Modelling Rod-like Flexible Biological Tissues for Medical Training

This paper outlines a framework for the modelling of slender rod-like biological tissue structures in both global and local scales. Volumetric discretization of a rod-like structure is expensive in computation and therefore is not ideal for applications where real-time performance is essential. In our approach, the Cosserat rod model is introduced to capture the global shape changes, which models the structure as a one-dimensional entity, while the local deformation is handled separately. In this way a good balance in accuracy and efficiency is achieved. These advantages make our method appropriate for the modelling of soft tissues for medical training applications

A Study of Speed of the Boundary Element Method as applied to the Realtime Computational Simulation of Biological Organs

In this work, possibility of simulating biological organs in realtime using the Boundary Element Method (BEM) is investigated. Biological organs are assumed to follow linear elastostatic material behavior, and constant boundary element is the element type used. First, a Graphics Processing Unit (GPU) is used to speed up the BEM computations to achieve the realtime performance. Next, instead of the GPU, a computer cluster is used. Results indicate that BEM is fast enough to provide for realtime graphics if biological organs are assumed to follow linear elastostatic material behavior. Although the present work does not conduct any simulation using nonlinear material models, results from using the linear elastostatic material model imply that it would be difficult to obtain realtime performance if highly nonlinear material models that properly characterize biological organs are used. Although the use of BEM for the simulation of biological organs is not new, the results presented in the present study are not found elsewhere in the literature.Comment: preprint, draft, 2 tables, 47 references, 7 files, Codes that can solve three dimensional linear elastostatic problems using constant boundary elements (of triangular shape) while ignoring body forces are provided as supplementary files; codes are distributed under the MIT License in three versions: i) MATLAB version ii) Fortran 90 version (sequential code) iii) Fortran 90 version (parallel code

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

Real-time hybrid cutting with dynamic fluid visualization for virtual surgery

It is widely accepted that a reform in medical teaching must be made to meet today's high volume training requirements. Virtual simulation offers a potential method of providing such trainings and some current medical training simulations integrate haptic and visual feedback to enhance procedure learning. The purpose of this project is to explore the capability of Virtual Reality (VR) technology to develop a training simulator for surgical cutting and bleeding in a general surgery

Real-time simulation of surgery by Proper Generalized Decomposition techniques

La simulación quirúrgica por ordenador en tiempo real se ha convertido en una alternativa muy atractiva a los simuladores quirúrgicos tradicionales. Entre otras ventajas, los simuladores por ordenador consiguen ahorros importantes de tiempo y de costes de mantenimiento, y permiten que los estudiantes practiquen sus habilidades quirúrgicas en un entorno seguro tantas veces como sea necesario. Sin embargo, a pesar de las capacidades de los ordenadores actuales, la cirugía computacional sigue siendo un campo de investigación exigente. Uno de sus mayores retos es la alta velocidad a la que se tienen que resolver complejos problemas de mecánica de medios continuos para que los interfaces hápticos puedan proporcionar un sentido del tacto realista (en general, se necesitan velocidades de respuesta de 500-1000 Hz).Esta tesis presenta algunos métodos numéricos novedosos para la simulación interactiva de dos procedimientos quirúrgicos habituales: el corte y el rasgado (o desgarro) de tejidos blandos. El marco común de los métodos presentados es el uso de la Descomposición Propia Generalizada (PGD en inglés) para la generación de vademécums computacionales, esto es, metasoluciones generales de problemas paramétricos de altas dimensiones que se pueden evaluar a velocidades de respuesta compatibles con entornos hápticos.En el caso del corte, los vademécums computacionales se utilizan de forma conjunta con técnicas basadas en XFEM, mientras que la carga de cálculo se distribuye entre una etapa off-line (previa a la ejecución interactiva) y otra on-line (en tiempo de ejecución). Durante la fase off-line, para el órgano en cuestión se precalculan tanto un vademécum computacional para cualquier posición de una carga, como los desplazamientos producidos por un conjunto de cortes. Así, durante la etapa on-line, los resultados precalculados se combinan de la forma más adecuada para obtener en tiempo real la respuesta a las acciones dirigidas por el usuario. En cuanto al rasgado, a partir de una ecuación paramétrica basada en mecánica del daño continuo, se obtiene un vademécum computacional. La complejidad del modelo se reduce mediante técnicas de Descomposición Ortogonal Propia (POD en inglés), y el vademécum se incorpora a una formulación incremental explícita que se puede interpretar como una especie de integrador temporal.A modo de ejemplo, el método para el corte se aplica a la simulación de un procedimiento quirúrgico refractivo de la córnea conocido como queratotomía radial, mientras que el método para el rasgado se centra en la simulación de la colecistectomía laparoscópica (la extirpación de la vesícula biliar mediante laparoscopia). En ambos casos, los métodos implementados ofrecen excelentes resultados en términos de velocidades de respuesta y producen simulaciones muy realistas desde los puntos de vista visual y háptico.The real-time computer-based simulation of surgery has proven to be an appealing alternative to traditional surgical simulators. Amongst other advantages, computer-based simulators provide considerable savings on time and maintenance costs, and allow trainees to practice their surgical skills in a safe environment as often as necessary. However, in spite of the current computer capabilities, computational surgery continues to be a challenging field of research. One of its major issues is the high speed at which complex problems in continuum mechanics have to be solved so that haptic interfaces can render a realistic sense of touch (generally, feedback rates of 500–1 000 Hz are required). This thesis introduces some novel numerical methods for the interactive simulation of two usual surgical procedures: cutting and tearing of soft tissues. The common framework of the presented methods is the use of the Proper Generalised Decomposition (PGD) for the generation of computational vademecums, i. e. general meta-solutions of parametric high-dimensional problems that can be evaluated at feedback rates compatible with haptic environments. In the case of cutting, computational vademecums are used jointly with XFEM-based techniques, and the computing workload is distributed into an off-line and an on-line stage. During the off-line stage, both a computational vademecum for any position of a load and the displacements produced by a set of cuts are pre-computed for the organ under consideration. Thus, during the on-line stage, the pre-computed results are properly combined together to obtain in real-time the response to the actions driven by the user. Concerning tearing, a computational vademecum is obtained from a parametric equation based on continuum damage mechanics. The complexity of the model is reduced by Proper Orthogonal Decomposition (POD) techniques, and the vademecum is incorporated into an explicit incremental formulation that can be viewed as a sort of time integrator. By way of example, the cutting method is applied to the simulation of a corneal refractive surgical procedure known as radial keratotomy, whereas the tearing method focuses on the simulation of laparoscopic cholecystectomy (i. e. the removal of the gallbladder). In both cases, the implemented methods offer excellent performances in terms of feedback rates, and produce.<br /

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

Development of a Reality-Based, Haptics-Enabled Simulator for Tool-Tissue Interactions

The advent of complex surgical procedures has driven the need for finite element based surgical training simulators which provide realistic visual and haptic feedback throughout the surgical task. The foundation of a simulator stems from the use of accurate, reality-based models for the global tissue response as well as the tool-tissue interactions. To that end, ex vivo and in vivo tests were conducted for soft-tissue probing and in vivo tests were conducted for soft-tissue cutting for the purpose of model development. In formulating a surgical training system, there is a desire to replicate the surgical task as accurately as possible for haptic and visual realism. However, for many biological tissues, there is a discrepancy between the mechanical characteristics of ex vivo and in vivo tissue. The efficacy of utilizing an ex vivo model for simulation of in vivo probing tasks on porcine liver was evaluated by comparing the simulated probing task to an identical in vivo probing experiment. The models were then further improved upon to better replicate the in vivo response. During the study of cutting modeling, in vivo cutting experiments were performed on porcine liver to derive the force-displacement response of the tissue to a scalpel blade. Using this information, a fracture mechanics based approach was applied to develop a fully defined cohesive zone model governing the separation properties of the liver directly in front of the scalpel blade. Further, a method of scaling the cohesive zone parameters was presented to minimize the computational expense in an effort to apply the cohesive based cutting approach to real-time simulators. The development of the models for the global tissue response and local tool-tissue interactions for probing and cutting of soft-tissue provided the framework for real-time simulation of basic surgical skills training. Initially, a pre-processing approach was used for the development of reality-based, haptics enabled simulators for probing and cutting of soft tissue. Then a real-time finite element based simulator was developed to simulate the probing task without the need to know the tool path prior to simulation

Surface and bulk stresses drive morphological changes in fibrous microtissues

Engineered fibrous tissues consisting of cells encapsulated within collagen gels are widely used three-dimensional in vitro models of morphogenesis and wound healing. Although cell-mediated matrix remodeling that occurs within these scaffolds has been extensively studied, less is known about the mesoscale physical principles governing the dynamics of tissue shape. Here, we show both experimentally and by using computer simulations how surface contraction through the development of surface stresses (analogous to surface tension in fluids) coordinates with bulk contraction to drive shape evolution in constrained three-dimensional microtissues. We used microelectromechanical systems technology to generate arrays of fibrous microtissues and robot-assisted microsurgery to perform local incisions and implantation. We introduce a technique based on phototoxic activation of a small molecule to selectively kill cells in a spatially controlled manner. The model simulations, which reproduced the experimentally observed shape changes after surgical and photochemical operations, indicate that fitting of only bulk and surface contractile moduli is sufficient for the prediction of the equilibrium shape of the microtissues. The computational and experimental methods we have developed provide a general framework to study and predict the morphogenic states of contractile fibrous tissues under external loading at multiple length scales.Published versio

High Fidelity Haptic Rendering for Deformable Objects Undergoing Topology Changes

International audienceThe relevance of haptic feedback for minimally invasive surgery has been demonstrated at numerous counts. However, the proposed methods often prove inadequate to handle correct contact computation during the complex interactions or topological changes that can be found in surgical interventions. In this paper, we introduce an approach that allows for accurate computation of contact forces even in the presence of topological changes due to the simulation of soft tissue cutting. We illustrate this approach with a simulation of cataract surgery, a typical example of microsurgery