Augmented reality for computer assisted orthopaedic surgery

In recent years, computer-assistance and robotics have established their presence in operating theatres and found success in orthopaedic procedures. Benefits of computer assisted orthopaedic surgery (CAOS) have been thoroughly explored in research, finding improvements in clinical outcomes, through increased control and precision over surgical actions. However, human-computer interaction in CAOS remains an evolving field, through emerging display technologies including augmented reality (AR) – a fused view of the real environment with virtual, computer-generated holograms. Interactions between clinicians and patient-specific data generated during CAOS are limited to basic 2D interactions on touchscreen monitors, potentially creating clutter and cognitive challenges in surgery. Work described in this thesis sought to explore the benefits of AR in CAOS through: an integration between commercially available AR and CAOS systems, creating a novel AR-centric surgical workflow to support various tasks of computer-assisted knee arthroplasty, and three pre–clinical studies exploring the impact of the new AR workflow on both existing and newly proposed quantitative and qualitative performance metrics. Early research focused on cloning the (2D) user-interface of an existing CAOS system onto a virtual AR screen and investigating any resulting impacts on usability and performance. An infrared-based registration system is also presented, describing a protocol for calibrating commercial AR headsets with optical trackers, calculating a spatial transformation between surgical and holographic coordinate frames. The main contribution of this thesis is a novel AR workflow designed to support computer-assisted patellofemoral arthroplasty. The reported workflow provided 3D in-situ holographic guidance for CAOS tasks including patient registration, pre-operative planning, and assisted-cutting. Pre-clinical experimental validation on a commercial system (NAVIO®, Smith & Nephew) for these contributions demonstrates encouraging early-stage results showing successful deployment of AR to CAOS systems, and promising indications that AR can enhance the clinician’s interactions in the future. The thesis concludes with a summary of achievements, corresponding limitations and future research opportunities.Open Acces

A gaze-contingent framework for perceptually-enabled applications in healthcare

Patient safety and quality of care remain the focus of the smart operating room of the future. Some of the most influential factors with a detrimental effect are related to suboptimal communication among the staff, poor flow of information, staff workload and fatigue, ergonomics and sterility in the operating room. While technological developments constantly transform the operating room layout and the interaction between surgical staff and machinery, a vast array of opportunities arise for the design of systems and approaches, that can enhance patient safety and improve workflow and efficiency. The aim of this research is to develop a real-time gaze-contingent framework towards a "smart" operating suite, that will enhance operator's ergonomics by allowing perceptually-enabled, touchless and natural interaction with the environment. The main feature of the proposed framework is the ability to acquire and utilise the plethora of information provided by the human visual system to allow touchless interaction with medical devices in the operating room. In this thesis, a gaze-guided robotic scrub nurse, a gaze-controlled robotised flexible endoscope and a gaze-guided assistive robotic system are proposed. Firstly, the gaze-guided robotic scrub nurse is presented; surgical teams performed a simulated surgical task with the assistance of a robot scrub nurse, which complements the human scrub nurse in delivery of surgical instruments, following gaze selection by the surgeon. Then, the gaze-controlled robotised flexible endoscope is introduced; experienced endoscopists and novice users performed a simulated examination of the upper gastrointestinal tract using predominately their natural gaze. Finally, a gaze-guided assistive robotic system is presented, which aims to facilitate activities of daily living. The results of this work provide valuable insights into the feasibility of integrating the developed gaze-contingent framework into clinical practice without significant workflow disruptions.Open Acces

Medical SLAM in an autonomous robotic system

One of the main challenges for computer-assisted surgery (CAS) is to determine the intra-operative 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 capabilities by observing beyond exposed tissue surfaces and for providing intelligent control of robotic-assisted instruments. In minimally invasive surgery (MIS), optical techniques are an increasingly attractive approach for in vivo 3D reconstruction of the soft-tissue surface geometry. This thesis addresses the ambitious goal of achieving surgical autonomy, through the study of the anatomical environment by Initially studying the technology present and what is needed to analyze the scene: vision sensors. A novel endoscope for autonomous surgical task execution is presented in the first part of this thesis. Which combines a standard stereo camera with a depth sensor. This solution introduces several key advantages, such as the possibility of reconstructing the 3D at a greater distance than traditional endoscopes. Then the problem of hand-eye calibration is tackled, which unites the vision system and the robot in a single reference system. Increasing the accuracy in the surgical work plan. In the second part of the thesis the problem of the 3D reconstruction and the algorithms currently in use were addressed. In MIS, simultaneous localization and mapping (SLAM) can be used to localize the pose of the endoscopic camera and build ta 3D model of the tissue surface. Another key element for MIS is to have real-time knowledge of the pose of surgical tools with respect to the surgical camera and underlying anatomy. Starting from the ORB-SLAM algorithm we have modified the architecture to make it usable in an anatomical environment by adding the registration of the pre-operative information of the intervention to the map obtained from the SLAM. Once it has been proven that the slam algorithm is usable in an anatomical environment, it has been improved by adding semantic segmentation to be able to distinguish dynamic features from static ones. All the results in this thesis are validated on training setups, which mimics some of the challenges of real surgery and on setups that simulate the human body within Autonomous Robotic Surgery (ARS) and Smart Autonomous Robotic Assistant Surgeon (SARAS) projects

Towards Intelligent Telerobotics: Visualization and Control of Remote Robot

Human-machine cooperative or co-robotics has been recognized as the next generation of robotics. In contrast to current systems that use limited-reasoning strategies or address problems in narrow contexts, new co-robot systems will be characterized by their flexibility, resourcefulness, varied modeling or reasoning approaches, and use of real-world data in real time, demonstrating a level of intelligence and adaptability seen in humans and animals. The research I focused is in the two sub-field of co-robotics: teleoperation and telepresence. We firstly explore the ways of teleoperation using mixed reality techniques. I proposed a new type of display: hybrid-reality display (HRD) system, which utilizes commodity projection device to project captured video frame onto 3D replica of the actual target surface. It provides a direct alignment between the frame of reference for the human subject and that of the displayed image. The advantage of this approach lies in the fact that no wearing device needed for the users, providing minimal intrusiveness and accommodating users eyes during focusing. The field-of-view is also significantly increased. From a user-centered design standpoint, the HRD is motivated by teleoperation accidents, incidents, and user research in military reconnaissance etc. Teleoperation in these environments is compromised by the Keyhole Effect, which results from the limited field of view of reference. The technique contribution of the proposed HRD system is the multi-system calibration which mainly involves motion sensor, projector, cameras and robotic arm. Due to the purpose of the system, the accuracy of calibration should also be restricted within millimeter level. The followed up research of HRD is focused on high accuracy 3D reconstruction of the replica via commodity devices for better alignment of video frame. Conventional 3D scanner lacks either depth resolution or be very expensive. We proposed a structured light scanning based 3D sensing system with accuracy within 1 millimeter while robust to global illumination and surface reflection. Extensive user study prove the performance of our proposed algorithm. In order to compensate the unsynchronization between the local station and remote station due to latency introduced during data sensing and communication, 1-step-ahead predictive control algorithm is presented. The latency between human control and robot movement can be formulated as a linear equation group with a smooth coefficient ranging from 0 to 1. This predictive control algorithm can be further formulated by optimizing a cost function. We then explore the aspect of telepresence. Many hardware designs have been developed to allow a camera to be placed optically directly behind the screen. The purpose of such setups is to enable two-way video teleconferencing that maintains eye-contact. However, the image from the see-through camera usually exhibits a number of imaging artifacts such as low signal to noise ratio, incorrect color balance, and lost of details. Thus we develop a novel image enhancement framework that utilizes an auxiliary color+depth camera that is mounted on the side of the screen. By fusing the information from both cameras, we are able to significantly improve the quality of the see-through image. Experimental results have demonstrated that our fusion method compares favorably against traditional image enhancement/warping methods that uses only a single image

Medical SLAM in an autonomous robotic system

One of the main challenges for computer-assisted surgery (CAS) is to determine the intra-operative 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 capabilities by observing beyond exposed tissue surfaces and for providing intelligent control of robotic-assisted instruments. In minimally invasive surgery (MIS), optical techniques are an increasingly attractive approach for in vivo 3D reconstruction of the soft-tissue surface geometry. This thesis addresses the ambitious goal of achieving surgical autonomy, through the study of the anatomical environment by Initially studying the technology present and what is needed to analyze the scene: vision sensors. A novel endoscope for autonomous surgical task execution is presented in the first part of this thesis. Which combines a standard stereo camera with a depth sensor. This solution introduces several key advantages, such as the possibility of reconstructing the 3D at a greater distance than traditional endoscopes. Then the problem of hand-eye calibration is tackled, which unites the vision system and the robot in a single reference system. Increasing the accuracy in the surgical work plan. In the second part of the thesis the problem of the 3D reconstruction and the algorithms currently in use were addressed. In MIS, simultaneous localization and mapping (SLAM) can be used to localize the pose of the endoscopic camera and build ta 3D model of the tissue surface. Another key element for MIS is to have real-time knowledge of the pose of surgical tools with respect to the surgical camera and underlying anatomy. Starting from the ORB-SLAM algorithm we have modified the architecture to make it usable in an anatomical environment by adding the registration of the pre-operative information of the intervention to the map obtained from the SLAM. Once it has been proven that the slam algorithm is usable in an anatomical environment, it has been improved by adding semantic segmentation to be able to distinguish dynamic features from static ones. All the results in this thesis are validated on training setups, which mimics some of the challenges of real surgery and on setups that simulate the human body within Autonomous Robotic Surgery (ARS) and Smart Autonomous Robotic Assistant Surgeon (SARAS) projects

Advanced Augmented Reality Telestration Techniques With Applications In Laparoscopic And Robotic Surgery

The art of teaching laparoscopic or robotic surgery currently has a primary reliance on an expert surgeon tutoring a student during a live surgery. During these operations, surgeons are viewing the inside of the body through a manipulatable camera. Due to the viewpoint translation and narrow field of view, these techniques have a substantial learning curve in order to gain the mastery necessary to operate safely. In addition to moving and rotating the camera, the surgeon must also manipulate tools inserted into the body. These tools are only visible on camera, and pass through a pivot point on the body that, in non-robotic cases, reverses their directions of motion when compared to the surgeon\u27s hands. These difficulties spurred on this dissertation. The main hypothesis of this research is that advanced augmented reality techniques can improve telementoring for use between expert surgeons and surgical students. In addition, it can provide a better method of communication between surgeon and camera operator. This research has two specific aims: (1) Create a head-mounted direction of focus indicator to provide non-verbal assistance for camera operation. A system was created to track where the surgeon is looking and provides augmented reality cues to the camera operator explaining the camera desires of the surgeon. (2) Create a hardware / software environment for the tracking of a camera and an object, allowing for the display of registered pre-operative imaging that can be manipulated during the procedure. A set of augmented reality cues describing the translation, zoom, and roll of a laparoscopic camera were developed for Aim 1. An experiment was run to determine whether using augmented reality cues or verbal cues was faster and more efficient at acquiring targets on camera at a specific location, zoom level, and roll angle. The study found that in all instances, the augmented reality cues resulted in faster completion of the task with better economy of movement than with the verbal cues. A large number of environmentally registered augmented reality telestration and visualization features were added to a hardware / software platform for Aim 2. The implemented manipulation of pre-operative imaging and the ability to provide different types of registered annotation in the working environment has provided numerous examples of improved utility in telementoring systems. The results of this work provide potential improvements to the utilization of pre-operative imaging in the operating room, to the effectiveness of telementoring as a surgical teaching tool, and to the effective communication between the surgeon and the camera operator in laparoscopic surgery

Augmented Reality: Mapping Methods and Tools for Enhancing the Human Role in Healthcare HMI

Background: Augmented Reality (AR) represents an innovative technology to improve data visualization and strengthen the human perception. Among Human–Machine Interaction (HMI), medicine can benefit most from the adoption of these digital technologies. In this perspective, the literature on orthopedic surgery techniques based on AR was evaluated, focusing on identifying the limitations and challenges of AR-based healthcare applications, to support the research and the development of further studies. Methods: Studies published from January 2018 to December 2021 were analyzed after a comprehensive search on PubMed, Google Scholar, Scopus, IEEE Xplore, Science Direct, and Wiley Online Library databases. In order to improve the review reporting, the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used. Results: Authors selected sixty-two articles meeting the inclusion criteria, which were categorized according to the purpose of the study (intraoperative, training, rehabilitation) and according to the surgical procedure used. Conclusions: AR has the potential to improve orthopedic training and practice by providing an increasingly human-centered clinical approach. Further research can be addressed by this review to cover problems related to hardware limitations, lack of accurate registration and tracking systems, and absence of security protocols

Augmented Reality

Augmented Reality (AR) is a natural development from virtual reality (VR), which was developed several decades earlier. AR complements VR in many ways. Due to the advantages of the user being able to see both the real and virtual objects simultaneously, AR is far more intuitive, but it's not completely detached from human factors and other restrictions. AR doesn't consume as much time and effort in the applications because it's not required to construct the entire virtual scene and the environment. In this book, several new and emerging application areas of AR are presented and divided into three sections. The first section contains applications in outdoor and mobile AR, such as construction, restoration, security and surveillance. The second section deals with AR in medical, biological, and human bodies. The third and final section contains a number of new and useful applications in daily living and learning