Image guided robotic assistance for the diagnosis and treatment of tumor

The aim of this thesis is to demonstrate the feasibility and the potentiality of introduction of robotics and image guidance in the overall oncologic workflow, from the diagnosis to the treatment phase. The popularity of robotics in the operating room has grown in recent years. Currently the most popular systems is the da Vinci telemanipulator (Intuitive Surgical), it is based on a master-slave control, for minimally invasive surgery and it is used in several surgical fields such us urology, general, gynecology, cardiothoracic. An accurate study of this system, from a technological field of view, has been conducted addressing all drawbacks and advantages of this system. The da Vinci System creates an immersive operating environment for the surgeon by providing both high quality stereo visualization and a human-machine interface that directly connects the surgeon’s hands to the motion of the surgical tool tips inside the patient’s body. It has undoubted advantages for the surgeon work and for the patient health, at least for some interventions, while its very high costs leaves many doubts on its price benefit ratio. In the robotic surgery field many researchers are working on the optimization and miniaturization robots mechanic, while others are trying to obtain smart functionalities to realize robotic systems, that, “knowing” the patient anatomy from radiological images, can assists the surgeon in an active way. Regarding the second point, image guided systems can be useful to plan and to control medical robots motion and to provide the surgeon pre-operative and intra-operative images with augmented reality visualization to enhance his/her perceptual capacities and, as a consequence, to improve the quality of treatments. To demonstrate this thesis some prototypes has been designed, implemented and tested. The development of image guided medical devices, comprehensive of augmented reality, virtual navigation and robotic surgical features, requires to address several problems. The first ones are the choosing of the robotic platform and of the image source to employ. An industrial anthropomorphic arm has been used as testing platform. The idea of integrating industrial robot components in the clinical workflow has been supported by the da Vinci technical analysis. The algorithms and methods developed, regarding in particular robot calibration, based on literature theories and on an easily integration in the clinical scenario, can be adapted to each anthropomorphic arm. In this way this work can be integrated with light-weight robots, for industrial or clinical use, able to work in close contact to humans, which will become numerous in the early future. Regarding the medical image source, it has been decided to work with ultrasound imaging. Two-dimensional ultrasound imaging is widely used in clinical practice because is not dangerous for the patient, inexpensive, compact and it is a highly flexible imaging that allows users to study many anatomic structures. It is routinely used for diagnosis and as guidance in percutaneous treatments. However the use of 2D ultrasound imaging presents some disadvantages that require great ability of the user: it requires that the clinician mentally integrates many images to reconstruct a complete idea of the anatomy in 3D. Furthermore the freehand control of the probe make it difficult to individuate anatomic positions and orientations and probe repositioning to reach a particular location. To overcome these problems it has been developed an image guided system that fuse 2D US real time images with routinely CT or MRI 3D images, previously acquired from the patient, to enhance clinician orientation and probe guidance. The implemented algorithms for robot calibration and US image guidance has been used to realize two applications responding to specific clinical needs. The first one to speed up the execution of routinely and very recurrently procedures like percutaneous biopsy or ablation. The second one to improve a new completely non invasive type of treatment for solid tumors, the HIFU (High Intensity Focused Ultrasound). An ultrasound guided robotic system has been developed to assist the clinician to execute complicated biopsies, or percutaneous ablations, in particular for deep abdominal organs. It was developed an integrated system that provides the clinician two types of assistance: a mixed reality visualization allows accurate and easy planning of needle trajectory and target reaching verification; the robot arm equipped with a six-degree-of-freedom force sensor allows the precise positioning of the needle holder and allows the clinician to adjust, by means of a cooperative control, the planned trajectory to overcome needle deflection and target motion. The second application consists in an augmented reality navigation system for HIFU treatment. HIFU represents a completely non invasive method for treatment of solid tumors, hemostasis and other vascular features in human tissues. The technology for HIFU treatments is still evolving and the systems available on the market have some limitations and drawbacks. A disadvantage resulting from our experience with the machinery available in our hospital (JC200 therapeutic system Haifu (HIFU) by Tech Co., Ltd, Chongqing), which is similar to other analogous machines, is the long time required to perform the procedure due to the difficulty to find the target, using the remote motion of an ultrasound probe under the patient. This problem has been addressed developing an augmented reality navigation system to enhance US guidance during HIFU treatments allowing an easy target localization. The system was implemented using an additional free hand ultrasound probe coupled with a localizer and CT fused imaging. It offers a simple and an economic solution to an easy HIFU target localization. This thesis demonstrates the utility and usability of robots for diagnosis and treatment of the tumor, in particular the combination of automatic positioning and cooperative control allows the surgeon and the robot to work in synergy. Further the work demonstrates the feasibility and the potentiality of the use of a mixed reality navigation system to facilitate the target localization and consequently to reduce the times of sittings, to increase the number of possible diagnosis/treatments and to decrease the risk of potential errors. The proposed solutions for the integration of robotics and image guidance in the overall oncologic workflow, take into account current available technologies, traditional clinical procedures and cost minimization

a computer assisted robotic platform for vascular procedures exploiting 3d us based tracking

AbstractBackground: Cardiovascular diseases are the first cause of death globally: an estimated 17.5 million people died in 2012. By combining the benefits of magnetic navigation and ultrasound (US) imaging, the authors proposed a robotic platform (i.e. the MicroVAST platform) for intravascular medical procedures.Methods: A 3D imaging US-based tracking algorithm is implemented for the navigation of a magnetic-dragged soft-tethered device. Tests were performed to evaluate the algorithm in terms of tracking error and precision of locomotion.Results: The 3D imaging US-based algorithm tracked the endovascular device with an error of 6.4 ± 2.8 pixels and a mean displacement between the endovascular device and the preoperative path of 13.6 ± 4.5 mm (computational time of 12.2 ± 1.5 ms and 30.7 ± 6.1 matched features).Conclusions: The MicroVAST platform includes innovative solutions for navigation allowing for an assisted magnetic locomotion of medical devices in the cardiovascular district by combining a 3D ima..

Comparative health technology assessment of robotic-assisted, direct manual laparoscopic and open surgery:a prospective study

Background: Despite many publications reporting on the increased hospital cost of robotic-assisted surgery (RAS) compared to direct manual laparoscopic surgery (DMLS) and open surgery (OS), the reported health economic studies lack details on clinical outcome, precluding valid health technology assessment (HTA). Methods: The present prospective study reports total cost analysis on 699 patients undergoing general surgical, gynecological and thoracic operations between 2011 and 2014 in the Italian Public Health Service, during which period eight major teaching hospitals treated the patients. The study compared total healthcare costs of RAS, DMLS and OS based on prospectively collected data on patient outcome in addition to healthcare costs incurred by the three approaches. Results: The cost of RAS operations was significantly higher than that of OS and DMLS for both gynecological and thoracic operations (p < 0.001). The study showed no significant difference in total costs between OS and DMLS. Total costs of general surgery RAS were significantly higher than those of OS (p < 0.001), but not against DMLS general surgery. Indirect costs were significantly lower in RAS compared to both DMLS general surgery and OS gynecological surgery due to the shorter length of hospital stay of RAS approach (p < 0.001). Additionally, in all specialties compared to OS, patients treated by RAS experienced a quicker recovery and significantly less pain during the hospitalization and after discharge. Conclusions: The present HTA while confirming higher total healthcare costs for RAS operations identified significant clinical benefits which may justify the increased expenditure incurred by this approach

Procedimento e sistema per Ia rappresentazione tridimensionale di una scena a realta aumentata, particolarmente per applicazioni chirurgiche"

Abstract not availabl

A wearable augmented reality platform for telemedicine

This paper describes the development of the prototype of an Augmented Reality based tele-consultation platform settled with a wearable video see through Head Mounted Display (HMD) with the aim to provide specialist consult to low specialist remote area without the need to move the patient. The platform prototype has the donning advantage that gives the user an immersive experience, moreover the video see through HMD allows for intrinsic coherence of the scenes shared between the users (the mentor and the proctored clinician). The platform has been preliminarily evaluated from a technical point of view and two different scenarios were identified for future clinical testing: ambulatorial (gynecologic) and surgical (orthopaedic)

Hybrid simulation using mixed reality for interventional ultrasound imaging training

Purpose : Ultrasound (US) imaging offers advantages over other imaging modalities and has become the most widespread modality for many diagnostic and interventional procedures. However, traditional 2D US requires a long training period, especially to learn how to manipulate the probe. A hybrid interactive system based on mixed reality was designed, implemented and tested for hand–eye coordination training in diagnostic and interventional US. Methods : A hybrid simulator was developed integrating a physical US phantom and a software application with a 3D virtual scene. In this scene, a 3D model of the probe with its relative scan plane is coherently displayed with a 3D representation of the phantom internal structures. An evaluation study of the diagnostic module was performed by recruiting thirty-six novices and four experts. The performances of the hybrid (HG) versus physical (PG) simulator were compared. After the training session, each novice was required to visualize a particular target structure. The four experts completed a 5-point Likert scale questionnaire. Results : Seventy-eight percentage of the HG novices successfully visualized the target structure, whereas only 45&nbsp;% of the PG reached this goal. The mean scores from the questionnaires were 5.00 for usefulness, 4.25 for ease of use, 4.75 for 3D perception, and 3.25 for phantom realism. Conclusions : The hybrid US training simulator provides ease of use and is effective as a hand–eye coordination teaching tool. Mixed reality can improve US probe manipulation training

Technical review of the da Vinci surgical telemanipulator

Background: The da Vinci robotic surgical telemanipulator has been utilized in several surgical specialties for varied procedures, and the users' experiences have been widely published. To date, no detailed system technical analyses have been performed. Methods: A detailed review was performed of all publications and patents about the technical aspects of the da Vinci robotic system. Results: Published technical literature on the da Vinci system highlight strengths and weaknesses of the robot design. While the system facilitates complex surgical operations and has a low malfunction rate, the lack of haptic (especially tactile) feedback and collisions between the robotic arms remain the major limitations of the system. Accurate, preplanned positioning of access ports is essential. Conclusion: Knowledge of the technical aspects of the da Vinci robot is important for optimal use. We confirmed the excellent system functionality and ease of use for surgeons without an engineering background. Research and development of the surgical robot has been predominant in the literature. Future trends address robot miniaturization and intelligent control design

Configurable software framework for 2D/3D video see-through displays in medical applications

Augmented Reality (AR) has already proven its worth in various applications in the medical domain. However, most of the solutions proposed were bound to specific hardware or software configurations, and/or their application was limited to specific cases, thus lacking in flexibility. In this paper, we present a software framework suitable for AR video see-through systems conceived for medical applications: our solution allows merging of real world images grabbed by one or more external cameras with computer-generated sceneries coregistered to the acquired images. The software framework is highly configurable and extensible thanks to the employment of two text configuration files that make it suitable for many typologies of potential applications. The proposed solution can be easily adapted to functioning with different tracking and AR visualization modalities. The versatility of the software for video see-through AR applications was already tested on various medical applications, in conjunction with head-mounted displays or with external spatial displays

Robust and Accurate Algorithm for Wearable Stereoscopic Augmented Reality with Three Indistinguishable Markers

In the context of surgical navigation systems based on augmented reality (AR), the key challenge is to ensure the highest degree of realism in merging computer-generated elements with live views of the surgical scene. This paper presents an algorithm suited for wearable stereoscopic augmented reality video see-through systems for use in a clinical scenario. A video-based tracking solution is proposed that relies on stereo localization of three monochromatic markers rigidly constrained to the scene. A PnP-based optimization step is introduced to refine separately the pose of the two cameras. Video-based tracking methods using monochromatic markers are robust to non-controllable and/or inconsistent lighting conditions. The two-stage camera pose estimation algorithm provides sub-pixel registration accuracy. From a technological and an ergonomic standpoint, the proposed approach represents an effective solution to the implementation of wearable AR-based surgical navigation systems wherever rigid anatomies are involved

Patient-specific ultrasound liver phantom: materials and fabrication method

Purpose : An anatomically realistic ultrasound liver phantom with tissue-specific distinct signal properties is needed for training of novices in diagnostic and interventional procedures. The main objective of this work was development and testing of a new durable liver ultrasound training phantom for use with a hybrid simulator. Methods : A liver ultrasound phantom was fabricated in four main phases: materials selection, segmentation of CT images and realization of 3D models, vessel and lesion realization, and final assembly with silicone casting. Silicone was used as basic material due to its durability and stability over time. Several additives were analyzed and mixed with the polymer to reproduce the echogenicity of three simulated soft tissue types: parenchyma, lesions, and veins. Results : Cysts and vessel trees appear anechoic in the B mode ultrasound images when realized with pure silicone. The liver parenchyma, hypoechoic, and hyperechoic lesions were realized with different concentrations of graphite and Vaseline oil to increase their relative echogenicity. These materials were successful for creation of an ultrasound liver phantom containing simulated blood vessels and lesions. Conclusion : The phantom reproduces the human liver morphology and provides vessels and lesions ultrasound images with recognizable differences in echogenicity. The speed of sound in the simulated materials is inaccurate, but the problem can be overcome via software adjustment in a hybrid simulator