Patient Specific Systems for Computer Assisted Robotic Surgery Simulation, Planning, and Navigation

The evolving scenario of surgery: starting from modern surgery, to the birth of medical imaging and the introduction of minimally invasive techniques, has seen in these last years the advent of surgical robotics. These systems, making possible to get through the difficulties of endoscopic surgery, allow an improved surgical performance and a better quality of the intervention. Information technology contributed to this evolution since the beginning of the digital revolution: providing innovative medical imaging devices and computer assisted surgical systems. Afterwards, the progresses in computer graphics brought innovative visualization modalities for medical datasets, and later the birth virtual reality has paved the way for virtual surgery. Although many surgical simulators already exist, there are no patient specific solutions. This thesis presents the development of patient specific software systems for preoperative planning, simulation and intraoperative assistance, designed for robotic surgery: in particular for bimanual robots that are becoming the future of single port interventions. The first software application is a virtual reality simulator for this kind of surgical robots. The system has been designed to validate the initial port placement and the operative workspace for the potential application of this surgical device. Given a bimanual robot with its own geometry and kinematics, and a patient specific 3D virtual anatomy, the surgical simulator allows the surgeon to choose the optimal positioning of the robot and the access port in the abdominal wall. Additionally, it makes possible to evaluate in a virtual environment if a dexterous movability of the robot is achievable, avoiding unwanted collisions with the surrounding anatomy to prevent potential damages in the real surgical procedure. Even if the software has been designed for a specific bimanual surgical robot, it supports any open kinematic chain structure: as far as it can be described in our custom format. The robot capabilities to accomplish specific tasks can be virtually tested using the deformable models: interacting directly with the target virtual organs, trying to avoid unwanted collisions with the surrounding anatomy not involved in the intervention. Moreover, the surgical simulator has been enhanced with algorithms and data structures to integrate biomechanical parameters into virtual deformable models (based on mass-spring-damper network) of target solid organs, in order to properly reproduce the physical behaviour of the patient anatomy during the interactions. The main biomechanical parameters (Young's modulus and density) have been integrated, allowing the automatic tuning of some model network elements, such as: the node mass and the spring stiffness. The spring damping coefficient has been modeled using the Rayleigh approach. Furthermore, the developed method automatically detect the external layer, allowing the usage of both the surface and internal Young's moduli, in order to model the main parts of dense organs: the stroma and the parenchyma. Finally the model can be manually tuned to represent lesion with specific biomechanical properties. Additionally, some software modules of the simulator have been properly extended to be integrated in a patient specific computer guidance system for intraoperative navigation and assistance in robotic single port interventions. This application provides guidance functionalities working in three different modalities: passive as a surgical navigator, assistive as a guide for the single port placement and active as a tutor preventing unwanted collision during the intervention. The simulation system has beed tested by five surgeons: simulating the robot access port placemen, and evaluating the robot movability and workspace inside the patient abdomen. The tested functionalities, rated by expert surgeons, have shown good quality and performance of the simulation. Moreover, the integration of biomechanical parameters into deformable models has beed tested with various material samples. The results have shown a good visual realism ensuring the performance required by an interactive simulation. Finally, the intraoperative navigator has been tested performing a cholecystectomy on a synthetic patient mannequin, in order to evaluate: the intraoperative navigation accuracy, the network communications latency and the overall usability of the system. The tests performed demonstrated the effectiveness and the usability of the software systems developed: encouraging the introduction of the proposed solution in the clinical practice, and the implementation of further improvements. Surgical robotics will be enhanced by an advanced integration of medical images into software systems: allowing the detailed planning of surgical interventions by means of virtual surgery simulation based on patient specific biomechanical parameters. Furthermore, the advanced functionalities offered by these systems, enable surgical robots to improve the intraoperative surgical assistance: benefitting of the knowledge of the virtual patient anatomy

ICMS-Ecológico no estado de São Paulo : contribuição para análise da viabilidade de ampliação do percentual

Orientador : Prof. Dr. Luiz César RibasCo-Orientadora: Profa. Jaqueline de Paula HeimannMonografia (especialização) - Universidade Federal do Paraná, Setor de Ciências Agrárias, Curso de Especialização em MBA em Gestão AmbientalInclui referênciasResumo : O ICMS-Ecológico foi criado para aumentar o repasse do ICMS para aqueles municípios que possuem áreas ambientalmente protegidas. No Estado de São Paulo, 0,5% do repasse do ICMS segue o critério do índice de áreas protegidas. Entretanto, essa porcentagem é considerada baixa ou insuficiente para apoiar as políticas municipais de proteção ambiental. Tendo isso em vista, o presente trabalho simulou como seria o repasse do ICMS para os municípios se o ICMS-Ecológico fosse aumentado de 0,5% para 3%. Para isso, foi reduzida de 13% para 11,5% a participação do índice populacional e de 76% para 75% a participação do valor adicionado fiscal. Ou seja, recursos seriam retirados daqueles municípios populosos e com elevada atividade econômica, para serem entregues àqueles com altos índices de área protegida. Os resultados mostraram que 142 municípios teriam aumento médio de 41,76% nos repasses, enquanto que os outros 503 municípios teriam redução média de 2,12%. Constatou-se, portanto, que os aumentos seriam muito mais significativos que as reduções. Os municípios mais beneficiados seriam aqueles situados nas regiões do Vale do Ribeira e do Vale do Paraíba, os quais possuem extensas unidades de proteção de mata atlântica. Além disso, essas duas regiões são as que possuem os menores IDHM e deverão colher muitos benefícios com o aumento do ICMS-Ecológico. Recomenda-se que essa elevação seja feita de forma gradual para permitir o planejamento seguro do orçamento público por parte dos municípios, e que seja dedicada especial atenção para alguns municípios que possuem baixo IDHM e significativa redução no repasse dos recursos, com destaque para os municípios de Potim e Ribeirão Branco

Test of the two TOTEM TripleGEM Chambers assembled at G&A Engineering

In this note we report the results of the tests performed at CERN on the two TOTEM TripleGEM chambers assembled by a private company

Wearable Augmented Reality Application for Shoulder Rehabilitation

Augmented reality (AR) technology is gaining popularity and scholarly interest in the rehabilitation sector because of the possibility to generate controlled, user-specific environmental and perceptual stimuli which motivate the patient, while still preserving the possibility to interact with the real environment and other subjects, including the rehabilitation specialist. The paper presents the first wearable AR application for shoulder rehabilitation, based on Microsoft HoloLens, with real-time markerless tracking of the user’s hand. Potentialities and current limits of commercial head-mounted displays (HMDs) are described for the target medical field, and details of the proposed application are reported. A serious game was designed starting from the analysis of a traditional rehabilitation exercise, taking into account HoloLens specifications to maximize user comfort during the AR rehabilitation session. The AR application implemented consistently meets the recommended target frame rate for immersive applications with HoloLens device: 60 fps. Moreover, the ergonomics and the motivational value of the proposed application were positively evaluated by a group of five rehabilitation specialists and 20 healthy subjects. Even if a larger study, including real patients, is necessary for a clinical validation of the proposed application, the results obtained encourage further investigations and the integration of additional technical features for the proposed AR application

Multivariate factor analysis of milk fatty acid composition in relation to the somatic cell count of single udder quarters

The present study investigated whether the fatty acid composition of milk changes in relation to an increase in the milk somatic cell count (SCC) of separate udder quarters. We investigated the potential of multivariate factor analysis to extract metabolic evidence from data on the quantity and quality of milk of quarters characterized by different SCC levels. We collected data from individual milk samples taken from single quarters of 49 Italian Holstein cows from the same dairy farm. Factor analysis was carried out on 64 individual fatty acids. In line with a previous study on multivariate factor analysis, a variable was considered to be associated with a specific factor if the absolute value of its correlation with the factor was ≥0.60. Seven factors were extracted that explained the following groups of fatty acids or functions: de novo synthesis, energy balance, uptake of dietary fatty acids, biohydrogenation, short-chain fatty acids, very long chain fatty acids, and odd- and branched-chain fatty acids. An ANOVA of factor scores highlighted the significant effects of the SCC level on de novo fatty acids and biohydrogenation. The de novo fatty acid factor decreased significantly with a high level of SCC, from just 10,000 cells/mL, whereas the biohydrogenation factor showed a significantly higher level in quarters with SCC levels greater than 400,000 cells/mL. This statistical approach enabled us to reduce the number of variables to a few latent factors with biological significance and to represent groups of fatty acids with a common origin and function. Multivariate factor analysis could therefore be key to studying the influence of SCC on the lipid metabolism of single quarters. This approach also demonstrated the metabolic differences between quarters of the same animal showing a different level of SCC

Review of the Augmented Reality Systems for Shoulder Rehabilitation

Literature shows an increasing interest for the development of augmented reality (AR) applications in several fields, including rehabilitation. Current studies show the need for new rehabilitation tools for upper extremity, since traditional interventions are less effective than in other body regions. This review aims at: Studying to what extent AR applications are used in shoulder rehabilitation, examining wearable/non-wearable technologies employed, and investigating the evidence supporting AR effectiveness. Nine AR systems were identified and analyzed in terms of: Tracking methods, visualization technologies, integrated feedback, rehabilitation setting, and clinical evaluation. Our findings show that all these systems utilize vision-based registration, mainly with wearable marker-based tracking, and spatial displays. No system uses head-mounted displays, and only one system (11%) integrates a wearable interface (for tactile feedback). Three systems (33%) provide only visual feedback; 66% present visual-audio feedback, and only 33% of these provide visual-audio feedback, 22% visual-audio with biofeedback, and 11% visual-audio with haptic feedback. Moreover, several systems (44%) are designed primarily for home settings. Three systems (33%) have been successfully evaluated in clinical trials with more than 10 patients, showing advantages over traditional rehabilitation methods. Further clinical studies are needed to generalize the obtained findings, supporting the effectiveness of the AR applications

Designing statistical models for holstein rearing heifers’ weight estimation from birth to 15 months old using body measurements

Body measurements could be used to estimate body weight (BW) with no need for a scale. The aim was to estimate heifers weight based on their body dimension characteristics. Twenty-five Holstein heifers represent the study group (SG); another 13 animals were evaluated as a validation group (VG). All the heifers were weighed (BW) and their wither height (WH), shin circumference (SC), heart girth circumference (HG), body length (BL), hip width (HW) and body condition score (BCS) were measured immediately after birth, and then weekly until 2 months and monthly until 15 months old. Equations were built with a stepwise regression in order to estimate the BW at each time using body measures for the SG. A linear regression was applied to evaluate the relationship between the estimated BW and the real BW. Equations found were to be statistically significant (r2 = 0.688 to 0.894; p < 0.0001). Three variables or fewer were needed for BW estimation a total of 11/23 times. Regression analysis indicated that the use of HG was promising in all the equations built for BW estimation. These models were feasible in the field; further studies will evaluate possible modifications to our equations based on different growing rate targets

How to Build a Patient-Specific Hybrid Simulator for Orthopaedic Open Surgery: Benefits and Limits of Mixed-Reality Using the Microsoft HoloLens

Orthopaedic simulators are popular in innovative surgical training programs, where trainees gain procedural experience in a safe and controlled environment. Recent studies suggest that an ideal simulator should combine haptic, visual, and audio technology to create an immersive training environment. This article explores the potentialities of mixed-reality using the HoloLens to develop a hybrid training system for orthopaedic open surgery. Hip arthroplasty, one of the most common orthopaedic procedures, was chosen as a benchmark to evaluate the proposed system. Patient-specific anatomical 3D models were extracted from a patient computed tomography to implement the virtual content and to fabricate the physical components of the simulator. Rapid prototyping was used to create synthetic bones. The Vuforia SDK was utilized to register virtual and physical contents. The Unity3D game engine was employed to develop the software allowing interactions with the virtual content using head movements, gestures, and voice commands. Quantitative tests were performed to estimate the accuracy of the system by evaluating the perceived position of augmented reality targets. Mean and maximum errors matched the requirements of the target application. Qualitative tests were carried out to evaluate workload and usability of the HoloLens for our orthopaedic simulator, considering visual and audio perception and interaction and ergonomics issues. The perceived overall workload was low, and the self-assessed performance was considered satisfactory. Visual and audio perception and gesture and voice interactions obtained a positive feedback. Postural discomfort and visual fatigue obtained a nonnegative evaluation for a simulation session of 40 minutes. These results encourage using mixed-reality to implement a hybrid simulator for orthopaedic open surgery. An optimal design of the simulation tasks and equipment setup is required to minimize the user discomfort. Future works will include Face Validity, Content Validity, and Construct Validity to complete the assessment of the hip arthroplasty simulator

How to Build a Patient-Specific Hybrid Simulator for Orthopaedic Open Surgery: Benefits and Limits of Mixed-Reality Using the Microsoft HoloLens

Orthopaedic simulators are popular in innovative surgical training programs, where trainees gain procedural experience in a safe and controlled environment. Recent studies suggest that an ideal simulator should combine haptic, visual, and audio technology to create an immersive training environment. This article explores the potentialities of mixed-reality using the HoloLens to develop a hybrid training system for orthopaedic open surgery. Hip arthroplasty, one of the most common orthopaedic procedures, was chosen as a benchmark to evaluate the proposed system. Patient-specific anatomical 3D models were extracted from a patient computed tomography to implement the virtual content and to fabricate the physical components of the simulator. Rapid prototyping was used to create synthetic bones. The Vuforia SDK was utilized to register virtual and physical contents. The Unity3D game engine was employed to develop the software allowing interactions with the virtual content using head movements, gestures, and voice commands. Quantitative tests were performed to estimate the accuracy of the system by evaluating the perceived position of augmented reality targets. Mean and maximum errors matched the requirements of the target application. Qualitative tests were carried out to evaluate workload and usability of the HoloLens for our orthopaedic simulator, considering visual and audio perception and interaction and ergonomics issues. The perceived overall workload was low, and the self-assessed performance was considered satisfactory. Visual and audio perception and gesture and voice interactions obtained a positive feedback. Postural discomfort and visual fatigue obtained a nonnegative evaluation for a simulation session of 40 minutes. These results encourage using mixed-reality to implement a hybrid simulator for orthopaedic open surgery. An optimal design of the simulation tasks and equipment setup is required to minimize the user discomfort. Future works will include Face Validity, Content Validity, and Construct Validity to complete the assessment of the hip arthroplasty simulator

Evidence for non-exponential elastic proton-proton differential cross-section at low |t| and sqrt(s) = 8 TeV by TOTEM

The TOTEM experiment has made a precise measurement of the elastic proton-proton differential cross-section at the centre-of-mass energy sqrt(s) = 8 TeV based on a high-statistics data sample obtained with the beta* = 90 optics. Both the statistical and systematic uncertainties remain below 1%, except for the t-independent contribution from the overall normalisation. This unprecedented precision allows to exclude a purely exponential differential cross-section in the range of four-momentum transfer squared 0.027 < |t| < 0.2 GeV^2 with a significance greater than 7 sigma. Two extended parametrisations, with quadratic and cubic polynomials in the exponent, are shown to be well compatible with the data. Using them for the differential cross-section extrapolation to t = 0, and further applying the optical theorem, yields total cross-section estimates of (101.5 +- 2.1) mb and (101.9 +- 2.1) mb, respectively, in agreement with previous TOTEM measurements.Comment: Final version published in Nuclear Physics