Optical techniques for 3D surface reconstruction in computer-assisted laparoscopic surgery

One of the main challenges for computer-assisted surgery (CAS) is to determine the intra-opera- tive morphology and motion of soft-tissues. This information is prerequisite to the registration of multi-modal patient-specific data for enhancing the surgeon’s navigation capabilites by observ- ing beyond exposed tissue surfaces and for providing intelligent control of robotic-assisted in- struments. In minimally invasive surgery (MIS), optical techniques are an increasingly attractive approach for in vivo 3D reconstruction of the soft-tissue surface geometry. This paper reviews the state-of-the-art methods for optical intra-operative 3D reconstruction in laparoscopic surgery and discusses the technical challenges and future perspectives towards clinical translation. With the recent paradigm shift of surgical practice towards MIS and new developments in 3D opti- cal imaging, this is a timely discussion about technologies that could facilitate complex CAS procedures in dynamic and deformable anatomical regions

Open-source virtual bronchoscopy for image guided navigation

This thesis describes the development of an open-source system for virtual bronchoscopy used in combination with electromagnetic instrument tracking. The end application is virtual navigation of the lung for biopsy of early stage cancer nodules. The open-source platform 3D Slicer was used for creating freely available algorithms for virtual bronchscopy. Firstly, the development of an open-source semi-automatic algorithm for prediction of solitary pulmonary nodule malignancy is presented. This approach may help the physician decide whether to proceed with biopsy of the nodule. The user-selected nodule is segmented in order to extract radiological characteristics (i.e., size, location, edge smoothness, calcification presence, cavity wall thickness) which are combined with patient information to calculate likelihood of malignancy. The overall accuracy of the algorithm is shown to be high compared to independent experts' assessment of malignancy. The algorithm is also compared with two different predictors, and our approach is shown to provide the best overall prediction accuracy. The development of an airway segmentation algorithm which extracts the airway tree from surrounding structures on chest Computed Tomography (CT) images is then described. This represents the first fundamental step toward the creation of a virtual bronchoscopy system. Clinical and ex-vivo images are used to evaluate performance of the algorithm. Different CT scan parameters are investigated and parameters for successful airway segmentation are optimized. Slice thickness is the most affecting parameter, while variation of reconstruction kernel and radiation dose is shown to be less critical. Airway segmentation is used to create a 3D rendered model of the airway tree for virtual navigation. Finally, the first open-source virtual bronchoscopy system was combined with electromagnetic tracking of the bronchoscope for the development of a GPS-like system for navigating within the lungs. Tools for pre-procedural planning and for helping with navigation are provided. Registration between the lungs of the patient and the virtually reconstructed airway tree is achieved using a landmark-based approach. In an attempt to reduce difficulties with registration errors, we also implemented a landmark-free registration method based on a balanced airway survey. In-vitro and in-vivo testing showed good accuracy for this registration approach. The centreline of the 3D airway model is extracted and used to compensate for possible registration errors. Tools are provided to select a target for biopsy on the patient CT image, and pathways from the trachea towards the selected targets are automatically created. The pathways guide the physician during navigation, while distance to target information is updated in real-time and presented to the user. During navigation, video from the bronchoscope is streamed and presented to the physician next to the 3D rendered image. The electromagnetic tracking is implemented with 5 DOF sensing that does not provide roll rotation information. An intensity-based image registration approach is implemented to rotate the virtual image according to the bronchoscope's rotations. The virtual bronchoscopy system is shown to be easy to use and accurate in replicating the clinical setting, as demonstrated in the pre-clinical environment of a breathing lung method. Animal studies were performed to evaluate the overall system performance

Activity profiling for minimally invasive surgery

Imperial Users onl

Surgical Subtask Automation for Intraluminal Procedures using Deep Reinforcement Learning

Intraluminal procedures have opened up a new sub-field of minimally invasive surgery that use flexible instruments to navigate through complex luminal structures of the body, resulting in reduced invasiveness and improved patient benefits. One of the major challenges in this field is the accurate and precise control of the instrument inside the human body. Robotics has emerged as a promising solution to this problem. However, to achieve successful robotic intraluminal interventions, the control of the instrument needs to be automated to a large extent. The thesis first examines the state-of-the-art in intraluminal surgical robotics and identifies the key challenges in this field, which include the need for safe and effective tool manipulation, and the ability to adapt to unexpected changes in the luminal environment. To address these challenges, the thesis proposes several levels of autonomy that enable the robotic system to perform individual subtasks autonomously, while still allowing the surgeon to retain overall control of the procedure. The approach facilitates the development of specialized algorithms such as Deep Reinforcement Learning (DRL) for subtasks like navigation and tissue manipulation to produce robust surgical gestures. Additionally, the thesis proposes a safety framework that provides formal guarantees to prevent risky actions. The presented approaches are evaluated through a series of experiments using simulation and robotic platforms. The experiments demonstrate that subtask automation can improve the accuracy and efficiency of tool positioning and tissue manipulation, while also reducing the cognitive load on the surgeon. The results of this research have the potential to improve the reliability and safety of intraluminal surgical interventions, ultimately leading to better outcomes for patients and surgeons

Characterising pattern asymmetry in pigmented skin lesions

Abstract. In clinical diagnosis of pigmented skin lesions asymmetric pigmentation is often indicative of melanoma. This paper describes a method and measures for characterizing lesion symmetry. The estimate of mirror symmetry is computed first for a number of axes at different degrees of rotation with respect to the lesion centre. The statistics of these estimates are the used to assess the overall symmetry. The method is applied to three different lesion representations showing the overall pigmentation, the pigmentation pattern, and the pattern of dermal melanin. The best measure is a 100% sensitive and 96% specific indicator of melanoma on a test set of 33 lesions, with a separate training set consisting of 66 lesions

Registration of serial sections: An evaluation method based on distortions of the ground truths

Registration of histological serial sections is a challenging task. Serial sections exhibit distortions and damage from sectioning. Missing information on how the tissue looked before cutting makes a realistic validation of 2D registrations extremely difficult. This work proposes methods for ground-truth-based evaluation of registrations. Firstly, we present a methodology to generate test data for registrations. We distort an innately registered image stack in the manner similar to the cutting distortion of serial sections. Test cases are generated from existing 3D data sets, thus the ground truth is known. Secondly, our test case generation premises evaluation of the registrations with known ground truths. Our methodology for such an evaluation technique distinguishes this work from other approaches. Both under- and over-registration become evident in our evaluations. We also survey existing validation efforts. We present a full-series evaluation across six different registration methods applied to our distorted 3D data sets of animal lungs. Our distorted and ground truth data sets are made publicly available.Comment: Supplemental data available under https://zenodo.org/record/428244

Learning-based depth and pose prediction for 3D scene reconstruction in endoscopy

Colorectal cancer is the third most common cancer worldwide. Early detection and treatment of pre-cancerous tissue during colonoscopy is critical to improving prognosis. However, navigating within the colon and inspecting the endoluminal tissue comprehensively are challenging, and success in both varies based on the endoscopist's skill and experience. Computer-assisted interventions in colonoscopy show much promise in improving navigation and inspection. For instance, 3D reconstruction of the colon during colonoscopy could promote more thorough examinations and increase adenoma detection rates which are associated with improved survival rates. Given the stakes, this thesis seeks to advance the state of research from feature-based traditional methods closer to a data-driven 3D reconstruction pipeline for colonoscopy. More specifically, this thesis explores different methods that improve subtasks of learning-based 3D reconstruction. The main tasks are depth prediction and camera pose estimation. As training data is unavailable, the author, together with her co-authors, proposes and publishes several synthetic datasets and promotes domain adaptation models to improve applicability to real data. We show, through extensive experiments, that our depth prediction methods produce more robust results than previous work. Our pose estimation network trained on our new synthetic data outperforms self-supervised methods on real sequences. Our box embeddings allow us to interpret the geometric relationship and scale difference between two images of the same surface without the need for feature matches that are often unobtainable in surgical scenes. Together, the methods introduced in this thesis help work towards a complete, data-driven 3D reconstruction pipeline for endoscopy

Advancements and Breakthroughs in Ultrasound Imaging

Ultrasonic imaging is a powerful diagnostic tool available to medical practitioners, engineers and researchers today. Due to the relative safety, and the non-invasive nature, ultrasonic imaging has become one of the most rapidly advancing technologies. These rapid advances are directly related to the parallel advancements in electronics, computing, and transducer technology together with sophisticated signal processing techniques. This book focuses on state of the art developments in ultrasonic imaging applications and underlying technologies presented by leading practitioners and researchers from many parts of the world

Medical device design within the ISO 13485 framework

The design and development of medical devices has become an increasing complex and regulated process. Little if any consideration is given to the regulatory requirements when developing medical devices in universities. This has resulted in an imposing barrier preventing academic innovation reaching clinical adoption. The scope of universities is not to become the legal manufacturer of medical devices. However, should the development of novel devices ever aim to benefit patient care and reach a clinical setting, design controls must be implemented throughout the project life cycle to demonstrate feasibility and safety. The aim of this thesis is to develop user-centred technologies which comply with industrial design control practices whilst helping to bolster and promote innovation within academia. Four projects relating to medical devices have been designed in response to well-defined and end-user-originated clinical needs. These devices can serve as the exemplar for the framework developed in this work with each reaching staggered phases of development within a controlled design process. Although unique, the devices have significant overlapping characteristics that lend the devices to parallel development, leveraging in-house know-how and ‘lessons learned’ into the process of innovation. This thesis focuses on the novelty and design of the aforementioned projects in a discrete structured approach and reflects on the development of each project within the context of a design control process which was developed as part of this work. It is the ultimate goal of this work to develop a flexible structured system compliant with the international requirements for product design and development which may be exported internationally. However, the full execution of this ambition was limited due physical, and financial limitations. This manuscript will describe the technical and commercial opportunity of devices and reflects on the success of developing same within a design control process developed as part of this work

Development and Experimental Analysis of Wireless High Accuracy Ultra-Wideband Localization Systems for Indoor Medical Applications

This dissertation addresses several interesting and relevant problems in the field of wireless technologies applied to medical applications and specifically problems related to ultra-wideband high accuracy localization for use in the operating room. This research is cross disciplinary in nature and fundamentally builds upon microwave engineering, software engineering, systems engineering, and biomedical engineering. A good portion of this work has been published in peer reviewed microwave engineering and biomedical engineering conferences and journals. Wireless technologies in medicine are discussed with focus on ultra-wideband positioning in orthopedic surgical navigation. Characterization of the operating room as a medium for ultra-wideband signal transmission helps define system design requirements. A discussion of the first generation positioning system provides a context for understanding the overall system architecture of the second generation ultra-wideband positioning system outlined in this dissertation. A system-level simulation framework provides a method for rapid prototyping of ultra-wideband positioning systems which takes into account all facets of the system (analog, digital, channel, experimental setup). This provides a robust framework for optimizing overall system design in realistic propagation environments. A practical approach is taken to outline the development of the second generation ultra-wideband positioning system which includes an integrated tag design and real-time dynamic tracking of multiple tags. The tag and receiver designs are outlined as well as receiver-side digital signal processing, system-level design support for multi-tag tracking, and potential error sources observed in dynamic experiments including phase center error, clock jitter and drift, and geometric position dilution of precision. An experimental analysis of the multi-tag positioning system provides insight into overall system performance including the main sources of error. A five base station experiment shows the potential of redundant base stations in improving overall dynamic accuracy. Finally, the system performance in low signal-to-noise ratio and non-line-of-sight environments is analyzed by focusing on receiver-side digitally-implemented ranging algorithms including leading-edge detection and peak detection. These technologies are aimed at use in next-generation medical systems with many applications including surgical navigation, wireless telemetry, medical asset tracking, and in vivo wireless sensors