Toward Supporting Maxillo-Facial Surgical Guides Positioning with Mixed Reality—A Preliminary Study

Following an oncological resection or trauma it may be necessary to reconstruct the normal anatomical and functional mandible structures to ensure the effective and complete social reintegration of patients. In most surgical procedures, reconstruction of the mandibular shape and its occlusal relationship is performed through the free fibula flap using a surgical guide which allows the surgeon to easily identify the location and orientation of the cutting plane. In the present work, we present a Mixed Reality (MR)-based solution to support professionals in surgical guide positioning. The proposed solution, through the use of a Head-Mounted Display (HMD) such as that of the HoloLens 2, visualizes a 3D virtual model of the surgical guide, positioned over the patient's real fibula in the correct position as identified by the medical team before the procedure. The professional wearing the HMD is then assisted in positioning the real guide over the virtual one by our solution, which is capable of tracking the real guide during the whole process and computing its distance from the final position. The assessment results highlight that Mixed Reality is an eligible technology to support surgeons, combining the usability of the device with an improvement of the accuracy in fibula flap removal surgery

Craniofacial Growth Series Volume 56

https://deepblue.lib.umich.edu/bitstream/2027.42/153991/1/56th volume CF growth series FINAL 02262020.pdfDescription of 56th volume CF growth series FINAL 02262020.pdf : Proceedings of the 46th Annual Moyers Symposium and 44th Moyers Presymposiu

Augmented reality implementations in stomatology

Augmented reality has a wide range of applications in many areas that can extend the study of real objects into the digital world, including stomatology. Real dental objects that were previously examined using their plaster casts are often replaced by their digital models or three-dimensional (3D) prints in the cyber-physical world. This paper reviews a selection of digital methods that have been applied in dentistry, including the use of intra-oral scanning technology for data acquisition and evaluation of fundamental features of dental arches. The methodology includes the use of digital filters and morphological operations for spatial objects analysis, their registration, and evaluation of changes during the treatment of specific disorders. The results include 3D models of selected dental arch objects, which allow a comparison of their shape and position during repeated observations. The proposed methods present digital alternatives to the use of plaster casts for semiautomatic evaluation of dental arch measures. This paper describes some of the advantages of 3D digital technology replacing real world elements and plaster cast dental models in many areas of classical stomatology

Mixed Reality system to study deformable objects: Breast Cancer application

Treballs Finals de Grau d'Enginyeria Biomèdica. Facultat de Medicina i Ciències de la Salut. Universitat de Barcelona. Curs: 2020-2021. Directors: Eduardo Soudah i Óscar de Coss. Tutor: Aida NiñerolaA significant amount of women who go through a breast cancer conservative surgery to treat early stage breast cancer undergo a repeat surgery due to concerns that residual tumor was left behind. To avoid this, tumor localization is needed to assist the surgeon in order to determine tumor extent and also, it is critical to account for tissue deformations. For these reasons, new navigation systems, like the one proposed on this project, are emerging to cover those needs. This project focuses on the use of a Mixed Reality system to improve the accuracy in placing the static hologram of the tumor and, to implement a dynamical hologram when deformation takes place. In order to do so, two different molds with objects inside have been manufactured. Next, two different approaches were considered, a mathematical approach to create a 3D CAD model of the molds and a medical approach, which consisted in performing a CT and then, segment the images. The models were post-processed and imported to the HoloLens head-mounted display. The system was tested on the molds and on a breast phantom provided by the Hospital Clinic. The results obtained were encouraging and although some things need to be improved, this exciting new use for Augmented Reality has the potential to improve the lives of many patients

ADVANCED IMAGING AND ROBOTICS TECHNOLOGIES FOR MEDICAL APPLICATIONS

Due to the importance of surgery in the medical field, a large amount of research has been conducted in this area. Imaging and robotics technologies provide surgeons with the advanced eye and hand to perform their surgeries in a safer and more accurate manner. Recently medical images have been utilized in the operating room as well as in the diagnostic stage. If the image to patient registration is done with sufficient accuracy, medical images can be used as "a map" for guidance to the target lesion. However, the accuracy and reliability of the surgical navigation system should be sufficiently verified before applying it to the patient. Along with the development of medical imaging, various medical robots have also been developed. In particular, surgical robots have been researched in order to reach the goal of minimal invasiveness. The most important factors to consider are determining the demand, the strategy for their use in operating procedures, and how it aids patients. In addition to the above considerations, medical doctors and researchers should always think from the patient's point of view. In this article, the latest medical imaging and robotic technologies focusing on surgical applications are reviewed based upon the factors described in the above. © 2011 Copyright Taylor and Francis Group, LLC.1

Augmented Reality

Augmented Reality (AR) is a natural development from virtual reality (VR), which was developed several decades earlier. AR complements VR in many ways. Due to the advantages of the user being able to see both the real and virtual objects simultaneously, AR is far more intuitive, but it's not completely detached from human factors and other restrictions. AR doesn't consume as much time and effort in the applications because it's not required to construct the entire virtual scene and the environment. In this book, several new and emerging application areas of AR are presented and divided into three sections. The first section contains applications in outdoor and mobile AR, such as construction, restoration, security and surveillance. The second section deals with AR in medical, biological, and human bodies. The third and final section contains a number of new and useful applications in daily living and learning

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

Goggle Augmented Imaging and Navigation System for Fluorescence-Guided Surgery

Surgery remains the only curative option for most solid tumors. The standard-of-care usually involves tumor resection and sentinel lymph node biopsy for cancer staging. Surgeons rely on their vision and touch to distinguish healthy from cancer tissue during surgery, often leading to incomplete tumor resection that necessitates repeat surgery. Sentinel lymph node biopsy by conventional radioactive tracking exposes patients and caregivers to ionizing radiation, while blue dye tracking stains the tissue highlighting only superficial lymph nodes. Improper identification of sentinel lymph nodes may misdiagnose the stage of the cancer. Therefore there is a clinical need for accurate intraoperative tumor and sentinel lymph node visualization. Conventional imaging modalities such as x-ray computed tomography, positron emission tomography, magnetic resonance imaging, and ultrasound are excellent for preoperative cancer diagnosis and surgical planning. However, they are not suitable for intraoperative use, due to bulky complicated hardware, high cost, non-real-time imaging, severe restrictions to the surgical workflow and lack of sufficient resolution for tumor boundary assessment. This has propelled interest in fluorescence-guided surgery, due to availability of simple hardware that can achieve real-time, high resolution and sensitive imaging. Near-infrared fluorescence imaging is of particular interest due to low background absorbance by photoactive biomolecules, enabling thick tissue assessment. As a result several near-infrared fluorescence-guided surgery systems have been developed. However, they are limited by bulky hardware, disruptive information display and non-matched field of view to the user. To address these limitations we have developed a compact, light-weight and wearable goggle augmented imaging and navigation system (GAINS). It detects the near-infrared fluorescence from a tumor accumulated contrast agent, along with the normal color view and displays accurately aligned, color-fluorescence images via a head-mounted display worn by the surgeon, in real-time. GAINS is a platform technology and capable of very sensitive fluorescence detection. Image display options include both video see-through and optical see-through head-mounted displays for high-contrast image guidance as well as direct visual access to the surgical bed. Image capture options from large field of view camera as well high magnification handheld microscope, ensures macroscopic as well as microscopic assessment of the tumor bed. Aided by tumor targeted near-infrared contrast agents, GAINS guided complete tumor resection in subcutaneous, metastatic and spontaneous mouse models of cancer with high sensitivity and specificity, in real-time. Using a clinically-approved near-infrared contrast agent, GAINS provided real-time image guidance for accurate visualization of lymph nodes in a porcine model and sentinel lymph nodes in human breast cancer and melanoma patients with high sensitivity. This work has addressed issues that have limited clinical adoption of fluorescence-guided surgery and paved the way for research into developing this approach towards standard-of-care practice that can potentially improve surgical outcomes in cancer

Image overlay surgery based on augmented reality : a systematic review

Acknowledgements We thank the staff of the Medical Library of the University of Aberdeen for their advice and Prof. Jennifer Cleland and Dr Jenny Gregory for discussion and support. This work was funded by the Roland Sutton Academic Trust (0053/R/17) and an Elphinstone PhD Scholarship from the University of Aberdeen.Postprin

Passive method for 3D reconstruction of human jaw: theory and application.

Oral dental applications based on visual data pose various challenges. There are problems with lighting (effect of saliva, tooth dis-colorization, gum texture, and other sources of specularity) and motion (even inevitable slight motions of the upper/ lower jaw may lead to errors far beyond the desired tolerance of sub-millimeter accuracy). Nowadays, the dental CAM systems have become more compromised and accurate to obtain the geometric data of the jaw from the active sensor (laser scanner). However, they have not met the expectations and the needs of dental professionals in many ways. The probes in these systems are bulky { even their newer versions - and are hard to maneuver. It requires multiple scans to get full coverage of the oral cavity. In addition, the dominant drawback of these systems is the cost. Stereo-based 3D reconstruction provides the highest accuracy among vision systems of this type. However, the evaluation of it\u27s performance for both accuracy results and the number of 3D points that are reconstructed would be affected by the type of the application and the quality of the data that is been acquired from the object of interest. Therefore, in this study, the stereo-based 3D reconstruction will vi be evaluated for the dental application. The handpiece of sensors holder would reach to areas inside the oral cavity, the gap between the tooth in the upper jaw and the tooth in the lower jaw in these areas would be very small, in such the stereo algorithms would not be able to reconstruct the tooth in that areas because of the distance between the optical sensors and the object of interest \tooth as well as the configuration of optical sensors are contradicted the geometric constraint roles of the stereo-based 3D reconstruction. Therefore, the configuration of the optical sensors as well as the number of sensors in the hand piece of sensors holder will be determined based on the morphological of the teeth surfaces. In addition to the 3D reconstruction, the panoramic view of a complete arch of human teeth will be accomplished as an application of dental imaging. Due to the low rate of features on teeth surfaces, the normal tooth surface is extracted using shape from shading. The extracted surface normals impact many imprecise values because of the oral environment; hence an algorithm is being formulated to rectify these values and generate normal maps. The normal maps reveal the impacted geometric properties of the images inside an area, boundary, and shape. Furthermore, the unrestricted camera movement problem is investigated. The camera may be moved along the jaw curve with different angles and distances due to handshaking. To overcome this problem, each frame is tested after warping it, and only correct frames are used to generate the panoramic view. The proposed approach outperforms comparing to the state-of-art auto stitching method