Realistic tool-tissue interaction models for surgical simulation and planning

Surgical simulators present a safe and potentially effective method for surgical training, and can also be used in pre- and intra-operative surgical planning. Realistic modeling of medical interventions involving tool-tissue interactions has been considered to be a key requirement in the development of high-fidelity simulators and planners. The soft-tissue constitutive laws, organ geometry and boundary conditions imposed by the connective tissues surrounding the organ, and the shape of the surgical tool interacting with the organ are some of the factors that govern the accuracy of medical intervention planning.\ud \ud This thesis is divided into three parts. First, we compare the accuracy of linear and nonlinear constitutive laws for tissue. An important consequence of nonlinear models is the Poynting effect, in which shearing of tissue results in normal force; this effect is not seen in a linear elastic model. The magnitude of the normal force for myocardial tissue is shown to be larger than the human contact force discrimination threshold. Further, in order to investigate and quantify the role of the Poynting effect on material discrimination, we perform a multidimensional scaling study. Second, we consider the effects of organ geometry and boundary constraints in needle path planning. Using medical images and tissue mechanical properties, we develop a model of the prostate and surrounding organs. We show that, for needle procedures such as biopsy or brachytherapy, organ geometry and boundary constraints have more impact on target motion than tissue material parameters. Finally, we investigate the effects surgical tool shape on the accuracy of medical intervention planning. We consider the specific case of robotic needle steering, in which asymmetry of a bevel-tip needle results in the needle naturally bending when it is inserted into soft tissue. We present an analytical and finite element (FE) model for the loads developed at the bevel tip during needle-tissue interaction. The analytical model explains trends observed in the experiments. We incorporated physical parameters (rupture toughness and nonlinear material elasticity) into the FE model that included both contact and cohesive zone models to simulate tissue cleavage. The model shows that the tip forces are sensitive to the rupture toughness. In order to model the mechanics of deflection of the needle, we use an energy-based formulation that incorporates tissue-specific parameters such as rupture toughness, nonlinear material elasticity, and interaction stiffness, and needle geometric and material properties. Simulation results follow similar trends (deflection and radius of curvature) to those observed in macroscopic experimental studies of a robot-driven needle interacting with gels

Robot Autonomy for Surgery

Autonomous surgery involves having surgical tasks performed by a robot operating under its own will, with partial or no human involvement. There are several important advantages of automation in surgery, which include increasing precision of care due to sub-millimeter robot control, real-time utilization of biosignals for interventional care, improvements to surgical efficiency and execution, and computer-aided guidance under various medical imaging and sensing modalities. While these methods may displace some tasks of surgical teams and individual surgeons, they also present new capabilities in interventions that are too difficult or go beyond the skills of a human. In this chapter, we provide an overview of robot autonomy in commercial use and in research, and present some of the challenges faced in developing autonomous surgical robots

Robotics-Assisted Needle Steering for Percutaneous Interventions: Modeling and Experiments

Needle insertion and guidance plays an important role in medical procedures such as brachytherapy and biopsy. Flexible needles have the potential to facilitate precise targeting and avoid collisions during medical interventions while reducing trauma to the patient and post-puncture issues. Nevertheless, error introduced during guidance degrades the effectiveness of the planned therapy or diagnosis. Although steering using flexible bevel-tip needles provides great mobility and dexterity, a major barrier is the complexity of needle-tissue interaction that does not lend itself to intuitive control. To overcome this problem, a robotic system can be employed to perform trajectory planning and tracking by manipulation of the needle base. This research project focuses on a control-theoretic approach and draws on the rich literature from control and systems theory to model needle-tissue interaction and needle flexion and then design a robotics-based strategy for needle insertion/steering. The resulting solutions will directly benefit a wide range of needle-based interventions. The outcome of this computer-assisted approach will not only enable us to perform efficient preoperative trajectory planning, but will also provide more insight into needle-tissue interaction that will be helpful in developing advanced intraoperative algorithms for needle steering. Experimental validation of the proposed methodologies was carried out on a state of-the-art 5-DOF robotic system designed and constructed in-house primarily for prostate brachytherapy. The system is equipped with a Nano43 6-DOF force/torque sensor (ATI Industrial Automation) to measure forces and torques acting on the needle shaft. In our setup, an Aurora electromagnetic tracker (Northern Digital Inc.) is the sensing device used for measuring needle deflection. A multi-threaded application for control, sensor readings, data logging and communication over the ethernet was developed using Microsoft Visual C 2005, MATLAB 2007 and the QuaRC Toolbox (Quanser Inc.). Various artificial phantoms were developed so as to create a realistic medium in terms of elasticity and insertion force ranges; however, they simulated a uniform environment without exhibiting complexities of organic tissues. Experiments were also conducted on beef liver and fresh chicken breast, beef, and ham, to investigate the behavior of a variety biological tissues

Virtual Reality simulator for dental anesthesia training in the inferior alveolar nerve block

Objectives This study shows the development and validation of a dental anesthesia-training simulator, specifically for the inferior alveolar nerve block (IANB). The system developed provides the tactile sensation of inserting a real needle in a human patient, using Virtual Reality (VR) techniques and a haptic device that can provide a perceived force feedback in the needle insertion task during the anesthesia procedure. Material and Methods To simulate a realistic anesthesia procedure, a Carpule syringe was coupled to a haptic device. The Volere method was used to elicit requirements from users in the Dentistry area; Repeated Measures Two-Way ANOVA (Analysis of Variance), Tukey post-hoc test and averages for the results’ analysis. A questionnaire-based subjective evaluation method was applied to collect information about the simulator, and 26 people participated in the experiments (12 beginners, 12 at intermediate level, and 2 experts). The questionnaire included profile, preferences (number of viewpoints, texture of the objects, and haptic device handler), as well as visual (appearance, scale, and position of objects) and haptic aspects (motion space, tactile sensation, and motion reproduction). Results The visual aspect was considered appropriate and the haptic feedback must be improved, which the users can do by calibrating the virtual tissues’ resistance. The evaluation of visual aspects was influenced by the participants’ experience, according to ANOVA test (F=15.6, p=0.0002, with

3D Multimodal Interaction with Physically-based Virtual Environments

The virtual has become a huge field of exploration for researchers: it could assist the surgeon, help the prototyping of industrial objects, simulate natural phenomena, be a fantastic time machine or entertain users through games or movies. Far beyond the only visual rendering of the virtual environment, the Virtual Reality aims at -literally- immersing the user in the virtual world. VR technologies simulate digital environments with which users can interact and, as a result, perceive through different modalities the effects of their actions in real time. The challenges are huge: the user's motions need to be perceived and to have an immediate impact on the virtual world by modifying the objects in real-time. In addition, the targeted immersion of the user is not only visual: auditory or haptic feedback needs to be taken into account, merging all the sensory modalities of the user into a multimodal answer. The global objective of my research activities is to improve 3D interaction with complex virtual environments by proposing novel approaches for physically-based and multimodal interaction. I have laid the foundations of my work on designing the interactions with complex virtual worlds, referring to a higher demand in the characteristics of the virtual environments. My research could be described within three main research axes inherent to the 3D interaction loop: (1) the physically-based modeling of the virtual world to take into account the complexity of the virtual object behavior, their topology modifications as well as their interactions, (2) the multimodal feedback for combining the sensory modalities into a global answer from the virtual world to the user and (3) the design of body-based 3D interaction techniques and devices for establishing the interfaces between the user and the virtual world. All these contributions could be gathered in a general framework within the 3D interaction loop. By improving all the components of this framework, I aim at proposing approaches that could be used in future virtual reality applications but also more generally in other areas such as medical simulation, gesture training, robotics, virtual prototyping for the industry or web contents.Le virtuel est devenu un vaste champ d'exploration pour la recherche et offre de nos jours de nombreuses possibilités : assister le chirurgien, réaliser des prototypes de pièces industrielles, simuler des phénomènes naturels, remonter dans le temps ou proposer des applications ludiques aux utilisateurs au travers de jeux ou de films. Bien plus que le rendu purement visuel d'environnement virtuel, la réalité virtuelle aspire à -littéralement- immerger l'utilisateur dans le monde virtuel. L'utilisateur peut ainsi interagir avec le contenu numérique et percevoir les effets de ses actions au travers de différents retours sensoriels. Permettre une véritable immersion de l'utilisateur dans des environnements virtuels de plus en plus complexes confronte la recherche en réalité virtuelle à des défis importants: les gestes de l'utilisateur doivent être capturés puis directement transmis au monde virtuel afin de le modifier en temps-réel. Les retours sensoriels ne sont pas uniquement visuels mais doivent être combinés avec les retours auditifs ou haptiques dans une réponse globale multimodale. L'objectif principal de mes activités de recherche consiste à améliorer l'interaction 3D avec des environnements virtuels complexes en proposant de nouvelles approches utilisant la simulation physique et exploitant au mieux les différentes modalités sensorielles. Dans mes travaux, je m'intéresse tout particulièrement à concevoir des interactions avec des mondes virtuels complexes. Mon approche peut être décrite au travers de trois axes principaux de recherche: (1) la modélisation dans les mondes virtuels d'environnements physiques plausibles où les objets réagissent de manière naturelle, même lorsque leur topologie est modifiée ou lorsqu'ils sont en interaction avec d'autres objets, (2) la mise en place de retours sensoriels multimodaux vers l'utilisateur intégrant des composantes visuelles, haptiques et/ou sonores, (3) la prise en compte de l'interaction physique de l'utilisateur avec le monde virtuel dans toute sa richesse : mouvements de la tête, des deux mains, des doigts, des jambes, voire de tout le corps, en concevant de nouveaux dispositifs ou de nouvelles techniques d'interactions 3D. Les différentes contributions que j'ai proposées dans chacun de ces trois axes peuvent être regroupées au sein d'un cadre plus général englobant toute la boucle d'interaction 3D avec les environnements virtuels. Elles ouvrent des perspectives pour de futures applications en réalité virtuelle mais également plus généralement dans d'autres domaines tels que la simulation médicale, l'apprentissage de gestes, la robotique, le prototypage virtuel pour l'industrie ou bien les contenus web

3D Multimodal Interaction with Physically-based Virtual Environments

The virtual has become a huge field of exploration for researchers: it could assist the surgeon, help the prototyping of industrial objects, simulate natural phenomena, be a fantastic time machine or entertain users through games or movies. Far beyond the only visual rendering of the virtual environment, the Virtual Reality aims at -literally- immersing the user in the virtual world. VR technologies simulate digital environments with which users can interact and, as a result, perceive through different modalities the effects of their actions in real time. The challenges are huge: the user's motions need to be perceived and to have an immediate impact on the virtual world by modifying the objects in real-time. In addition, the targeted immersion of the user is not only visual: auditory or haptic feedback needs to be taken into account, merging all the sensory modalities of the user into a multimodal answer. The global objective of my research activities is to improve 3D interaction with complex virtual environments by proposing novel approaches for physically-based and multimodal interaction. I have laid the foundations of my work on designing the interactions with complex virtual worlds, referring to a higher demand in the characteristics of the virtual environments. My research could be described within three main research axes inherent to the 3D interaction loop: (1) the physically-based modeling of the virtual world to take into account the complexity of the virtual object behavior, their topology modifications as well as their interactions, (2) the multimodal feedback for combining the sensory modalities into a global answer from the virtual world to the user and (3) the design of body-based 3D interaction techniques and devices for establishing the interfaces between the user and the virtual world. All these contributions could be gathered in a general framework within the 3D interaction loop. By improving all the components of this framework, I aim at proposing approaches that could be used in future virtual reality applications but also more generally in other areas such as medical simulation, gesture training, robotics, virtual prototyping for the industry or web contents.Le virtuel est devenu un vaste champ d'exploration pour la recherche et offre de nos jours de nombreuses possibilités : assister le chirurgien, réaliser des prototypes de pièces industrielles, simuler des phénomènes naturels, remonter dans le temps ou proposer des applications ludiques aux utilisateurs au travers de jeux ou de films. Bien plus que le rendu purement visuel d'environnement virtuel, la réalité virtuelle aspire à -littéralement- immerger l'utilisateur dans le monde virtuel. L'utilisateur peut ainsi interagir avec le contenu numérique et percevoir les effets de ses actions au travers de différents retours sensoriels. Permettre une véritable immersion de l'utilisateur dans des environnements virtuels de plus en plus complexes confronte la recherche en réalité virtuelle à des défis importants: les gestes de l'utilisateur doivent être capturés puis directement transmis au monde virtuel afin de le modifier en temps-réel. Les retours sensoriels ne sont pas uniquement visuels mais doivent être combinés avec les retours auditifs ou haptiques dans une réponse globale multimodale. L'objectif principal de mes activités de recherche consiste à améliorer l'interaction 3D avec des environnements virtuels complexes en proposant de nouvelles approches utilisant la simulation physique et exploitant au mieux les différentes modalités sensorielles. Dans mes travaux, je m'intéresse tout particulièrement à concevoir des interactions avec des mondes virtuels complexes. Mon approche peut être décrite au travers de trois axes principaux de recherche: (1) la modélisation dans les mondes virtuels d'environnements physiques plausibles où les objets réagissent de manière naturelle, même lorsque leur topologie est modifiée ou lorsqu'ils sont en interaction avec d'autres objets, (2) la mise en place de retours sensoriels multimodaux vers l'utilisateur intégrant des composantes visuelles, haptiques et/ou sonores, (3) la prise en compte de l'interaction physique de l'utilisateur avec le monde virtuel dans toute sa richesse : mouvements de la tête, des deux mains, des doigts, des jambes, voire de tout le corps, en concevant de nouveaux dispositifs ou de nouvelles techniques d'interactions 3D. Les différentes contributions que j'ai proposées dans chacun de ces trois axes peuvent être regroupées au sein d'un cadre plus général englobant toute la boucle d'interaction 3D avec les environnements virtuels. Elles ouvrent des perspectives pour de futures applications en réalité virtuelle mais également plus généralement dans d'autres domaines tels que la simulation médicale, l'apprentissage de gestes, la robotique, le prototypage virtuel pour l'industrie ou bien les contenus web

Robust GPU-based Virtual Reality Simulation of Radio Frequency Ablations for Various Needle Geometries and Locations

Purpose: Radio-frequency ablations play an important role in the therapy of malignant liver lesions. The navigation of a needle to the lesion poses a challenge for both the trainees and intervening physicians. Methods: This publication presents a new GPU-based, accurate method for the simulation of radio-frequency ablations for lesions at the needle tip in general and for an existing visuo-haptic 4D VR simulator. The method is implemented real-time capable with Nvidia CUDA. Results: It performs better than a literature method concerning the theoretical characteristic of monotonic convergence of the bioheat PDE and a in vitro gold standard with significant improvements (p < 0.05) in terms of Pearson correlations. It shows no failure modes or theoretically inconsistent individual simulation results after the initial phase of 10 seconds. On the Nvidia 1080 Ti GPU it achieves a very high frame rendering performance of >480 Hz. Conclusion: Our method provides a more robust and safer real-time ablation planning and intraoperative guidance technique, especially avoiding the over-estimation of the ablated tissue death zone, which is risky for the patient in terms of tumor recurrence. Future in vitro measurements and optimization shall further improve the conservative estimate.Comment: 18 pages, 14 figures, 1 table, 2 algorithms, 2 movie

Sensorless Motion Planning for Medical Needle Insertion in Deformable Tissues

Minimally invasive medical procedures such as biopsies, anesthesia drug injections, and brachytherapy cancer treatments require inserting a needle to a specific target inside soft tissues. This is difficult because needle insertion displaces and deforms the surrounding soft tissues causing the target to move during the procedure. To facilitate physician training and preoperative planning for these procedures, we develop a needle insertion motion planning system based on an interactive simulation of needle insertion in deformable tissues and numerical optimization to reduce placement error. We describe a 2-D physically based, dynamic simulation of needle insertion that uses a finite-element model of deformable soft tissues and models needle cutting and frictional forces along the needle shaft. The simulation offers guarantees on simulation stability for mesh modications and achieves interactive, real-time performance on a standard PC. Using texture mapping, the simulation provides visualization comparable to ultrasound images that the physician would see during the procedure. We use the simulation as a component of a sensorless planning algorithm that uses numerical optimization to compute needle insertion offsets that compensate for tissue deformations. We apply the method to radioactive seed implantation during permanent seed prostate brachytherapy to minimize seed placement error