Augmented Reality Assisted Surgical Navigation System for Epidural Needle Intervention.

An augmented reality (AR)-assisted surgical navigation system was developed for epidural needle intervention. The system includes three components: a virtual reality-based surgical planning software, a patient and tool tracking system, and an AR-based surgical navigation system. A three-dimensional (3D) path plan for the epidural needle was established on the preoperative computed tomography (CT) image. The plan is then registered to the intraoperative space by 3D models of the target vertebrae using skin markers and real-time tracking information. In the procedure, the plan and tracking information are transmitted to the head-mounted display (HMD) through a wireless network such that the device directly visualizes the plan onto the back surface of the patient. The physician determines the entry point and inserts the needle into the target based on the direct visual guidance of the system. An experiment was conducted to validate the system using two torso phantoms that mimic human respiration. The experimental results demonstrated that the time and the number of X-rays required for needle insertion were significantly decreased by the proposed method (43.6±20.55sec, 2.9±1.3times) compared to those of the conventional fluoroscopy-guided approach (124.5 ± 46.7s, 9.3±2.4times), whereas the average targeting errors were similar in both cases. The proposed system may potentially decrease ionizing radiation exposure not only to the patient but also to the medical team.

Artificial Neural Network enabling Clinically Meaningful Biological Image Data Generation.

Biological experiments for developing efficient cancer therapeutics require significant resources of time and costs particularly in acquiring biological image data. Thanks to recent advances in AI technologies, there have been active researches in generating realistic images by adapting artificial neural networks. Along the same lines, this paper proposes a learning-based method to generate images inheriting biological characteristics. Through a statistical comparison of tumor penetration metrics between generated images and real images, we have shown that forged micrograph images contain vital characteristics to analyze tumor penetration performance of infecting agents, which opens up the promising possibilities for utilizing proposed methods for generating clinically meaningful image data.

3D Pose and Curvature Estimation of Bendable Interventional Device using Single-view X-ray Image.

We present a novel method to estimate the 3D pose and curvature of bendable interventional devices using a single X-ray image. A preliminary experiment was performed to demonstrate the feasibility of the proposed method. The mean estimation accuracies were 3.48mm and 0.59mm for the 3D pose and the radius of curvature of the bendable cardiac ablation catheter, respectively. This method has the potential to help clinicians to make a better intraoperative decision during the procedure, resulting in expedite surgery and reduce exposure to ionizing radiation.Clinical relevance- This novel method has the potential to improve clinician's intraoperative decision-making by providing the 3D pose and curvature information of bendable interventional devices, such as flexible catheter and endoscope.

Preclinical evaluation of a pediatric airway stent for tracheobronchomalacia.

OBJECTIVES: We sought to demonstrate in an animal model that helical stents made from a nickel titanium alloy called nitinol (NiTi) and designed for malacic airways could be delivered and removed without significant trauma while minimally impeding mucus clearance during the period of implantation. METHODS: Stents were delivered and removed from the tracheas of healthy 20 kg swine (n = 5) using tools designed to minimize trauma. In 4-week experiments, the stents were implanted on day 0, removed after 3 weeks, and swine were put to death after 4 weeks. Weekly bronchoscopies, radiographs, and mucus clearance examinations were performed in vivo. Hematoxylin and eosin staining and scanning electron microscopy imaging were used to evaluate foreign body response, tracheal tissue reaction, and damage and to measure unciliated regions. RESULTS: In all in vivo experiments, the stent was implanted and removed atraumatically. Mucus clearance was maintained throughout the experiment period. Hematoxylin and eosin-stained slides showed that foreign body response and tracheal tissue damage were localized to the stented subsections. Tracheal tissue reaction and damage was further restricted to the epithelium and submucosal layers. Scanning electron microscopy imaging revealed that the cilia were absent only over the contact area between the trachea and the wire forming the helical stent. CONCLUSIONS: Helical nitinol stents designed to provide radial support for malacic airways were well tolerated in a porcine model, providing for mucus clearance while also enabling atraumatic removal.

Pediatric Airway Stent Designed to Facilitate Mucus Transport and Atraumatic Removal.

OBJECTIVE: The goal was to develop a pediatric airway stent for treating tracheobronchomalacia that could be used as an alternative to positive pressure ventilation. The design goals were for the stent to allow mucus flow and to resist migration inside the airways, while also enabling easy insertion and removal. METHODS: A helical stent design, together with insertion and removal tools, is presented. A mechanics model of stent compression is derived to assist in selecting stent design parameters (pitch and wire diameter) that provide the desired amount of tracheal support, while introducing the minimal amount of foreign material into the airway. Worst-case airway area reduction with stent support is investigated experimentally using a pressurized tracheal phantom matched to porcine tracheal tissue properties. The stent design is then evaluated in a porcine in vivo experiment. RESULTS: Phantom testing validated the mechanics model of stent compression. In vivo testing demonstrated that the stent was well tolerated by the animal. Since the helical design covers only a small portion of the epithelium, mucus transport through the stented region was minimally impeded. Furthermore, the screw-like stent resisted migration, while also providing for atraumatic removal through the use of an unscrewing motion during removal. CONCLUSION: The proposed stent design and tools represent a promising approach to prevent airway collapse in children with tracheobronchomalacia. SIGNIFICANCE: The proposed technology overcomes the limitations of existing airway stents and may provide an alternative to maintaining children on a ventilator.

Optimizing Tube Precurvature to Enhance Elastic Stability of Concentric Tube Robots.

Robotic instruments based on concentric tube technology are well suited to minimally invasive surgery since they are slender, can navigate inside small cavities and can reach around sensitive tissues by taking on shapes of varying curvature. Elastic instabilities can arise, however, when rotating one precurved tube inside another. In contrast to prior work that considered only tubes of piecewise constant precurvature, we allow precurvature to vary along the tube's arc length. Stability conditions for a planar tube pair are derived and used to formulate an optimal design problem. An analytic formulation of the optimal precurvature function is derived that achieves a desired tip orientation range while maximizing stability and respecting bending strain limits. This formulation also includes straight transmission segments at the proximal ends of the tubes. The result, confirmed by both numerical and physical experiment, enables designs with enhanced stability in comparison to designs of constant precurvature.

Elastic Stability of Concentric Tube Robots Subject to External Loads.

Concentric tube robots, which are comprised of precurved elastic tubes that are concentrically arranged, are being developed for many medical interventions. The shape of the robot is determined by the rotation and translation of the tubes relative to each other, and also by any external forces applied by the environment. As the tubes rotate and translate relative to each other, elastic potential energy caused by tube bending and twisting can accumulate; if a configuration is not locally elastically stable, then a dangerous snapping motion may occur as energy is suddenly released. External loads on the robot also influence elastic stability. In this paper, we provide a second-order sufficient condition, and also a separate necessary condition, for elastic stability. Using methods of optimal control theory, we show that these conditions apply to general concentric tube robot designs subject to arbitrary conservative external loads. They can be used to assess the stability of candidate robot configurations. Our results are validated via comparison with other known stability criteria, and their utility is demonstrated by an application to stable path planning.