Medical Robotics for use in MRI Guided Endoscopy

Interventional Magnetic Resonance Imaging (MRI) is a developing field that aims to provide intra-operative MRI to a clinician to guide diagnostic or therapeutic medical procedures. MRI provides excellent soft tissue contrast at sub-millimetre resolution in both 2D and 3D without the need for ionizing radiation. Images can be acquired in near real-time for guidance purposes. Operating in the MR environment brings challenges due to the high static magnetic field, switching magnetic field gradients and RF excitation pulses. In addition high field closed bore scanners have spatial constraints that severely limit access to the patient. This thesis presents a system for MRI-guided Endoscopic Retrograde Cholangio-pancreatography (ERCP). This includes a remote actuation system that enables an MRI-compatible endoscope to be controlled whilst the patient is inside the MRI scanner, overcoming the spatial and procedural constraints imposed by the closed scanner bore. The modular system utilises non-magnetic ultrasonic motors and is designed for image-guided user-in-the-loop control. A novel miniature MRI compatible clutch has been incorporated into the design to reduce the need for multiple parallel motors. The actuation system is MRI compatible does not degrade the MR images below acceptable levels. User testing showed that the actuation system requires some degree of training but enables completion of a simulated ERCP procedure with no loss of performance. This was demonstrated using a tailored ERCP simulator and kinematic assessment tool, which was validated with users from a range of skill levels to ensure that it provides an objective measurement of endoscopic skill. Methods of tracking the endoscope in real-time using the MRI scanner are explored and presented here. Use of the MRI-guided ERCP system was shown to improve the operator’s ability to position the endoscope in an experimental environment compared with a standard fluoroscopic-guided system.Open Acces

A hybrid localization method for Wireless Capsule Endoscopy (WCE)

Wireless capsule endoscopy (WCE) is a well-established diagnostic tool for visualizing the Gastrointestinal (GI) tract. WCE provides a unique view of the GI system with minimum discomfort for patients. Doctors can determine the type and severity of abnormality by analyzing the taken images. Early diagnosis helps them act and treat the disease in its earlier stages. However, the location information is missing in the frames. Pictures labeled by their location assist doctors in prescribing suitable medicines. The disease progress can be monitored, and the best treatment can be advised for the patients. Furthermore, at the time of surgery, it indicates the correct position for operation. Several attempts have been performed to localize the WCE accurately. Methods such as Radio frequency (RF), magnetic, image processing, ultrasound, and radiative imaging techniques have been investigated. Each one has its strengths and weaknesses. RF-based and magnetic-based localization methods need an external reference point, such as a belt or box around the patient, which limits their activities and causes discomfort. Computing the location solely based on an external reference could not distinguish between GI motion from capsule motion. Hence, this relative motion causes errors in position estimation. The GI system can move inside the body, while the capsule is stationary inside the intestine. This proposal presents two pose fusion methods, Method 1 and Method 2, that compensate for the relative motion of the GI tract with respect to the body. Method 1 is based on the data fusion from the Inertial measurement unit (IMU) sensor and side wall cameras. The IMU sensor consists of 9 Degree-Of-Freedom (DOF), including a gyroscope, an accelerometer, and a magnetometer to monitor the capsule’s orientation and its heading vector (the heading vector is a three-dimensional vector pointing to the direction of the capsule's head). Four monochromic cameras are placed at the side of the capsule to measure the displacement. The proposed method computes the heading vector using IMU data. Then, the heading vector is fused with displacements to estimate the 3D trajectory. This method has high accuracy in the short term. Meanwhile, due to the accumulation of errors from side wall cameras, the estimated trajectory tends to drift over time. Method 2 was developed to resolve the drifting issue while keeping the same positioning error. The capsule is equipped with four side wall cameras and a magnet. Magnetic localization acquires the capsule’s global position using 9 three-axis Hall effect sensors. However, magnetic localization alone cannot distinguish between the capsule’s and GI tract’s motions. To overcome this issue and increase tracking accuracy, side wall cameras are utilized, which are responsible for measuring the capsule’s movement, not the involuntary motion of the GI system. A complete setup is designed to test the capsule and perform the experiments. The results show that Method 2 has an average position error of only 3.5 mm and can compensate for the GI tract’s relative movements. Furthermore, environmental parameters such as magnetic interference and the nonhomogeneous structure of the GI tract have little influence on our system compared to the available magnetic localization methods. The experiment showed that Method 2 is suitable for localizing the WCE inside the body

New Techniques in Gastrointestinal Endoscopy

As result of progress, endoscopy has became more complex, using more sophisticated devices and has claimed a special form. In this moment, the gastroenterologist performing endoscopy has to be an expert in macroscopic view of the lesions in the gut, with good skills for using standard endoscopes, with good experience in ultrasound (for performing endoscopic ultrasound), with pathology experience for confocal examination. It is compulsory to get experience and to have patience and attention for the follow-up of thousands of images transmitted during capsule endoscopy or to have knowledge in physics necessary for autofluorescence imaging endoscopy. Therefore, the idea of an endoscopist has changed. Examinations mentioned need a special formation, a superior level of instruction, accessible to those who have already gained enough experience in basic diagnostic endoscopy. This is the reason for what these new issues of endoscopy are presented in this book of New techniques in Gastrointestinal Endoscopy

Ultrasound Imaging

This book provides an overview of ultrafast ultrasound imaging, 3D high-quality ultrasonic imaging, correction of phase aberrations in medical ultrasound images, etc. Several interesting medical and clinical applications areas are also discussed in the book, like the use of three dimensional ultrasound imaging in evaluation of Asherman's syndrome, the role of 3D ultrasound in assessment of endometrial receptivity and follicular vascularity to predict the quality oocyte, ultrasound imaging in vascular diseases and the fetal palate, clinical application of ultrasound molecular imaging, Doppler abdominal ultrasound in small animals and so on

A prospective evaluation to define optimal surgical strategies in the management of complex pancreatic injuries based on the analysis of patients treated at a major South African academic institution

In order to address crucial existing limitations in the assessment and analysis of pancreatic injuries due to the lack of robust data and deficient surgical strategies, this thesis focused on priority topics to resolve existing unanswered and under-researched questions in the management of complex pancreatic injuries. Each of the twelve clinical studies in this thesis evaluated a specific aspect of pancreatic trauma based on the detailed analysis of prospective granular data from a large cohort of patients treated in an academic surgery and trauma centre with substantial experience in civilian operative trauma care in which standard and uniform protocols were applied

Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.

BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of Yaoundé's emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SD = 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (p < 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (p < 0.001). Males were significantly more likely to be admitted than females (p < 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of Yaoundé. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted

Drug Delivery Technology Development in Canada

Canada continues to have a rich history of ground-breaking research in drug delivery within academic institutions, pharmaceutical industry and the biotechnology community

Olfactory Inputs Modulate Respiration-Related Activity In The Prefrontal Cortex And Fear Behavior

Voluntary control of respiration, especially via rhythmic nasal breathing, alleviates negative feelings such as fear and is used clinically to manage certain types of panic attacks. However, the neural substrates that link nasal breathing to fear circuits remains unknown. Here we show that during conditioned fear-induced freezing behavior, mice breathe at a steady rate (~4 Hz) which is strongly correlated with a predominant 4 Hz oscillation observed in the olfactory bulb and the prelimbic prefrontal cortex (plPFC), a structure critical for the expression of conditioned fear behaviors. We demonstrate anatomical and functional connectivity between the olfactory pathway and plPFC via circuit tracing and optogenetic approaches. Disrupting olfactory inputs significantly reduces the 4 Hz oscillation in the plPFC suggesting that respiration-related signals from the olfactory system play a role in entraining this fear-related signal. Surprisingly, we find that without olfactory inputs, freezing times are significantly prolonged. Collectively, our results indicate that olfactory inputs modulate rhythmic activity in fear circuits and suggest a neural pathway that may underlie the behavioral benefits of respiration-entrained olfactory signals

Aerospace medicine and biology, an annotated bibliography. volume xi- 1962-1963 literature

Aerospace medicine and biology - annotated bibliography for 1962 and 196