Artificial Intelligence, Computational Simulations, and Extended Reality in Cardiovascular Interventions

Artificial intelligence, computational simulations, and extended reality, among other 21st century computational technologies, are changing the health care system. To collectively highlight the most recent advances and benefits of artificial intelligence, computational simulations, and extended reality in cardiovascular therapies, we coined the abbreviation AISER. The review particularly focuses on the following applications of AISER: 1) preprocedural planning and clinical decision making; 2) virtual clinical trials, and cardiovascular device research, development, and regulatory approval; and 3) education and training of interventional health care professionals and medical technology innovators. We also discuss the obstacles and constraints associated with the application of AISER technologies, as well as the proposed solutions. Interventional health care professionals, computer scientists, biomedical engineers, experts in bioinformatics and visualization, the device industry, ethics committees, and regulatory agencies are expected to streamline the use of AISER technologies in cardiovascular interventions and medicine in general

Medical Robotics

The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not

Context-aware learning for robot-assisted endovascular catheterization

Endovascular intervention has become a mainstream treatment of cardiovascular diseases. However, multiple challenges remain such as unwanted radiation exposures, limited two-dimensional image guidance, insufficient force perception and haptic cues. Fast evolving robot-assisted platforms improve the stability and accuracy of instrument manipulation. The master-slave system also removes radiation to the operator. However, the integration of robotic systems into the current surgical workflow is still debatable since repetitive, easy tasks have little value to be executed by the robotic teleoperation. Current systems offer very low autonomy, potential autonomous features could bring more benefits such as reduced cognitive workloads and human error, safer and more consistent instrument manipulation, ability to incorporate various medical imaging and sensing modalities. This research proposes frameworks for automated catheterisation with different machine learning-based algorithms, includes Learning-from-Demonstration, Reinforcement Learning, and Imitation Learning. Those frameworks focused on integrating context for tasks in the process of skill learning, hence achieving better adaptation to different situations and safer tool-tissue interactions. Furthermore, the autonomous feature was applied to next-generation, MR-safe robotic catheterisation platform. The results provide important insights into improving catheter navigation in the form of autonomous task planning, self-optimization with clinical relevant factors, and motivate the design of intelligent, intuitive, and collaborative robots under non-ionizing image modalities.Open Acces

INTERFACE DESIGN FOR A VIRTUAL REALITY-ENHANCED IMAGE-GUIDED SURGERY PLATFORM USING SURGEON-CONTROLLED VIEWING TECHNIQUES

Initiative has been taken to develop a VR-guided cardiac interface that will display and deliver information without affecting the surgeons’ natural workflow while yielding better accuracy and task completion time than the existing setup. This paper discusses the design process, the development of comparable user interface prototypes as well as an evaluation methodology that can measure user performance and workload for each of the suggested display concepts. User-based studies and expert recommendations are used in conjunction to es­ tablish design guidelines for our VR-guided surgical platform. As a result, a better understanding of autonomous view control, depth display, and use of virtual context, is attained. In addition, three proposed interfaces have been developed to allow a surgeon to control the view of the virtual environment intra-operatively. Comparative evaluation of the three implemented interface prototypes in a simulated surgical task scenario, revealed performance advantages for stereoscopic and monoscopic biplanar display conditions, as well as the differences between three types of control modalities. One particular interface prototype demonstrated significant improvement in task performance. Design recommendations are made for this interface as well as the others as we prepare for prospective development iterations

Modeling and Control of Steerable Ablation Catheters

Catheters are long, flexible tubes that are extensively used in vascular and cardiac interventions, e.g., cardiac ablation, coronary angiography and mitral valve annuloplasty. Catheter-based cardiac ablation is a well-accepted treatment for atrial fibrillation, a common type of cardiac arrhythmia. During this procedure, a steerable ablation catheter is guided through the vasculature to the left atrium to correct the signal pathways inside the heart and restore normal heart rhythm. The outcome of the ablation procedure depends mainly on the correct positioning of the catheter tip at the target location inside the heart and also on maintaining a consistent contact between the catheter tip and cardiac tissue. In the presence of cardiac and respiratory motions, achieving these goals during the ablation procedure is very challenging without proper 3D visualization, dexterous control of the flexible catheter and an estimate of the catheter tip/tissue contact force. This research project provides the required basis for developing a robotics-assisted catheter manipulation system with contact force control for use in cardiac ablation procedures. The behavior of the catheter is studied in free space as well in contact with the environment to develop mathematical models of the catheter tip that are well suited for developing control systems. The validity of the proposed modeling approaches and the performance of the suggested control techniques are evaluated experimentally. As the first step, the static force-deflection relationship for ablation catheters is described with a large-deflection beam model and an optimized pseudo-rigid-body 3R model. The proposed static model is then used in developing a control system for controlling the contact force when the catheter tip is interacting with a static environment. Our studies also showed that it is possible to estimate the tip/tissue contact force by analyzing the shape of the catheter without installing a force sensor on the catheter. During cardiac ablation, the catheter tip is in contact with a relatively fast moving environment (cardiac tissue). Robotic manipulation of the catheter has the potential to improve the quality of contact between the catheter tip and cardiac tissue. To this end, the frequency response of the catheter is investigated and a control technique is proposed to compensate for the cardiac motion and to maintain a constant tip/tissue contact force. Our study on developing a motion compensated robotics-assisted catheter manipulation system suggests that redesigning the actuation mechanism of current ablation catheters would provide a major improvement in using these catheters in robotics-assisted cardiac ablation procedures

MR-based navigation for robot-assisted endovascular procedures

There is increasing interests in robotic and computer technologies to accurately perform endovascular intervention. One major limitation of current endovascular intervention—either manual or robot-assisted is the surgical navigation which still relies on 2D fluoroscopy. Recent research efforts are towards MRI-guided interventions to reduce ionizing radiation exposure, and to improve diagnosis, planning, navigation, and execution of endovascular interventions. We propose an MR-based navigation framework for robot-assisted endovascular procedures. The framework allows the acquisition of real-time MR images; segmentation of the vasculature and tracking of vascular instruments; and generation of MR-based guidance, both visual and haptic. The instrument tracking accuracy—a key aspect of the navigation framework—was assessed via 4 dedicated experiments with different acquisition settings, framerate, and time. The experiments showed clinically acceptable tracking accuracy in the range of 1.30–3.80 mm RMSE. We believe that this work represents a valuable first step towards MR-guided robot-assisted intervention

Angiography Simulation and Planning Using A Multi-Fluid Approach

Angiography is a minimally invasive diagnostic procedure in endovascular interventions. Training interventional procedures is a big challenge, due to the complexity of the procedures with the changes of measurement and visualization in blood flow rate, volume, and image contrast. In this paper, we present a novel virtual reality-based 3D interactive training platform for angiography procedure training. We propose a multi-fluid flow approach with a novel corresponding non-slip boundary condition to simulate the effect of diffusion between the blood and contrast media. A novel syringe device tool is also designed as an add-on hardware to the 3D software simulation system to model haptics through real physical interactions to enhance the realism of the simulation-based training. Experimental results show that the system can simulate realistic blood flow in complex blood vessel structures. The results are validated by visual comparisons between real angiography images and simulations. By combining the proposed software and hardware, our system is applicable and scalable to many interventional radiology procedures. Finally, we have tested the system with clinicians to assess its efficacy for virtual reality-based medical training

Modelling and simulation of flexible instruments for minimally invasive surgical training in virtual reality

Improvements in quality and safety standards in surgical training, reduction in training hours and constant technological advances have challenged the traditional apprenticeship model to create a competent surgeon in a patient-safe way. As a result, pressure on training outside the operating room has increased. Interactive, computer based Virtual Reality (VR) simulators offer a safe, cost-effective, controllable and configurable training environment free from ethical and patient safety issues. Two prototype, yet fully-functional VR simulator systems for minimally invasive procedures relying on flexible instruments were developed and validated. NOViSE is the first force-feedback enabled VR simulator for Natural Orifice Transluminal Endoscopic Surgery (NOTES) training supporting a flexible endoscope. VCSim3 is a VR simulator for cardiovascular interventions using catheters and guidewires. The underlying mathematical model of flexible instruments in both simulator prototypes is based on an established theoretical framework – the Cosserat Theory of Elastic Rods. The efficient implementation of the Cosserat Rod model allows for an accurate, real-time simulation of instruments at haptic-interactive rates on an off-the-shelf computer. The behaviour of the virtual tools and its computational performance was evaluated using quantitative and qualitative measures. The instruments exhibited near sub-millimetre accuracy compared to their real counterparts. The proposed GPU implementation further accelerated their simulation performance by approximately an order of magnitude. The realism of the simulators was assessed by face, content and, in the case of NOViSE, construct validity studies. The results indicate good overall face and content validity of both simulators and of virtual instruments. NOViSE also demonstrated early signs of construct validity. VR simulation of flexible instruments in NOViSE and VCSim3 can contribute to surgical training and improve the educational experience without putting patients at risk, raising ethical issues or requiring expensive animal or cadaver facilities. Moreover, in the context of an innovative and experimental technique such as NOTES, NOViSE could potentially facilitate its development and contribute to its popularization by keeping practitioners up to date with this new minimally invasive technique.Open Acces