Optical techniques for 3D surface reconstruction in computer-assisted laparoscopic surgery

One of the main challenges for computer-assisted surgery (CAS) is to determine the intra-opera- tive morphology and motion of soft-tissues. This information is prerequisite to the registration of multi-modal patient-specific data for enhancing the surgeon’s navigation capabilites by observ- ing beyond exposed tissue surfaces and for providing intelligent control of robotic-assisted in- struments. In minimally invasive surgery (MIS), optical techniques are an increasingly attractive approach for in vivo 3D reconstruction of the soft-tissue surface geometry. This paper reviews the state-of-the-art methods for optical intra-operative 3D reconstruction in laparoscopic surgery and discusses the technical challenges and future perspectives towards clinical translation. With the recent paradigm shift of surgical practice towards MIS and new developments in 3D opti- cal imaging, this is a timely discussion about technologies that could facilitate complex CAS procedures in dynamic and deformable anatomical regions

Técnicas de coste reducido para el posicionamiento del paciente en radioterapia percutánea utilizando un sistema de imágenes ópticas

Patient positioning is an important part of radiation therapy which is one of the main solutions for the treatment of malignant tissue in the human body. Currently, the most common patient positioning methods expose healthy tissue of the patient's body to extra dangerous radiations. Other non-invasive positioning methods are either not very accurate or are very costly for an average hospital. In this thesis, we explore the possibility of developing a system comprised of affordable hardware and advanced computer vision algorithms that facilitates patient positioning. Our algorithms are based on the usage of affordable RGB-D sensors, image features, ArUco planar markers, and other geometry registration methods. Furthermore, we take advantage of consumer-level computing hardware to make our systems widely accessible. More specifically, we avoid the usage of approaches that need to take advantage of dedicated GPU hardware for general-purpose computing since they are more costly. In different publications, we explore the usage of the mentioned tools to increase the accuracy of reconstruction/localization of the patient in its pose. We also take into account the visualization of the patient's target position with respect to their current position in order to assist the person who performs patient positioning. Furthermore, we make usage of augmented reality in conjunction with a real-time 3D tracking algorithm for better interaction between the program and the operator. We also solve more fundamental problems about ArUco markers that could be used in the future to improve our systems. These include highquality multi-camera calibration and mapping using ArUco markers plus detection of these markers in event cameras which are very useful in the presence of fast camera movement. In the end, we conclude that it is possible to increase the accuracy of 3D reconstruction and localization by combining current computer vision algorithms with fiducial planar markers with RGB-D sensors. This is reflected in the low amount of error we have achieved in our experiments for patient positioning, pushing forward the state of the art for this application.En el tratamiento de tumores malignos en el cuerpo, el posicionamiento del paciente en las sesiones de radioterapia es una cuestión crucial. Actualmente, los métodos más comunes de posicionamiento del paciente exponen tejido sano del mismo a radiaciones peligrosas debido a que no es posible asegurar que la posición del paciente siempre sea la misma que la que tuvo cuando se planificó la zona a radiar. Los métodos que se usan actualmente, o no son precisos o tienen costes que los hacen inasequibles para ser usados en hospitales con financiación limitada. En esta Tesis hemos analizado la posibilidad de desarrollar un sistema compuesto por hardware de bajo coste y métodos avanzados de visión por ordenador que ayuden a que el posicionamiento del paciente sea el mismo en las diferentes sesiones de radioterapia, con respecto a su pose cuando fue se planificó la zona a radiar. La solución propuesta como resultado de la Tesis se basa en el uso de sensores RGB-D, características extraídas de la imagen, marcadores cuadrados denominados ArUco y métodos de registro de la geometría en la imagen. Además, en la solución propuesta, se aprovecha la existencia de hardware convencional de bajo coste para hacer nuestro sistema ampliamente accesible. Más específicamente, evitamos el uso de enfoques que necesitan aprovechar GPU, de mayores costes, para computación de propósito general. Se han obtenido diferentes publicaciones para conseguir el objetivo final. Las mismas describen métodos para aumentar la precisión de la reconstrucción y la localización del paciente en su pose, teniendo en cuenta la visualización de la posición ideal del paciente con respecto a su posición actual, para ayudar al profesional que realiza la colocación del paciente. También se han propuesto métodos de realidad aumentada junto con algoritmos para seguimiento 3D en tiempo real para conseguir una mejor interacción entre el sistema ideado y el profesional que debe realizar esa labor. De forma añadida, también se han propuesto soluciones para problemas fundamentales relacionados con el uso de marcadores cuadrados que han sido utilizados para conseguir el objetivo de la Tesis. Las soluciones propuestas pueden ser empleadas en el futuro para mejorar otros sistemas. Los problemas citados incluyen la calibración y el mapeo multicámara de alta calidad utilizando los marcadores y la detección de estos marcadores en cámaras de eventos, que son muy útiles en presencia de movimientos rápidos de la cámara. Al final, concluimos que es posible aumentar la precisión de la reconstrucción y localización en 3D combinando los actuales algoritmos de visión por ordenador, que usan marcadores cuadrados de referencia, con sensores RGB-D. Los resultados obtenidos con respecto al error que el sistema obtiene al reproducir el posicionamiento del paciente suponen un importante avance en el estado del arte de este tópico

Laser speckle contrast imaging for intraoperative monitoring of cerebral blood flow

Ensuring adequate blood flow during surgical procedures is crucial, as prolonged ischemia can result in tissue death and lead to poor clinical outcomes. This is especially important during neurosurgery, since the brain relies on a constant supply of cerebral blood flow (CBF) to maintain normal function. Intraoperative blood flow monitoring tools are essential to detect ischemia in a timely manner, and allow surgical correction before the onset of irreversible brain injury. Laser speckle contrast imaging (LSCI) is an optical imaging method that provides blood flow maps with high spatiotemporal resolution, and overcomes many of the limitations of current intraoperative monitoring technologies. The objective of this dissertation is to demonstrate that LSCI is an effective tool for blood flow monitoring during neurosurgery, and to optimize and improve LSCI technology for clinical use. This research has two primary elements: assessing the LSCI instrumentation components in a controlled laboratory setting, and evaluating the clinical performance of LSCI during neurosurgery. The laboratory study aims to determine the optimal specifications for the clinical instrument design, using controlled static and microfluidic flow experiments. Two of the main components of the LSCI instrument are the camera used for recording, and the laser used for coherent illumination of the tissue. Thus, a broad camera and laser comparison was performed spanning a wide array of available hardware options to determine which specifications are the most important for reliable and highly sensitive flow measurements. The two-phase clinical study aims to demonstrate the performance and utility of LSCI in a neurosurgical setting as a potential tool for real-time, continuous, and noninvasive image guidance. These studies demonstrate that LSCI can produce blood flow maps consistent with expected physiological trends, and show the impact of instrument design and image acquisition techniques on image quality and quantitative flow assessment. The results from both the laboratory and clinical studies can be used to design a more sensitive and robust LSCI system, which increases its value as an intraoperative tool for monitoring blood flow. LSCI has the potential to be the next generation of neurosurgical image guidance for blood flow visualization, and the work presented in this dissertation can accelerate its clinical adoption.Biomedical Engineerin

Sensor architectures and technologies for upper limb 3d surface reconstruction: A review

3D digital models of the upper limb anatomy represent the starting point for the design process of bespoke devices, such as orthoses and prostheses, which can be modeled on the actual patient’s anatomy by using CAD (Computer Aided Design) tools. The ongoing research on optical scanning methodologies has allowed the development of technologies that allow the surface reconstruction of the upper limb anatomy through procedures characterized by minimum discomfort for the patient. However, the 3D optical scanning of upper limbs is a complex task that requires solving problematic aspects, such as the difficulty of keeping the hand in a stable position and the presence of artefacts due to involuntary movements. Scientific literature, indeed, investigated different approaches in this regard by either integrating commercial devices, to create customized sensor architectures, or by developing innovative 3D acquisition techniques. The present work is aimed at presenting an overview of the state of the art of optical technologies and sensor architectures for the surface acquisition of upper limb anatomies. The review analyzes the working principles at the basis of existing devices and proposes a categorization of the approaches based on handling, pre/post-processing effort, and potentialities in real-time scanning. An in-depth analysis of strengths and weaknesses of the approaches proposed by the research community is also provided to give valuable support in selecting the most appropriate solution for the specific application to be addressed

Towards markerless orthopaedic navigation with intuitive Optical See-through Head-mounted displays

The potential of image-guided orthopaedic navigation to improve surgical outcomes has been well-recognised during the last two decades. According to the tracked pose of target bone, the anatomical information and preoperative plans are updated and displayed to surgeons, so that they can follow the guidance to reach the goal with higher accuracy, efficiency and reproducibility. Despite their success, current orthopaedic navigation systems have two main limitations: for target tracking, artificial markers have to be drilled into the bone and calibrated manually to the bone, which introduces the risk of additional harm to patients and increases operating complexity; for guidance visualisation, surgeons have to shift their attention from the patient to an external 2D monitor, which is disruptive and can be mentally stressful. Motivated by these limitations, this thesis explores the development of an intuitive, compact and reliable navigation system for orthopaedic surgery. To this end, conventional marker-based tracking is replaced by a novel markerless tracking algorithm, and the 2D display is replaced by a 3D holographic Optical see-through (OST) Head-mounted display (HMD) precisely calibrated to a user's perspective. Our markerless tracking, facilitated by a commercial RGBD camera, is achieved through deep learning-based bone segmentation followed by real-time pose registration. For robust segmentation, a new network is designed and efficiently augmented by a synthetic dataset. Our segmentation network outperforms the state-of-the-art regarding occlusion-robustness, device-agnostic behaviour, and target generalisability. For reliable pose registration, a novel Bounded Iterative Closest Point (BICP) workflow is proposed. The improved markerless tracking can achieve a clinically acceptable error of 0.95 deg and 2.17 mm according to a phantom test. OST displays allow ubiquitous enrichment of perceived real world with contextually blended virtual aids through semi-transparent glasses. They have been recognised as a suitable visual tool for surgical assistance, since they do not hinder the surgeon's natural eyesight and require no attention shift or perspective conversion. The OST calibration is crucial to ensure locational-coherent surgical guidance. Current calibration methods are either human error-prone or hardly applicable to commercial devices. To this end, we propose an offline camera-based calibration method that is highly accurate yet easy to implement in commercial products, and an online alignment-based refinement that is user-centric and robust against user error. The proposed methods are proven to be superior to other similar State-of- the-art (SOTA)s regarding calibration convenience and display accuracy. Motivated by the ambition to develop the world's first markerless OST navigation system, we integrated the developed markerless tracking and calibration scheme into a complete navigation workflow designed for femur drilling tasks during knee replacement surgery. We verify the usability of our designed OST system with an experienced orthopaedic surgeon by a cadaver study. Our test validates the potential of the proposed markerless navigation system for surgical assistance, although further improvement is required for clinical acceptance.Open Acces

Refractive Structure-From-Motion Through a Flat Refractive Interface

Recovering 3D scene geometry from underwater images involves the Refractive Structure-from-Motion (RSfM) problem, where the image distortions caused by light refraction at the interface between different propagation media invalidates the single view point assumption. Direct use of the pinhole camera model in RSfM leads to inaccurate camera pose estimation and consequently drift. RSfM methods have been thoroughly studied for the case of a thick glass interface that assumes two refractive interfaces between the camera and the viewed scene. On the other hand, when the camera lens is in direct contact with the water, there is only one refractive interface. By explicitly considering a refractive interface, we develop a succinct derivation of the refractive fundamental matrix in the form of the generalised epipolar constraint for an axial camera. We use the refractive fundamental matrix to refine initial pose estimates obtained by assuming the pinhole model. This strategy allows us to robustly estimate underwater camera poses, where other methods suffer from poor noise-sensitivity. We also formulate a new four view constraint enforcing camera pose consistency along a video which leads us to a novel RSfM framework. For validation we use synthetic data to show the numerical properties of our method and we provide results on real data to demonstrate performance within laboratory settings and for applications in endoscopy

Medical SLAM in an autonomous robotic system

One of the main challenges for computer-assisted surgery (CAS) is to determine the intra-operative morphology and motion of soft-tissues. This information is prerequisite to the registration of multi-modal patient-specific data for enhancing the surgeon’s navigation capabilities by observing beyond exposed tissue surfaces and for providing intelligent control of robotic-assisted instruments. In minimally invasive surgery (MIS), optical techniques are an increasingly attractive approach for in vivo 3D reconstruction of the soft-tissue surface geometry. This thesis addresses the ambitious goal of achieving surgical autonomy, through the study of the anatomical environment by Initially studying the technology present and what is needed to analyze the scene: vision sensors. A novel endoscope for autonomous surgical task execution is presented in the first part of this thesis. Which combines a standard stereo camera with a depth sensor. This solution introduces several key advantages, such as the possibility of reconstructing the 3D at a greater distance than traditional endoscopes. Then the problem of hand-eye calibration is tackled, which unites the vision system and the robot in a single reference system. Increasing the accuracy in the surgical work plan. In the second part of the thesis the problem of the 3D reconstruction and the algorithms currently in use were addressed. In MIS, simultaneous localization and mapping (SLAM) can be used to localize the pose of the endoscopic camera and build ta 3D model of the tissue surface. Another key element for MIS is to have real-time knowledge of the pose of surgical tools with respect to the surgical camera and underlying anatomy. Starting from the ORB-SLAM algorithm we have modified the architecture to make it usable in an anatomical environment by adding the registration of the pre-operative information of the intervention to the map obtained from the SLAM. Once it has been proven that the slam algorithm is usable in an anatomical environment, it has been improved by adding semantic segmentation to be able to distinguish dynamic features from static ones. All the results in this thesis are validated on training setups, which mimics some of the challenges of real surgery and on setups that simulate the human body within Autonomous Robotic Surgery (ARS) and Smart Autonomous Robotic Assistant Surgeon (SARAS) projects