276 research outputs found
From Concept to Market: Surgical Robot Development
Surgical robotics and supporting technologies have really become a prime example of modern applied
information technology infiltrating our everyday lives. The development of these systems spans across
four decades, and only the last few years brought the market value and saw the rising customer base
imagined already by the early developers. This chapter guides through the historical development of the
most important systems, and provide references and lessons learnt for current engineers facing similar
challenges. A special emphasis is put on system validation, assessment and clearance, as the most
commonly cited barrier hindering the wider deployment of a system
Image-Guided Robotic Dental Implantation With Natural-Root-Formed Implants
Dental implantation is now recognized as the standard of the care for tooth replacement. Although many studies show high short term survival rates greater than 95%, long term studies (\u3e 5 years) have shown success rates as low as 41.9%. Reasons affecting the long term success rates might include surgical factors such as limited accuracy of implant placement, lack of spacing controls, and overheating during the placement.
In this dissertation, a comprehensive solution for improving the outcome of current dental implantation is presented, which includes computer-aided preoperative planning for better visualization of patient-specific information and automated robotic site-preparation for superior placement and orientation accuracy. Surgical planning is generated using patient-specific three-dimensional (3D) models which are reconstructed from Cone-beam CT images. An innovative image-guided robotic site-preparation system for implants insertion is designed and implemented. The preoperative plan of the implant insertion is transferred into intra-operative operations of the robot using a two-step registration procedure with the help of a Coordinate Measurement Machine (CMM). The natural-root implants mimic the root structure of natural teeth and were proved by Finite Element Method (FEM) to provide superior stress distribution than current cylinder-shape implants. However, due to their complicated geometry, manual site-preparation for these implants cannot be accomplished. Our innovative image-guided robotic implantation system provides the possibility of using this advanced type of implant.
Phantom experiments with patient-specific jaw models were performed to evaluate the accuracy of positioning and orientation. Fiducial Registration Error (FRE) values less than 0.20 mm and final Target Registration Error (TRE) values after the two-step registration of 0.36±0.13 mm (N=5) were achieved. Orientation error was 1.99±1.27° (N=14). Robotic milling of the natural-root implant shape with single- and double-root was also tested, and the results proved that their complicated volumes can be removed as designed by the robot. The milling time for single- and double-root shape was 177 s and 1522 s, respectively
Computer-Assisted Electroanatomical Guidance for Cardiac Electrophysiology Procedures
Cardiac arrhythmias are serious life-threatening episodes aïŹecting both the aging population and younger patients with pre-existing heart conditions. One of the most eïŹective therapeutic procedures is the minimally-invasive catheter-driven endovascular electrophysiology study, whereby electrical potentials and activation patterns in the aïŹected cardiac chambers are measured and subsequent ablation of arrhythmogenic tissue is performed. Despite emerging technologies such as electroanatomical mapping and remote intraoperative navigation systems for improved catheter manipulation and stability, successful ablation of arrhythmias is still highly-dependent on the operatorâs skills and experience. This thesis proposes a framework towards standardisation in the electroanatomical mapping and ablation planning by merging knowledge transfer from previous cases and patient-speciïŹc data. In particular, contributions towards four diïŹerent procedural aspects were made: optimal electroanatomical mapping, arrhythmia path computation, catheter tip stability analysis, and ablation simulation and optimisation. In order to improve the intraoperative electroanatomical map, anatomical areas of high mapping interest were proposed, as learned from previous electrophysiology studies. Subsequently, the arrhythmic wave propagation on the endocardial surface and potential ablation points were computed. The ablation planning is further enhanced, ïŹrstly by the analysis of the catheter tip stability and the probability of slippage at sparse locations on the endocardium and, secondly, by the simulation of the ablation result from the computation of convolutional matrices which model mathematically the ablation process. The methods proposed by this thesis were validated on data from patients with complex congenital heart disease, who present unusual cardiac anatomy and consequently atypical arrhythmias. The proposed methods also build a generic framework for computer guidance of electrophysiology, with results showing complementary information that can be easily integrated into the clinical workïŹow.Open Acces
A continuum robotic platform for endoscopic non-contact laser surgery: design, control, and preclinical evaluation
The application of laser technologies in surgical interventions has been accepted in the clinical
domain due to their atraumatic properties. In addition to manual application of fibre-guided
lasers with tissue contact, non-contact transoral laser microsurgery (TLM) of laryngeal tumours
has been prevailed in ENT surgery. However, TLM requires many years of surgical training
for tumour resection in order to preserve the function of adjacent organs and thus preserve the
patientâs quality of life. The positioning of the microscopic laser applicator outside the patient
can also impede a direct line-of-sight to the target area due to anatomical variability and limit
the working space. Further clinical challenges include positioning the laser focus on the tissue
surface, imaging, planning and performing laser ablation, and motion of the target area during
surgery. This dissertation aims to address the limitations of TLM through robotic approaches and
intraoperative assistance. Although a trend towards minimally invasive surgery is apparent, no
highly integrated platform for endoscopic delivery of focused laser radiation is available to date.
Likewise, there are no known devices that incorporate scene information from endoscopic imaging
into ablation planning and execution. For focusing of the laser beam close to the target tissue, this
work first presents miniaturised focusing optics that can be integrated into endoscopic systems.
Experimental trials characterise the optical properties and the ablation performance. A robotic
platform is realised for manipulation of the focusing optics. This is based on a variable-length
continuum manipulator. The latter enables movements of the endoscopic end effector in five
degrees of freedom with a mechatronic actuation unit. The kinematic modelling and control of the
robot are integrated into a modular framework that is evaluated experimentally. The manipulation
of focused laser radiation also requires precise adjustment of the focal position on the tissue. For
this purpose, visual, haptic and visual-haptic assistance functions are presented. These support
the operator during teleoperation to set an optimal working distance. Advantages of visual-haptic
assistance are demonstrated in a user study. The system performance and usability of the overall
robotic system are assessed in an additional user study. Analogous to a clinical scenario, the
subjects follow predefined target patterns with a laser spot. The mean positioning accuracy of the
spot is 0.5 mm. Finally, methods of image-guided robot control are introduced to automate laser
ablation. Experiments confirm a positive effect of proposed automation concepts on non-contact
laser surgery.Die Anwendung von Lasertechnologien in chirurgischen Interventionen hat sich aufgrund der atraumatischen Eigenschaften in der Klinik etabliert. Neben manueller Applikation von fasergefĂŒhrten
Lasern mit Gewebekontakt hat sich die kontaktfreie transorale Lasermikrochirurgie (TLM) von
Tumoren des Larynx in der HNO-Chirurgie durchgesetzt. Die TLM erfordert zur Tumorresektion
jedoch ein langjÀhriges chirurgisches Training, um die Funktion der angrenzenden Organe zu
sichern und damit die LebensqualitĂ€t der Patienten zu erhalten. Die Positionierung des mikroskopis chen Laserapplikators auĂerhalb des Patienten kann zudem die direkte Sicht auf das Zielgebiet
durch anatomische VariabilitÀt erschweren und den Arbeitsraum einschrÀnken. Weitere klinische
Herausforderungen betreffen die Positionierung des Laserfokus auf der GewebeoberflÀche, die
Bildgebung, die Planung und AusfĂŒhrung der Laserablation sowie intraoperative Bewegungen
des Zielgebietes. Die vorliegende Dissertation zielt darauf ab, die Limitierungen der TLM durch
robotische AnsÀtze und intraoperative Assistenz zu adressieren. Obwohl ein Trend zur minimal
invasiven Chirurgie besteht, sind bislang keine hochintegrierten Plattformen fĂŒr die endoskopische
Applikation fokussierter Laserstrahlung verfĂŒgbar. Ebenfalls sind keine Systeme bekannt, die
Szeneninformationen aus der endoskopischen Bildgebung in die Ablationsplanung und -ausfĂŒhrung
einbeziehen. FĂŒr eine situsnahe Fokussierung des Laserstrahls wird in dieser Arbeit zunĂ€chst
eine miniaturisierte Fokussieroptik zur Integration in endoskopische Systeme vorgestellt. Experimentelle Versuche charakterisieren die optischen Eigenschaften und das Ablationsverhalten. Zur
Manipulation der Fokussieroptik wird eine robotische Plattform realisiert. Diese basiert auf einem
lÀngenverÀnderlichen Kontinuumsmanipulator. Letzterer ermöglicht in Kombination mit einer
mechatronischen Aktuierungseinheit Bewegungen des Endoskopkopfes in fĂŒnf Freiheitsgraden.
Die kinematische Modellierung und Regelung des Systems werden in ein modulares Framework
eingebunden und evaluiert. Die Manipulation fokussierter Laserstrahlung erfordert zudem eine
prĂ€zise Anpassung der Fokuslage auf das Gewebe. DafĂŒr werden visuelle, haptische und visuell haptische Assistenzfunktionen eingefĂŒhrt. Diese unterstĂŒtzen den Anwender bei Teleoperation
zur Einstellung eines optimalen Arbeitsabstandes. In einer Anwenderstudie werden Vorteile der
visuell-haptischen Assistenz nachgewiesen. Die Systemperformanz und Gebrauchstauglichkeit
des robotischen Gesamtsystems werden in einer weiteren Anwenderstudie untersucht. Analog zu
einem klinischen Einsatz verfolgen die Probanden mit einem Laserspot vorgegebene Sollpfade. Die
mittlere Positioniergenauigkeit des Spots betrÀgt dabei 0,5 mm. Zur Automatisierung der Ablation
werden abschlieĂend Methoden der bildgestĂŒtzten Regelung vorgestellt. Experimente bestĂ€tigen
einen positiven Effekt der Automationskonzepte fĂŒr die kontaktfreie Laserchirurgie
Advanced Applications of Rapid Prototyping Technology in Modern Engineering
Rapid prototyping (RP) technology has been widely known and appreciated due to its flexible and customized manufacturing capabilities. The widely studied RP techniques include stereolithography apparatus (SLA), selective laser sintering (SLS), three-dimensional printing (3DP), fused deposition modeling (FDM), 3D plotting, solid ground curing (SGC), multiphase jet solidification (MJS), laminated object manufacturing (LOM). Different techniques are associated with different materials and/or processing principles and thus are devoted to specific applications. RP technology has no longer been only for prototype building rather has been extended for real industrial manufacturing solutions. Today, the RP technology has contributed to almost all engineering areas that include mechanical, materials, industrial, aerospace, electrical and most recently biomedical engineering. This book aims to present the advanced development of RP technologies in various engineering areas as the solutions to the real world engineering problems
Nephroblastoma in MRI Data
The main objective of this work is the mathematical analysis of nephroblastoma in MRI sequences. At the beginning we provide two different datasets for segmentation and classification. Based on the first dataset, we analyze the current clinical practice regarding therapy planning on the basis of annotations of a single radiologist. We can show with our benchmark that this approach is not optimal and that there may be significant differences between human annotators and even radiologists. In addition, we demonstrate that the approximation of the tumor shape currently used is too coarse granular and thus prone to errors. We address this problem and develop a method for interactive segmentation that allows an intuitive and accurate annotation of the tumor. While the first part of this thesis is mainly concerned with the segmentation of Wilmsâ tumors, the second part deals with the reliability of diagnosis and the planning of the course of therapy. The second data set we compiled allows us to develop a method that dramatically improves the differential diagnosis between nephroblastoma and its precursor lesion nephroblastomatosis. Finally, we can show that even the standard MRI modality for Wilmsâ tumors is sufficient to estimate the developmental tendencies of nephroblastoma under chemotherapy
A parametric modeling concept for predicting biomechanical compatibility in total hip arthroplasty
This work attempts to predict the long-term outcome of total hip arthroplasty based on available patient-specific information and possible installation positions of the prosthesis. For this purpose, a holistic modeling approach for the numerical simulation of osseointegration and long-term stability of endoprostheses, including possible prosthesis positions, is developed. In addition, new, efficient, and reliable methods for the numerical description of adaptive bone remodeling and osseointegration are proposed:
The adaptive bone remodeling is described as a geometric-linear, material-nonlinear finite element model, following thermodynamically consistent material modeling guidelines. The resulting constitutive equations are expanded to describe osseointegration and transferred into a contact interface between bone and prosthesis. Finally, the results are projected to an imaging format that is easier to interpret for medical professionals, using a newly developed simulation for X-ray images.
The inclusion of possible prosthesis positions spans an infinite-dimensional event space. Therefore, the model is reduced to a finite-dimensional surrogate model sampled with an adaptive sparse-grid collocation method.
Without clinical validation, reliable statements cannot be made, and therefore the numerical examples given in this thesis can be regarded as proof of correct implementation and feasibility studies. This dissertation thus provides an answer to how much computational effort is required to provide a real digital decision aid in orthopedic surgery
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