Augmented Reality Ultrasound Guidance in Anesthesiology

Real-time ultrasound has become a mainstay in many image-guided interventions and increasingly popular in several percutaneous procedures in anesthesiology. One of the main constraints of ultrasound-guided needle interventions is identifying and distinguishing the needle tip from needle shaft in the image. Augmented reality (AR) environments have been employed to address challenges surrounding surgical tool visualization, navigation, and positioning in many image-guided interventions. The motivation behind this work was to explore the feasibility and utility of such visualization techniques in anesthesiology to address some of the specific limitations of ultrasound-guided needle interventions. This thesis brings together the goals, guidelines, and best development practices of functional AR ultrasound image guidance (AR-UIG) systems, examines the general structure of such systems suitable for applications in anesthesiology, and provides a series of recommendations for their development. The main components of such systems, including ultrasound calibration and system interface design, as well as applications of AR-UIG systems for quantitative skill assessment, were also examined in this thesis. The effects of ultrasound image reconstruction techniques, as well as phantom material and geometry on ultrasound calibration, were investigated. Ultrasound calibration error was reduced by 10% with synthetic transmit aperture imaging compared with B-mode ultrasound. Phantom properties were shown to have a significant effect on calibration error, which is a variable based on ultrasound beamforming techniques. This finding has the potential to alter how calibration phantoms are designed cognizant of the ultrasound imaging technique. Performance of an AR-UIG guidance system tailored to central line insertions was evaluated in novice and expert user studies. While the system outperformed ultrasound-only guidance with novice users, it did not significantly affect the performance of experienced operators. Although the extensive experience of the users with ultrasound may have affected the results, certain aspects of the AR-UIG system contributed to the lackluster outcomes, which were analyzed via a thorough critique of the design decisions. The application of an AR-UIG system in quantitative skill assessment was investigated, and the first quantitative analysis of needle tip localization error in ultrasound in a simulated central line procedure, performed by experienced operators, is presented. Most participants did not closely follow the needle tip in ultrasound, resulting in 42% unsuccessful needle placements and a 33% complication rate. Compared to successful trials, unsuccessful procedures featured a significantly greater (p=0.04) needle-tip to image-plane distance. Professional experience with ultrasound does not necessarily lead to expert level performance. Along with deliberate practice, quantitative skill assessment may reinforce clinical best practices in ultrasound-guided needle insertions. Based on the development guidelines, an AR-UIG system was developed to address the challenges in ultrasound-guided epidural injections. For improved needle positioning, this system integrated A-mode ultrasound signal obtained from a transducer housed at the tip of the needle. Improved needle navigation was achieved via enhanced visualization of the needle in an AR environment, in which B-mode and A-mode ultrasound data were incorporated. The technical feasibility of the AR-UIG system was evaluated in a preliminary user study. The results suggested that the AR-UIG system has the potential to outperform ultrasound-only guidance

Real-Time Superficial Vein Imaging System for Observing Abnormalities on Vascular Structures

Circulatory system abnormalities might be an indicator of diseases or tissue damage. Early detection of vascular abnormalities might have an important role during treatment and also raise the patient's awarenes. Current detection methods for vascular imaging are high-cost, invasive, and mostly radiation-based. In this study, a low-cost and portable microcomputer-based tool has been developed as a near-infrared (NIR) superficial vascular imaging device. The device uses NIR light-emitting diode (LED) light at 850 nm along with other electronic and optical components. It operates as a non-contact and safe infrared (IR) imaging method in real-time. Image and video analysis are carried out using OpenCV (Open-Source Computer Vision), a library of programming functions mainly used in computer vision. Various tests were carried out to optimize the imaging system and set up a suitable external environment. To test the performance of the device, the images taken from three diabetic volunteers, who are expected to have abnormalities in the vascular structure due to the possibility of deformation caused by high glucose levels in the blood, were compared with the images taken from two non-diabetic volunteers. As a result, tortuosity was observed successfully in the superficial vascular structures, where the results need to be interpreted by the medical experts in the field to understand the underlying reasons. Although this study is an engineering study and does not have an intention to diagnose any diseases, the developed system here might assist healthcare personnel in early diagnosis and treatment follow-up for vascular structures and may enable further opportunities

Multi-Distance Veins Projection Based on Single Axis Camera and Projector System

Every person has different location of veins, some veins are easily detected because it is visible due to thin tissue, and the other are invisible. This different location of veins causes intravenous access procedures and the procreas of intravenous therapy become longer. Multi-distance vein projections aim to simplify the measurement process where the device and object do not have to be at a certain distance. Some research that has been done especially for real-time vein projection does not conduct how the characteristics of projection at different distances. In this paper, we propose a method for performing multi-distance real-time back-projection by using the intersection between camera and projector. This method equiped with an ultrasonic distance sensor to identify the projection characteristic in any distance. In its implementation, this method is able to project at a distance of 20-40 cm with a maximum projection error of 0.6 mm. The measurement angle tolerance between the object and the device is ±5 degrees with a maximum error of 0.7 mm

Co-Design with Myself: A Brain-Computer Interface Design Tool that Predicts Live Emotion to Enhance Metacognitive Monitoring of Designers

Intuition, metacognition, and subjective uncertainty interact in complex ways to shape the creative design process. Design intuition, a designer's innate ability to generate creative ideas and solutions based on implicit knowledge and experience, is often evaluated and refined through metacognitive monitoring. This self-awareness and management of cognitive processes can be triggered by subjective uncertainty, reflecting the designer's self-assessed confidence in their decisions. Despite their significance, few creativity support tools have targeted the enhancement of these intertwined components using biofeedback, particularly the affect associated with these processes. In this study, we introduce "Multi-Self," a BCI-VR design tool designed to amplify metacognitive monitoring in architectural design. Multi-Self evaluates designers' affect (valence and arousal) to their work, providing real-time, visual biofeedback. A proof-of-concept pilot study with 24 participants assessed its feasibility. While feedback accuracy responses were mixed, most participants found the tool useful, reporting that it sparked metacognitive monitoring, encouraged exploration of the design space, and helped modulate subjective uncertainty

Accurate geometry reconstruction of vascular structures using implicit splines

3-D visualization of blood vessel from standard medical datasets (e.g. CT or MRI) play an important role in many clinical situations, including the diagnosis of vessel stenosis, virtual angioscopy, vascular surgery planning and computer aided vascular surgery. However, unlike other human organs, the vasculature system is a very complex network of vessel, which makes it a very challenging task to perform its 3-D visualization. Conventional techniques of medical volume data visualization are in general not well-suited for the above-mentioned tasks. This problem can be solved by reconstructing vascular geometry. Although various methods have been proposed for reconstructing vascular structures, most of these approaches are model-based, and are usually too ideal to correctly represent the actual variation presented by the cross-sections of a vascular structure. In addition, the underlying shape is usually expressed as polygonal meshes or in parametric forms, which is very inconvenient for implementing ramification of branching. As a result, the reconstructed geometries are not suitable for computer aided diagnosis and computer guided minimally invasive vascular surgery. In this research, we develop a set of techniques associated with the geometry reconstruction of vasculatures, including segmentation, modelling, reconstruction, exploration and rendering of vascular structures. The reconstructed geometry can not only help to greatly enhance the visual quality of 3-D vascular structures, but also provide an actual geometric representation of vasculatures, which can provide various benefits. The key findings of this research are as follows: 1. A localized hybrid level-set method of segmentation has been developed to extract the vascular structures from 3-D medical datasets. 2. A skeleton-based implicit modelling technique has been proposed and applied to the reconstruction of vasculatures, which can achieve an accurate geometric reconstruction of the vascular structures as implicit surfaces in an analytical form. 3. An accelerating technique using modern GPU (Graphics Processing Unit) is devised and applied to rendering the implicitly represented vasculatures. 4. The implicitly modelled vasculature is investigated for the application of virtual angioscopy

The Role of IT Feature Recombinations in Individuals\u27 Innovative Use of IT

Innovations do not emerge in isolation but are to some extent recombinations of previously existing building blocks. In this paper, we build on the recombination processes feature set broadening and deepening to show how individuals innovate with IT. We employ a qualitative research setting using a rich case of a self-tracker, who constantly changed his use of a stress tracking device from simple meditation to, eventually, a creative use configuration allowing him to sense stress at work, address prejudicial work-related behavioral patterns, and increase his work-related performance. Our preliminary analysis show that innovating with IT operates in constant cycles of feature set broadening and deepening, with broadening preceding the deepening. By linking feature set broadening and deepening to existing tasks as well as to new deliverables, we intend to clarify the relationships and transitions between different configurations of innovative use and show which patterns of innovative use occur over time

Physically stimulated nanotheranostics for next generation cancer therapy: Focus on magnetic and light stimulations

Physically or externally stimulated nanostructures often employ multimodality and show encouraging results at preclinical stage in cancer therapy. Specially designed smart nanostructures such as hybrid nanostructures are responsive to external physical stimuli such as light, magnetic field, electric, ultrasound, radio frequency, X-ray, etc. These physically responsive nanostructures have been widely explored as nonconventional innovative “nanotheranostics” in cancer therapies. Physically stimulated (particularly magnetic and light) nanotheranostics provide a unique combination of important properties to address key challenges in modern cancer therapy: (i) an active tumor targeting mechanism of therapeutic drugs driven by a physical force rather than passive antibody matching, (ii) an externally/remotely controlled drugs on-demand release mechanism, and (iii) a capability for advanced image guided tumor therapy and therapy monitoring. Although primarily addressed to the scientific community, this review offers valuable and accessible information for a wide range of readers interested in the current technological progress with direct relevance to the physics, chemistry, biomedical field, and theranostics. We herein cover magnetic and light-triggered modalities currently being developed for nonconventional cancer treatments. The physical basis of each modality is explained; so readers with a physics or, materials science background can easily grasp new developments in this field

In vitro characterization of cancer cell morphology, chemokinesis, and matrix invasion using a novel microfabricated system

A diagnosis of metastatic cancer reduces a patient's 5-year survival rate by nearly 80% compared to a primary tumor diagnosed at an early stage. While gene expression arrays have revealed unique gene signatures for metastatic cancer cells, we are lacking an understanding of the tangible physical changes that distinguish metastatic tumor cells from each other and from their related primary tumors. At the fundamental level, this translates into first characterizing the phenotype of metastatic cancer cells in vitro both in 2D – looking at morphology and migration – and in 3D – focusing on matrix invasion. While 2D in vitro studies have provided insight into the effects of specific environmental conditions on specific cancer cell lines, the unique details included in each experimental design make it challenging to compare cell phenotype across different in vitro platforms as well as between laboratories and disciplines thatshare the goal of understanding cancer. While 3D phenotype studies have employed more standardized and ubiquitous assays, most available tools lack the imaging capability and geometry to effectively characterize all factors driving 3D matrix invasion. In this work, we present protocols and platforms aimed at addressing the problems identified in the tools currently available for studying metastatic cancer in vitro. First, we present a 2D study of morphology and migration using widely accepted protocols. The study is applied to characterizing phenotypes of three breast cancer cell lines with different metastatic organ tropisms. The results show that general populations of cells from each of the 3 lines are unique in shape and motility despite being derived from the same tumor line and that the observed phenotype differences may be related to differences in focal adhesion assembly. More broadly, these studies suggest that standardizing phenotype studies using commonly available techniques may provide a platform by which to compare phenotypic studies across cancer cell types and between research groups to investigate tropism-specific cancer phenotypes. We conclude our investigation of phenotype with a study of 3D matrix invasion using a novel microfluidic platform. The results show that invasion of metastatic breast cancer cells into a 3D type I collagen gel is significantly enhanced in the presence of live endothelial cells. In applying the model to study cell-cell and cell-matrix interactions driving invasion, our platform revealed that, while the fibronectin-rich matrix deposited by endothelial cells was not sufficient to drive invasion alone, metastatic breast cancer cells were able to exploit a structural or secreted component of energetically inactivated endothelial cell to gain entry into the underlying matrix. These findings have important implications for designing drugs targeted at preventing cancer metastasis. The findings in this dissertation reveal significant phenotypic differences in metastatic breast cancer cells with different preferences in metastatic target organ. In addition, the microfluidic platform reveals novel cell-cell interactions driving a key step in the seeding and colonization of a metastatic tumor. Collectively, these results reveal important characteristics of metastatic cancer cells and their interactions with other cell types during metastasis. These studies also provide platforms on which to target or prevent malignant phenotypes and cellular interactions in the future

TrauMAP - Integrating Anatomical and Physiological Simulation (Dissertation Proposal)

In trauma, many injuries impact anatomical structures, which may in turn affect physiological processes - not only those processes within the structure, but also ones occurring in physical proximity to them. Our goal with this research is to model mechanical interactions of different body systems and their impingement on underlying physiological processes. We are particularly concerned with pathological situations in which body system functions that normally do not interact become dependent as a result of mechanical behavior. Towards that end, the proposed TRAUMAP system (Trauma Modeling of Anatomy and Physiology) consists of three modules: (1) a hypothesis generator for suggesting possible structural changes that result from the direct injuries sustained; (2) an information source for responding to operator querying about anatomical structures, physiological processes, and pathophysiological processes; and (3) a continuous system simulator for simulating and illustrating anatomical and physiological changes in three dimensions. Models that can capture such changes may serve as an infrastructure for more detailed modeling and benefit surgical planning, surgical training, and general medical education, enabling students to visualize better, in an interactive environment, certain basic anatomical and physiological dependencies