Sensorized Tools for Haptic Force Feedback in Computer Assisted Surgery

Structural engineerin

Navigation system based in motion tracking sensor for percutaneous renal access

Tese de Doutoramento em Engenharia BiomédicaMinimally-invasive kidney interventions are daily performed to diagnose and treat several renal diseases. Percutaneous renal access (PRA) is an essential but challenging stage for most of these procedures, since its outcome is directly linked to the physician’s ability to precisely visualize and reach the anatomical target. Nowadays, PRA is always guided with medical imaging assistance, most frequently using X-ray based imaging (e.g. fluoroscopy). Thus, radiation on the surgical theater represents a major risk to the medical team, where its exclusion from PRA has a direct impact diminishing the dose exposure on both patients and physicians. To solve the referred problems this thesis aims to develop a new hardware/software framework to intuitively and safely guide the surgeon during PRA planning and puncturing. In terms of surgical planning, a set of methodologies were developed to increase the certainty of reaching a specific target inside the kidney. The most relevant abdominal structures for PRA were automatically clustered into different 3D volumes. For that, primitive volumes were merged as a local optimization problem using the minimum description length principle and image statistical properties. A multi-volume Ray Cast method was then used to highlight each segmented volume. Results show that it is possible to detect all abdominal structures surrounding the kidney, with the ability to correctly estimate a virtual trajectory. Concerning the percutaneous puncturing stage, either an electromagnetic or optical solution were developed and tested in multiple in vitro, in vivo and ex vivo trials. The optical tracking solution aids in establishing the desired puncture site and choosing the best virtual puncture trajectory. However, this system required a line of sight to different optical markers placed at the needle base, limiting the accuracy when tracking inside the human body. Results show that the needle tip can deflect from its initial straight line trajectory with an error higher than 3 mm. Moreover, a complex registration procedure and initial setup is needed. On the other hand, a real-time electromagnetic tracking was developed. Hereto, a catheter was inserted trans-urethrally towards the renal target. This catheter has a position and orientation electromagnetic sensor on its tip that function as a real-time target locator. Then, a needle integrating a similar sensor is used. From the data provided by both sensors, one computes a virtual puncture trajectory, which is displayed in a 3D visualization software. In vivo tests showed a median renal and ureteral puncture times of 19 and 51 seconds, respectively (range 14 to 45 and 45 to 67 seconds). Such results represent a puncture time improvement between 75% and 85% when comparing to state of the art methods. 3D sound and vibrotactile feedback were also developed to provide additional information about the needle orientation. By using these kind of feedback, it was verified that the surgeon tends to follow a virtual puncture trajectory with a reduced amount of deviations from the ideal trajectory, being able to anticipate any movement even without looking to a monitor. Best results show that 3D sound sources were correctly identified 79.2 ± 8.1% of times with an average angulation error of 10.4º degrees. Vibration sources were accurately identified 91.1 ± 3.6% of times with an average angulation error of 8.0º degrees. Additionally to the EMT framework, three circular ultrasound transducers were built with a needle working channel. One explored different manufacture fabrication setups in terms of the piezoelectric materials, transducer construction, single vs. multi array configurations, backing and matching material design. The A-scan signals retrieved from each transducer were filtered and processed to automatically detect reflected echoes and to alert the surgeon when undesirable anatomical structures are in between the puncture path. The transducers were mapped in a water tank and tested in a study involving 45 phantoms. Results showed that the beam cross-sectional area oscillates around the ceramics radius and it was possible to automatically detect echo signals in phantoms with length higher than 80 mm. Hereupon, it is expected that the introduction of the proposed system on the PRA procedure, will allow to guide the surgeon through the optimal path towards the precise kidney target, increasing surgeon’s confidence and reducing complications (e.g. organ perforation) during PRA. Moreover, the developed framework has the potential to make the PRA free of radiation for both patient and surgeon and to broad the use of PRA to less specialized surgeons.Intervenções renais minimamente invasivas são realizadas diariamente para o tratamento e diagnóstico de várias doenças renais. O acesso renal percutâneo (ARP) é uma etapa essencial e desafiante na maior parte destes procedimentos. O seu resultado encontra-se diretamente relacionado com a capacidade do cirurgião visualizar e atingir com precisão o alvo anatómico. Hoje em dia, o ARP é sempre guiado com recurso a sistemas imagiológicos, na maior parte das vezes baseados em raios-X (p.e. a fluoroscopia). A radiação destes sistemas nas salas cirúrgicas representa um grande risco para a equipa médica, aonde a sua remoção levará a um impacto direto na diminuição da dose exposta aos pacientes e cirurgiões. De modo a resolver os problemas existentes, esta tese tem como objetivo o desenvolvimento de uma framework de hardware/software que permita, de forma intuitiva e segura, guiar o cirurgião durante o planeamento e punção do ARP. Em termos de planeamento, foi desenvolvido um conjunto de metodologias de modo a aumentar a eficácia com que o alvo anatómico é alcançado. As estruturas abdominais mais relevantes para o procedimento de ARP, foram automaticamente agrupadas em volumes 3D, através de um problema de optimização global com base no princípio de “minimum description length” e propriedades estatísticas da imagem. Por fim, um procedimento de Ray Cast, com múltiplas funções de transferência, foi utilizado para enfatizar as estruturas segmentadas. Os resultados mostram que é possível detetar todas as estruturas abdominais envolventes ao rim, com a capacidade para estimar corretamente uma trajetória virtual. No que diz respeito à fase de punção percutânea, foram testadas duas soluções de deteção de movimento (ótica e eletromagnética) em múltiplos ensaios in vitro, in vivo e ex vivo. A solução baseada em sensores óticos ajudou no cálculo do melhor ponto de punção e na definição da melhor trajetória a seguir. Contudo, este sistema necessita de uma linha de visão com diferentes marcadores óticos acoplados à base da agulha, limitando a precisão com que a agulha é detetada no interior do corpo humano. Os resultados indicam que a agulha pode sofrer deflexões à medida que vai sendo inserida, com erros superiores a 3 mm. Por outro lado, foi desenvolvida e testada uma solução com base em sensores eletromagnéticos. Para tal, um cateter que integra um sensor de posição e orientação na sua ponta, foi colocado por via trans-uretral junto do alvo renal. De seguida, uma agulha, integrando um sensor semelhante, é utilizada para a punção percutânea. A partir da diferença espacial de ambos os sensores, é possível gerar uma trajetória de punção virtual. A mediana do tempo necessário para puncionar o rim e ureter, segundo esta trajetória, foi de 19 e 51 segundos, respetivamente (variações de 14 a 45 e 45 a 67 segundos). Estes resultados representam uma melhoria do tempo de punção entre 75% e 85%, quando comparados com o estado da arte dos métodos atuais. Além do feedback visual, som 3D e feedback vibratório foram explorados de modo a fornecer informações complementares da posição da agulha. Verificou-se que com este tipo de feedback, o cirurgião tende a seguir uma trajetória de punção com desvios mínimos, sendo igualmente capaz de antecipar qualquer movimento, mesmo sem olhar para o monitor. Fontes de som e vibração podem ser corretamente detetadas em 79,2 ± 8,1% e 91,1 ± 3,6%, com erros médios de angulação de 10.4º e 8.0 graus, respetivamente. Adicionalmente ao sistema de navegação, foram também produzidos três transdutores de ultrassom circulares com um canal de trabalho para a agulha. Para tal, foram exploradas diferentes configurações de fabricação em termos de materiais piezoelétricos, transdutores multi-array ou singulares e espessura/material de layers de suporte. Os sinais originados em cada transdutor foram filtrados e processados de modo a detetar de forma automática os ecos refletidos, e assim, alertar o cirurgião quando existem variações anatómicas ao longo do caminho de punção. Os transdutores foram mapeados num tanque de água e testados em 45 phantoms. Os resultados mostraram que o feixe de área em corte transversal oscila em torno do raio de cerâmica, e que os ecos refletidos são detetados em phantoms com comprimentos superiores a 80 mm. Desta forma, é expectável que a introdução deste novo sistema a nível do ARP permitirá conduzir o cirurgião ao longo do caminho de punção ideal, aumentado a confiança do cirurgião e reduzindo possíveis complicações (p.e. a perfuração dos órgãos). Além disso, de realçar que este sistema apresenta o potencial de tornar o ARP livre de radiação e alarga-lo a cirurgiões menos especializados.The present work was only possible thanks to the support by the Portuguese Science and Technology Foundation through the PhD grant with reference SFRH/BD/74276/2010 funded by FCT/MEC (PIDDAC) and by Fundo Europeu de Desenvolvimento Regional (FEDER), Programa COMPETE - Programa Operacional Factores de Competitividade (POFC) do QREN

Haptics Rendering and Applications

There has been significant progress in haptic technologies but the incorporation of haptics into virtual environments is still in its infancy. A wide range of the new society's human activities including communication, education, art, entertainment, commerce and science would forever change if we learned how to capture, manipulate and reproduce haptic sensory stimuli that are nearly indistinguishable from reality. For the field to move forward, many commercial and technological barriers need to be overcome. By rendering how objects feel through haptic technology, we communicate information that might reflect a desire to speak a physically- based language that has never been explored before. Due to constant improvement in haptics technology and increasing levels of research into and development of haptics-related algorithms, protocols and devices, there is a belief that haptics technology has a promising future

Virtual environments for medical training : graphic and haptic simulation of tool-tissue interactions

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2004.Includes bibliographical references (leaves 122-127).For more than 2,500 years, surgical teaching has been based on the so called "see one, do one, teach one" paradigm, in which the surgical trainee learns by operating on patients under close supervision of peers and superiors. However, higher demands on the quality of patient care and rising malpractice costs have made it increasingly risky to train on patients. Minimally invasive surgery, in particular, has made it more difficult for an instructor to demonstrate the required manual skills. It has been recognized that, similar to flight simulators for pilots, virtual reality (VR) based surgical simulators promise a safer and more comprehensive way to train manual skills of medical personnel in general and surgeons in particular. One of the major challenges in the development of VR-based surgical trainers is the real-time and realistic simulation of interactions between surgical instruments and biological tissues. It involves multi-disciplinary research areas including soft tissue mechanical behavior, tool-tissue contact mechanics, computer haptics, computer graphics and robotics integrated into VR-based training systems. The research described in this thesis addresses many of the problems of simulating tool-tissue interactions in medical virtual environments. First, two kinds of physically based real time soft tissue models - the local deformation and the hybrid deformation model - were developed to compute interaction forces and visual deformation fields that provide real-time feed back to the user. Second, a system to measure in vivo mechanical properties of soft tissues was designed, and eleven sets of animal experiments were performed to measure in vivo and in vitro biomechanical properties of porcine intra-abdominal organs. Viscoelastic tissue(cont.) parameters were then extracted by matching finite element model predictions with the empirical data. Finally, the tissue parameters were combined with geometric organ models segmented from the Visible Human Dataset and integrated into a minimally invasive surgical simulation system consisting of haptic interface devices inside a mannequin and a graphic display. This system was used to demonstrate deformation and cutting of the esophagus, where the user can haptically interact with the virtual soft tissues and see the corresponding organ deformation on the visual display at the same time.by Jung Kim.Ph.D

Design of a Haptic Interface for Medical Applications using Magneto-Rheological Fluid based Actuators

This thesis reports on the design, construction, and evaluation of a prototype two degrees-of-freedom (DOF) haptic interface, which takes advantage of Magneto-Rheological Fluid (MRF) based clutches for actuation. Haptic information provides important cues in teleoperated systems and enables the user to feel the interaction with a remote or virtual environment during teleoperation. The two main objectives in designing a haptic interface are stability and transparency. Indeed, deficiencies in these factors in haptics-enabled telerobotic systems has the introduction of haptics in medical environments where safety and reliability are prime considerations. An actuator with poor dynamics, high inertia, large size, and heavy weight can significantly undermine the stability and transparency of a teleoperated system. In this work, the potential benefits of MRF-based actuators to the field of haptics in medical applications are studied. Devices developed with such fluids are known to possess superior mechanical characteristics over conventional servo systems. These characteristics significantly contribute to improved stability and transparency of haptic devices. This idea is evaluated and verified through both theoretical and experimental points of view. The design of a small-scale MRF-based clutch, suitable for a multi-DOF haptic interface, is discussed and its performance is compared with conventional servo systems. This design is developed into four prototype clutches. In addition, a closed-loop torque control strategy is presented. The feedback signal used in this control scheme comes from the magnetic field acquired from embedded Hall sensors in the clutch. The controller uses this feedback signal to compensate for the nonlinear behavior using an estimated model, based on Artificial Neural Networks. Such a control strategy eliminates the need for torque sensors for providing feedback signals. The performance of the developed design and the effectiveness of the proposed modeling and control techniques are experimentally validated. Next, a 2-DOF haptic interface based on a distributed antagonistic configuration of MRF-based clutches is constructed for a class of medical applications. This device is incorporated in a master-slave teleoperation setup that is used for applications involving needle insertion and soft-tissue palpation. Phantom and in vitro animal tissue were used to assess the performance of the haptic interface. The results show a great potential of MRF-based actuators for integration in haptic devices for medical interventions that require reliable, safe, accurate, highly transparent, and stable force reflection

Haptics: Science, Technology, Applications

This open access book constitutes the proceedings of the 13th International Conference on Human Haptic Sensing and Touch Enabled Computer Applications, EuroHaptics 2022, held in Hamburg, Germany, in May 2022. The 36 regular papers included in this book were carefully reviewed and selected from 129 submissions. They were organized in topical sections as follows: haptic science; haptic technology; and haptic applications

Arterial Tissue Perforation Using Ultrasonically Vibrating Wire Waveguides

Chronic Total Occlusions (CTOs) are fibrous and calcified atherosclerotic lesions which completely occlude the artery. They are difficult to treat with standard dilation procedures as they cannot be traversed easily. Their treatment is also associated with a high risk of arterial perforation. Low frequency ultrasonic vibrations delivered via wire waveguides represent a minimally invasive treatment for CTOs and other tissue ablation applications. These devices typically operate at 20–50 kHz delivering wire waveguide distal tip amplitudes of vibration of 0-60 μm. The diseased tissue is ablated or disrupted by repetitive direct mechanical contact and cavitation. This research assesses the susceptibility of arterial tissue to perforation and residual damage under the action of ultrasonically energised wire waveguides. Using Finite Element Analysis (FEA), a linear acoustic model of the wire waveguide distal tips can predict the pressures for a range of operating parameters typically used for these devices. High mesh densities (140 EPW) were required to solve the entire acoustic field, including complex wave interactions. The FEA model was used to aid in the further design and modification of an ultrasonic apparatus and wire waveguide (0–34.3 μm at 22.5 kHz). Using a test rig, the effects of distal tip amplitudes of vibration, feedrate and angled entry on the perforation forces, energy and temperature were measured. The perforation forces reduced (≈ 60%, 6.13 N - 2.46 N mean) when the wire waveguide was energised at low amplitudes of vibrations (\u3c 27.8 μm). There were no significant change in tissue perforation forces above this or when the waveguide was operating above the cavitation threshold. Histological analysis also showed tissue removal. While this knowledge is useful in the prediction and avoidance of perforations during CTO operations; it is also envisaged that this information can aid in the design and development of generic ultrasonic wire waveguide tissue cutting tools