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Surgery & Intervention
Chair: Jenny Dankelman
14:00
15 mins
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Real-time tissue feedback for spine surgery using a customized fiber optic probe
Merle S. Losch, Jenny Dankelman, Benno H. W. Hendriks
Abstract: Significance: Multiple medical conditions such as vertebral fractures, degenerative diseases or spinal deformities can require patients to undergo spine surgery. Accuracy varies greatly depending on the experience of the physician, and guidance is required to prevent serious injury to nearby neural and vascular structures. Integrating fiber optics into the spine surgery device allows for reliable tissue feedback in real time using Diffuse Reflectance Spectroscopy (DRS). So far, research has been limited to conventional probes with two parallel optical fibers, which is a convenient probe layout for the detection (and prevention) of perpendicular breaches.
Aim: As anatomical conditions and entry point recommendations for spine surgery are likely to produce breaches non-perpendicular to the bone interface, our study aims at investigating how an optical probe with a customized layout can help to anticipate non-perpendicular breaches. A sideways-looking DRS probe can be created by protruding the collecting fiber with regards to the emitting fiber.
Approach: We conducted Monte Carlo simulations and optical phantom experiments to investigate how protrusion of the collecting fiber affects the probed volume to allow for the detection of acute breaches employing a customized fiber optic probe.
Results: The simulations show that the probed volume can be manipulated with the help of fiber protrusion. In the phantom experiments, difference in intensity magnitude between cancellous and cortical spectra changes with fiber protrusion.
Conclusion: DRS can enhance spine surgery by allowing to detect impending breaches. With our results from MC simulations and optical phantom experiments, we show how the use of protruded fibers allows to manipulate the probed volume to detect proximity of the cortical layer at acute angles. This suggests that our customized fiber optic probe is beneficial in acute breach scenarios.
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14:15
15 mins
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Estimation of hepatic respiratory-induced motion using an RGB-D camera as a surrogate
Ana Cordon Cordon, Yoeko Mak, Momen Abayazid
Abstract: Liver cancer is one of the most common causes of cancer death [1]. Percutaneous liver biopsy and tumor ablation are two procedures widely implemented in the diagnosis and treatment of hepatic lesions. Respiratory motion limits the accuracy of abdominal/thoracic percutaneous procedures [2]. The tumor’s position changes with time, and current medical imaging modalities fail to provide simultaneous high-quality real-time visualization [3]. Motion tracking techniques offer the possibility to estimate the position of a tumor in real-time using surrogate signals [4]. This work aims to evaluate the implementation of an RGB-D camera as a surrogate signal to create a motion model that estimates the respiratory-induced motion in the liver.
The proposed approach uses the RGB-D camera to create point clouds that capture the respiratory-induced changes in the abdominal area and use it as an input for the motion model. A correspondence model is created implementing supervised learning approaches. The RGB-D camera was evaluated in two scenarios, a robotic liver phantom and a human subject experiment. An electromagnetic sensor and ultrasound images served as ground truth for the phantom and human subject experiments, respectively. A robotic manipulator was included in the phantom set-up to perform the needle steering and insertion tasks. The performance of the correspondence models and the robotic manipulator were evaluated using the ground truth.
The created motion model for the robotic liver phantom showed a mean absolute error of 0.59 mm and 2.66 mm. The coefficients of determination for the anterior-posterior and superior-inferior directions were 0.96 and 0.70, respectively. The implementation of the robotic manipulator displayed a needle insertion error of 3 mm. The human subject experiment results displayed a coefficient of determination above 0.75 in all sessions.
To conclude, abdominal point cloud reconstructions can serve as a surrogate to estimate in real-time the respiratory-induced motion in the liver. This work incorporates a real-time tumor tracking algorithm implemented by a robotic manipulator which performs the needle steering task. Further work should account for the tool-tissue interaction that takes place while performing the needle insertion, as well as other sources of motion that might affect the position of the tumor.
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14:30
15 mins
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Optimization of edge enhancement in endoscopic systems to the perception of ENT-professionals
Geert Geleijnse, Laura Veder, Marieke Hakkesteegt, Jet de Gier, Bernd Rieger, Mick Metselaar
Abstract: Introduction. Flexible endoscopes are essential for diagnostics [1]. Digital endoscopes are connected to a video processor that can perform various operations to improve the image. One of those operations is edge enhancement that sharpens the image [2, 3]. Sharpening is applied to compensate for the blur that results from enlarging the image captured by the endoscope chip. The image on screen is typically enlarged by a factor of four. Sharpness has a major impact on the perception of image quality by ENT-professionals [4]. Unfortunately, the algorithm and parameters that the processors apply are unknown, the name varies per video processor and the units that express the strength of the operation are arbitrary. These unknowns make it difficult to compare the image quality or standardize the level of edge enhancement. We solved this by uniformly measuring the level of edge enhancement with test images [5, 6].
Now we would like to optimize the level of edge enhancement with respect to the perception by ENT-professionals. Images without edge enhancement will be perceived as vague, whereas excessive levels of edge enhancement yield sharper images but contain objectionable artifacts and too much noise.
Method. Edge enhancement is studied in three types of flexible digital ENT endoscopes by taking in vitro pictures of the Rez checker target, while systematically varying the levels of edge enhancement that are available on the video processors. The level of edge enhancement, sharpness and noise can be measured using these test images. We then collected series of in vivo images of the larynx of a healthy test subject while systematically varying the levels of edge enhancement that are available on the video processors.
Each series of in vivo images will be presented to ENT-professionals for a forced pairwise comparison test, in which the participants have to select the image with the best image quality for diagnostic purposes and ignore variables like orientation and position of the endoscopic tip. The numbers of votes are converted to a psychometric scale of just noticeable differences according to the Thurstone V model.
Results. We expect to present preliminary results at BME 2023.
References
[1] B. C. Paul, S. Chen, S. Sridharan, Y. Fang, M. R. Amin and R. C. Branski, “Diagnostic accuracy of history, laryngoscopy, and stroboscopy,” The Laryngoscope, vol. 123, no. 1, pp. 215-219, 2012.
[2] M. Kawaida, F. Hiroyuki and N. Kohno, “Observations of laryngeal lesions with a rhinolarynx electronic videoendoscope system and digital image processing,” Ann Otol Rhinol Laryngol, vol. 107, no. 10 Pt 1, pp. 855-9, 1998.
[3] M. Kawaida, H. Fukuda and N. Kohno, “Digital image processing of laryngeal lesions by electronic videoendoscopy,” Laryngoscope, vol. 112, no. 3, pp. 559-64, 2002.
[4] G. Geleijnse, L. L. Veder, M. M. Hakkesteegt and R. M. Metselaar, “The objective measurement and subjective perception of image quality of flexible ENT endoscopes,” Journal of Image Science & Technology, vol. 66, no. 3, pp. 1-6, 2022.
[5] G. Geleijnse and B. Rieger, “Influence of edge enhancement applied in endoscopic systems on sharpness and noise,” Journal of Biomedical Optics, vol. 27, no. 10, 2022.
[6] G. Geleijnse and B. Rieger, “Edge enhancement applied in ENT-endoscopic systems,” in 9th Dutch Bio-Medical Engineering Conference, Egmond aan Zee, 2022.
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14:45
15 mins
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Augmented reality image guidance for minimally invasive craniosynostosis surgery
Abdullah Thabit, ohamed Benmahdjoub, Marie-lise van Veelen, Wiro Niessen, Eppo Wolvius, Theo van Walsum
Abstract: Purpose: In minimally invasive spring-assisted craniectomy, surgeons plan the surgery by manually locating the cranial sutures. However, this approach is prone to error. Augmented reality (AR) could be used to visualize the cranial sutures and assist in the surgery planning. The purpose of this work is to develop an AR-based system to visualize cranial sutures, and to assess the accuracy and usability of using AR-based navigation for surgical guidance in minimally invasive spring-assisted craniectomy.
Methods: An AR system was developed that consists of an electromagnetic (EM) tracking system linked with a Microsoft HoloLens. The system was used to conduct a phantom study with two skull phantoms. For each phantom, five sutures were annotated and visualized on the skull surface. Twelve participants assessed the system. For each participant, model alignment using six anatomical landmarks was performed, followed by the participant delineation of the visualized sutures. At the end, the participants filled a System Usability Scale (SUS) questionnaire. For evaluation, a model alignment using ten registration landmarks was performed and the delineated sutures were digitized and compared to the CT-annotated sutures. Furthermore, the time spent during the delineation task was assessed.
Results: For a total of 120 delineated sutures, the distance of the annotated sutures to the planning reference was 2.4 ± 1.2 mm. The average delineation time per suture was 13 ± 5 s. For the system usability questionnaire, an average SUS score of 73 was obtained.
Conclusion: The developed AR-system has good accuracy (average 2.4 mm distance) and could be used in the OR.
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15:00
15 mins
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Towards safer-and more efficient remote liver needle insertion with haptic feedback
Mostafa Selim, Anne Verhoef, Momen Abayazid
Abstract: One of the most challenging medical procedures involves operating on the liver because of its
complex features, mechanical properties, and continuous movement. Remote needle insertion
for the liver and general medical procedures using haptic feedback are uncommon. The required
training, safety considerations, and technological feasibility are some challenges to
implementing such a feature. Stability and transparency are the main challenges of any haptic
device in a teleoperated system. These make it challenging to develop a safe and efficient
system that suits the physician's needs in liver needle insertion procedures, not damaging
healthy tissues, and extracting correct samples. [1] [2] [3]
The work aims to investigate whether teleoperation with haptic feedback potentially improves
the efficiency and safety of the liver needle insertion procedure compared to conventional
methods. We conducted a study to look into state-of-the-art haptic device technologies, and
then we developed a prototype to test the hypothesis.
The 1 DOF pneumatic haptic device provides kinesthetic feedback to perform the needle
insertion remotely to investigate the added value of haptic feedback. It consists of a joystick to
control the needle position and two soft pneumatic actuators assembled into a ring, which
provides force feedback. The device can be used for multiple procedures, such as biopsies and
ablation. The design requirements were investigated by conducting experiments in different
operating conditions and evaluating the potentiometer and the force sensor measurements.
The results showed that the haptic device can be controlled to generate forces up to 20 N with
keeping track of the handle position in real-time. Future work will include integrating this
device with a replica needle insertion device and a force sensor to send the signal to the haptic
device. Moreover, we will evaluate the system's transparency by comparing the force signal
provided by the replica and the one felt by the user. Finally, mechanical stops and
environmental awareness algorithms will be integrated into the system to guarantee safety.
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15:15
15 mins
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Biomedical Engineering for Global Health Design of a laparoscope using a USB camera to support the global implementation of minimally invasive surgery
Roos Oosting, Jenny Dankelman
Abstract: The need for surgery in low- and middle-income countries (LMICs) is tremendous; more people die from treatable surgical conditions than from tuberculosis, malaria and HIV put together (1). As such, patients in these regions can benefit from minimally invasive surgeries (MIS) with its reduction in pain and operation time, length of hospitalization, and morbidity compared to open surgical techniques. There is a growing interest in MIS in most LMICs, but its widespread adoption has been challenging due to high start-up costs, lack of technological support, and limited access to training (2).
To overcome these barriers, we see a huge opportunity and need for biomedical engineers from all over the world to contribute to increasing access to safe (minimally invasive) surgery on a global scale, which is also more and more endorsed by the international community of biomedical engineers (3). For the last 5 years, we have been working on various projects in the field of Biomedical Engineering for Global Health within the department of Biomechanical Engineering at the TU Delft in collaboration with biomedical engineers and surgeons working in Kenya, India, Surinam, Malawi, and Nepal. We conducted various context studies to understand the context of use (4-6), and we worked on a context-driven design approach to support engineers working on innovations for LMICs settings (7) and various prototypes for example a novel context-specific electrosurgical device (8), a video laryngoscope using a USB camera and mobile phone, a manual vacuum pump (all currently under development by the spin-off company Layco Medical) and a dozen graduation projects on various solutions for global health.
One of our studies (6) revealed that the light source and cameras used during MIS are prone to breaking, we are therefore currently developing a laparoscope using a USB-Camera connected to a laptop or tablet that provides enough light for diagnostic purposes and small laparoscopic surgeries. Prototypes are currently under development and our aim is to perform user tests on a large Innovation for Global Surgery conference in Kenya in April 2023.
1. Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet. 2015;386(9993):569-624.
2. Gheza F, Oginni FO, Crivellaro S, Masrur MA, Adisa AO. Affordable laparoscopic camera system (ALCS) designed for low-and middle-income countries: a feasibility study. World journal of surgery. 2018;42(11):3501-7.
3. De Maria C, Díaz Lantada A, Jämsä T, Pecchia L, Ahluwalia A. Biomedical engineering in low-and middle-income settings: analysis of current state, challenges and best practices. Health and technology. 2022:1-11.
4. Oosting RM, Wauben LS, Mwaura SW, Madete JK, Groen RS, Dankelman J. Barriers to availability of surgical equipment in Kenya: A surgical equipment journey approach. Global Clinical Engineering Journal. 2019;1(2):35-42.
5. Oosting R, Wauben L, Groen R, Dankelman J. Equipment for essential surgical care in 9 countries across Africa: availability, barriers and need for novel design. Health and Technology. 2019;9(3):269-75.
6. Oosting R, Wauben L, Madete J, Groen R, Dankelman J. Availability, procurement, training, usage, maintenance and complications of electrosurgical units and laparoscopic equipment in 12 African countries. BJS open. 2020;4(2):326-31.
7. Oosting R, Dankelman J, Wauben L, Madete J, Groen R, editors. Roadmap for design of surgical equipment for safe surgery worldwide. 2018 IEEE Global Humanitarian Technology Conference (GHTC); 2018: IEEE.
8. Oosting R, Ouweltjes K, Hoeboer M, Hesselink L, Madete J, Diehl J-C, et al. A context-specific design of an electrosurgical unit and monopolar handheld to enhance global access to surgical care: a design approach based on contextual factors. Journal of Medical Devices. 2020;14(1).
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