Advanced tracking and image registration techniques for intraoperative radiation therapy

Mención Internacional en el título de doctorIntraoperative electron radiation therapy (IOERT) is a technique used to deliver radiation to the surgically opened tumor bed without irradiating healthy tissue. Treatment planning systems and mobile linear accelerators enable clinicians to optimize the procedure, minimize stress in the operating room (OR) and avoid transferring the patient to a dedicated radiation room. However, placement of the radiation collimator over the tumor bed requires a validation methodology to ensure correct delivery of the dose prescribed in the treatment planning system. In this dissertation, we address three well-known limitations of IOERT: applicator positioning over the tumor bed, docking of the mobile linear accelerator gantry with the applicator and validation of the dose delivery prescribed. This thesis demonstrates that these limitations can be overcome by positioning the applicator appropriately with respect to the patient’s anatomy. The main objective of the study was to assess technological and procedural alternatives for improvement of IOERT performance and resolution of problems of uncertainty. Image-to-world registration, multicamera optical trackers, multimodal imaging techniques and mobile linear accelerator docking are addressed in the context of IOERT. IOERT is carried out by a multidisciplinary team in a highly complex environment that has special tracking needs owing to the characteristics of its working volume (i.e., large and prone to occlusions), in addition to the requisites of accuracy. The first part of this dissertation presents the validation of a commercial multicamera optical tracker in terms of accuracy, sensitivity to miscalibration, camera occlusions and detection of tools using a feasible surgical setup. It also proposes an automatic miscalibration detection protocol that satisfies the IOERT requirements of automaticity and speed. We show that the multicamera tracker is suitable for IOERT navigation and demonstrate the feasibility of the miscalibration detection protocol in clinical setups. Image-to-world registration is one of the main issues during image-guided applications where the field of interest and/or the number of possible anatomical localizations is large, such as IOERT. In the second part of this dissertation, a registration algorithm for image-guided surgery based on lineshaped fiducials (line-based registration) is proposed and validated. Line-based registration decreases acquisition time during surgery and enables better registration accuracy than other published algorithms. In the third part of this dissertation, we integrate a commercial low-cost ultrasound transducer and a cone beam CT C-arm with an optical tracker for image-guided interventions to enable surgical navigation and explore image based registration techniques for both modalities. In the fourth part of the dissertation, a navigation system based on optical tracking for the docking of the mobile linear accelerator to the radiation applicator is assessed. This system improves safety and reduces procedure time. The system tracks the prescribed collimator location to solve the movements that the linear accelerator should perform to reach the docking position and warns the user about potentially unachievable arrangements before the actual procedure. A software application was implemented to use this system in the OR, where it was also evaluated to assess the improvement in docking speed. Finally, in the last part of the dissertation, we present and assess the installation setup for a navigation system in a dedicated IOERT OR, determine the steps necessary for the IOERT process, identify workflow limitations and evaluate the feasibility of the integration of the system in a real OR. The navigation system safeguards the sterile conditions of the OR, clears the space available for surgeons and is suitable for any similar dedicated IOERT OR.La Radioterapia Intraoperatoria por electrones (RIO) consiste en la aplicación de radiación de alta energía directamente sobre el lecho tumoral, accesible durante la cirugía, evitando radiar los tejidos sanos. Hoy en día, avances como los sistemas de planificación (TPS) y la aparición de aceleradores lineales móviles permiten optimizar el procedimiento, minimizar el estrés clínico en el entorno quirúrgico y evitar el desplazamiento del paciente durante la cirugía a otra sala para ser radiado. La aplicación de la radiación se realiza mediante un colimador del haz de radiación (aplicador) que se coloca sobre el lecho tumoral de forma manual por el oncólogo radioterápico. Sin embargo, para asegurar una correcta deposición de la dosis prescrita y planificada en el TPS, es necesaria una adecuada validación de la colocación del colimador. En esta Tesis se abordan tres limitaciones conocidas del procedimiento RIO: el correcto posicionamiento del aplicador sobre el lecho tumoral, acoplamiento del acelerador lineal con el aplicador y validación de la dosis de radiación prescrita. Esta Tesis demuestra que estas limitaciones pueden ser abordadas mediante el posicionamiento del aplicador de radiación en relación con la anatomía del paciente. El objetivo principal de este trabajo es la evaluación de alternativas tecnológicas y procedimentales para la mejora de la práctica de la RIO y resolver los problemas de incertidumbre descritos anteriormente. Concretamente se revisan en el contexto de la radioterapia intraoperatoria los siguientes temas: el registro de la imagen y el paciente, sistemas de posicionamiento multicámara, técnicas de imagen multimodal y el acoplamiento del acelerador lineal móvil. El entorno complejo y multidisciplinar de la RIO precisa de necesidades especiales para el empleo de sistemas de posicionamiento como una alta precisión y un volumen de trabajo grande y propenso a las oclusiones de los sensores de posición. La primera parte de esta Tesis presenta una exhaustiva evaluación de un sistema de posicionamiento óptico multicámara comercial. Estudiamos la precisión del sistema, su sensibilidad a errores cometidos en la calibración, robustez frente a posibles oclusiones de las cámaras y precisión en el seguimiento de herramientas en un entorno quirúrgico real. Además, proponemos un protocolo para la detección automática de errores por calibración que satisface los requisitos de automaticidad y velocidad para la RIO demostrando la viabilidad del empleo de este sistema para la navegación en RIO. Uno de los problemas principales de la cirugía guiada por imagen es el correcto registro de la imagen médica y la anatomía del paciente en el quirófano. En el caso de la RIO, donde el número de posibles localizaciones anatómicas es bastante amplio, así como el campo de trabajo es grande se hace necesario abordar este problema para una correcta navegación. Por ello, en la segunda parte de esta Tesis, proponemos y validamos un nuevo algoritmo de registro (LBR) para la cirugía guiada por imagen basado en marcadores lineales. El método propuesto reduce el tiempo de la adquisición de la posición de los marcadores durante la cirugía y supera en precisión a otros algoritmos de registro establecidos y estudiados en la literatura. En la tercera parte de esta tesis, integramos un transductor de ultrasonido comercial de bajo coste, un arco en C de rayos X con haz cónico y un sistema de posicionamiento óptico para intervenciones guiadas por imagen que permite la navegación quirúrgica y exploramos técnicas de registro de imagen para ambas modalidades. En la cuarta parte de esta tesis se evalúa un navegador basado en el sistema de posicionamiento óptico para el acoplamiento del acelerador lineal móvil con aplicador de radiación, mejorando la seguridad y reduciendo el tiempo del propio acoplamiento. El sistema es capaz de localizar el colimador en el espacio y proporcionar los movimientos que el acelerador lineal debe realizar para alcanzar la posición de acoplamiento. El sistema propuesto es capaz de advertir al usuario de aquellos casos donde la posición de acoplamiento sea inalcanzable. El sistema propuesto de ayuda para el acoplamiento se integró en una aplicación software que fue evaluada para su uso final en quirófano demostrando su viabilidad y la reducción de tiempo de acoplamiento mediante su uso. Por último, presentamos y evaluamos la instalación de un sistema de navegación en un quirófano RIO dedicado, determinamos las necesidades desde el punto de vista procedimental, identificamos las limitaciones en el flujo de trabajo y evaluamos la viabilidad de la integración del sistema en un entorno quirúrgico real. El sistema propuesto demuestra ser apto para el entorno RIO manteniendo las condiciones de esterilidad y dejando despejado el campo quirúrgico además de ser adaptable a cualquier quirófano similar.Programa Oficial de Doctorado en Multimedia y ComunicacionesPresidente: Raúl San José Estépar.- Secretario: María Arrate Muñoz Barrutia.- Vocal: Carlos Ferrer Albiac

D-branes and Azumaya noncommutative geometry: From Polchinski to Grothendieck

We review first Azumaya geometry and D-branes in the realm of algebraic geometry along the line of Polchinski-Grothendieck Ansatz from our earlier work and then use it as background to introduce Azumaya $C^{\infty}$-manifolds with a fundamental module and morphisms therefrom to a projective complex manifold. This gives us a description of D-branes of A-type. Donaldson's picture of Lagrangian and special Lagrangian submanifolds as selected from the zero-locus of a moment map on a related space of maps can be merged into the setting. As a pedagogical toy model, we study D-branes of A-type in a Calabi-Yau torus. Simple as it is, it reveals several features of D-branes, including their assembling/disassembling. The 4th theme of Sec. 2.4, the 2nd theme of Sec. 4.2, and Sec. 4.3 are to be read respectively with G\'omez-Sharpe (arXiv:hep-th/0008150), Donagi-Katz-Sharpe (arXiv:hep-th/0309270), and Denef (arXiv:hep-th/0107152). Some string-theoretical remarks are given at the end of each section.Comment: 58+2 pages, 7 figure

GelSight360: An Omnidirectional Camera-Based Tactile Sensor for Dexterous Robotic Manipulation

Camera-based tactile sensors have shown great promise in enhancing a robot's ability to perform a variety of dexterous manipulation tasks. Advantages of their use can be attributed to the high resolution tactile data and 3D depth map reconstructions they can provide. Unfortunately, many of these tactile sensors use either a flat sensing surface, sense on only one side of the sensor's body, or have a bulky form-factor, making it difficult to integrate the sensors with a variety of robotic grippers. Of the camera-based sensors that do have all-around, curved sensing surfaces, many cannot provide 3D depth maps; those that do often require optical designs specified to a particular sensor geometry. In this work, we introduce GelSight360, a fingertip-like, omnidirectional, camera-based tactile sensor capable of producing depth maps of objects deforming the sensor's surface. In addition, we introduce a novel cross-LED lighting scheme that can be implemented in different all-around sensor geometries and sizes, allowing the sensor to easily be reconfigured and attached to different grippers of varying DOFs. With this work, we enable roboticists to quickly and easily customize high resolution tactile sensors to fit their robotic system's needs

Multi-touch Detection and Semantic Response on Non-parametric Rear-projection Surfaces

The ability of human beings to physically touch our surroundings has had a profound impact on our daily lives. Young children learn to explore their world by touch; likewise, many simulation and training applications benefit from natural touch interactivity. As a result, modern interfaces supporting touch input are ubiquitous. Typically, such interfaces are implemented on integrated touch-display surfaces with simple geometry that can be mathematically parameterized, such as planar surfaces and spheres; for more complicated non-parametric surfaces, such parameterizations are not available. In this dissertation, we introduce a method for generalizable optical multi-touch detection and semantic response on uninstrumented non-parametric rear-projection surfaces using an infrared-light-based multi-camera multi-projector platform. In this paradigm, touch input allows users to manipulate complex virtual 3D content that is registered to and displayed on a physical 3D object. Detected touches trigger responses with specific semantic meaning in the context of the virtual content, such as animations or audio responses. The broad problem of touch detection and response can be decomposed into three major components: determining if a touch has occurred, determining where a detected touch has occurred, and determining how to respond to a detected touch. Our fundamental contribution is the design and implementation of a relational lookup table architecture that addresses these challenges through the encoding of coordinate relationships among the cameras, the projectors, the physical surface, and the virtual content. Detecting the presence of touch input primarily involves distinguishing between touches (actual contact events) and hovers (near-contact proximity events). We present and evaluate two algorithms for touch detection and localization utilizing the lookup table architecture. One of the algorithms, a bounded plane sweep, is additionally able to estimate hover-surface distances, which we explore for interactions above surfaces. The proposed method is designed to operate with low latency and to be generalizable. We demonstrate touch-based interactions on several physical parametric and non-parametric surfaces, and we evaluate both system accuracy and the accuracy of typical users in touching desired targets on these surfaces. In a formative human-subject study, we examine how touch interactions are used in the context of healthcare and present an exploratory application of this method in patient simulation. A second study highlights the advantages of touch input on content-matched physical surfaces achieved by the proposed approach, such as decreases in induced cognitive load, increases in system usability, and increases in user touch performance. In this experiment, novice users were nearly as accurate when touching targets on a 3D head-shaped surface as when touching targets on a flat surface, and their self-perception of their accuracy was higher

Mixed-reality visualization environments to facilitate ultrasound-guided vascular access

Ultrasound-guided needle insertions at the site of the internal jugular vein (IJV) are routinely performed to access the central venous system. Ultrasound-guided insertions maintain high rates of carotid artery puncture, as clinicians rely on 2D information to perform a 3D procedure. The limitations of 2D ultrasound-guidance motivated the research question: “Do 3D ultrasound-based environments improve IJV needle insertion accuracy”. We addressed this by developing advanced surgical navigation systems based on tracked surgical tools and ultrasound with various visualizations. The point-to-line ultrasound calibration enables the use of tracked ultrasound. We automated the fiducial localization required for this calibration method such that fiducials can be automatically localized within 0.25 mm of the manual equivalent. The point-to-line calibration obtained with both manual and automatic localizations produced average normalized distance errors less than 1.5 mm from point targets. Another calibration method was developed that registers an optical tracking system and the VIVE Pro head-mounted display (HMD) tracking system with sub-millimetre and sub-degree accuracy compared to ground truth values. This co-calibration enabled the development of an HMD needle navigation system, in which the calibrated ultrasound image and tracked models of the needle, needle trajectory, and probe were visualized in the HMD. In a phantom experiment, 31 clinicians had a 96 % success rate using the HMD system compared to 70 % for the ultrasound-only approach (p= 0.018). We developed a machine-learning-based vascular reconstruction pipeline that automatically returns accurate 3D reconstructions of the carotid artery and IJV given sequential tracked ultrasound images. This reconstruction pipeline was used to develop a surgical navigation system, where tracked models of the needle, needle trajectory, and the 3D z-buffered vasculature from a phantom were visualized in a common coordinate system on a screen. This system improved the insertion accuracy and resulted in 100 % success rates compared to 70 % under ultrasound-guidance (p=0.041) across 20 clinicians during the phantom experiment. Overall, accurate calibrations and machine learning algorithms enable the development of advanced 3D ultrasound systems for needle navigation, both in an immersive first-person perspective and on a screen, illustrating that 3D US environments outperformed 2D ultrasound-guidance used clinically

Indoor Localization Based on Wireless Sensor Networks

Indoor localization techniques based on wireless sensor networks (WSNs) have been increasingly used in various applications such as factory automation, intelligent building, facility management, security, and health care. However, existing localization techniques cannot meet the accuracy requirement of many applications. Meanwhile, some localization algorithms are affected by environmental conditions and cannot be directly used in an indoor environment. Cost is another limitation of the existing localization algorithms. This thesis is to address those issues of indoor localization through a new Sensing Displacement (SD) approach. It consists of four major parts: platform design, SD algorithm development, SD algorithm improvement, and evaluation. Platform design includes hardware design and software design. Hardware design is the foundation for the system, which consists of the motion sensors embedded on mobile nodes and WSN design. Motion sensors are used to collect motion information for the localizing objects. A WSN is designed according to the characteristics of an indoor scenario. A Cloud Computing based system architecture is developed to support the software design of the proposed system. In order to address the special issues in an indoor environment, a new Sensing Displacement algorithm is developed, which estimates displacement of a node based on the motion information from the sensors embedded on the node. The sensor assembly consists of acceleration sensors and gyroscope sensors, separately sensing the acceleration and angular velocity of the localizing object. The first SD algorithm is designed in a way to be used in a 2-D localization demo to validate the proposal. A detailed analysis of the results of 2-D SD algorithm reveals that there are two critical issues (sensor’s noise and cumulative error) affecting the measurement results. Therefore a low-pass filter and a modified Kalman filter are introduced to solve the issue of sensor’s noises. An inertia tensor factor is introduced to address the cumulative error in a 3-D SD algorithm. Finally, the proposed SD algorithm is evaluated against the commercial AeroScout (WiFi-RFID) system and the ZigBee based Fingerprint algorithm