2,973 research outputs found
Ultrasound Imaging
Ultrasound Imaging - Current Topics presents complex and current topics in ultrasound imaging in a simplified format. It is easy to read and exemplifies the range of experiences of each contributing author. Chapters address such topics as anatomy and dimensional variations, pediatric gastrointestinal emergencies, musculoskeletal and nerve imaging as well as molecular sonography. The book is a useful resource for researchers, students, clinicians, and sonographers looking for additional information on ultrasound imaging beyond the basics
Arterial Tissue Perforation Using Ultrasonically Vibrating Wire Waveguides
Chronic Total Occlusions (CTOs) are fibrous and calcified atherosclerotic lesions which completely occlude the artery. They are difficult to treat with standard dilation procedures as they cannot be traversed easily. Their treatment is also associated with a high risk of arterial perforation. Low frequency ultrasonic vibrations delivered via wire waveguides represent a minimally invasive treatment for CTOs and other tissue ablation applications. These devices typically operate at 20–50 kHz delivering wire waveguide distal tip amplitudes of vibration of 0-60 μm. The diseased tissue is ablated or disrupted by repetitive direct mechanical contact and cavitation. This research assesses the susceptibility of arterial tissue to perforation and residual damage under the action of ultrasonically energised wire waveguides. Using Finite Element Analysis (FEA), a linear acoustic model of the wire waveguide distal tips can predict the pressures for a range of operating parameters typically used for these devices. High mesh densities (140 EPW) were required to solve the entire acoustic field, including complex wave interactions. The FEA model was used to aid in the further design and modification of an ultrasonic apparatus and wire waveguide (0–34.3 μm at 22.5 kHz). Using a test rig, the effects of distal tip amplitudes of vibration, feedrate and angled entry on the perforation forces, energy and temperature were measured. The perforation forces reduced (≈ 60%, 6.13 N - 2.46 N mean) when the wire waveguide was energised at low amplitudes of vibrations (\u3c 27.8 μm). There were no significant change in tissue perforation forces above this or when the waveguide was operating above the cavitation threshold. Histological analysis also showed tissue removal. While this knowledge is useful in the prediction and avoidance of perforations during CTO operations; it is also envisaged that this information can aid in the design and development of generic ultrasonic wire waveguide tissue cutting tools
Navigation system based in motion tracking sensor for percutaneous renal access
Tese de Doutoramento em Engenharia BiomédicaMinimally-invasive kidney interventions are daily performed to diagnose and treat several renal
diseases. Percutaneous renal access (PRA) is an essential but challenging stage for most of these
procedures, since its outcome is directly linked to the physician’s ability to precisely visualize and
reach the anatomical target.
Nowadays, PRA is always guided with medical imaging assistance, most frequently using X-ray
based imaging (e.g. fluoroscopy). Thus, radiation on the surgical theater represents a major risk to
the medical team, where its exclusion from PRA has a direct impact diminishing the dose exposure
on both patients and physicians.
To solve the referred problems this thesis aims to develop a new hardware/software framework
to intuitively and safely guide the surgeon during PRA planning and puncturing.
In terms of surgical planning, a set of methodologies were developed to increase the certainty of
reaching a specific target inside the kidney. The most relevant abdominal structures for PRA were
automatically clustered into different 3D volumes. For that, primitive volumes were merged as a local
optimization problem using the minimum description length principle and image statistical
properties. A multi-volume Ray Cast method was then used to highlight each segmented volume.
Results show that it is possible to detect all abdominal structures surrounding the kidney, with the
ability to correctly estimate a virtual trajectory.
Concerning the percutaneous puncturing stage, either an electromagnetic or optical solution
were developed and tested in multiple in vitro, in vivo and ex vivo trials. The optical tracking solution
aids in establishing the desired puncture site and choosing the best virtual puncture trajectory.
However, this system required a line of sight to different optical markers placed at the needle base,
limiting the accuracy when tracking inside the human body. Results show that the needle tip can
deflect from its initial straight line trajectory with an error higher than 3 mm. Moreover, a complex
registration procedure and initial setup is needed.
On the other hand, a real-time electromagnetic tracking was developed. Hereto, a catheter
was inserted trans-urethrally towards the renal target. This catheter has a position and orientation
electromagnetic sensor on its tip that function as a real-time target locator. Then, a needle integrating a similar sensor is used. From the data provided by both sensors, one computes a virtual puncture
trajectory, which is displayed in a 3D visualization software. In vivo tests showed a median renal and
ureteral puncture times of 19 and 51 seconds, respectively (range 14 to 45 and 45 to 67 seconds).
Such results represent a puncture time improvement between 75% and 85% when comparing to
state of the art methods.
3D sound and vibrotactile feedback were also developed to provide additional information about
the needle orientation. By using these kind of feedback, it was verified that the surgeon tends to
follow a virtual puncture trajectory with a reduced amount of deviations from the ideal trajectory,
being able to anticipate any movement even without looking to a monitor. Best results show that 3D
sound sources were correctly identified 79.2 ± 8.1% of times with an average angulation error of
10.4º degrees. Vibration sources were accurately identified 91.1 ± 3.6% of times with an average
angulation error of 8.0º degrees.
Additionally to the EMT framework, three circular ultrasound transducers were built with a needle
working channel. One explored different manufacture fabrication setups in terms of the piezoelectric
materials, transducer construction, single vs. multi array configurations, backing and matching
material design. The A-scan signals retrieved from each transducer were filtered and processed to
automatically detect reflected echoes and to alert the surgeon when undesirable anatomical
structures are in between the puncture path. The transducers were mapped in a water tank and
tested in a study involving 45 phantoms. Results showed that the beam cross-sectional area
oscillates around the ceramics radius and it was possible to automatically detect echo signals in
phantoms with length higher than 80 mm.
Hereupon, it is expected that the introduction of the proposed system on the PRA procedure,
will allow to guide the surgeon through the optimal path towards the precise kidney target, increasing
surgeon’s confidence and reducing complications (e.g. organ perforation) during PRA. Moreover, the
developed framework has the potential to make the PRA free of radiation for both patient and surgeon
and to broad the use of PRA to less specialized surgeons.Intervenções renais minimamente invasivas são realizadas diariamente para o tratamento e
diagnóstico de várias doenças renais. O acesso renal percutâneo (ARP) é uma etapa essencial e
desafiante na maior parte destes procedimentos. O seu resultado encontra-se diretamente
relacionado com a capacidade do cirurgião visualizar e atingir com precisão o alvo anatómico.
Hoje em dia, o ARP é sempre guiado com recurso a sistemas imagiológicos, na maior parte
das vezes baseados em raios-X (p.e. a fluoroscopia). A radiação destes sistemas nas salas cirúrgicas
representa um grande risco para a equipa médica, aonde a sua remoção levará a um impacto direto
na diminuição da dose exposta aos pacientes e cirurgiões.
De modo a resolver os problemas existentes, esta tese tem como objetivo o desenvolvimento
de uma framework de hardware/software que permita, de forma intuitiva e segura, guiar o cirurgião
durante o planeamento e punção do ARP.
Em termos de planeamento, foi desenvolvido um conjunto de metodologias de modo a
aumentar a eficácia com que o alvo anatómico é alcançado. As estruturas abdominais mais
relevantes para o procedimento de ARP, foram automaticamente agrupadas em volumes 3D, através
de um problema de optimização global com base no princípio de “minimum description length” e
propriedades estatísticas da imagem. Por fim, um procedimento de Ray Cast, com múltiplas funções
de transferência, foi utilizado para enfatizar as estruturas segmentadas. Os resultados mostram que
é possível detetar todas as estruturas abdominais envolventes ao rim, com a capacidade para
estimar corretamente uma trajetória virtual.
No que diz respeito à fase de punção percutânea, foram testadas duas soluções de deteção
de movimento (ótica e eletromagnética) em múltiplos ensaios in vitro, in vivo e ex vivo. A solução
baseada em sensores óticos ajudou no cálculo do melhor ponto de punção e na definição da melhor
trajetória a seguir. Contudo, este sistema necessita de uma linha de visão com diferentes
marcadores óticos acoplados à base da agulha, limitando a precisão com que a agulha é detetada
no interior do corpo humano. Os resultados indicam que a agulha pode sofrer deflexões à medida
que vai sendo inserida, com erros superiores a 3 mm.
Por outro lado, foi desenvolvida e testada uma solução com base em sensores
eletromagnéticos. Para tal, um cateter que integra um sensor de posição e orientação na sua ponta, foi colocado por via trans-uretral junto do alvo renal. De seguida, uma agulha, integrando um sensor
semelhante, é utilizada para a punção percutânea. A partir da diferença espacial de ambos os
sensores, é possível gerar uma trajetória de punção virtual. A mediana do tempo necessário para
puncionar o rim e ureter, segundo esta trajetória, foi de 19 e 51 segundos, respetivamente
(variações de 14 a 45 e 45 a 67 segundos). Estes resultados representam uma melhoria do tempo
de punção entre 75% e 85%, quando comparados com o estado da arte dos métodos atuais.
Além do feedback visual, som 3D e feedback vibratório foram explorados de modo a fornecer
informações complementares da posição da agulha. Verificou-se que com este tipo de feedback, o
cirurgião tende a seguir uma trajetória de punção com desvios mínimos, sendo igualmente capaz
de antecipar qualquer movimento, mesmo sem olhar para o monitor. Fontes de som e vibração
podem ser corretamente detetadas em 79,2 ± 8,1% e 91,1 ± 3,6%, com erros médios de angulação
de 10.4º e 8.0 graus, respetivamente.
Adicionalmente ao sistema de navegação, foram também produzidos três transdutores de
ultrassom circulares com um canal de trabalho para a agulha. Para tal, foram exploradas diferentes
configurações de fabricação em termos de materiais piezoelétricos, transdutores multi-array ou
singulares e espessura/material de layers de suporte. Os sinais originados em cada transdutor
foram filtrados e processados de modo a detetar de forma automática os ecos refletidos, e assim,
alertar o cirurgião quando existem variações anatómicas ao longo do caminho de punção. Os
transdutores foram mapeados num tanque de água e testados em 45 phantoms. Os resultados
mostraram que o feixe de área em corte transversal oscila em torno do raio de cerâmica, e que os
ecos refletidos são detetados em phantoms com comprimentos superiores a 80 mm.
Desta forma, é expectável que a introdução deste novo sistema a nível do ARP permitirá
conduzir o cirurgião ao longo do caminho de punção ideal, aumentado a confiança do cirurgião e
reduzindo possíveis complicações (p.e. a perfuração dos órgãos). Além disso, de realçar que este
sistema apresenta o potencial de tornar o ARP livre de radiação e alarga-lo a cirurgiões menos
especializados.The present work was only possible thanks to the support by the Portuguese Science and
Technology Foundation through the PhD grant with reference SFRH/BD/74276/2010 funded by
FCT/MEC (PIDDAC) and by Fundo Europeu de Desenvolvimento Regional (FEDER), Programa
COMPETE - Programa Operacional Factores de Competitividade (POFC) do QREN
Smart Surgical Microscope based on Optical Coherence Domain Reflectometry
Department of Biomedical EngineeringOver the several decades, there have been clinical needs that requires advanced technologies in medicine. Optical coherence tomography (OCT), one of the newly emerged medical imaging devices, provides non-invasive cross-sectional images in high resolution which is mainly used in ophthalmology. However, due to the limited penetration depth of 1-2 mm in bio-samples, there is a limit to be widely used. In order to easily integrate with existing medical tools and be convenient to users, it is necessary that the sample unit of OCT should be compact and simple.
In this study, we developed high-speed swept-source OCT (SS-OCT) for advanced screening of otolaryngology. Synchronized signal sampling with a high-speed digitizer using a clock signal from a swept laser source, its trigger signal is also used to synchronize with the movement of the scanning mirror. The SS-OCT system can reliably provide high-throughput images, and two-axis scanning of galvano mirrors enables real-time acquisition of 3D data. Graphic processing unit (GPU) can performs high-speed data processing through parallel programming, and can also implement perspective projection 3D OCT visualization with optimal ray casting techniques. In the Clinical Study of Otolaryngology, OCT was applied to identify the microscopic extrathyroidal extension (mETE) of papillary thyroid cancer (PTC). As a result to detect the mETE of around 60% in conventional ultrasonography, it could be improved to 84.1% accuracy in our study. The detection ratio of the mETE was calculated by the pathologist analyzing the histologic image.
In chapter 3, we present a novel study using combined OCT system integrated with a conventional surgical microscope. In the current set-up of surgical microscope, only two-dimensional microscopic images through the eyepiece view are provided to the surgeon. Thus, image-guided surgery, which provides real-time image information of the tissues or the organs, has been developed as an advanced surgical technique. This study illustrate newly designed optical set-up of smart surgical microscope that combined sample arm of the OCT with an existing microscope. Specifically, we used a beam projector to overlay OCT images on existing eyepiece views, and demonstrated augmented reality images.
In chapter 4, in order to develop novel microsurgical instruments, optical coherence domain reflectometry (OCDR) was applied. Introduces smart surgical forceps using OCDR as a sensor that provides high-speed, high-resolution distance information in the tissue. To attach the sensor to the forceps, the lensed fiber which is a small and high sensitivity sensor was fabricated and the results are shown to be less affected by the tilt angle. In addition, the piezo actuator compensates the hand tremor, resulting in a reduction in the human hand tremor of 5 to 15 Hz.
Finally, M-mode OCT needle is proposed for microsurgery guidance in ophthalmic surgery. Stepwise transitional core (STC) fiber was applied as a sensor to measure information within the tissue and attached to a 26 gauge needle. It shows the modified OCT system and the position-guided needle design of the sample stage and shows the algorithm flowchart of M-mode OCT imaging software. The developed M-mode OCT needle has been applied to animal studies using rabbit eyes and demonstrates the big-bubble deep anterior lamellar keratoplasty (DALK) surgery for corneal transplantation. Through this study, we propose a novel microsurgical instrument for lamellar keratoplasty and evaluate its feasibility with conventional regular OCT system images.
In conclusion, for fundamental study required new augmented reality guided surgery with smart surgical microscope, it is expected that OCT combined with surgical microscope can be widely used. We demonstrated a novel microsurgical instrument to share with light source and the various optical components. Acquired information throughout our integrated system would be a key method to meet a wide range of different clinical needs in the real world.ope
Severe Acute Pancreatitis and its Management
Severe acute pancreatitis (SAP) is a severe form of acute pancreatitis, which requires often intensive care therapy. The common aetiology varies with geographic locations. In Middle East, biliary pancreatitis is the commonest type. Initial phase of the disease is due to profound release of the proinflammatory marker, then the organ dysfunction takes over. It mainly divided into three types depending upon the pathological changes that are oedematous, necrotic and haemorrhagic. The common clinical presentation is typical abdominal pain radiating to the back and relieved by typical positioning i.e. sitting or leaning forwards. Raised pancreatic amylase and lipase with imaging will help to diagnose the SAP. The outcome of SAP is dictated by various criteria and scores. The commonly used scoring systems are Ranson’s and Glasgow scores, whereas the local complication is diagnosed and predicted by the Balthazar’s score. The management of SAP is mainly analgesia, prevention of complications and supportive care. Initially, laparotomy was recommended routinely for SAP complicated by necrosis of the pancreas and continuous lavage, but nowadays, minimal invasive image guided drainage is the recommended modality. The most common complications of concern are the abdominal compartment syndrome, Acute respiratory distress syndrome (ARDS), and infection of the pancreatitis necrosis. SAP has a high mortality rate (up to 40%), but initial aggressive supportive management will improve the outcome
Liver Biopsy
Liver biopsy is recommended as the gold standard method to determine diagnosis, fibrosis staging, prognosis and therapeutic indications in patients with chronic liver disease. However, liver biopsy is an invasive procedure with a risk of complications which can be serious. This book provides the management of the complications in liver biopsy. Additionally, this book provides also the references for the new technology of liver biopsy including the non-invasive elastography, imaging methods and blood panels which could be the alternatives to liver biopsy. The non-invasive methods, especially the elastography, which is the new procedure in hot topics, which were frequently reported in these years. In this book, the professionals of elastography show the mechanism, availability and how to use this technology in a clinical field of elastography. The comprehension of elastography could be a great help for better dealing and for understanding of liver biopsy
Ultrasonic actuation of a fine-needle improves biopsy yield
Despite the ubiquitous use over the past 150 years, the functions of the current medical needle are facilitated only by mechanical shear and cutting by the needle tip, i.e. the lancet. In this study, we demonstrate how nonlinear ultrasonics (NLU) extends the functionality of the medical needle far beyond its present capability. The NLU actions were found to be localized to the proximity of the needle tip, the SonoLancet, but the effects extend to several millimeters from the physical needle boundary. The observed nonlinear phenomena, transient cavitation, fluid streams, translation of micro- and nanoparticles and atomization, were quantitatively characterized. In the fine-needle biopsy application, the SonoLancet contributed to obtaining tissue cores with an increase in tissue yield by 3-6x in different tissue types compared to conventional needle biopsy technique using the same 21G needle. In conclusion, the SonoLancet could be of interest to several other medical applications, including drug or gene delivery, cell modulation, and minimally invasive surgical procedures.Peer reviewe
Improving the Management of Large Colorectal Polyps
This thesis is focused on identifying current practices in the management of large non pedunculated colorectal polyps (LNPCPs) and the development of a structured management framework to improve outcomes. The methodology used includes a systematic review to ascertain current knowledge and retrospective quantitative analysis to identify current LNPCP management outcomes. The English Bowel Cancer Screening Programme (BCSP) which has a high volume of recorded LNPCP data was used to facilitate the latter process. In addition, qualitative analysis using consensus methodology to create best practice guidelines, key performance indicators (KPIs) to audit LNPCP outcomes and a complex polyp multidisciplinary team process was undertaken.
The main outcomes of this thesis were:
1. Confirmation of variation in LNPCP management practices leading to variable outcomes
2. Formulation of evidence based and expert consensus LNPCP management guidelines
3. Identification of KPIs to allow audit of LNPCP management and outcomes
4. Identification of pertinent research questions to improve evidence LNPCP base
5. Development and pilot of regional complex polyp multidisciplinary team meetin
Product Development of a Neurovascular Embolization Device
Stroke is the number one cause of adult disability in the United States and the third leading cause of death in the United States, Europe, and China.12 It is estimated 5% to 15% of all strokes are caused by ruptured intracranial aneurysms.3 In 2010, the National Stroke Association estimated the direct and indirect cost of strokes was $73.3 billion.
The most common method for treating intracranial aneurysms is with platinum coils that are deployed to pack the aneurysm and block blood flow and prevent rupture. However, coil compaction and re-bleeding are two limitations with the coils because they have limited space filling capacity. Dr. Duncan Maitland has proposed a neurovascular embolization device (NED) be made out of shape memory polymer foam (SMP). The SMP device can be compressed down into a compact size for delivery via a catheter. Once in place, the device can be stimulated to regain its primary shape and expand up to 70x for superior occlusion of aneurysms.
Design research is necessary to generate performance specifications for the NED that can assess the quality of prototypes. Customer needs are generated from interviews, activity diagrams, and market research. Functional models define the function and various sub-functions of the NED. Benchmarking highlights technology trends. A House of Quality matrix maps the customer needs to the engineering requirements. A failure modes and effects analysis emphasizes possible design deficiencies as a way of mitigating future risk. Performance specifications for the SMP foam are defined and can be used to establish a quality control program. Purification methods are suggested for the chemicals used in the synthesis of the SMP foam. Purification of the chemicals can reduce potential biocompatibility issues
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