Realistic tool-tissue interaction models for surgical simulation and planning

Surgical simulators present a safe and potentially effective method for surgical training, and can also be used in pre- and intra-operative surgical planning. Realistic modeling of medical interventions involving tool-tissue interactions has been considered to be a key requirement in the development of high-fidelity simulators and planners. The soft-tissue constitutive laws, organ geometry and boundary conditions imposed by the connective tissues surrounding the organ, and the shape of the surgical tool interacting with the organ are some of the factors that govern the accuracy of medical intervention planning.\ud \ud This thesis is divided into three parts. First, we compare the accuracy of linear and nonlinear constitutive laws for tissue. An important consequence of nonlinear models is the Poynting effect, in which shearing of tissue results in normal force; this effect is not seen in a linear elastic model. The magnitude of the normal force for myocardial tissue is shown to be larger than the human contact force discrimination threshold. Further, in order to investigate and quantify the role of the Poynting effect on material discrimination, we perform a multidimensional scaling study. Second, we consider the effects of organ geometry and boundary constraints in needle path planning. Using medical images and tissue mechanical properties, we develop a model of the prostate and surrounding organs. We show that, for needle procedures such as biopsy or brachytherapy, organ geometry and boundary constraints have more impact on target motion than tissue material parameters. Finally, we investigate the effects surgical tool shape on the accuracy of medical intervention planning. We consider the specific case of robotic needle steering, in which asymmetry of a bevel-tip needle results in the needle naturally bending when it is inserted into soft tissue. We present an analytical and finite element (FE) model for the loads developed at the bevel tip during needle-tissue interaction. The analytical model explains trends observed in the experiments. We incorporated physical parameters (rupture toughness and nonlinear material elasticity) into the FE model that included both contact and cohesive zone models to simulate tissue cleavage. The model shows that the tip forces are sensitive to the rupture toughness. In order to model the mechanics of deflection of the needle, we use an energy-based formulation that incorporates tissue-specific parameters such as rupture toughness, nonlinear material elasticity, and interaction stiffness, and needle geometric and material properties. Simulation results follow similar trends (deflection and radius of curvature) to those observed in macroscopic experimental studies of a robot-driven needle interacting with gels

Robotics-Assisted Needle Steering for Percutaneous Interventions: Modeling and Experiments

Needle insertion and guidance plays an important role in medical procedures such as brachytherapy and biopsy. Flexible needles have the potential to facilitate precise targeting and avoid collisions during medical interventions while reducing trauma to the patient and post-puncture issues. Nevertheless, error introduced during guidance degrades the effectiveness of the planned therapy or diagnosis. Although steering using flexible bevel-tip needles provides great mobility and dexterity, a major barrier is the complexity of needle-tissue interaction that does not lend itself to intuitive control. To overcome this problem, a robotic system can be employed to perform trajectory planning and tracking by manipulation of the needle base. This research project focuses on a control-theoretic approach and draws on the rich literature from control and systems theory to model needle-tissue interaction and needle flexion and then design a robotics-based strategy for needle insertion/steering. The resulting solutions will directly benefit a wide range of needle-based interventions. The outcome of this computer-assisted approach will not only enable us to perform efficient preoperative trajectory planning, but will also provide more insight into needle-tissue interaction that will be helpful in developing advanced intraoperative algorithms for needle steering. Experimental validation of the proposed methodologies was carried out on a state of-the-art 5-DOF robotic system designed and constructed in-house primarily for prostate brachytherapy. The system is equipped with a Nano43 6-DOF force/torque sensor (ATI Industrial Automation) to measure forces and torques acting on the needle shaft. In our setup, an Aurora electromagnetic tracker (Northern Digital Inc.) is the sensing device used for measuring needle deflection. A multi-threaded application for control, sensor readings, data logging and communication over the ethernet was developed using Microsoft Visual C 2005, MATLAB 2007 and the QuaRC Toolbox (Quanser Inc.). Various artificial phantoms were developed so as to create a realistic medium in terms of elasticity and insertion force ranges; however, they simulated a uniform environment without exhibiting complexities of organic tissues. Experiments were also conducted on beef liver and fresh chicken breast, beef, and ham, to investigate the behavior of a variety biological tissues

Haptics in Robot-Assisted Surgery: Challenges and Benefits

Robotic surgery is transforming the current surgical practice, not only by improving the conventional surgical methods but also by introducing innovative robot-enhanced approaches that broaden the capabilities of clinicians. Being mainly of man-machine collaborative type, surgical robots are seen as media that transfer pre- and intra-operative information to the operator and reproduce his/her motion, with appropriate filtering, scaling, or limitation, to physically interact with the patient. The field, however, is far from maturity and, more critically, is still a subject of controversy in medical communities. Limited or absent haptic feedback is reputed to be among reasons that impede further spread of surgical robots. In this paper objectives and challenges of deploying haptic technologies in surgical robotics is discussed and a systematic review is performed on works that have studied the effects of providing haptic information to the users in major branches of robotic surgery. It has been tried to encompass both classical works and the state of the art approaches, aiming at delivering a comprehensive and balanced survey both for researchers starting their work in this field and for the experts

Virtual Reality simulator for dental anesthesia training in the inferior alveolar nerve block

Objectives This study shows the development and validation of a dental anesthesia-training simulator, specifically for the inferior alveolar nerve block (IANB). The system developed provides the tactile sensation of inserting a real needle in a human patient, using Virtual Reality (VR) techniques and a haptic device that can provide a perceived force feedback in the needle insertion task during the anesthesia procedure. Material and Methods To simulate a realistic anesthesia procedure, a Carpule syringe was coupled to a haptic device. The Volere method was used to elicit requirements from users in the Dentistry area; Repeated Measures Two-Way ANOVA (Analysis of Variance), Tukey post-hoc test and averages for the results’ analysis. A questionnaire-based subjective evaluation method was applied to collect information about the simulator, and 26 people participated in the experiments (12 beginners, 12 at intermediate level, and 2 experts). The questionnaire included profile, preferences (number of viewpoints, texture of the objects, and haptic device handler), as well as visual (appearance, scale, and position of objects) and haptic aspects (motion space, tactile sensation, and motion reproduction). Results The visual aspect was considered appropriate and the haptic feedback must be improved, which the users can do by calibrating the virtual tissues’ resistance. The evaluation of visual aspects was influenced by the participants’ experience, according to ANOVA test (F=15.6, p=0.0002, with

SMART IMAGE-GUIDED NEEDLE INSERTION FOR TISSUE BIOPSY

M.S

Design and Development of a Surgical Robot for Needle-Based Medical Interventions

Lung cancer is the leading cause of cancer related deaths. If diagnosed in a timely manner, the treatment of choice is surgical resection of the cancerous lesions followed by radiotherapy. However, surgical resection may be too invasive for some patients due to old age or weakness. An alternative is minimally invasive needle-based interventions for cancer diagnosis and treatment. This project describes the design, analysis, development and experimental evaluation of a modular, compact, patient-mounted robotic manipulator for lung cancer diagnosis and treatment. In this regard, a novel parallel Remote Centre of Motion (RCM) mechanism is proposed for minimally invasive delivery of needle-based interventions. The proposed robot provides four degrees of freedom (DOFs) to orient and move a surgical needle within a spherical coordinate system. There is an analytical solution for the kinematics of the proposed parallel mechanism and the end-effectors motion is well-conditioned within the required workspace. The RCM is located beneath the skin surface to minimize the invasiveness of the surgical procedure while providing the required workspace to target the cancerous lesions. In addition, the proposed robot benefits from a design capable of measuring the interaction forces between the needle and the tissue. The experimental evaluation of the robot has proved its capability to accurately orient and move a surgical needle within the required workspace. Although this robotic system has been designed for the treatment of lung cancer, it is capable of performing other procedures in the thoracic or abdominal cavity such as liver cancer diagnosis and treatment

InterNAV3D: A Navigation Tool for Robot-Assisted Needle-Based Intervention for the Lung

Lung cancer is one of the leading causes of cancer deaths in North America. There are recent advances in cancer treatment techniques that can treat cancerous tumors, but require a real-time imaging modality to provide intraoperative assistive feedback. Ultrasound (US) imaging is one such modality. However, while its application to the lungs has been limited because of the deterioration of US image quality (due to the presence of air in the lungs); recent work has shown that appropriate lung deflation can help to improve the quality sufficiently to enable intraoperative, US-guided robotics-assisted techniques to be used. The work described in this thesis focuses on this approach. The thesis describes a project undertaken at Canadian Surgical Technologies and Advanced Robotics (CSTAR) that utilizes the image processing techniques to further enhance US images and implements an advanced 3D virtual visualization software approach. The application considered is that for minimally invasive lung cancer treatment using procedures such as brachytherapy and microwave ablation while taking advantage of the accuracy and teleoperation capabilities of surgical robots, to gain higher dexterity and precise control over the therapy tools (needles and probes). A number of modules and widgets are developed and explained which improve the visibility of the physical features of interest in the treatment and help the clinician to have more reliable and accurate control of the treatment. Finally the developed tools are validated with extensive experimental evaluations and future developments are suggested to enhance the scope of the applications

Study of Needle Insertion Parameters of Human Body Tissue for Surgical Operations

The thesis introduces the study on needle insertion during the laboratory experiment. The percutaneous needle insertion is performed several times in day to day life. Manually placement of needle in the tissue may cause damage inside the body sothe thesis presents the existing methodology of needle insertion and researched methodology in our laboratory. It shows the proper way of needle placement and which parameters are necessary to keep in mind when perform the needle insertion. It deals with the proper way of needle insertion, minimise the deflection of needle inside the tissue and gives an idea of reduction in deformation of tissue. The test procedures and experimental setup provide an understanding on the mechanics of needle placement and the design improvement of insertion instruments.The experimental analysis optimize the results of operative parameters of needle when it insert in the tissue like needle translation motion during the insertion, needle rotational motion during insertion, angle of needle insertion and force acting on the needle when it inserted in the tissue. The optimize results provide a brief knowledge for the surgeons about the needle behaviour during the insertion in soft tissue so surgeons are pre imagined the situations by which they would going through during the operation. The model enhances the quality of insertion by presenting the optimize model for parameters of needle insertion. In most of the insertion operations accuracy and precision is important parameters which must be kept in mind by the surgeons when they performed the insertion of needle inside the tissue so this is study is relevant for them to get the accuracy and precision in work. The aim of this research is to present standard methodology for needle insertion which can be possible by experimental analysis of needle insertion in laborator

Controlling the Error on Target Motion through Real-time Mesh Adaptation: Applications to Deep Brain Stimulation

We present an error-controlled mesh refinement procedure for needle insertion simulation and apply it to the simulation of electrode implantation for deep brain stimulation, including brain shift. Our approach enables to control the error in the computation of the displacement and stress fields around the needle tip and needle shaft by suitably refining the mesh, whilst maintaining a coarser mesh in other parts of the domain. We demonstrate through academic and practical examples that our approach increases the accuracy of the displacement and stress fields around the needle without increasing the computational expense. This enables real-time simulations. The proposed methodology has direct implications to increase the accuracy and control the computational expense of the simulation of percutaneous procedures such as biopsy, brachytherapy, regional anesthesia, or cryotherapy and can be essential to the development of robotic guidance.Comment: 21 pages, 14 figure

3D Multimodal Interaction with Physically-based Virtual Environments

The virtual has become a huge field of exploration for researchers: it could assist the surgeon, help the prototyping of industrial objects, simulate natural phenomena, be a fantastic time machine or entertain users through games or movies. Far beyond the only visual rendering of the virtual environment, the Virtual Reality aims at -literally- immersing the user in the virtual world. VR technologies simulate digital environments with which users can interact and, as a result, perceive through different modalities the effects of their actions in real time. The challenges are huge: the user's motions need to be perceived and to have an immediate impact on the virtual world by modifying the objects in real-time. In addition, the targeted immersion of the user is not only visual: auditory or haptic feedback needs to be taken into account, merging all the sensory modalities of the user into a multimodal answer. The global objective of my research activities is to improve 3D interaction with complex virtual environments by proposing novel approaches for physically-based and multimodal interaction. I have laid the foundations of my work on designing the interactions with complex virtual worlds, referring to a higher demand in the characteristics of the virtual environments. My research could be described within three main research axes inherent to the 3D interaction loop: (1) the physically-based modeling of the virtual world to take into account the complexity of the virtual object behavior, their topology modifications as well as their interactions, (2) the multimodal feedback for combining the sensory modalities into a global answer from the virtual world to the user and (3) the design of body-based 3D interaction techniques and devices for establishing the interfaces between the user and the virtual world. All these contributions could be gathered in a general framework within the 3D interaction loop. By improving all the components of this framework, I aim at proposing approaches that could be used in future virtual reality applications but also more generally in other areas such as medical simulation, gesture training, robotics, virtual prototyping for the industry or web contents.Le virtuel est devenu un vaste champ d'exploration pour la recherche et offre de nos jours de nombreuses possibilités : assister le chirurgien, réaliser des prototypes de pièces industrielles, simuler des phénomènes naturels, remonter dans le temps ou proposer des applications ludiques aux utilisateurs au travers de jeux ou de films. Bien plus que le rendu purement visuel d'environnement virtuel, la réalité virtuelle aspire à -littéralement- immerger l'utilisateur dans le monde virtuel. L'utilisateur peut ainsi interagir avec le contenu numérique et percevoir les effets de ses actions au travers de différents retours sensoriels. Permettre une véritable immersion de l'utilisateur dans des environnements virtuels de plus en plus complexes confronte la recherche en réalité virtuelle à des défis importants: les gestes de l'utilisateur doivent être capturés puis directement transmis au monde virtuel afin de le modifier en temps-réel. Les retours sensoriels ne sont pas uniquement visuels mais doivent être combinés avec les retours auditifs ou haptiques dans une réponse globale multimodale. L'objectif principal de mes activités de recherche consiste à améliorer l'interaction 3D avec des environnements virtuels complexes en proposant de nouvelles approches utilisant la simulation physique et exploitant au mieux les différentes modalités sensorielles. Dans mes travaux, je m'intéresse tout particulièrement à concevoir des interactions avec des mondes virtuels complexes. Mon approche peut être décrite au travers de trois axes principaux de recherche: (1) la modélisation dans les mondes virtuels d'environnements physiques plausibles où les objets réagissent de manière naturelle, même lorsque leur topologie est modifiée ou lorsqu'ils sont en interaction avec d'autres objets, (2) la mise en place de retours sensoriels multimodaux vers l'utilisateur intégrant des composantes visuelles, haptiques et/ou sonores, (3) la prise en compte de l'interaction physique de l'utilisateur avec le monde virtuel dans toute sa richesse : mouvements de la tête, des deux mains, des doigts, des jambes, voire de tout le corps, en concevant de nouveaux dispositifs ou de nouvelles techniques d'interactions 3D. Les différentes contributions que j'ai proposées dans chacun de ces trois axes peuvent être regroupées au sein d'un cadre plus général englobant toute la boucle d'interaction 3D avec les environnements virtuels. Elles ouvrent des perspectives pour de futures applications en réalité virtuelle mais également plus généralement dans d'autres domaines tels que la simulation médicale, l'apprentissage de gestes, la robotique, le prototypage virtuel pour l'industrie ou bien les contenus web