Recent trends, technical concepts and components of computer-assisted orthopedic surgery systems: A comprehensive review

Computer-assisted orthopedic surgery (CAOS) systems have become one of the most important and challenging types of system in clinical orthopedics, as they enable precise treatment of musculoskeletal diseases, employing modern clinical navigation systems and surgical tools. This paper brings a comprehensive review of recent trends and possibilities of CAOS systems. There are three types of the surgical planning systems, including: systems based on the volumetric images (computer tomography (CT), magnetic resonance imaging (MRI) or ultrasound images), further systems utilize either 2D or 3D fluoroscopic images, and the last one utilizes the kinetic information about the joints and morphological information about the target bones. This complex review is focused on three fundamental aspects of CAOS systems: their essential components, types of CAOS systems, and mechanical tools used in CAOS systems. In this review, we also outline the possibilities for using ultrasound computer-assisted orthopedic surgery (UCAOS) systems as an alternative to conventionally used CAOS systems.Web of Science1923art. no. 519

Studies of the effects of gravitational and inertial forces on cardiovascular and respiratory dynamics Semiannual status report, period ending 1 Oct. 1968

Gravitational and inertial force environment effects on cardiovascular and respiratory functions in dogs and chimpanzee

Adaptive spatial-temporal filtering applied to x-ray fluoroscopy angiography

Adaptive filtering of temporally varying X-ray image sequences acquired during endovascular interventions can improve the visual tracking of catheters by radiologists. Existing techniques blur the important parts of image sequences, such as catheter tips, anatomical structures and organs; and they may introduce trailing artifacts. To address this concern, an adaptive filtering process is presented to apply temporal filtering in regions without motion and spatial filtering in regions with motion. The adaptive filtering process is a multi-step procedure. First a normalized motion mask that describes the differences between two successive frames is generated. Secondly each frame is spatially filtered using the specific motion mask to specify different types of filtering in each region. Third an IIR filter is then used to combine the spatially filtered image with the previous output image; the motion mask thus serves as a weighted input mask to determine how much spatial and temporal filtering should be applied. This method results in improving both the stationary and moving fields. The visibility of static anatomical structures and organs increases, while the motion of the catheter tip and motion of anatomical structures and organs remain unblurred and visible during interventional procedures

Development and investigation of single-scan TV radiography for the acquisition of dynamic physiologic data

A light amplifier for large flat screen fluoroscopy was investigated which will decrease both its size and weight. The work on organ contouring was extended to yield volumes. This is a simple extension since the fluoroscopic image contains density (gray scale) information which can be translated as tissue thickness, integrated, yielding accurate volume data in an on-line situation. A number of devices were developed for analog image processing of video signals, operating on-line in real time, and with simple selection mechanisms. The results show that this approach is feasible and produces are improvement in image quality which should make diagnostic error significantly lower. These are all low cost devices, small and light in weight, thereby making them usable in a space environment, on the Ames centrifuge, and in a typical clinical situation

3D Imaging for Planning of Minimally Invasive Surgical Procedures

Novel minimally invasive surgeries are used for treating cardiovascular diseases and are performed under 2D fluoroscopic guidance with a C-arm system. 3D multidetector row computed tomography (MDCT) images are routinely used for preprocedural planning and postprocedural follow-up. For preprocedural planning, the ability to integrate the MDCT with fluoroscopic images for intraprocedural guidance is of clinical interest. Registration may be facilitated by rotating the C-arm to acquire 3D C-arm CT images. This dissertation describes the development of optimal scan and contrast parameters for C-arm CT in 6 swine. A 5-s ungated C-arm CT acquisition during rapid ventricular pacing with aortic root injection using minimal contrast (36 mL), producing high attenuation (1226), few artifacts (2.0), and measurements similar to those from MDCT (p\u3e0.05) was determined optimal. 3D MDCT and C-arm CT images were registered to overlay the aortic structures from MDCT onto fluoroscopic images for guidance in placing the prosthesis. This work also describes the development of a methodology to develop power equation (R2\u3e0.998) for estimating dose with C-arm CT based on applied tube voltage. Application in 10 patients yielded 5.48┬▒177 2.02 mGy indicating minimal radiation burden. For postprocedural follow-up, combinations of non-contrast, arterial, venous single energy CT (SECT) scans are used to monitor patients at multiple time intervals resulting in high cumulative radiation dose. Employing a single dual-energy CT (DECT) scan to replace two SECT scans can reduce dose. This work focuses on evaluating the feasibility of DECT imaging in the arterial phase. The replacement of non-contrast and arterial SECT acquisitions with one arterial DECT acquisition in 30 patients allowed generation of virtual non-contrast (VNC) images with 31 dose savings. Aortic luminal attenuation in VNC (32┬▒177 2 HU) was similar to true non-contrast images (35┬▒177 4 HU) indicating presence of unattenuated blood. To improve discrimination between c

Development and investigation of single-scan TV radiography for the acquisition of dynamic physiologic data

Research data obtained by the low dose electronic radiography system are reported. Data cover: (1) localization and tracking of Ta screws implanted in the inner wall of the right ventrical of the heart, (2) use of cross hairs to outline inner or outer heart wall contours, (3) quantitative measure of anatomical components which are stationary in size or change size dynamically, and (4) study of dynamic quantitative data from roentenologic or fluoroscopic procedures

Development of a Surgical Assistance System for Guiding Transcatheter Aortic Valve Implantation

Development of image-guided interventional systems is growing up rapidly in the recent years. These new systems become an essential part of the modern minimally invasive surgical procedures, especially for the cardiac surgery. Transcatheter aortic valve implantation (TAVI) is a recently developed surgical technique to treat severe aortic valve stenosis in elderly and high-risk patients. The placement of stented aortic valve prosthesis is crucial and typically performed under live 2D fluoroscopy guidance. To assist the placement of the prosthesis during the surgical procedure, a new fluoroscopy-based TAVI assistance system has been developed. The developed assistance system integrates a 3D geometrical aortic mesh model and anatomical valve landmarks with live 2D fluoroscopic images. The 3D aortic mesh model and landmarks are reconstructed from interventional angiographic and fluoroscopic C-arm CT system, and a target area of valve implantation is automatically estimated using these aortic mesh models. Based on template-based tracking approach, the overlay of visualized 3D aortic mesh model, landmarks and target area of implantation onto fluoroscopic images is updated by approximating the aortic root motion from a pigtail catheter motion without contrast agent. A rigid intensity-based registration method is also used to track continuously the aortic root motion in the presence of contrast agent. Moreover, the aortic valve prosthesis is tracked in fluoroscopic images to guide the surgeon to perform the appropriate placement of prosthesis into the estimated target area of implantation. An interactive graphical user interface for the surgeon is developed to initialize the system algorithms, control the visualization view of the guidance results, and correct manually overlay errors if needed. Retrospective experiments were carried out on several patient datasets from the clinical routine of the TAVI in a hybrid operating room. The maximum displacement errors were small for both the dynamic overlay of aortic mesh models and tracking the prosthesis, and within the clinically accepted ranges. High success rates of the developed assistance system were obtained for all tested patient datasets. The results show that the developed surgical assistance system provides a helpful tool for the surgeon by automatically defining the desired placement position of the prosthesis during the surgical procedure of the TAVI.Die Entwicklung bildgeführter interventioneller Systeme wächst rasant in den letzten Jahren. Diese neuen Systeme werden zunehmend ein wesentlicher Bestandteil der technischen Ausstattung bei modernen minimal-invasiven chirurgischen Eingriffen. Diese Entwicklung gilt besonders für die Herzchirurgie. Transkatheter Aortenklappen-Implantation (TAKI) ist eine neue entwickelte Operationstechnik zur Behandlung der schweren Aortenklappen-Stenose bei alten und Hochrisiko-Patienten. Die Platzierung der Aortenklappenprothese ist entscheidend und wird in der Regel unter live-2D-fluoroskopischen Bildgebung durchgeführt. Zur Unterstützung der Platzierung der Prothese während des chirurgischen Eingriffs wurde in dieser Arbeit ein neues Fluoroskopie-basiertes TAKI Assistenzsystem entwickelt. Das entwickelte Assistenzsystem überlagert eine 3D-Geometrie des Aorten-Netzmodells und anatomischen Landmarken auf live-2D-fluoroskopische Bilder. Das 3D-Aorten-Netzmodell und die Landmarken werden auf Basis der interventionellen Angiographie und Fluoroskopie mittels eines C-Arm-CT-Systems rekonstruiert. Unter Verwendung dieser Aorten-Netzmodelle wird das Zielgebiet der Klappen-Implantation automatisch geschätzt. Mit Hilfe eines auf Template Matching basierenden Tracking-Ansatzes wird die Überlagerung des visualisierten 3D-Aorten-Netzmodells, der berechneten Landmarken und der Zielbereich der Implantation auf fluoroskopischen Bildern korrekt überlagert. Eine kompensation der Aortenwurzelbewegung erfolgt durch Bewegungsverfolgung eines Pigtail-Katheters in Bildsequenzen ohne Kontrastmittel. Eine starrere Intensitätsbasierte Registrierungsmethode wurde verwendet, um kontinuierlich die Aortenwurzelbewegung in Bildsequenzen mit Kontrastmittelgabe zu detektieren. Die Aortenklappenprothese wird in die fluoroskopischen Bilder eingeblendet und dient dem Chirurg als Leitfaden für die richtige Platzierung der realen Prothese. Eine interaktive Benutzerschnittstelle für den Chirurg wurde zur Initialisierung der Systemsalgorithmen, zur Steuerung der Visualisierung und für manuelle Korrektur eventueller Überlagerungsfehler entwickelt. Retrospektive Experimente wurden an mehreren Patienten-Datensätze aus der klinischen Routine der TAKI in einem Hybrid-OP durchgeführt. Hohe Erfolgsraten des entwickelten Assistenzsystems wurden für alle getesteten Patienten-Datensätze erzielt. Die Ergebnisse zeigen, dass das entwickelte chirurgische Assistenzsystem ein hilfreiches Werkzeug für den Chirurg bei der Platzierung Position der Prothese während des chirurgischen Eingriffs der TAKI bietet

3D Imaging for Planning of Minimally Invasive Surgical Procedures

Novel minimally invasive surgeries are used for treating cardiovascular diseases and are performed under 2D fluoroscopic guidance with a C-arm system. 3D multidetector row computed tomography (MDCT) images are routinely used for preprocedural planning and postprocedural follow-up. For preprocedural planning, the ability to integrate the MDCT with fluoroscopic images for intraprocedural guidance is of clinical interest. Registration may be facilitated by rotating the C-arm to acquire 3D C-arm CT images. This dissertation describes the development of optimal scan and contrast parameters for C-arm CT in 6 swine. A 5-s ungated C-arm CT acquisition during rapid ventricular pacing with aortic root injection using minimal contrast (36 mL), producing high attenuation (1226), few artifacts (2.0), and measurements similar to those from MDCT (p\u3e0.05) was determined optimal. 3D MDCT and C-arm CT images were registered to overlay the aortic structures from MDCT onto fluoroscopic images for guidance in placing the prosthesis. This work also describes the development of a methodology to develop power equation (R2\u3e0.998) for estimating dose with C-arm CT based on applied tube voltage. Application in 10 patients yielded 5.48┬▒177 2.02 mGy indicating minimal radiation burden. For postprocedural follow-up, combinations of non-contrast, arterial, venous single energy CT (SECT) scans are used to monitor patients at multiple time intervals resulting in high cumulative radiation dose. Employing a single dual-energy CT (DECT) scan to replace two SECT scans can reduce dose. This work focuses on evaluating the feasibility of DECT imaging in the arterial phase. The replacement of non-contrast and arterial SECT acquisitions with one arterial DECT acquisition in 30 patients allowed generation of virtual non-contrast (VNC) images with 31 dose savings. Aortic luminal attenuation in VNC (32┬▒177 2 HU) was similar to true non-contrast images (35┬▒177 4 HU) indicating presence of unattenuated blood. To improve discrimination between c

Real-Time Quantum Noise Suppression In Very Low-Dose Fluoroscopy

Fluoroscopy provides real-time X-ray screening of patient's organs and of various radiopaque objects, which make it an invaluable tool for many interventional procedures. For this reason, the number of fluoroscopy screenings has experienced a consistent growth in the last decades. However, this trend has raised many concerns about the increase in X-ray exposure, as even low-dose procedures turned out to be not as safe as they were considered, thus demanding a rigorous monitoring of the X-ray dose delivered to the patients and to the exposed medical staff. In this context, the use of very low-dose protocols would be extremely beneficial. Nonetheless, this would result in very noisy images, which need to be suitably denoised in real-time to support interventional procedures. Simple smoothing filters tend to produce blurring effects that undermines the visibility of object boundaries, which is essential for the human eye to understand the imaged scene. Therefore, some denoising strategies embed noise statistics-based criteria to improve their denoising performances. This dissertation focuses on the Noise Variance Conditioned Average (NVCA) algorithm, which takes advantage of the a priori knowledge of quantum noise statistics to perform noise reduction while preserving the edges and has already outperformed many state-of-the-art methods in the denoising of images corrupted by quantum noise, while also being suitable for real-time hardware implementation. Different issues are addressed that currently limit the actual use of very low-dose protocols in clinical practice, e.g. the evaluation of actual performances of denoising algorithms in very low-dose conditions, the optimization of tuning parameters to obtain the best denoising performances, the design of an index to properly measure the quality of X-ray images, and the assessment of an a priori noise characterization approach to account for time-varying noise statistics due to changes of X-ray tube settings. An improved NVCA algorithm is also presented, along with its real-time hardware implementation on a Field Programmable Gate Array (FPGA). The novel algorithm provides more efficient noise reduction performances also for low-contrast moving objects, thus relaxing the trade-off between noise reduction and edge preservation, while providing a further reduction of hardware complexity, which allows for low usage of logic resources also on small FPGA platforms. The results presented in this dissertation provide the means for future studies aimed at embedding the NVCA algorithm in commercial fluoroscopic devices to accomplish real-time denoising of very low-dose X-ray images, which would foster their actual use in clinical practice