A (Near) Real-Time Simulation Method of Aneurysm Coil Embolization

International audienceA (Near) Real-Time Simulation Method of Aneurysm Coil Embolizatio

Interactive Blood-Coil Simulation in Real-time during Aneurysm Embolization

International audienceOver the last decade, remarkable progress has been made in the field of endovascular treatment of aneurysms. Technological advances continue to make it possible for a growing number of patients with cerebral aneurysms to be treated with a variety of endovascular strategies, essentially using detachable platinum coils. Yet, coil embolization remains a very complex medical procedure for which careful planning must be combined with advanced technical skills in order to be successful. In this paper, we describe a complete process for patient-specific simulations of coil embolization, from mesh generation with medical datasets to computation of coil-flow bilateral influence. We propose a new method for simulating the complex blood flow patterns that take place within the aneurysm, and for simulating the interaction of coils with this flow. This interaction is twofold, first involving the impact of the flow on the coil during the initial stages of its deployment, and second concerning the decrease of blood velocity within the aneurysm, as a consequence of coil packing. We also propose an approach to achieve real-time computation of coil-flow bilateral influence, necessary for interactive simulation. This in turns allows to dynamically plan coil embolization for two key steps of the procedure: choice and placement of the first coils, and assessment of the number of coils necessary to reduce aneurysmal blood velocity and wall pressure. Finally, we provide the blood flow simulation results on several aneurysms with interesting clinical characteristics both in 2D and 3D, as well as comparisons with a commercial package for validation. The coil embolization procesure is simulated within an aneurysm, and pre- and post-operative status is reported

Dual-display laparoscopic laser speckle contrast imaging for real-time surgical assistance

Laser speckle contrast imaging (LSCI) utilizes the speckle pattern of a laser to determine the blood flow in tissues. The current approaches for its use in a clinical setting require a camera system with a laser source on a separate optical axis making it unsuitable for minimally invasive surgery (MIS). With blood flow visualization, bowel viability, for example, can be determined. Thus, LSCI can be a valuable tool in gastrointestinal surgery. In this work, we develop the first-of-its-kind dual-display laparoscopic vision system integrating LSCI with a commercially available 10mm rigid laparoscope where the laser has the same optical axis as the laparoscope. Designed for MIS, our system permits standard color RGB, label-free vasculature imaging, and fused display modes. A graphics processing unit accelerated algorithm enables the real-time display of three different modes at the surgical site. We demonstrate the capability of our system for imaging relative flow rates in a microfluidic phantom with channels as small as 200 μm at a working distance of 1–5 cm from the laparoscope tip to the phantom surface. Using our system, we reveal early changes in bowel perfusion, which are invisible to standard color vision using a rat bowel occlusion model. Furthermore, we apply our system for the first time for imaging intestinal vasculature during MIS in a swine

A Systematic Review and Discussion of the Clinical Potential

Funding Information: Funding by Portuguese Foundation for Science and Technology (FCT-MCTES) under the following projects: PTDC/EMD-EMD/1230/2021—Fluid-structure interaction for functional assessment of ascending aortic aneurysms: a biomechanical-based approach toward clinical practice ; UNIDEMI UIDB/00667/2020; A. Mourato PhD grant UI/BD/151212/2021; R. Valente PhD grant 2022.12223.BD. Publisher Copyright: © 2022 by the authors.Aortic aneurysm is a cardiovascular disease related to the alteration of the aortic tissue. It is an important cause of death in developed countries, especially for older patients. The diagnosis and treatment of such pathology is performed according to guidelines, which suggest surgical or interventional (stenting) procedures for aneurysms with a maximum diameter above a critical threshold. Although conservative, this clinical approach is also not able to predict the risk of acute complications for every patient. In the last decade, there has been growing interest towards the development of advanced in silico aortic models, which may assist in clinical diagnosis, surgical procedure planning or the design and validation of medical devices. This paper details a comprehensive review of computational modelling and simulations of blood vessel interaction in aortic aneurysms and dissection, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). In particular, the following questions are addressed: “What mathematical models were applied to simulate the biomechanical behaviour of healthy and diseased aortas?” and “Why are these models not clinically implemented?”. Contemporary evidence proves that computational models are able to provide clinicians with additional, otherwise unavailable in vivo data and potentially identify patients who may benefit from earlier treatment. Notwithstanding the above, these tools are still not widely implemented, primarily due to low accuracy, an extensive reporting time and lack of numerical validation.publishersversionpublishe

Real-time hybrid cutting with dynamic fluid visualization for virtual surgery

It is widely accepted that a reform in medical teaching must be made to meet today's high volume training requirements. Virtual simulation offers a potential method of providing such trainings and some current medical training simulations integrate haptic and visual feedback to enhance procedure learning. The purpose of this project is to explore the capability of Virtual Reality (VR) technology to develop a training simulator for surgical cutting and bleeding in a general surgery

Thermal ablation of biological tissues in disease treatment: A review of computational models and future directions

Percutaneous thermal ablation has proved to be an effective modality for treating both benign and malignant tumors in various tissues. Among these modalities, radiofrequency ablation (RFA) is the most promising and widely adopted approach that has been extensively studied in the past decades. Microwave ablation (MWA) is a newly emerging modality that is gaining rapid momentum due to its capability of inducing rapid heating and attaining larger ablation volumes, and its lesser susceptibility to the heat sink effects as compared to RFA. Although the goal of both these therapies is to attain cell death in the target tissue by virtue of heating above 50 oC, their underlying mechanism of action and principles greatly differs. Computational modelling is a powerful tool for studying the effect of electromagnetic interactions within the biological tissues and predicting the treatment outcomes during thermal ablative therapies. Such a priori estimation can assist the clinical practitioners during treatment planning with the goal of attaining successful tumor destruction and preservation of the surrounding healthy tissue and critical structures. This review provides current state-of- the-art developments and associated challenges in the computational modelling of thermal ablative techniques, viz., RFA and MWA, as well as touch upon several promising avenues in the modelling of laser ablation, nanoparticles assisted magnetic hyperthermia and non- invasive RFA. The application of RFA in pain relief has been extensively reviewed from modelling point of view. Additionally, future directions have also been provided to improve these models for their successful translation and integration into the hospital work flow