Intelligent viewpoint selection for efficient CT to video registration in laparoscopic liver surgery

PURPOSE: Minimally invasive surgery offers advantages over open surgery due to a shorter recovery time, less pain and trauma for the patient. However, inherent challenges such as lack of tactile feedback and difficulty in controlling bleeding lower the percentage of suitable cases. Augmented reality can show a better visualisation of sub-surface structures and tumour locations by fusing pre-operative CT data with real-time laparoscopic video. Such augmented reality visualisation requires a fast and robust video to CT registration that minimises interruption to the surgical procedure. METHODS: We propose to use view planning for efficient rigid registration. Given the trocar position, a set of camera positions are sampled and scored based on the corresponding liver surface properties. We implement a simulation framework to validate the proof of concept using a segmented CT model from a human patient. Furthermore, we apply the proposed method on clinical data acquired during a human liver resection. RESULTS: The first experiment motivates the viewpoint scoring strategy and investigates reliable liver regions for accurate registrations in an intuitive visualisation. The second experiment shows wider basins of convergence for higher scoring viewpoints. The third experiment shows that a comparable registration performance can be achieved by at least two merged high scoring views and four low scoring views. Hence, the focus could change from the acquisition of a large liver surface to a small number of distinctive patches, thereby giving a more explicit protocol for surface reconstruction. We discuss the application of the proposed method on clinical data and show initial results. CONCLUSION: The proposed simulation framework shows promising results to motivate more research into a comprehensive view planning method for efficient registration in laparoscopic liver surgery

Automatic registration of 3D models to laparoscopic video images for guidance during liver surgery

Laparoscopic liver interventions offer significant advantages over open surgery, such as less pain and trauma, and shorter recovery time for the patient. However, they also bring challenges for the surgeons such as the lack of tactile feedback, limited field of view and occluded anatomy. Augmented reality (AR) can potentially help during laparoscopic liver interventions by displaying sub-surface structures (such as tumours or vasculature). The initial registration between the 3D model extracted from the CT scan and the laparoscopic video feed is essential for an AR system which should be efficient, robust, intuitive to use and with minimal disruption to the surgical procedure. Several challenges of registration methods in laparoscopic interventions include the deformation of the liver due to gas insufflation in the abdomen, partial visibility of the organ and lack of prominent geometrical or texture-wise landmarks. These challenges are discussed in detail and an overview of the state of the art is provided. This research project aims to provide the tools to move towards a completely automatic registration. Firstly, the importance of pre-operative planning is discussed along with the characteristics of the liver that can be used in order to constrain a registration method. Secondly, maximising the amount of information obtained before the surgery, a semi-automatic surface based method is proposed to recover the initial rigid registration irrespective of the position of the shapes. Finally, a fully automatic 3D-2D rigid global registration is proposed which estimates a global alignment of the pre-operative 3D model using a single intra-operative image. Moving towards incorporating the different liver contours can help constrain the registration, especially for partial surfaces. Having a robust, efficient AR system which requires no manual interaction from the surgeon will aid in the translation of such approaches to the clinics

Global and European Constraints Upon National Right to Regulate: The Services Sector

This volume brings together research aimed at shedding light on a general problem, by focusing specifically on the services sector. In the WTO system, the services sector is regulated by the General Agreement on Trade in Services (GATS); in the European system, it is regulated by a broad and complex body of rules, combining judge-made principles with those embodied in the secondary legislation, which codifies and applies these principles to different regulated sectors. The general problem at the core of this study stems from the difficulty in striking a balance between two important needs. One the one hand, there is the need to recognise national authorities' right to autonomously regulate and govern in their own territory. On the other hand, there is the need to limit this power of autonomous regulation, mainly to protect the right of foreign economic operators to access the national market and function in conditions of equality with respect to all other operators. This problem is addressed from the particular perspective of administrative law. The premise underlying the various contributions is that supranational (global and European) law constrains domestic regulation (and domestic administrations) largely through techniques and procedures drawn from administrative law. Sovereignty-limiting procedures developed by national legal systems in order to protect citizens have been readapted by supranational public powers to protect the rights of foreign economic operators and to realise the goal of market integration. This administrative law perspective also gives shape to the structure of this volume, which is divided into three thematic areas. Each area corresponds to a category of constraints imposed by supranational administrative law upon States' right to regulate.Giulio Vesperini and Stefano Battini editor

Digitaler kieferorthopädischer Workflow unter Berücksichtigung funktionstherapeutischer Aspekte

Zielstellung Ziel der vorliegenden Studie ist, einen digitalen Workflow für die Erwachsenenkieferorthopädie unter Einbeziehung funktioneller Aspekte des Kiefergelenks zu erarbeiten und die aktuelle Evidenzlage von dafür notwendigen Teilschritten zusammenzutragen sowie zukünftige Entwicklungsbereiche aufzuzeigen. Als klinischer Anteil soll eine Methode entwickelt werden, um die individuelle Scharnierachse ohne extraoralen Registrierbehelf digital zu bestimmen. Material und Methoden Die Literaturübersicht wird als ausführliche Handsuche in PubMed/MEDLINE und aus referenzierten Quellen erstellt. Das neu erdachte, dreidimensionale Verfahren wird als Proof-of-concept an einem Probanden modifiziert und getestet. Mit dem CentricGuide wird die zentrische Kondylenpostion registriert und anschließend per DVT und MRT validiert und beurteilt. Die Berechnung der Scharnierachsen erfolgt in Matlab anhand von im zahntechnischen Laborscanner digitalisierten Endpositionen mehrerer rotatorischer Öffnungsbewegungen aus der registrierten Zentrikposition. Ergebnisse Ein vollständig digitaler, kieferorthopädischer Workflow unter Einbeziehung funktioneller Aspekte des Kiefergelenkes ist technisch möglich. Mit dem CentricGuide gelingt es bei diesem Probanden, reproduzierbar eine zentrale Position der Kondylen in den Fossae einzustellen. Der erdachte Ansatz ist bei diesem Probanden geeignet, die individuelle Scharnierachse auf 2 mm genau zu lokalisieren. Schlussfolgerungen Der digitale Workflow sollte zugunsten einer patientenindividuelleren Planung und Therapie stärkere Verbreitung finden. Dazu sind weitere klinische Studien zur Validierung der Teilschritte und das Zusammenführen all dieser in einer anwenderfreundlichen Software notwendig. Zur schnellen und einfachen, digitalen Bestimmung der individuellen Scharnierachse sollten entsprechende Algorithmen in die Software von Intraoralscannern aufgenommen und klinisch an größeren Kohorten überprüft werden.Objective A fully digital workflow for orthodontics in adults incorporating functional aspects of the temporomandibular joint (TMJ) is proposed. The current scientific evidence of necessary substeps ranging from planning and simulation to execution is presented. Regarding the substep of patient specific hinge axis determination a novel method independent of any facebow is developed and tested. Materials and Methods To gather scientific evidence PubMed/MEDLINE is searched and the bibliography of relevant articles is considered. As a proof-of-concept the novel 3D-method is tested and refined based on one subject. The centric relation is determined using CentricGuide and evaluated through the means of cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI). To investigate rotatory jaw opening multiple bite registrations of intermediate positions starting from the same centric relation bite are taken and later digitized in a dental laboratory scanner. Calculation of hinge axes is carried out in Matlab. Results A fully digital workflow for orthodontics in adults incorporating functional aspects of the TMJ is technically feasible. Using CentricGuide a centric condyle-fossa-relation was achieved reproducibly in this subject. Furthermore, hinge axis location could be determined with an accuracy of 2 mm using the novel method. Conclusion To improve patient specific planning, simulation and treatment the digital workflow should be increasingly adopted. This can be accelerated by validating all substeps in clinical studies and finally uniting the whole workflow in a user-friendly software. Algorithms for hinge axis determination (possibly similar to the approach presented) should be implemented in the software of intraoral scanners and tested on validation cohorts. This may lead to an easy, digital and more patient specific, clinical procedure

Integrated adaptive skills program model (IASP)

Integrated Adaptive Skills Program Model (IASP) is designed to offer supportive services to disabled students seeking to integrate into a local after-school program. IASP Model focuses on teaching adaptive skills to disabled students that would prepare them to be fully included into an after-school program with their same age peers. The program offers support, training, and consultation to the students and staff involved in the program. A variety of research-methods and assessment screening tools are used to determine eligibility and program implementation. The IASP Model was piloted during the 2011-2012 school year, in California, United States, but due to limited local and state funds the program could not continue. Students with disabilities deserve to be involved in the community and should not be excluded based on funds. Teaching and educating others on how to integrate students with disabilities into programs will minimize and/or eliminate exclusion of participating in recreation programs within residing communities.https://scholar.dominican.edu/books/1179/thumbnail.jp

Proceedings of Braga 2014 Embracing Inclusive Approaches for Children and Youth with Special Education Needs Conference

This e-book, which is published under the title Braga 2014: Embracing Inclusive Approaches for Children and Youth with Special Education Needs contains a set of papers submitted by the authors in an international conference during July 2014 with the same name. Practitioners, researchers, policy makers, and NGOs from around the world joined their international colleagues to engage in lively and informed discussions about the current state of the art in meeting the needs of children and youth with special educational needs. Topic areas included research, practice, policy, advocacy, and the arts in special education. The conference was co–hosted by The Division of International Special Education and Services (DISES) and the University of Minho in cooperation with the Council for Exceptional Children (CEC). As more and more countries around the world strive towards the goals of the Education for All initiative, education systems are turning to increasingly inclusive approaches in order to meet the needs of children and youth who have traditionally been excluded from mainstream education. Research and practice have shown abundant benefits, both academic and social, to all children and youth involved in inclusive education programs. However, simply placing children with special educational needs in mainstream classrooms without appropriate planning, commitment, and support does not guarantee positive outcomes. In this exciting and prestigious international event, participants will share and learn about evidenced–based practices with an emphasis on access, quality, and equity; creative, comprehensive inclusive education approaches; innovations in creating inclusive schools; and integrating research into practice to create stronger links with stakeholders. A special strand focusing on the Arts in Special Education provides a rich forum for special education professionals to build upon innovative practices that encourage creative thinking, draw upon diverse abilities expressed through the arts and develops the individual in ways that traditional academic instruction fails to do so. Finally, the organizers want to emphasize the commitment and systematic work of Paula Frapiccini Ferreira in preparing this e-book.This edition is funded by National Funds through FCT - Foundation for Science and Technology for the Research Center on Education- PEst-OE/CED/UI1661/2014, CIE