Haptic Training Simulator for Pedicle Screw Insertion in Scoliosis Surgery

This thesis develops a haptic training simulator that imitates the sensations experienced by a surgeon in pedicle screw insertions in a scoliosis surgery. Pedicle screw insertion is a common treatment for fixing spinal deformities in idiopathic scoliosis. Surgeons using the free hand technique are guided primarily by haptic feedback. A vital step in this free hand technique is the use of a probe to make a channel through the vertebrae pedicle. This is a sensitive process which carries risk of serious mechanical, neurological and vascular complications. Surgeons are currently trained using cadavers or live patients. Cadavers often have vertebrae that are softer than the real surgeons would typically encounter, while training on live patients carries the obvious issue of increased risk of complications to the patient. In this thesis, a haptic virtual reality simulator is designed and studied as a training tool for surgeons in this procedure. Creating a pathway through the pedicle by the free-hand technique is composed of two main degrees of freedom: rotation and linear progression. The rotary stage of the device which was developed by a previous student, is enhanced in this research by adding hardware, improving the haptic model and proposing techniques to couple the rotary and linear degree of freedom. Haptic model parameters for a spine surgery with normal bone density are then clinically tuned within a user study. Over ten surgeons of varying experience levels used the simulator and were able to change various parameters in order to tune the simulator to what felt most realistic. The surgeons also evaluated the simulator for its feasibility and usefulness. Four research questions were investigated. First, can a reference set of values be found that replicate the surgeon's interpretation of the surgical scenario? Second, how are the rotary stage parameters influenced in the presence of linear effects? Third, do the results differ across different expertise levels? Finally, can the simulator serve as a useful tool in the education of surgical trainees for teaching channel creation in pedicle screw insertion? Statistical analysis are carried out to examine the research questions. The results indicates the feasibility of the simulator for surgical education

Pedicle Screw Insertion Surgical Simulator

Scoliosis is a sideway spinal deformity. If the curvature is measured to be more than 50 degrees, the patient can feel significant discomfort. In such cases, surgery is required to straighten the spine. Pedicle screw insertion is a common procedure for scoliosis surgery. The technique requires the placement of screws from the pedicle into the spine. A rod is used to connect all the pedicle screws. The spine is straightened during the connection process. One of the most common techniques used for pedicle screw insertion is called the free hand technique. During free hand surgery, the surgeon creates a screw channel by manually probe into the spine. The lack of visual aid requires the surgeon to rely strongly on haptics feedback. Due to the spine sensitivity and the limited operating range, small changes in force or direction can cause the probe to breach out of the spine. If the breach reaches the spine medial, the spinal cord could be damaged. Even experienced surgeons can not prevent breach. Studies have found that surgeons with 5 or more years of surgical experience have a breach rate of 10.8 %. In this thesis, pedicle screw insertion simulator is developed and examined in detail. The simulator combines visual and haptics sensation to recreate the channel creation process of the surgery. A 2DOF mechanical device is used for the haptics sensation. The device includes a linear actuator and a rotary motor. The simulator was tuned to four different surgical scenarios by 2 expert surgeons. The scenarios are soft probing, hard probing, lateral breach, and in-out-in breach. 10 additional surgeons were asked to participant in a clinical study. Measurements were collected for analysis. The focus of the study is to find if the surgeon can recognize the simulated breach scenarios. Four research questions were examined, and they are: 1. Can experience help the surgeon improve correct breach recognition rate? 2. Can experience help the surgeon improve overall correct recognition rate? 3. Is there any performance difference between surgeons with different experience level? 4. Can the simulation trials become a learning tool for the simulation tasks? Each question has its own null hypothesis and statistical analysis is used to determine if the null hypothesis is rejected. The main conclusion is that there is no statistically significant relationship between the wrong breach or total wrong recognition rate and surgical experience. Furthermore, there is statistically significant in hard probing scenario between surgical experience and vertical force variance. Lastly, ANOVA analysis showed that the breach force and velocity in three trials are close to statistically significant, more data may prove that the simulator can be a training tool for the tasks

The state-of-the-art in ultrasound-guided spine interventions.

During the last two decades, intra-operative ultrasound (iUS) imaging has been employed for various surgical procedures of the spine, including spinal fusion and needle injections. Accurate and efficient registration of pre-operative computed tomography or magnetic resonance images with iUS images are key elements in the success of iUS-based spine navigation. While widely investigated in research, iUS-based spine navigation has not yet been established in the clinic. This is due to several factors including the lack of a standard methodology for the assessment of accuracy, robustness, reliability, and usability of the registration method. To address these issues, we present a systematic review of the state-of-the-art techniques for iUS-guided registration in spinal image-guided surgery (IGS). The review follows a new taxonomy based on the four steps involved in the surgical workflow that include pre-processing, registration initialization, estimation of the required patient to image transformation, and a visualization process. We provide a detailed analysis of the measurements in terms of accuracy, robustness, reliability, and usability that need to be met during the evaluation of a spinal IGS framework. Although this review is focused on spinal navigation, we expect similar evaluation criteria to be relevant for other IGS applications

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

Advanced Applications of Rapid Prototyping Technology in Modern Engineering

Rapid prototyping (RP) technology has been widely known and appreciated due to its flexible and customized manufacturing capabilities. The widely studied RP techniques include stereolithography apparatus (SLA), selective laser sintering (SLS), three-dimensional printing (3DP), fused deposition modeling (FDM), 3D plotting, solid ground curing (SGC), multiphase jet solidification (MJS), laminated object manufacturing (LOM). Different techniques are associated with different materials and/or processing principles and thus are devoted to specific applications. RP technology has no longer been only for prototype building rather has been extended for real industrial manufacturing solutions. Today, the RP technology has contributed to almost all engineering areas that include mechanical, materials, industrial, aerospace, electrical and most recently biomedical engineering. This book aims to present the advanced development of RP technologies in various engineering areas as the solutions to the real world engineering problems

Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): Guidelines for medical 3D printing and appropriateness for clinical scenarios

Este número da revista Cadernos de Estudos Sociais estava em organização quando fomos colhidos pela morte do sociólogo Ernesto Laclau. Seu falecimento em 13 de abril de 2014 surpreendeu a todos, e particularmente ao editor Joanildo Burity, que foi seu orientando de doutorado na University of Essex, Inglaterra, e que recentemente o trouxe à Fundação Joaquim Nabuco para uma palestra, permitindo que muitos pudessem dialogar com um dos grandes intelectuais latinoamericanos contemporâneos. Assim, buscamos fazer uma homenagem ao sociólogo argentino publicando uma entrevista inédita concedida durante a sua passagem pelo Recife, em 2013, encerrando essa revista com uma sessão especial sobre a sua trajetória

Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios

Abstract Medical three-dimensional (3D) printing has expanded dramatically over the past three decades with growth in both facility adoption and the variety of medical applications. Consideration for each step required to create accurate 3D printed models from medical imaging data impacts patient care and management. In this paper, a writing group representing the Radiological Society of North America Special Interest Group on 3D Printing (SIG) provides recommendations that have been vetted and voted on by the SIG active membership. This body of work includes appropriate clinical use of anatomic models 3D printed for diagnostic use in the care of patients with specific medical conditions. The recommendations provide guidance for approaches and tools in medical 3D printing, from image acquisition, segmentation of the desired anatomy intended for 3D printing, creation of a 3D-printable model, and post-processing of 3D printed anatomic models for patient care.https://deepblue.lib.umich.edu/bitstream/2027.42/146524/1/41205_2018_Article_30.pd

Pedagogical strategy for VOEU (Virtual Orthopaedics European University)

Research Report D35.07The pedagogical strategy in VOEU is based upon the creation of a novel learning environment which aims to maximise the relationship between the pedagogical approaches adopted, and the tools and resources available to support them. The project therefore builds on current thinking in educational research on pedagogy, in terms of learning being situated, with learners adopting an active and constructive approach