Applied AI/ML for automatic customisation of medical implants

Most knee replacement surgeries are performed using ‘off-the-shelf’ implants, supplied with a set number of standardised sizes. X-rays are taken during pre-operative assessment and used by clinicians to estimate the best options for patients. Manual templating and implant size selection have, however, been shown to be inaccurate, and frequently the generically shaped products do not adequately fit patients’ unique anatomies. Furthermore, off-the-shelf implants are typically made from solid metal and do not exhibit mechanical properties like the native bone. Consequently, the combination of these factors often leads to poor outcomes for patients. Various solutions have been outlined in the literature for customising the size, shape, and stiffness of implants for the specific needs of individuals. Such designs can be fabricated via additive manufacturing which enables bespoke and intricate geometries to be produced in biocompatible materials. Despite this, all customisation solutions identified required some level of manual input to segment image files, identify anatomical features, and/or drive design software. These tasks are time consuming, expensive, and require trained resource. Almost all currently available solutions also require CT imaging, which adds further expense, incurs high levels of potentially harmful radiation, and is not as commonly accessible as X-ray imaging. This thesis explores how various levels of knee replacement customisation can be completed automatically by applying artificial intelligence, machine learning and statistical methods. The principal output is a software application, believed to be the first true ‘mass-customisation’ solution. The software is compatible with both 2D X-ray and 3D CT data and enables fully automatic and accurate implant size prediction, shape customisation and stiffness matching. It is therefore seen to address the key limitations associated with current implant customisation solutions and will hopefully enable the benefits of customisation to be more widely accessible.Open Acces

Design of customised total knee implants with musculoskeletal dynamic simulations

Effects of a customised total knee implant (CTKI) on the contact forces and relative motions of the tibiofemoral and patellofemoral joints have been investigated with computer simulations by applying the patient-specific muscle forces on the lower limb and the joint reaction forces at the ankle and hip joints. Firstly, a method was proposed and realized to create a CTKI based on the geometry of a patient’s knee joint using ANSYS Mechanical APDL. Secondly, a patient-specific musculoskeletal model was built to calculate the muscle forces and joint reaction forces during a squat motion. Finally, a dynamic finite element (FE) model was created in ANSYS incorporating the aforementioned forces and the CTKI to calculate the contact forces and relative motions of the tibiofemoral and patellofemoral joints. In addition, an off-the-shelf symmetric total knee implant (STKI) with cruciate ligaments (CLs) retained was simulated for comparison analysis. Knee joint collateral ligaments with nonlinear properties and pretensions were created in the dynamic FE model. A series of dynamic simulations of a squat motion with different initial laxities of the collateral ligaments were performed on the CTKI model under three treatment scenarios of CLs: both CLs retained, anterior cruciate ligament (ACL) removed and both CLs removed. Results showed that only the CTKI model with both CLs retained resulted in similar femoral external rotation and posterior translation with those of the healthy knees. There were not big differences in the tibiofemoral compressive forces among the three scenarios. All the three tibiofemoral compressive forces showed good agreement with other research results from either in-vivo measurements or simulations. The CTKI has better mobility than the traditional STKI designs. The curvatures of the tibial bearing surfaces have been varied in the transverse and longitudinal directions. Compared with the STKI, the CTKIs could restore patient’s knee function to normal, though the tibiofemoral compressive force observed in CTKIs was larger than that of the STKI in the late 25° of simulated knee flexion angles, which was caused by the large passive knee ligament forces and the larger knee motion ranges. The patella has also been studied and compared between the unresurfaced and resurfaced patellar components. The laxity of patellofemoral ligament was firstly tested on the unresurfaced patellar component. Then, the same dynamic boundary conditions were applied on three different patellar button components. Differences were found in the patellar internal rotation and medial tilt motions between the unresurfaced and resurfaced patellar components. The original patellar button component showed contact between the patellar bone and the femoral component apart from contact between the patellar component and the femoral component. The scaled-up button was able to avoid the contact between the patellar component and the femoral component and reduce the patellar medial translation. However, it resulted in larger patellofemoral force than that of the original and flat patellar components. The patellofemoral forces on the scaled-up patellar component were more fluctuating due to less conformity of the contact surfaces. The scaled-up patellar components were found to have two contact areas on the patellofemoral joint, while the original one had only one contact area

Software for full-color 3D reconstruction of the biological tissues internal structure

A software for processing sets of full-color images of biological tissue histological sections is developed. We used histological sections obtained by the method of high-precision layer-by-layer grinding of frozen biological tissues. The software allows restoring the image of the tissue for an arbitrary cross-section of the tissue sample. Thus, our method is designed to create a full-color 3D reconstruction of the biological tissue structure. The resolution of 3D reconstruction is determined by the quality of the initial histological sections. The newly developed technology available to us provides a resolution of up to 5 - 10 {\mu}m in three dimensions.Comment: 11 pages, 8 figure

Patient-Specific Implants in Musculoskeletal (Orthopedic) Surgery

Most of the treatments in medicine are patient specific, aren’t they? So why should we bother with individualizing implants if we adapt our therapy to patients anyway? Looking at the neighboring field of oncologic treatment, you would not question the fact that individualization of tumor therapy with personalized antibodies has led to the thriving of this field in terms of success in patient survival and positive responses to alternatives for conventional treatments. Regarding the latest cutting-edge developments in orthopedic surgery and biotechnology, including new imaging techniques and 3D-printing of bone substitutes as well as implants, we do have an armamentarium available to stimulate the race for innovation in medicine. This Special Issue of Journal of Personalized Medicine will gather all relevant new and developed techniques already in clinical practice. Examples include the developments in revision arthroplasty and tumor (pelvic replacement) surgery to recreate individual defects, individualized implants for primary arthroplasty to establish physiological joint kinematics, and personalized implants in fracture treatment, to name but a few

Development of procedures for the design, optimization and manufacturing of customized orthopaedic and trauma implants: Geometrical/anatomical modelling from 3D medical imaging

Tese de Doutoramento (Programa Doutoral em Engenharia Biomédica)The introduction of imaging techniques in 1970 is one of the most relevant historical milestones in modern medicine. Medical imaging techniques have dramatically changed our understanding of the Human anatomy and physiology. The ability to non-invasively extract visual information allowed, not only the three-dimensional representation of the internal organs and musculo-skeletal system, but also the simulation of surgical procedures, the execution of computer aided surgeries, the development of more accurate biomechanical models, the development of custom-made implants, among others. The combination of the most advanced medical imaging systems with the most advanced CAD and CAM techniques, may allow the development of custom-made implants that meet patient-speci c traits. The geometrical and functional optimization of these devices may increase implant life-expectancy, especially in patients with marked deviations from the anatomical standards. In the implant customization protocol from medical image data, there are several steps that need to be followed in a sequential way, namely: Medical Image Processing and Recovering; Accurate Image Segmentation and 3D Surface Model Generation; Geometrical Customization based on CAD and CAE techniques; FEA Optimization of the Implant Geometry; and Manufacturing using CAD-CAM Technologies. This work aims to develop the necessary procedures for custom implant development from medical image data. This includes the extraction of highly accurate three-dimensional representation of the musculo-skeletal system from the Computed Tomography imaging, and the development of customized implants, given the speci c requirements of the target anatomy, and the applicable best practices found in the literature. A two-step segmentation protocol is proposed. In the rst step the region of interest is pre-segmented in order to obtain a good approximation to the desired geometry. Next, a fully automatic segmentation re nement is applied to obtain a more accurate representation of the target domain. The re nement step is composed by several sub-steps, more precisely, the recovery of the original image, considering the limiting resolution of the imaging system; image cropping; image interpolation; and segmentation re nement over the up-sampled domain. Highly accurate segmentations of the target domain were obtained with the proposed pipeline. The limiting factor to the accurate description of the domain accuracy is the image acquisition process, rather the following image processing, segmentation and surface meshing steps. The new segmentation pipeline was used in the development of three tailor-made implants, namely, a tibial nailing system, a mandibular implant, and a Total Hip Replacement system. Implants optimization is carried with Finite Element Analysis, considering the critical loading conditions that may be applied to each implant in working conditions. The new tibial nailing system is able of sustaining critical loads without implant failure; the new mandibular endoprosthesis that allows the recovery of the natural stress and strain elds observed in intact mandibles; and the Total Hip Replacement system that showed comparable strain shielding levels as commercially available stems. In summary, in the present thesis the necessary procedures for custom implant design are investigated, and new algorithms proposed. The guidelines for the characterization of the image acquisition, image processing, image segmentation and 3D reconstruction are presented and discussed. This new image processing pipeline is applied and validated in the development of the three abovementioned customized implants, for di erent medical applications and that satisfy speci c anatomical needs.Um dos principais marcos da história moderna da medicina e a introdução da imagem médica, em meados da década de 1970. As tecnologias de imagem permitiram aumentar e potenciar o nosso conhecimento acerca da anatomia e fisiologia do corpo Humano. A capacidade de obter informação imagiológica de forma não invasiva permitiu, não são a representação tridimensional de órgãos e do sistema músculo-esquelético, mas também a simulação de procedimentos cirúrgicos, a realização de cirurgias assistidas por computador, a criação de modelos biomecânicos mais realistas, a criação de implantes personalizados, entre outros. A conjugação dos sistemas mais avançados de imagem medica com as técnicas mais avançadas de modelação e maquinagem, pode permitir o desenvolvimento de implantes personalizados mais otimizados, que vão de encontro as especificidades de cada paciente. Por sua vez, a otimização geométrica e biomecânica destes dispositivos pode permitir, quer o aumento da sua longevidade, quer o tratamento de pessoas com estruturas anatómicas que se afastam dos padrões normais. O processo de modelação de implantes a partir da imagem medica passa por um conjunto de procedimentos a adotar, sequencialmente, ate ao produto final, a saber: Processamento e Recuperação de Imagem; Segmentação de Imagem e Reconstrução tridimensional da Região de Interesse; Modelação Geométrica do Implante; Simulação Numérica para a Otimização da Geometria; a Maquinagem do Implante. Este trabalho visa o desenvolvimento dos procedimentos necessários para a criação de implantes personalizados a partir da imagem medica, englobando a extração de modelos ósseos geométricos rigorosos a partir de imagens de Tomografia Computorizada e, a partir desses modelos, desenvolver implantes personalizados baseados nas melhores praticas existentes na literatura e que satisfaçam as especificidades da anatomia do paciente. Assim, apresenta-se e discute-se um novo procedimento de segmentação em dois passos. No primeiro e feita uma pre-segmentação que visa obter uma aproximação iniciala região de interesse. De seguida, um procedimento de refinamento da segmentação totalmente automático e aplicada a segmentação inicial para obter uma descrição mais precisa do domínio de interesse. O processo de refinamento da segmentação e constituído por vários procedimentos, designadamente: recuperação da imagem original, tendo em consideração a resolução limitante do sistema de imagem; o recorte da imagem na vizinhança da região pre-segmentada; a interpolação da região de interesse; e o refinamento da segmentação aplicando a técnica de segmentação Level-Sets sobre o domínio interpolado. O procedimento de segmentação permitiu extrair modelos extremamente precisos a partir da informação imagiológica. Os resultados revelam que o fator limitante a descrição do domínio e o processo de aquisição de imagem, em detrimento dos diversos passos de processamento subsequentes. O novo protocolo de segmentação foi utilizado no desenvolvimento de três implantes personalizados, a saber: um sistema de fixação interna para a tíbia; um implante mandibular; e um sistema para a Reconstrução Total da articulação da Anca. A otimização do comportamento mecânico dos implantes foi feita utilizado o Método dos Elementos Finitos, tendo em conta os carregamentos críticos a que estes podem estar sujeitos durante a sua vida útil. O sistema de fixação interna para a tíbia e capaz de suportar os carregamentos críticos, sem que a sua integridade mecânica seja comprometida; o implante mandibular permite recuperar os campos de tensão e deformação observados em mandíbulas intactas; e a Prótese Total da Anca apresenta níveis de strain shielding ao longo do fémur proximal comparáveis com os níveis observados em dispositivos comercialmente disponíveis. Em suma, nesta tese de Doutoramento são investigados e propostos novos procedimentos para o projeto de implantes feitos por medida. São apresentadas e discutidas as linhas orientadoras para a caracterização precisa do sistema de aquisição de imagem, para o processamento de imagem, para a segmentação, e para a reconstrução 3D das estruturas anatómicas a partir da imagem medica. Este conjunto de linhas orientadoras é aplicado e validado no desenvolvimento de três implantes personalizados, citados anteriormente, para aplicações médicas distintas e que satisfazem as necessidades anatómicas específicas de cada paciente.Fundação para a Ciência e Tecnologia (FCT

Optimization of Operation Sequencing in CAPP Using Hybrid Genetic Algorithm and Simulated Annealing Approach

In any CAPP system, one of the most important process planning functions is selection of the operations and corresponding machines in order to generate the optimal operation sequence. In this paper, the hybrid GA-SA algorithm is used to solve this combinatorial optimization NP (Non-deterministic Polynomial) problem. The network representation is adopted to describe operation and sequencing flexibility in process planning and the mathematical model for process planning is described with the objective of minimizing the production time. Experimental results show effectiveness of the hybrid algorithm that, in comparison with the GA and SA standalone algorithms, gives optimal operation sequence with lesser computational time and lesser number of iterations

Optimization of Operation Sequencing in CAPP Using Hybrid Genetic Algorithm and Simulated Annealing Approach

In any CAPP system, one of the most important process planning functions is selection of the operations and corresponding machines in order to generate the optimal operation sequence. In this paper, the hybrid GA-SA algorithm is used to solve this combinatorial optimization NP (Non-deterministic Polynomial) problem. The network representation is adopted to describe operation and sequencing flexibility in process planning and the mathematical model for process planning is described with the objective of minimizing the production time. Experimental results show effectiveness of the hybrid algorithm that, in comparison with the GA and SA standalone algorithms, gives optimal operation sequence with lesser computational time and lesser number of iterations

Autonomous Navigation of Automated Guided Vehicle Using Monocular Camera

This paper presents a hybrid control algorithm for Automated Guided Vehicle (AGV) consisting of two independent control loops: Position Based Control (PBC) for global navigation within manufacturing environment and Image Based Visual Servoing (IBVS) for fine motions needed for accurate steering towards loading/unloading point. The proposed hybrid control separates the initial transportation task into global navigation towards the goal point, and fine motion from the goal point to the loading/unloading point. In this manner, the need for artificial landmarks or accurate map of the environment is bypassed. Initial experimental results show the usefulness of the proposed approach.COBISS.SR-ID 27383808