Research on real-time physics-based deformation for haptic-enabled medical simulation

This study developed a multiple effective visuo-haptic surgical engine to handle a variety of surgical manipulations in real-time. Soft tissue models are based on biomechanical experiment and continuum mechanics for greater accuracy. Such models will increase the realism of future training systems and the VR/AR/MR implementations for the operating room

A morphometric analysis of ultrastructural dynamics in the murine glomerulus following surgically-induced renal hypertension

Chronic kidney disease (CKD) and end stage renal disease (ESRD) are significant causes of adult morbidity and mortality worldwide. Though these conditions are common, the mechanisms of pathogenesis in kidney disease are poorly understood. Genetic predisposition has been established in the African American population; however this does not explain the ubiquity of CKD in the United States and abroad. Diabetes and hypertension are the two most frequently occurring co-morbidities in kidney disease and both have been identified as putative sources of injury to the delicate filtering structures of the kidney. Furthermore, the intrinsic functional relationship between the cardiovascular and renal organ systems adds to the plausibility of a hemodynamic cause. In light of this knowledge, we aim to explore the roles of genetic predisposition and hypertension in the pathogenesis and progression of CKD. The filtering apparatus of the kidney, the glomerulus, is a looping tuft of capillaries specialized to allow the passage of water and certain substances from the blood while restricting others. Glomeruli at the corticomedullary boundary of the kidney experience blood pressures closer to those in systemic arterioles and are subject to similar hemodynamic stresses. To evaluate the role of hypertension in CKD, we employed a well-known model of hypertensive kidney disease in mice involving uninephrectomy (UNX), subcutaneous implantation of a timed-release pellet containing the active aldosterone precursor deoxycorticosterone acetate (DOCA), and a high-salt diet. Given the role of heritability in human CKD pathogenesis, we applied the DOCA-UNX model in two strains of mice with differing susceptibility to kidney damage, the 129S6 and C57BL/6 strains, to evaluate the effects of genetic predisposition. Mice were subjected to varying lengths of hypertension exposure and their kidneys were subsequently examined by transmission electron microscopy (TEM). Ultrastructural lesions of glomeruli were evaluated by a renal pathologist and assigned subjective pathology scores based on the extent and severity of involvement. We hypothesized that certain glomerular lesions, particularly those involving the podocytes of the visceral epithelium, would increase in severity in mice with heritable susceptibility (129S6) as well as those with longer exposure to glomerular hypertension. Our observations demonstrate these hypotheses are partially correct. By TEM histopathology, mouse strain was found to have a significant effect on the severity of certain epithelial lesions while duration of hypertension had a significant effect on the overall morphological pathology of the podocytes, glomerular basement membrane, and glomerulus as a whole. These results provide a promising foundation for further investigation of the pathogenesis of CKD in mice

The Challenge of Augmented Reality in Surgery

Imaging has revolutionized surgery over the last 50 years. Diagnostic imaging is a key tool for deciding to perform surgery during disease management; intraoperative imaging is one of the primary drivers for minimally invasive surgery (MIS), and postoperative imaging enables effective follow-up and patient monitoring. However, notably, there is still relatively little interchange of information or imaging modality fusion between these different clinical pathway stages. This book chapter provides a critique of existing augmented reality (AR) methods or application studies described in the literature using relevant examples. The aim is not to provide a comprehensive review, but rather to give an indication of the clinical areas in which AR has been proposed, to begin to explain the lack of clinical systems and to provide some clear guidelines to those intending pursue research in this area

Development and Validation of Augmented Reality Training Simulator for Ultrasound Guided Percutaneous Renal Access

Percutaneous renal access (PCA) is a critical step in needle-based renal procedures. Traditional PCA training relies on apprenticeship, which raises concerns about patient safety and limits training opportunities. In this thesis, we reviewed simulation-based training for PCA, described the development of a novel augmented reality (AR) simulator for ultrasound (US)-guided PCA, and evaluated its validity and efficacy as a teaching tool. Our AR simulator allows the user to practice PCA on a silicone phantom using a tracked needle and US probe emulator under the guidance of simulated US on a tablet screen. 6 Expert and 24 novice participants were recruited to evaluate the efficacy of our simulator. Experts highly rated the realism and usefulness of our simulator, reflected by the average face validity score of 4.39 and content validity score of 4.53 on a 5-point Likert scale. Comparisons with a Mann-Whitney U test revealed significant differences (p Our cost-effective, flexible, and easily customizable AR training simulator can provide opportunities for trainees to acquire basic skills of US-guided PCA in a safe and stress-free environment. The effectiveness of our simulator is demonstrated through strong face, content, and construct validity, indicating its value as a novel training tool

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

Real-Time Magnetic Resonance Imaging

Real‐time magnetic resonance imaging (RT‐MRI) allows for imaging dynamic processes as they occur, without relying on any repetition or synchronization. This is made possible by modern MRI technology such as fast‐switching gradients and parallel imaging. It is compatible with many (but not all) MRI sequences, including spoiled gradient echo, balanced steady‐state free precession, and single‐shot rapid acquisition with relaxation enhancement. RT‐MRI has earned an important role in both diagnostic imaging and image guidance of invasive procedures. Its unique diagnostic value is prominent in areas of the body that undergo substantial and often irregular motion, such as the heart, gastrointestinal system, upper airway vocal tract, and joints. Its value in interventional procedure guidance is prominent for procedures that require multiple forms of soft‐tissue contrast, as well as flow information. In this review, we discuss the history of RT‐MRI, fundamental tradeoffs, enabling technology, established applications, and current trends

Patient-specific simulation environment for surgical planning and preoperative rehearsal

Surgical simulation is common practice in the fields of surgical education and training. Numerous surgical simulators are available from commercial and academic organisations for the generic modelling of surgical tasks. However, a simulation platform is still yet to be found that fulfils the key requirements expected for patient-specific surgical simulation of soft tissue, with an effective translation into clinical practice. Patient-specific modelling is possible, but to date has been time-consuming, and consequently costly, because data preparation can be technically demanding. This motivated the research developed herein, which addresses the main challenges of biomechanical modelling for patient-specific surgical simulation. A novel implementation of soft tissue deformation and estimation of the patient-specific intraoperative environment is achieved using a position-based dynamics approach. This modelling approach overcomes the limitations derived from traditional physically-based approaches, by providing a simulation for patient-specific models with visual and physical accuracy, stability and real-time interaction. As a geometrically- based method, a calibration of the simulation parameters is performed and the simulation framework is successfully validated through experimental studies. The capabilities of the simulation platform are demonstrated by the integration of different surgical planning applications that are found relevant in the context of kidney cancer surgery. The simulation of pneumoperitoneum facilitates trocar placement planning and intraoperative surgical navigation. The implementation of deformable ultrasound simulation can assist surgeons in improving their scanning technique and definition of an optimal procedural strategy. Furthermore, the simulation framework has the potential to support the development and assessment of hypotheses that cannot be tested in vivo. Specifically, the evaluation of feedback modalities, as a response to user-model interaction, demonstrates improved performance and justifies the need to integrate a feedback framework in the robot-assisted surgical setting.Open Acces

Ultrasound Imaging

Ultrasound Imaging - Current Topics presents complex and current topics in ultrasound imaging in a simplified format. It is easy to read and exemplifies the range of experiences of each contributing author. Chapters address such topics as anatomy and dimensional variations, pediatric gastrointestinal emergencies, musculoskeletal and nerve imaging as well as molecular sonography. The book is a useful resource for researchers, students, clinicians, and sonographers looking for additional information on ultrasound imaging beyond the basics