Recent trends, technical concepts and components of computer-assisted orthopedic surgery systems: A comprehensive review

Computer-assisted orthopedic surgery (CAOS) systems have become one of the most important and challenging types of system in clinical orthopedics, as they enable precise treatment of musculoskeletal diseases, employing modern clinical navigation systems and surgical tools. This paper brings a comprehensive review of recent trends and possibilities of CAOS systems. There are three types of the surgical planning systems, including: systems based on the volumetric images (computer tomography (CT), magnetic resonance imaging (MRI) or ultrasound images), further systems utilize either 2D or 3D fluoroscopic images, and the last one utilizes the kinetic information about the joints and morphological information about the target bones. This complex review is focused on three fundamental aspects of CAOS systems: their essential components, types of CAOS systems, and mechanical tools used in CAOS systems. In this review, we also outline the possibilities for using ultrasound computer-assisted orthopedic surgery (UCAOS) systems as an alternative to conventionally used CAOS systems.Web of Science1923art. no. 519

인간 기계 상호작용을 위한 강건하고 정확한 손동작 추적 기술 연구

학위논문(박사) -- 서울대학교대학원 : 공과대학 기계항공공학부, 2021.8. 이동준.Hand-based interface is promising for realizing intuitive, natural and accurate human machine interaction (HMI), as the human hand is main source of dexterity in our daily activities. For this, the thesis begins with the human perception study on the detection threshold of visuo-proprioceptive conflict (i.e., allowable tracking error) with or without cutantoues haptic feedback, and suggests tracking error specification for realistic and fluidic hand-based HMI. The thesis then proceeds to propose a novel wearable hand tracking module, which, to be compatible with the cutaneous haptic devices spewing magnetic noise, opportunistically employ heterogeneous sensors (IMU/compass module and soft sensor) reflecting the anatomical properties of human hand, which is suitable for specific application (i.e., finger-based interaction with finger-tip haptic devices). This hand tracking module however loses its tracking when interacting with, or being nearby, electrical machines or ferromagnetic materials. For this, the thesis presents its main contribution, a novel visual-inertial skeleton tracking (VIST) framework, that can provide accurate and robust hand (and finger) motion tracking even for many challenging real-world scenarios and environments, for which the state-of-the-art technologies are known to fail due to their respective fundamental limitations (e.g., severe occlusions for tracking purely with vision sensors; electromagnetic interference for tracking purely with IMUs (inertial measurement units) and compasses; and mechanical contacts for tracking purely with soft sensors). The proposed VIST framework comprises a sensor glove with multiple IMUs and passive visual markers as well as a head-mounted stereo camera; and a tightly-coupled filtering-based visual-inertial fusion algorithm to estimate the hand/finger motion and auto-calibrate hand/glove-related kinematic parameters simultaneously while taking into account the hand anatomical constraints. The VIST framework exhibits good tracking accuracy and robustness, affordable material cost, light hardware and software weights, and ruggedness/durability even to permit washing. Quantitative and qualitative experiments are also performed to validate the advantages and properties of our VIST framework, thereby, clearly demonstrating its potential for real-world applications.손 동작을 기반으로 한 인터페이스는 인간-기계 상호작용 분야에서 직관성, 몰입감, 정교함을 제공해줄 수 있어 많은 주목을 받고 있고, 이를 위해 가장 필수적인 기술 중 하나가 손 동작의 강건하고 정확한 추적 기술 이다. 이를 위해 본 학위논문에서는 먼저 사람 인지의 관점에서 손 동작 추적 오차의 인지 범위를 규명한다. 이 오차 인지 범위는 새로운 손 동작 추적 기술 개발 시 중요한 설계 기준이 될 수 있어 이를 피험자 실험을 통해 정량적으로 밝히고, 특히 손끝 촉각 장비가 있을때 이 인지 범위의 변화도 밝힌다. 이를 토대로, 촉각 피드백을 주는 것이 다양한 인간-기계 상호작용 분야에서 널리 연구되어 왔으므로, 먼저 손끝 촉각 장비와 함께 사용할 수 있는 손 동작 추적 모듈을 개발한다. 이 손끝 촉각 장비는 자기장 외란을 일으켜 착용형 기술에서 흔히 사용되는 지자기 센서를 교란하는데, 이를 적절한 사람 손의 해부학적 특성과 관성 센서/지자기 센서/소프트 센서의 적절한 활용을 통해 해결한다. 이를 확장하여 본 논문에서는, 촉각 장비 착용 시 뿐 아니라 모든 장비 착용 / 환경 / 물체와의 상호작용 시에도 사용 가능한 새로운 손 동작 추적 기술을 제안한다. 기존의 손 동작 추적 기술들은 가림 현상 (영상 기반 기술), 지자기 외란 (관성/지자기 센서 기반 기술), 물체와의 접촉 (소프트 센서 기반 기술) 등으로 인해 제한된 환경에서 밖에 사용하지 못한다. 이를 위해 많은 문제를 일으키는 지자기 센서 없이 상보적인 특성을 지니는 관성 센서와 영상 센서를 융합하고, 이때 작은 공간에 다 자유도의 움직임을 갖는 손 동작을 추적하기 위해 다수의 구분되지 않는 마커들을 사용한다. 이 마커의 구분 과정 (correspondence search)를 위해 기존의 약결합 (loosely-coupled) 기반이 아닌 강결합 (tightly-coupled 기반 센서 융합 기술을 제안하고, 이를 통해 지자기 센서 없이 정확한 손 동작이 가능할 뿐 아니라 착용형 센서들의 정확성/편의성에 문제를 일으키던 센서 부착 오차 / 사용자의 손 모양 등을 자동으로 정확히 보정한다. 이 제안된 영상-관성 센서 융합 기술 (Visual-Inertial Skeleton Tracking (VIST)) 의 뛰어난 성능과 강건성이 다양한 정량/정성 실험을 통해 검증되었고, 이는 VIST의 다양한 일상환경에서 기존 시스템이 구현하지 못하던 손 동작 추적을 가능케 함으로써, 많은 인간-기계 상호작용 분야에서의 가능성을 보여준다.1 Introduction 1 1.1. Motivation 1 1.2. Related Work 5 1.3. Contribution 12 2 Detection Threshold of Hand Tracking Error 16 2.1. Motivation 16 2.2. Experimental Environment 20 2.2.1. Hardware Setup 21 2.2.2. Virtual Environment Rendering 23 2.2.3. HMD Calibration 23 2.3. Identifying the Detection Threshold of Tracking Error 26 2.3.1. Experimental Setup 27 2.3.2. Procedure 27 2.3.3. Experimental Result 31 2.4. Enlarging the Detection Threshold of Tracking Error by Haptic Feedback 31 2.4.1. Experimental Setup 31 2.4.2. Procedure 32 2.4.3. Experimental Result 34 2.5. Discussion 34 3 Wearable Finger Tracking Module for Haptic Interaction 38 3.1. Motivation 38 3.2. Development of Finger Tracking Module 42 3.2.1. Hardware Setup 42 3.2.2. Tracking algorithm 45 3.2.3. Calibration method 48 3.3. Evaluation for VR Haptic Interaction Task 50 3.3.1. Quantitative evaluation of FTM 50 3.3.2. Implementation of Wearable Cutaneous Haptic Interface 51 3.3.3. Usability evaluation for VR peg-in-hole task 53 3.4. Discussion 57 4 Visual-Inertial Skeleton Tracking for Human Hand 59 4.1. Motivation 59 4.2. Hardware Setup and Hand Models 62 4.2.1. Human Hand Model 62 4.2.2. Wearable Sensor Glove 62 4.2.3. Stereo Camera 66 4.3. Visual Information Extraction 66 4.3.1. Marker Detection in Raw Images 68 4.3.2. Cost Function for Point Matching 68 4.3.3. Left-Right Stereo Matching 69 4.4. IMU-Aided Correspondence Search 72 4.5. Filtering-based Visual-Inertial Sensor Fusion 76 4.5.1. EKF States for Hand Tracking and Auto-Calibration 78 4.5.2. Prediction with IMU Information 79 4.5.3. Correction with Visual Information 82 4.5.4. Correction with Anatomical Constraints 84 4.6. Quantitative Evaluation for Free Hand Motion 87 4.6.1. Experimental Setup 87 4.6.2. Procedure 88 4.6.3. Experimental Result 90 4.7. Quantitative and Comparative Evaluation for Challenging Hand Motion 95 4.7.1. Experimental Setup 95 4.7.2. Procedure 96 4.7.3. Experimental Result 98 4.7.4. Performance Comparison with Existing Methods for Challenging Hand Motion 101 4.8. Qualitative Evaluation for Real-World Scenarios 105 4.8.1. Visually Complex Background 105 4.8.2. Object Interaction 106 4.8.3. Wearing Fingertip Cutaneous Haptic Devices 109 4.8.4. Outdoor Environment 111 4.9. Discussion 112 5 Conclusion 116 References 124 Abstract (in Korean) 139 Acknowledgment 141박

Assistance strategies for robotized laparoscopy

Robotizing laparoscopic surgery not only allows achieving better accuracy to operate when a scale factor is applied between master and slave or thanks to the use of tools with 3 DoF, which cannot be used in conventional manual surgery, but also due to additional informatic support. Relying on computer assistance different strategies that facilitate the task of the surgeon can be incorporated, either in the form of autonomous navigation or cooperative guidance, providing sensory or visual feedback, or introducing certain limitations of movements. This paper describes different ways of assistance aimed at improving the work capacity of the surgeon and achieving more safety for the patient, and the results obtained with the prototype developed at UPC.Peer ReviewedPostprint (author's final draft

A quantum volume hologram

We propose a new scheme for parallel spatially multimode quantum memory for light. The scheme is based on counter-propagating quantum signal wave and strong classical reference wave, like in a classical volume hologram, and therefore can be called a quantum volume hologram. The medium for the hologram consists of a spatially extended ensemble of atoms placed in a magnetic field. The write-in and read-out of this quantum hologram is as simple as that of its classical counterpart and consists of a single pass illumination. In addition we show that the present scheme for a quantum hologram is less sensitive to diffraction and therefore is capable of achieving higher density of storage of spatial modes as compared to previous proposals. A quantum hologram capable of storing entangled images can become an important ingredient in quantum information processing and quantum imaging.Comment: 8 pages, 2 figure

py4DSTEM: a software package for multimodal analysis of four-dimensional scanning transmission electron microscopy datasets

Scanning transmission electron microscopy (STEM) allows for imaging, diffraction, and spectroscopy of materials on length scales ranging from microns to atoms. By using a high-speed, direct electron detector, it is now possible to record a full 2D image of the diffracted electron beam at each probe position, typically a 2D grid of probe positions. These 4D-STEM datasets are rich in information, including signatures of the local structure, orientation, deformation, electromagnetic fields and other sample-dependent properties. However, extracting this information requires complex analysis pipelines, from data wrangling to calibration to analysis to visualization, all while maintaining robustness against imaging distortions and artifacts. In this paper, we present py4DSTEM, an analysis toolkit for measuring material properties from 4D-STEM datasets, written in the Python language and released with an open source license. We describe the algorithmic steps for dataset calibration and various 4D-STEM property measurements in detail, and present results from several experimental datasets. We have also implemented a simple and universal file format appropriate for electron microscopy data in py4DSTEM, which uses the open source HDF5 standard. We hope this tool will benefit the research community, helps to move the developing standards for data and computational methods in electron microscopy, and invite the community to contribute to this ongoing, fully open-source project

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

Investigation of in-vivo hindfoot and orthotic interactions using bi-planar x-ray fluoroscopy

A markerless RSA method was used to determine the effect of orthotics on the normal, pes planus and pes cavus populations. Computed tomography (CT) was used to create bone models that were imported into the virtual environment. Joint coordinate systems were developed to measure kinematic changes in the hindfoot during weight-bearing gait and quiet standing. The objectives of this thesis were to (1) implement a fluoroscopy-based markerless RSA system on the foot, (2) determine the effect of various orthotics at midstance of fully weight-bearing dynamic gait, and (3) determine the effect of orthotics as measured using three different techniques. Every individual in this study reacted differently depending on the footwear condition tested. Despite the change in alignment caused by orthotics lacking statistical significance it appears the change may be significant with more subjects. Fluoroscopy should enable substantial improvements in orthotic design for optimal results in the future