240 research outputs found

    3D Innovations in Personalized Surgery

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    Current practice involves the use of 3D surgical planning and patient-specific solutions in multiple surgical areas of expertise. Patient-specific solutions have been endorsed for several years in numerous publications due to their associated benefits around accuracy, safety, and predictability of surgical outcome. The basis of 3D surgical planning is the use of high-quality medical images (e.g., CT, MRI, or PET-scans). The translation from 3D digital planning toward surgical applications was developed hand in hand with a rise in 3D printing applications of multiple biocompatible materials. These technical aspects of medical care require engineers’ or technical physicians’ expertise for optimal safe and effective implementation in daily clinical routines.The aim and scope of this Special Issue is high-tech solutions in personalized surgery, based on 3D technology and, more specifically, bone-related surgery. Full-papers or highly innovative technical notes or (systematic) reviews that relate to innovative personalized surgery are invited. This can include optimization of imaging for 3D VSP, optimization of 3D VSP workflow and its translation toward the surgical procedure, or optimization of personalized implants or devices in relation to bone surgery

    Advancement in total elbow arthroplasty care

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    Translational Models for Advancement of Regenerative Medicine and Tissue Engineering

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    At the root of each regenerative medicine or tissue engineering breakthrough is a simple goal, to improve quality of healing, thus improving a patient’s quality of life. Each tissue presents its own complexities and limitations to healing, whether it is the scarring nature of tendon healing or the mechanical complexity driving bone regeneration. Preclinical, translational models aim to reflect these complexities and limitations, allowing for effective development and refinement of tissue engineered therapeutics for human use. The following body of work explores several of these translational models, both utilizing them for tissue regenerative therapy development and evaluating the benefits and complications incurred with each model. This work begins with a discussion of the complexity of bone healing and how dysfunction in the mechanical, surgical, and systemic fracture environment can lead to delayed healing and nonunion. A comprehensive review of the advances in preventative and corrective therapeutics for bone nonunion is included next, with specific focuses on mechanical and tissue-engineered technology. Then, this work presents a tissue-engineered application of mesenchymal stem cells in acute tendon injury, highlighting experimentation in cell fate direction in vitro and intralesional mesenchymal stem cell implantation in vivo. Next, this work presents a series of experiments that evaluated and refined a commonly utilized preclinical model of delayed bone healing, the caprine segmental tibial defect stabilized using single locking plate fixation. First, the biomechanical stability of the model was evaluated in vivo using plantar-pressure analysis of gait. Then, the surgical technique was refined through a retrospective analysis of the effects of plate length and position on fixation stability in vitro and in vivo. Finally, the comorbidities of this preclinical model were explored via an analysis of the effect of long-term tibial locking plate fixation on cortical dimensions and density

    Advancement in total elbow arthroplasty care

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    Augmented reality (AR) for surgical robotic and autonomous systems: State of the art, challenges, and solutions

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    Despite the substantial progress achieved in the development and integration of augmented reality (AR) in surgical robotic and autonomous systems (RAS), the center of focus in most devices remains on improving end-effector dexterity and precision, as well as improved access to minimally invasive surgeries. This paper aims to provide a systematic review of different types of state-of-the-art surgical robotic platforms while identifying areas for technological improvement. We associate specific control features, such as haptic feedback, sensory stimuli, and human-robot collaboration, with AR technology to perform complex surgical interventions for increased user perception of the augmented world. Current researchers in the field have, for long, faced innumerable issues with low accuracy in tool placement around complex trajectories, pose estimation, and difficulty in depth perception during two-dimensional medical imaging. A number of robots described in this review, such as Novarad and SpineAssist, are analyzed in terms of their hardware features, computer vision systems (such as deep learning algorithms), and the clinical relevance of the literature. We attempt to outline the shortcomings in current optimization algorithms for surgical robots (such as YOLO and LTSM) whilst providing mitigating solutions to internal tool-to-organ collision detection and image reconstruction. The accuracy of results in robot end-effector collisions and reduced occlusion remain promising within the scope of our research, validating the propositions made for the surgical clearance of ever-expanding AR technology in the future

    Wright State University\u27s Symposium of Student Research, Scholarship & Creative Activities from Thursday, October 26, 2023

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    The student abstract booklet is a compilation of abstracts from students\u27 oral and poster presentations at Wright State University\u27s Symposium of Student Research, Scholarship & Creative Activities on October 26, 2023.https://corescholar.libraries.wright.edu/celebration_abstract_books/1001/thumbnail.jp

    Studies on Spinal Fusion from Computational Modelling to ‘Smart’ Implants

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    Low back pain, the worldwide leading cause of disability, is commonly treated with lumbar interbody fusion surgery to address degeneration, instability, deformity, and trauma of the spine. Following fusion surgery, nearly 20% experience complications requiring reoperation while 1 in 3 do not experience a meaningful improvement in pain. Implant subsidence and pseudarthrosis in particular present a multifaceted challenge in the management of a patient’s painful symptoms. Given the diversity of fusion approaches, materials, and instrumentation, further inputs are required across the treatment spectrum to prevent and manage complications. This thesis comprises biomechanical studies on lumbar spinal fusion that provide new insights into spinal fusion surgery from preoperative planning to postoperative monitoring. A computational model, using the finite element method, is developed to quantify the biomechanical impact of temporal ossification on the spine, examining how the fusion mass stiffness affects loads on the implant and subsequent subsidence risk, while bony growth into the endplates affects load-distribution among the surrounding spinal structures. The computational modelling approach is extended to provide biomechanical inputs to surgical decisions regarding posterior fixation. Where a patient is not clinically pre-disposed to subsidence or pseudarthrosis, the results suggest unilateral fixation is a more economical choice than bilateral fixation to stabilise the joint. While finite element modelling can inform pre-surgical planning, effective postoperative monitoring currently remains a clinical challenge. Periodic radiological follow-up to assess bony fusion is subjective and unreliable. This thesis describes the development of a ‘smart’ interbody cage capable of taking direct measurements from the implant for monitoring fusion progression and complication risk. Biomechanical testing of the ‘smart’ implant demonstrated its ability to distinguish between graft and endplate stiffness states. The device is prepared for wireless actualisation by investigating sensor optimisation and telemetry. The results show that near-field communication is a feasible approach for wireless power and data transfer in this setting, notwithstanding further architectural optimisation required, while a combination of strain and pressure sensors will be more mechanically and clinically informative. Further work in computational modelling of the spine and ‘smart’ implants will enable personalised healthcare for low back pain, and the results presented in this thesis are a step in this direction

    Assessment of the accuracy in the alignment of the extremity and positioning of implants in total knee arthroplasties

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    Treballs Finals de Grau d'Enginyeria Biomèdica. Facultat de Medicina i Ciències de la Salut. Universitat de Barcelona. Curs: 2022-2023. Tutor/Director: Segur Vilalta, Josep Maria ; Martínez Pastor, Juan Carlos, Balaguer Castro, MarianoOsteoarthritis is the most frequent diagnosis of arthritis that requires for a Total Knee Replacement (TKA). This disease is characterised by a slowly degeneration of the cartilage within a joint causing pain, stiffness and swelling. TKA surgery consists of the resection of the affected joint surfaces, so they can be replaced by metal and polyethylene biomaterials (which reproduce the knee anatomy and function). Due to the variety of results between surgeries, an interest in assistive robotic technologies to standardize the procedure and more accurately place and align the implant with the limb has increased. This thesis explains the realisation of an unicentric prospective cohort study that examines the accuracy of ROSA Knee System (Robotic Surgical Assistant) a surgical robot to assist and support surgeons during TKA achieved by Hospital Clinic recently. To study this feature, certain variables have been recorded intraoperatively by ROSA and compared with the same variables but extracted from Computed Tomography (CT) or X-Ray (XR) postoperative images. All the phases to conduct, from scratch, the clinical study are explained in detail in this project. This project has been carried out under the supervision of the Knee Department of the Clinic hospital, which has allowed the use of data from their patients and their inclusion as participants in the study. This thesis will be attached to an extensive study conducted by the Knee Department regarding the ROSA robot that tries to answer the question: is the robotic assistance an improvement in TKAs surgeries

    Biomanufacturing Technologies for Tissue Engineering

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    Il seguente lavoro di tesi ha come obiettivo lo studio e la realizzazione di device biomedicali realizzati tramite la manifattura additiva. La manifattura additiva sta avendo una forte crescita negli ultimi anni grazie soprattutto alla possibilità di realizzare facilmente geometrie complesse. Questa caratteristica permette di personalizzare i prodotti ad un costo competitivo. Inoltre, lo spreco di materiale viene ridotto moltissimo dal principio di fabbricazione. Tutte queste proprietà hanno fatto in modo che negli ultimi anni la manifattura additiva prendesse sempre più piede in campi come l’automotive, l’aerospace e il biomedicale. Questo lavoro di tesi è focalizzato sull’utilizzo di alcune tra le più diffuse tecnologie additive per la produzione di device biomedicali. In particolare, il lavoro si è concentrato principalmente sulla realizzazione di due modelli, il primo per lo studio dello sviluppo dei black floaters all’interno del corpo vitreo dell’occhio, il secondo per l’emulazione del comportamento dell’osso mandibolare durante la foratura per l’installazione di impianti dentali. Il modello dell’occhio è composto da due elementi principali, un supporto e un hydrogel. Il supporto serve a contenere e supportare l’hydrogel. Deve essere trasparente, biocompatibile facilmente manovrabile in laboratorio. La sua realizzazione è avvenuta tramite stereolitografia. L’hydrogel, invece, ha lo scopo di fornire un’ambiente 3D per la crescita e sviluppo delle cellule. Deve perciò anche lui essere biocompatibile e con adeguate caratteristiche meccaniche e di stampabilità. La struttura 3D è stata realizzata tramite material extrusion. Il modello di osso mandibolare è stato realizzato tramite fused filament fabrication. Il modello si compone di due parti, una parte esterna piena per emulare l’osso corticale, e una parte interna porosa per emulare l’osso trabecolare. Le prove di foratura sono state realizzate con un trapano dentistico agganciato a robot collaborativi. La ricerca ha infine toccato ulteriori due ambiti, lo studio delle proprietà di strutture lattice realizzate tramite laser based- powder bed fusion e la valutazione di diversi trattamenti di finitura superficiale. La tesi, dunque, ha la seguente organizzazione. Il capitolo 1 presenta un’introduzione sull’additive manufacturing e il bioprinting. Le tecnologie ed i materiali utilizzati sono brevemente descritti e sono riportati alcuni esempi di applicazione della manifattura additiva nel campo biomedicale. I capitoli seguenti, invece, riportano gli articoli pubblicati o in corso di pubblicazione riguardo alle diverse tematiche affrontate. Nello specifico, il capitolo 2 riporta la ricerca sulle strutture lattice e la loro realizzazione. I capitoli 3 e 4 comprendono gli studi relativi al modello dell’occhio. Il capitolo 3 si concentra sulla realizzazione del supporto, il 4 sulla formulazione e la valutazione dell’hydrogel. Il capitolo 5 approfondisce lo studio del modello per l’emulazione del comportamento dell’osso mandibolare a foratura mentre il capitolo 6, l’ultimo di questo elaborato, si concentra sui processi di finitura superficiale. Per concludere, la manifattura additiva include processi molto diversi tra loro, ma che presentano molti punti in comune come la flessibilità, libertà di progettazione e personalizzazione. Sfruttando queste proprietà è possibile realizzare oggetti su misura, soprattutto in campi come quello biomedicale dove la personalizzazione e la specificità sono fondamentali.The following thesis aims to study and to develop biomedical devices made through additive manufacturing. Additive manufacturing has been experiencing a strong growth in recent years, mainly due to its ability to easily realize complex geometries. This feature allows customization of products at a competitive cost. In addition, material waste is greatly reduced by the manufacturing principle. All these properties helped the recent years diffusion of additive manufacturing in fields such as automotive, aerospace and biomedical. This thesis focuses on the use of some of the most popular additive technologies for the production of biomedical devices. In particular, the work focused mainly on the fabrication of two models, the first to study the development of black floaters within the vitreous body of the eye, and the second to emulate the mandibular bone behavior during drilling for the installation of dental implants. The eye model consists of two main elements, a scaffold and a hydrogel. The scaffold contains and provides support to the hydrogel. It must be transparent, biocompatible easily handled in the laboratory. It is printed by stereolithography. The hydrogel, on the other hand, is intended to provide a 3D environment for cell growth and development. Therefore, it must be biocompatible and have adequate mechanical properties together with good printability. The 3D scaffold structure was made by material extrusion. The mandibular bone model was made by fused filament fabrication. The model consists of two parts, a solid outer part to emulate cortical bone, and a porous inner part to emulate trabecular bone. Drilling tests were performed with a dental drill attached to collaborative robots. Finally, the research covered two additional areas, the study of the properties of lattice structures made by laser-based- powder bed fusion and the evaluation of different surface finish treatments. The following thesis, therefore, has the following organization. Chapter 1 presents an introduction on additive manufacturing and bioprinting. The technologies and materials used are briefly described, and examples of additive manufacturing applications in the biomedical field are given. The following chapters, on the other hand, report published or forthcoming articles regarding the various topics mentioned above. Specifically, Chapter 2 reports the research on lattice structures and their fabrication. Chapters 3 and 4 include studies related to the eye model. Chapter 3 focuses on the fabrication of the support, and Chapter 4 on the formulation and evaluation of the hydrogel. Chapter 5 presents the study of the model for emulating the behavior of mandibular bone upon drilling, while Chapter 6, the last of this work, focuses on surface finishing processes. In conclusion, additive manufacturing includes various processes that are very different from each other but have many common points such as flexibility, freedom of design, and customization. By exploiting these properties, it is possible to make tailored objects, especially important in fields such as the biomedical one, where customization and specificity are a great added value

    Augmented Reality (AR) for Surgical Robotic and Autonomous Systems: State of the Art, Challenges, and Solutions

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    Despite the substantial progress achieved in the development and integration of augmented reality (AR) in surgical robotic and autonomous systems (RAS), the center of focus in most devices remains on improving end-effector dexterity and precision, as well as improved access to minimally invasive surgeries. This paper aims to provide a systematic review of different types of state-of-the-art surgical robotic platforms while identifying areas for technological improvement. We associate specific control features, such as haptic feedback, sensory stimuli, and human–robot collaboration, with AR technology to perform complex surgical interventions for increased user perception of the augmented world. Current researchers in the field have, for long, faced innumerable issues with low accuracy in tool placement around complex trajectories, pose estimation, and difficulty in depth perception during two-dimensional medical imaging. A number of robots described in this review, such as Novarad and SpineAssist, are analyzed in terms of their hardware features, computer vision systems (such as deep learning algorithms), and the clinical relevance of the literature. We attempt to outline the shortcomings in current optimization algorithms for surgical robots (such as YOLO and LTSM) whilst providing mitigating solutions to internal tool-to-organ collision detection and image reconstruction. The accuracy of results in robot end-effector collisions and reduced occlusion remain promising within the scope of our research, validating the propositions made for the surgical clearance of ever-expanding AR technology in the future
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