Soft tissue modelling and facial movement simulation using the finite element method

This thesis presents a framework for soft tissue modelling, facial surgery simulation, and facial movement synthesis based on the volumetric finite element method. Assessment of facial appearance pre- and post-surgery is of major concern for both patients and clinicians. Pre-surgical planning is a prerequisite for successful surgical procedures and outcomes. Early computer-assisted facial models have been geometrically based. They are computationally efficient, but cannot give an accurate prediction for facial surgery simulation. Therefore, in this thesis, the emphasis is placed on physically-based methods, especially the finite element technique. To achieve realistic surgery simulation, soft tissue modelling is of crucial importance. Thus, in this thesis, considerable effort has been directed to develop constitutive equations for facial skeletal muscles. The skeletal muscle model subsequently developed is able to capture the complex mechanical properties of skeletal muscle, which are active, quasi-incompressible, fibre-reinforced and hyperelastic. In addition, to improve the characterisation of in-vivo muscle behaviour, a technique has been developed to visualise the internal fibre arrangement of skeletal muscle using the FEM-NURBS method, which is the combination of the finite element method and the non-uniform rational B-spline solid mathematical representation. Another principal contribution made in this thesis is the three-dimensional finite element facial model, which can be used for the simulations of facial surgery and facial movement. The procedure of one cranio-facial surgery is simulated by using this facial model and the numerical predictions show a good agreement with the patient post-surgical data. In addition, it would be very helpful to also simulate the facial movement and facial expressions. In this thesis, two facial expressions (smile and disgust) and the mouth opening are simulated to assess the post-surgical appearance and test the muscle-driven facial movement simulation method

Semiautonomous Robotic Manipulator for Minimally Invasive Aortic Valve Replacement

Aortic valve surgery is the preferred procedure for replacing a damaged valve with an artificial one. The ValveTech robotic platform comprises a flexible articulated manipulator and surgical interface supporting the effective delivery of an artificial valve by teleoperation and endoscopic vision. This article presents our recent work on force-perceptive, safe, semiautonomous navigation of the ValveTech platform prior to valve implantation. First, we present a force observer that transfers forces from the manipulator body and tip to a haptic interface. Second, we demonstrate how hybrid forward/inverse mechanics, together with endoscopic visual servoing, lead to autonomous valve positioning. Benchtop experiments and an artificial phantom quantify the performance of the developed robot controller and navigator. Valves can be autonomously delivered with a 2.0±0.5 mm position error and a minimal misalignment of 3.4±0.9°. The hybrid force/shape observer (FSO) algorithm was able to predict distributed external forces on the articulated manipulator body with an average error of 0.09 N. FSO can also estimate loads on the tip with an average accuracy of 3.3%. The presented system can lead to better patient care, delivery outcome, and surgeon comfort during aortic valve surgery, without requiring sensorization of the robot tip, and therefore obviating miniaturization constraints.</p

Sistemas Robóticos en la asistencia a la cirugía

La robótica es el campo del conocimiento que integra diversas tecnologías como son la electrónica, mecánica, programación, pero también del conocimiento como son la lógica, la filosofía, etc. El objetivo de esa integración es la fabricación de dispositivos mecatrónicos (es decir, un sistema híbrido entre mecánica y electrónica) con distintos niveles de inteligencia para ser usados en un abanico de aplicaciones. Las aplicaciones más comunes de la robótica tienen su campo de acción en la industria, donde se pueden encontrar robots pintando, ensamblando piezas, paletizando productos, etc de manera autónoma. Otro campo de la robótica es la robótica de servicio, donde los robots interactúan con las personas, de modo que su tarea no se realiza de forma autónoma sino que su respuesta estará condicionada por el diálogo persona-robot. El presente artículo expone, a nivel divulgativo pero riguro, las aplicaciones emergentes de la robótica en el campo de la cirugía donde los robots se presentan como asistentes o ayudantes durante las intervenciones. Otro ejemplo dentro de la robótica médica es el uso de los robots como herramientas avanzadas para ser usadas durante el proceso de rehabilitación de un paciente que ha sufrido una merma de movilidad en alguno de sus miembros. Este campo se encuentra fuera del objetivo del presente artículo. Por último, citar que el presente artículo no trata ser una exhaustiva revisión del estado del arte ni tampoco sobre la biorobótica, entendida como la ciencia que persigue el diseñar y construir mecanismos que simulen el funcionamiento de órganos/miembros y/o el comportamiento de un ser vivo y/o conjuntos de seres vivos

Medical image registration and soft tissue deformation for image guided surgery system

In parallel with the developments in imaging modalities, image-guided surgery (IGS) can now provide the surgeon with high quality three-dimensional images depicting human anatomy. Although IGS is now in widely use in neurosurgery, there remain some limitations that must be overcome before it can be employed in more general minimally invasive procedures. In this thesis, we have developed several contributions to the field of medical image registration and brain tissue deformation modeling. From the methodology point of view, medical image registration algorithms can be classified into feature-based and intensity-based methods. One of the challenges faced by feature-based registration would be to determine which specific type of feature is desired for a given task and imaging type. For this reason, a point set registration using points and curves feature is proposed, which has the accuracy of registration based on points and the robustness of registration based on lines or curves. We have also tackled the problem on rigid registration of multimodal images using intensity-based similarity measures. Mutual information (MI) has emerged in recent years as a popular similarity metric and widely being recognized in the field of medical image registration. Unfortunately, it ignores the spatial information contained in the images such as edges and corners that might be useful in the image registration. We introduce a new similarity metric, called Adaptive Mutual Information (AMI) measure which incorporates the gradient spatial information. Salient pixels in the regions with high gradient value will contribute more in the estimation of mutual information of image pairs being registered. Experimental results showed that our proposed method improves registration accuracy and it is more robust to noise images which have large deviation from the reference image. Along with this direction, we further improve the technique to simultaneously use all information obtained from multiple features. Using multiple spatial features, the proposed algorithm is less sensitive to the effect of noise and some inherent variations, giving more accurate registration. Brain shift is a complex phenomenon and there are many different reasons causing brain deformation. We have investigated the pattern of brain deformation with respect to location and magnitude and to consider the implications of this pattern for correcting brain deformation in IGS systems. A computational finite element analysis was carried out to analyze the deformation and stress tensor experienced by the brain tissue during surgical operations. Finally, we have developed a prototype visualization display and navigation platform for interpretation of IGS. The system is based upon Qt (cross-platform GUI toolkit) and it integrates VTK (an object-oriented visualization library) as the rendering kernel. Based on the construction of a visualization software platform, we have laid a foundation on the future research to be extended to implement brain tissue deformation into the system

Biomechanics and Remodelling for Design and Optimisation in Oral Prosthesis and Therapeutical Procedure

The purpose of dental prostheses is to restore the oral function for edentulous patients. Introducing any dental prosthesis into mouth will alter biomechanical status of the oral environment, consequently inducing bone remodelling. Despite the advantageous benefits brought by dental prostheses, the attendant clinical complications and challenges, such as pain, discomfort, tooth root resorption, and residual ridge reduction, remain to be addressed. This thesis aims to explore several different dental prostheses by understanding the biomechanics associated with the potential tissue responses and adaptation, and thereby applying the new knowledge gained from these studies to dental prosthetic design and optimisation. Within its biomechanics focus, this thesis is presented in three major clinical areas, namely prosthodontics, orthodontics and dental implantology. In prosthodontics, the oral mucosa plays a critical role in distributing occlusal forces a denture to the underlying bony structure, and its response is found in a complex, dynamic and nonlinear manner. It is discovered that interstitial fluid pressure in mocosa is the most important indicator to the potential resorption induced by prosthetic denture insertion, and based on this finding, patient-specific analysis is performed to investigate the effects caused by various types of dentures and prediction of the bone remodelling activities. In orthodontic treatments, a dynamic algorithm is developed to analyse and predict potential bone remodelling around the target tooth during orthodontic treatment, thereby providing a numerical approach for treatment planning. In dental implantology, a graded surface morphology of an implant is designed to improve osseointegration over that of a smooth uniform surface in both the short and long term. The graded surface can be optimised to achieve the best possible balance between the bone-implant contact and the peak Tresca stress for the specific clinical application need