavoidable and untracked pelvic movements because only the femoral pose is acquired during passive pivoting manoeuvres. We present a dual unscented Kalman filter algorithm that allows the estimation of the hip joint centre also using as input the position of a pelvic reference point that can be acquired with a skin marker placed on the hip, without increasing the invasiveness of the surgical procedure. A comparative assessment of the algorithm was carried out using data provided by in vitro experiments mimicking in vivo surgical conditions. Soft tissue artefacts were simulated and superimposed onto the position of a pelvic landmark. Femoral pivoting made of a sequence of star-like quasi-planar movements followed by a circumduction was performed. The dual unscented Kalman filter method proved to be less sensitive to pelvic displacements, which were shown to be larger during the manoeuvres in which the femur was more adducted. Comparable accuracy between all the analysed methods resulted for hip joint centre displacements smaller than 1 mm (error: 2.2 ± [0.2; 0.3] mm, median ± [inter-quartile range 25%; inter-quartile range 75%]) and between 1 and 6 mm (error: 4.8 ± [0.5; 0.8] mm) during planar movements. When the hip joint centre displacement exceeded 6 mm, the dual unscented Kalman filter proved to be more accurate than the other methods by 30% during multi-planar movements (error: 5.2 ± [1.2; 1] mm)

A Combined EM and Visual Tracking Probabilistic Model for Robust Mosaicking: Application to Fetoscopy

Twin-to-Twin Transfusion Syndrome (TTTS) is a progressive pregnancy complication in which inter-twin vascular connections in the shared placenta result in a blood flow imbalance between the twins. The most effective therapy is to sever these connections by laser photo-coagulation. However, the limited field of view of the fetoscope hinders their identification. A potential solution is to augment the surgeon’s view by creating a mosaic image of the placenta. State-of-the-art mosaicking methods use feature-based ap- proaches, which have three main limitations: (i) they are not robust against corrupt data e.g. blurred frames, (ii) tem- poral information is not used, (iii) the resulting mosaic suf- fers from drift. We introduce a probabilistic temporal model that incorporates electromagnetic and visual tracking data to achieve a robust mosaic with reduced drift. By assuming planarity of the imaged object, the nRT decomposition can be used to parametrize the state vector. Finally, we tackle the non-linear nature of the problem in a numerically stable manner by using the Square Root Unscented Kalman Filter. We show an improvement in performance in terms of robustness as well as a reduction of the drift in comparison to state-of-the-art methods in synthetic, phantom and ex vivo datasets

Multimodal Noncontact Tracking of Surgical Instruments

For many procedures, open surgery is being replaced with minimally invasive surgical (MIS) techniques. The advantages of MIS include reduced operative trauma and fewer complications leading to faster patient recovery, better cosmetic results and shorter hospital stays. As the demand for MIS procedures increases, effective surgical training tools must be developed to improve procedure efficiency and patient safety. Motion tracking of laparoscopic instruments can provide objective skills assessment for novices and experienced users. The most common approaches to noncontact motion capture are optical and electromagnetic (EM) tracking systems, though each approach has operational limitations. Optical trackers are prone to occlusion and the performance of EM trackers degrades in the presence of magnetic and ferromagnetic material. The cost of these systems also limits their availability for surgical training and clinical environments. This thesis describes the development and validation of a novel, noncontact laparoscopic tracking system as an inexpensive alternative to current technology. This system is based on the fusion of inertial, magnetic and distance sensing to generate real-time, 6-DOF pose data. Orientation is estimated using a Kalman-filtered attitude-heading reference system (AHRS) and restricted motion at the trocar provides a datum from which position information can be recovered. The Inertial and Range-Enhanced Surgical (IRES) Tracker was prototyped, then validated using a MIS training box and by comparison to an EM tracking system. Results of IRES tracker testing showed similar performance to an EM tracker with position error as low as 1.25 mm RMS and orientation error \u3c0.58 degrees RMS along each axis. The IRES tracker also displayed greater precision and superior magnetic interference rejection capabilities. At a fraction of the cost of current laparoscopic tracking methods, the IRES tracking system would provide an excellent alternative for use in surgical training and skills assessment

Ultrasound-Augmented Laparoscopy

Laparoscopic surgery is perhaps the most common minimally invasive procedure for many diseases in the abdomen. Since the laparoscopic camera provides only the surface view of the internal organs, in many procedures, surgeons use laparoscopic ultrasound (LUS) to visualize deep-seated surgical targets. Conventionally, the 2D LUS image is visualized in a display spatially separate from that displays the laparoscopic video. Therefore, reasoning about the geometry of hidden targets requires mentally solving the spatial alignment, and resolving the modality differences, which is cognitively very challenging. Moreover, the mental representation of hidden targets in space acquired through such cognitive medication may be error prone, and cause incorrect actions to be performed. To remedy this, advanced visualization strategies are required where the US information is visualized in the context of the laparoscopic video. To this end, efficient computational methods are required to accurately align the US image coordinate system with that centred in the camera, and to render the registered image information in the context of the camera such that surgeons perceive the geometry of hidden targets accurately. In this thesis, such a visualization pipeline is described. A novel method to register US images with a camera centric coordinate system is detailed with an experimental investigation into its accuracy bounds. An improved method to blend US information with the surface view is also presented with an experimental investigation into the accuracy of perception of the target locations in space

NON-RIGID BODY MECHANICAL PROPERTY RECOVERY FROM IMAGES AND VIDEOS

Material property has great importance in surgical simulation and virtual reality. The mechanical properties of the human soft tissue are critical to characterize the tissue deformation of each patient. Studies have shown that the tissue stiffness described by the tissue properties may indicate abnormal pathological process. The (recovered) elasticity parameters can assist surgeons to perform better pre-op surgical planning and enable medical robots to carry out personalized surgical procedures. Traditional elasticity parameters estimation methods rely largely on known external forces measured by special devices and strain field estimated by landmarks on the deformable bodies. Or they are limited to mechanical property estimation for quasi-static deformation. For virtual reality applications such as virtual try-on, garment material capturing is of equal significance as the geometry reconstruction. In this thesis, I present novel approaches for automatically estimating the material properties of soft bodies from images or from a video capturing the motion of the deformable body. I use a coupled simulation-optimization-identification framework to deform one soft body at its original, non-deformed state to match the deformed geometry of the same object in its deformed state. The optimal set of material parameters is thereby determined by minimizing the error metric function. This method can simultaneously recover the elasticity parameters of multiple regions of soft bodies using Finite Element Method-based simulation (of either linear or nonlinear materials undergoing large deformation) and particle-swarm optimization methods. I demonstrate the effectiveness of this approach on real-time interaction with virtual organs in patient-specific surgical simulation, using parameters acquired from low-resolution medical images. With the recovered elasticity parameters and the age of the prostate cancer patients as features, I build a cancer grading and staging classifier. The classifier achieves up to 91% for predicting cancer T-Stage and 88% for predicting Gleason score. To recover the mechanical properties of soft bodies from a video, I propose a method which couples statistical graphical model with FEM simulation. Using this method, I can recover the material properties of a soft ball from a high-speed camera video that captures the motion of the ball. Furthermore, I extend the material recovery framework to fabric material identification. I propose a novel method for garment material extraction from a single-view image and a learning based cloth material recovery method from a video recording the motion of the cloth. Most recent garment capturing techniques rely on acquiring multiple views of clothing, which may not always be readily available, especially in the case of pre-existing photographs from the web. As an alternative, I propose a method that can compute a 3D model of a human body and its outfit from a single photograph with little human interaction. My proposed learning-based cloth material type recovery method exploits simulated data-set and deep neural network. I demonstrate the effectiveness of my algorithms by re-purposing the reconstructed garments for virtual try-on, garment transfer, and cloth animation on digital characters. With the recovered mechanical properties, one can construct a virtual world with soft objects exhibiting real-world behaviors.Doctor of Philosoph

Advanced Strategies for Robot Manipulators

Amongst the robotic systems, robot manipulators have proven themselves to be of increasing importance and are widely adopted to substitute for human in repetitive and/or hazardous tasks. Modern manipulators are designed complicatedly and need to do more precise, crucial and critical tasks. So, the simple traditional control methods cannot be efficient, and advanced control strategies with considering special constraints are needed to establish. In spite of the fact that groundbreaking researches have been carried out in this realm until now, there are still many novel aspects which have to be explored

Directional Estimation for Robotic Beating Heart Surgery

In robotic beating heart surgery, a remote-controlled robot can be used to carry out the operation while automatically canceling out the heart motion. The surgeon controlling the robot is shown a stabilized view of the heart. First, we consider the use of directional statistics for estimation of the phase of the heartbeat. Second, we deal with reconstruction of a moving and deformable surface. Third, we address the question of obtaining a stabilized image of the heart

A multi-modal person perception framework for socially interactive mobile service robots

In order to meet the increasing demands of mobile service robot applications, a dedicated perception module is an essential requirement for the interaction with users in real-world scenarios. In particular, multi sensor fusion and human re-identification are recognized as active research fronts. Through this paper we contribute to the topic and present a modular detection and tracking system that models position and additional properties of persons in the surroundings of a mobile robot. The proposed system introduces a probability-based data association method that besides the position can incorporate face and color-based appearance features in order to realize a re-identification of persons when tracking gets interrupted. The system combines the results of various state-of-the-art image-based detection systems for person recognition, person identification and attribute estimation. This allows a stable estimate of a mobile robot’s user, even in complex, cluttered environments with long-lasting occlusions. In our benchmark, we introduce a new measure for tracking consistency and show the improvements when face and appearance-based re-identification are combined. The tracking system was applied in a real world application with a mobile rehabilitation assistant robot in a public hospital. The estimated states of persons are used for the user-centered navigation behaviors, e.g., guiding or approaching a person, but also for realizing a socially acceptable navigation in public environments

Directional Estimation for Robotic Beating Heart Surgery

In robotic beating heart surgery, a remote-controlled robot can be used to carry out the operation while automatically canceling out the heart motion. The surgeon controlling the robot is shown a stabilized view of the heart. First, we consider the use of directional statistics for estimation of the phase of the heartbeat. Second, we deal with reconstruction of a moving and deformable surface. Third, we address the question of obtaining a stabilized image of the heart