Omnidirectional Monolithic Marker for Intra-Operative MR-Based Positional Sensing in Closed MRI.

We present a design of an inductively coupled radio frequency (ICRF) marker for magnetic resonance (MR)-based positional tracking, enabling the robust increase of tracking signal at all scanning orientations in quadrature-excited closed MR imaging (MRI). The marker employs three curved resonant circuits fully covering a cylindrical surface that encloses the signal source. Each resonant circuit is a planar spiral inductor with parallel plate capacitors fabricated monolithically on flexible printed circuit board (FPC) and bent to achieve the curved structure. Size of the constructed marker is Ø3-mm ×5 -mm with quality factor > 22, and its tracking performance was validated with 1.5 T MRI scanner. As result, the marker remains as a high positive contrast spot under 360° rotations in 3 axes. The marker can be accurately localized with a maximum error of 0.56 mm under a displacement of 56 mm from the isocenter, along with an inherent standard deviation of 0.1-mm. Accrediting to the high image contrast, the presented marker enables automatic and real-time tracking in 3D without dependency on its orientation with respect to the MRI scanner receive coil. In combination with its small form-factor, the presented marker would facilitate robust and wireless MR-based tracking for intervention and clinical diagnosis. This method targets applications that can involve rotational changes in all axes (X-Y-Z).

Interactive Multi-Stage Robotic Positioner for Intra-Operative MRI-Guided Stereotactic Neurosurgery.

Magnetic resonance imaging (MRI) demonstrates clear advantages over other imaging modalities in neurosurgery with its ability to delineate critical neurovascular structures and cancerous tissue in high-resolution 3D anatomical roadmaps. However, its application has been limited to interventions performed based on static pre/post-operative imaging, where errors accrue from stereotactic frame setup, image registration, and brain shift. To leverage the powerful intra-operative functions of MRI, e.g., instrument tracking, monitoring of physiological changes and tissue temperature in MRI-guided bilateral stereotactic neurosurgery, a multi-stage robotic positioner is proposed. The system positions cannula/needle instruments using a lightweight (203 g) and compact (Ø97 × 81 mm) skull-mounted structure that fits within most standard imaging head coils. With optimized design in soft robotics, the system operates in two stages: i) manual coarse adjustment performed interactively by the surgeon (workspace of ±30°), ii) automatic fine adjustment with precise (<0.2° orientation error), responsive (1.4 Hz bandwidth), and high-resolution (0.058°) soft robotic positioning. Orientation locking provides sufficient transmission stiffness (4.07 N/mm) for instrument advancement. The system's clinical workflow and accuracy is validated with lab-based (<0.8 mm) and MRI-based testing on skull phantoms (<1.7 mm) and a cadaver subject (<2.2 mm). Custom-made wireless omni-directional tracking markers facilitated robot registration under MRI.

In Situ Flexible Needle Adjustment Towards MRI-Guided Spinal Injections Based on Finite Element Simulation.

This paper investigates the possibility of robotically performing in situ needle manipulations to correct the needle tip position in the setting of robot-assisted, MRI-guided spinal injections, where real time MRI images cannot be effectively used to guide the needle. Open-loop control of the needle tip is derived from finite element simulation, and the proposed method is tested with ex vivo animal muscle tissues and validated by cone beam computed tomography. Preliminary results have shown promise of performing needle tip correction in situ to improve needle insertion accuracy when real-time feedback is not readily available.

Flexible Needle Bending Model for Spinal Injection Procedures.

An in situ needle manipulation technique used by physicians when performing spinal injections is modeled to study its effect on needle shape and needle tip position. A mechanics-based model is proposed and solved using finite element method. A test setup is presented to mimic the needle manipulation motion. Tissue phantoms made from plastisol as well as porcine skeletal muscle samples are used to evaluate the model accuracy against medical images. The effect of different compression models as well as model parameters on model accuracy is studied, and the effect of needle-tissue interaction on the needle remote center of motion is examined. With the correct combination of compression model and model parameters, the model simulation is able to predict needle tip position within submillimeter accuracy.

Output Reachable Set-Based Leader-Following Consensus of Positive Agents Over Switching Networks.

This work addresses the output reachable set-based leader-following consensus problem, focusing on a group of positive agents over directed dwell-time switching networks. Two types of non-negative disturbances, namely, 1) L1 -norm bounded disturbances and 2) L∞,1 -norm bounded disturbances are studied. Meanwhile, a class of directed dwell-time switching networks for modeling the communication protocol of positive agents is investigated. To deal with the presence of disturbances, an output-feedback control protocol is developed to achieve a robust consensus with positivity preserved based on the output reachable set. By exploiting the positive characteristics, switched linear copositive Lyapunov functions are adopted to establish output reachable set-based consensus conditions. These conditions can facilitate the control protocol design by solving a bilinear programming problem, and also generate hyperpyramidal regions to confine the output consensus error. A particle swarm optimization-based (PSO-based) algorithm is applied to compute the controller gains and optimize the volume of the hyperpyramids. The proposed methods are verified by the presented numerical case studies.

Decentralized H2 Control for Discrete-Time Networked Systems With Positivity Constraint.

In this brief, we study the decentralized H2 state-feedback control problem for networked discrete-time systems with positivity constraint. This problem (for a single positive system), raised recently in the area of positive systems theory, is known to be challenging due to its inherent nonconvexity. In contrast to most works, which only provide sufficient synthesis conditions for a single positive system, we study this problem within a primal-dual scheme, in which necessary and sufficient synthesis conditions are proposed for networked positive systems. Based on the equivalent conditions, we develop a primal-dual iterative algorithm for solution, which helps prevent from converging to a local minimum. In the simulation, two illustrative examples are employed for verification of our proposed results.

Positive Consensus of Fractional-Order Multiagent Systems Over Directed Graphs.

This article investigates the positive consensus problem of a special kind of interconnected positive systems over directed graphs. They are composed of multiple fractional-order continuous-time positive linear systems. Unlike most existing works in the literature, we study this problem for the first time, in which the communication topology of agents is described by a directed graph containing a spanning tree. This is a more general and new scenario due to the interplay between the eigenvalues of the Laplacian matrix and the controller gains, which renders the positivity analysis fairly challenging. Based on the existing results in spectral graph theory, fractional-order systems (FOSs) theory, and positive systems theory, we derive several necessary and/or sufficient conditions on the positive consensus of fractional-order multiagent systems (PCFMAS). It is shown that the protocol, which is designed for a specific graph, can solve the positive consensus problem of agents over an additional set of directed graphs. Finally, a comprehensive comparison study of different approaches is carried out, which shows that the proposed approaches have advantages over the existing ones.

Antibody stabilization for thermally accelerated deep immunostaining.

Antibodies have diverse applications due to their high reaction specificities but are sensitive to denaturation when a higher working temperature is required. We have developed a simple, highly scalable and generalizable chemical approach for stabilizing off-the-shelf antibodies against thermal and chemical denaturation. We demonstrate that the stabilized antibodies (termed SPEARs) can withstand up to 4 weeks of continuous heating at 55 °C and harsh denaturants, and apply our method to 33 tested antibodies. SPEARs enable flexible applications of thermocycling and denaturants to dynamically modulate their binding kinetics, reaction equilibrium, macromolecular diffusivity and aggregation propensity. In particular, we show that SPEARs permit the use of a thermally facilitated three-dimensional immunolabeling strategy (termed ThICK staining), achieving whole mouse brain immunolabeling within 72 h, as well as nearly fourfold deeper penetration with threefold less antibodies in human brain tissue. With faster deep-tissue immunolabeling and broad compatibility with tissue processing and clearing methods without the need for any specialized equipment, we anticipate the wide applicability of ThICK staining with SPEARs for deep immunostaining.

State of the Art and Future Opportunities in MRI-Guided Robot-Assisted Surgery and Interventions.

Magnetic resonance imaging (MRI) can provide high-quality 3-D visualization of target anatomy, surrounding tissue, and instrumentation, but there are significant challenges in harnessing it for effectively guiding interventional procedures. Challenges include the strong static magnetic field, rapidly switching magnetic field gradients, high-power radio frequency pulses, sensitivity to electrical noise, and constrained space to operate within the bore of the scanner. MRI has a number of advantages over other medical imaging modalities, including no ionizing radiation, excellent soft-tissue contrast that allows for visualization of tumors and other features that are not readily visible by other modalities, true 3-D imaging capabilities, including the ability to image arbitrary scan plane geometry or perform volumetric imaging, and capability for multimodality sensing, including diffusion, dynamic contrast, blood flow, blood oxygenation, temperature, and tracking of biomarkers. The use of robotic assistants within the MRI bore, alongside the patient during imaging, enables intraoperative MR imaging (iMRI) to guide a surgical intervention in a closed-loop fashion that can include tracking of tissue deformation and target motion, localization of instrumentation, and monitoring of therapy delivery. With the ever-expanding clinical use of MRI, MRI-compatible robotic systems have been heralded as a new approach to assist interventional procedures to allow physicians to treat patients more accurately and effectively. Deploying robotic systems inside the bore synergizes the visual capability of MRI and the manipulation capability of robotic assistance, resulting in a closed-loop surgery architecture. This article details the challenges and history of robotic systems intended to operate in an MRI environment and outlines promising clinical applications and associated state-of-the-art MRI-compatible robotic systems and technology for making this possible.

Nonnegative Consensus Tracking of Networked Systems With Convergence Rate Optimization.

This article investigates the nonnegative consensus tracking problem for networked systems with a distributed static output-feedback (SOF) control protocol. The distributed SOF controller design for networked systems presents a more challenging issue compared with the distributed state-feedback controller design. The agents are described by multi-input multi-output (MIMO) positive dynamic systems which may contain uncertain parameters, and the interconnection among the followers is modeled using an undirected connected communication graph. By employing positive systems theory, a series of necessary and sufficient conditions governing the consensus of the nominal, as well as uncertain, networked positive systems, is developed. Semidefinite programming consensus design approaches are proposed for the convergence rate optimization of MIMO agents. In addition, by exploiting the positivity characteristic of the systems, a linear-programming-based design approach is also proposed for the convergence rate optimization of single-input multi-output (SIMO) agents. The proposed approaches and the corresponding theoretical results are validated by case studies.

Further Improvements on Non-Negative Edge Consensus of Networked Systems.

In this article, the non-negative edge consensus problem is addressed for positive networked systems with undirected graphs using state-feedback protocols. In contrast to existing results, the major contributions of this work included: 1) significantly improved criteria of consequentiality and non-negativity, therefore leading to a linear programming approach and 2) necessary and sufficient criteria giving rise to a semidefinite programming approach. Specifically, an improved upper bound is given for the maximum eigenvalue of the Laplacian matrix and the (out-) in-degree of the degree matrix, and an improved consensuability and non-negativevity condition is obtained. The sufficient condition presented only requires the number of edges of a nodal network without the connection topology. Also, with the introduction of slack matrix variables, two equivalent conditions of consensuability and non-negativevity are obtained. In the conditions, the system matrices, controller gain, as well as Lyapunov matrices are separated, which is helpful for parameterization. Based on the results, a semidefinite programming algorithm for the controller is readily developed. Finally, a comprehensive analytical and numerical comparison of three illustrative examples is conducted to show that the proposed results are less conservative than the existing work.

Consensus of Positive Networked Systems on Directed Graphs.

This article addresses the distributed consensus problem for identical continuous-time positive linear systems with state-feedback control. Existing works of such a problem mainly focus on the case where the networked communication topologies are of either undirected and incomplete graphs or strongly connected directed graphs. On the other hand, in this work, the communication topologies of the networked system are described by directed graphs each containing a spanning tree, which is a more general and new scenario due to the interplay between the eigenvalues of the Laplacian matrix and the controller gains. Specifically, the problem involves complex eigenvalues, the Hurwitzness of complex matrices, and positivity constraints, which make analysis difficult in the Laplacian matrix. First, a necessary and sufficient condition for the consensus analysis of directed networked systems with positivity constraints is given, by using positive systems theory and graph theory. Unlike the general Riccati design methods that involve solving an algebraic Riccati equation (ARE), a condition represented by an algebraic Riccati inequality (ARI) is obtained for the existence of a solution. Subsequently, an equivalent condition, which corresponds to the consensus design condition, is derived, and a semidefinite programming algorithm is developed. It is shown that, when a protocol is solved by the algorithm for the networked system on a specific communication graph, there exists a set of graphs such that the positive consensus problem can be solved as well.

A Survey for Machine Learning-Based Control of Continuum Robots.

Soft continuum robots have been accepted as a promising category of biomedical robots, accredited to the robots' inherent compliance that makes them safely interact with their surroundings. In its application of minimally invasive surgery, such a continuum concept shares the same view of robotization for conventional endoscopy/laparoscopy. Different from rigid-link robots with accurate analytical kinematics/dynamics, soft robots encounter modeling uncertainties due to intrinsic and extrinsic factors, which would deteriorate the model-based control performances. However, the trade-off between flexibility and controllability of soft manipulators may not be readily optimized but would be demanded for specific kinds of modeling approaches. To this end, data-driven modeling strategies making use of machine learning algorithms would be an encouraging way out for the control of soft continuum robots. In this article, we attempt to overview the current state of kinematic/dynamic model-free control schemes for continuum manipulators, particularly by learning-based means, and discuss their similarities and differences. Perspectives and trends in the development of new control methods are also investigated through the review of existing limitations and challenges.

Soft robotic manipulator for intraoperative MRI-guided transoral laser microsurgery.

Magnetic resonance (MR) imaging (MRI) provides compelling features for the guidance of interventional procedures, including high-contrast soft tissue imaging, detailed visualization of physiological changes, and thermometry. Laser-based tumor ablation stands to benefit greatly from MRI guidance because 3D resection margins alongside thermal distributions can be evaluated in real time to protect critical structures while ensuring adequate resection margins. However, few studies have investigated the use of projection-based lasers like those for transoral laser microsurgery, potentially because dexterous laser steering is required at the ablation site, raising substantial challenges in the confined MRI bore and its strong magnetic field. Here, we propose an MR-safe soft robotic system for MRI-guided transoral laser microsurgery. Owing to its miniature size (Ø12 × 100 mm), inherent compliance, and five degrees of freedom, the soft robot ensures zero electromagnetic interference with MRI and enables safe and dexterous operation within the confined oral and pharyngeal cavities. The laser manipulator is rapidly fabricated with hybrid soft and hard structures and is powered by microvolume (<0.004 milliter) fluid flow to enable laser steering with enhanced stiffness and lowered hysteresis. A learning-based controller accommodates the inherent nonlinear robot actuation, which was validated with laser path-following tests. Submillimeter laser steering accuracy was demonstrated with a mean error < 0.20 mm. MRI compatibility testing demonstrated zero observable image artifacts during robot operation. Ex vivo tissue ablation and a cadaveric head-and-neck trial were carried out under MRI, where we employed MR thermometry to monitor the tissue ablation margin and thermal diffusion intraoperatively.

Real-to-virtual domain transfer-based depth estimation for real-time 3D annotation in transnasal surgery: a study of annotation accuracy and stability.

PURPOSE: Surgical annotation promotes effective communication between medical personnel during surgical procedures. However, existing approaches to 2D annotations are mostly static with respect to a display. In this work, we propose a method to achieve 3D annotations that anchor rigidly and stably to target structures upon camera movement in a transnasal endoscopic surgery setting. METHODS: This is accomplished through intra-operative endoscope tracking and monocular depth estimation. A virtual endoscopic environment is utilized to train a supervised depth estimation network. An adversarial network transfers the style from the real endoscopic view to a synthetic-like view for input into the depth estimation network, wherein framewise depth can be obtained in real time. RESULTS: (1) Accuracy: Framewise depth was predicted from images captured from within a nasal airway phantom and compared with ground truth, achieving a SSIM value of 0.8310 ± 0.0655. (2) Stability: mean absolute error (MAE) between reference and predicted depth of a target point was 1.1330 ± 0.9957 mm. CONCLUSION: Both the accuracy and stability evaluations demonstrated the feasibility and practicality of our proposed method for achieving 3D annotations.

Performance-aware programming for intraoperative intensity-based image registration on graphics processing units.

PURPOSE: Intensity-based image registration has been proven essential in many applications accredited to its unparalleled ability to resolve image misalignments. However, long registration time for image realignment prohibits its use in intra-operative navigation systems. There has been much work on accelerating the registration process by improving the algorithm's robustness, but the innate computation required by the registration algorithm has been unresolved. METHODS: Intensity-based registration methods involve operations with high arithmetic load and memory access demand, which supposes to be reduced by graphics processing units (GPUs). Although GPUs are widespread and affordable, there is a lack of open-source GPU implementations optimized for non-rigid image registration. This paper demonstrates performance-aware programming techniques, which involves systematic exploitation of GPU features, by implementing the diffeomorphic log-demons algorithm. RESULTS: By resolving the pinpointed computation bottlenecks on GPU, our implementation of diffeomorphic log-demons on Nvidia GTX Titan X GPU has achieved ~ 95 times speed-up compared to the CPU and registered a 1.3-M voxel image in 286 ms. Even for large 37-M voxel images, our implementation is able to register in 8.56 s, which attained ~ 258 times speed-up. Our solution involves effective employment of GPU computation units, memory, and data bandwidth to resolve computation bottlenecks. CONCLUSION: The computation bottlenecks in diffeomorphic log-demons are pinpointed, analyzed, and resolved using various GPU performance-aware programming techniques. The proposed fast computation on basic image operations not only enhances the computation of diffeomorphic log-demons, but is also potentially extended to speed up many other intensity-based approaches. Our implementation is open-source on GitHub at https://bit.ly/2PYZxQz .

Reachable Set Estimation and Synthesis for Periodic Positive Systems.

This paper investigates the problems of reachable set estimation and synthesis for periodic positive systems with two different exogenous disturbances. The lifting method and the pseudoperiodic Lyapunov function method are adopted for the estimation problem. The reachable set bounding conditions are proposed by employing Lyapunov-based inequalities and the S-procedure technique. Two optimization methods are used to minimize the bounding hyper-pyramids of the reachable set. In addition, the state-feedback controller design conditions that make the reachable set of closed-loop systems lie within a given hyper-pyramid are derived. Finally, numerical examples are presented to illustrate the validity of the obtained conditions.

An Unsupervised Machine Learning Clustering and Prediction of Differential Clinical Phenotypes of COVID-19 Patients Based on Blood Tests-A Hong Kong Population Study.

Background: To better understand the different clinical phenotypes across the disease spectrum in patients with COVID-19 using an unsupervised machine learning clustering approach. Materials and Methods: A population-based retrospective study was conducted utilizing demographics, clinical characteristics, comorbidities, and clinical outcomes of 7,606 COVID-19-positive patients on admission to public hospitals in Hong Kong in the year 2020. An unsupervised machine learning clustering was used to explore this large cohort. Results: Four clusters of differing clinical phenotypes based on data at initial admission was derived in which 86.6% of the deceased cases were aggregated in one of the clusters without prior knowledge of their clinical outcomes. Other distinctive clinical characteristics of this cluster were old age and high concurrent comorbidities as well as laboratory characteristics of lower hemoglobin/hematocrit levels, higher neutrophil, C-reactive protein, lactate dehydrogenase, and creatinine levels. The clinical patterns captured by the cluster analysis was validated on other temporally distinct cohorts in 2021. The phenotypes aligned with existing literature. Conclusion: The study demonstrated the usefulness of unsupervised machine learning techniques with the potential to uncover latent clinical phenotypes. It could serve as a more robust classification for patient triaging and patient-tailored treatment strategies.

Towards Safe In Situ Needle Manipulation for Robot Assisted Lumbar Injection in Interventional MRI.

Lumbar injection is an image-guided procedure performed manually for diagnosis and treatment of lower back pain and leg pain. Previously, we have developed and verified an MR-Conditional robotic solution to assisting the needle insertion process. Drawing on our clinical experiences, a virtual remote center of motion (RCM) constraint is implemented to enable our robot to mimic a clinician's hand motion to adjust the needle tip position in situ. Force and image data are collected to study the needle behavior in gel phantoms during this motion, and a mechanics-based needle-tissue interaction model is proposed and evaluated to further examine the underlying physics. This work extends the commonly-adopted notion of an RCM for flexible needles, and introduces new motion parameters to describe the needle behavior. The model parameters can be tuned to match the experimental result to sub-millimeter accuracy, and this proposed needle manipulation method presents a safer alternative to laterally translating the needle during in situ needle adjustments.