Real-time in vitro intravascular reconstruction and navigation for endovascular aortic stent grafting.

BACKGROUND: Trans-catheter endovascular stent grafting minimizes trauma and increases the benefitting patient population. However, the alignment between stent graft branches and vasculature branches remains time-consuming and challenging, and such techniques require a significant amount of contrast agent for imaging. METHODS: A new framework for intravascular reconstruction based on sensor fusion between intravascular ultrasound (IVUS) imaging and electromagnetic (EM) tracking was proposed. A new image processing method was presented to realize fully automatic processing of IVUS imaging and 3D reconstruction in real time, as well as branch detection for alignment and deployment. Complementary navigation using CT data allows for efficient catheter advancement and assistant clinical judgement. RESULTS: The reconstruction of an in vitro descending aorta phantom with branches was realized at 35 Hz, with cross-section radius average error of 0.64 mm. CONCLUSION: The proposed method demonstrates significant potential for clinical applications, enables navigation for precise alignment and placement for stent grafting to reduce surgical time, and decreases hemorrhagic collisions and the use of contrast agent. Copyright © 2016 John Wiley & Sons, Ltd.

In vitro simulator with numerical stress analysis for evaluation of stent-assisted coiling embolization in cerebral aneurysm treatments.

BACKGROUND: There are several complications associated with Stent-assisted Coil Embolization (SACE) in cerebral aneurysm treatments, due to damaging operations by surgeons and undesirable mechanical properties of stents. Therefore, it is necessary to develop an in vitro simulator that provides both training and research for evaluating the mechanical properties of stents. METHODS: A new in vitro simulator for three-dimensional digital subtraction angiography was constructed, followed by aneurysm models fabricated with new materials. Next, this platform was used to provide training and to conduct photoelastic stress analysis to evaluate the SACE technique. RESULTS: The average interaction stress increasingly varied for the two different stents. Improvements for the Maximum-Likelihood Expectation-Maximization method were developed to reconstruct cross-sections with both thickness and stress information. CONCLUSIONS: The technique presented can improve a surgeon's skills and quantify the performance of stents to improve mechanical design and classification. This method can contribute to three-dimensional stress and volume variation evaluation and assess a surgeon's skills.

In vitro strain measurements in cerebral aneurysm models for cyber-physical diagnosis.

BACKGROUND: The development of new diagnostic technologies for cerebrovascular diseases requires an understanding of the mechanism behind the growth and rupture of cerebral aneurysms. To provide a comprehensive diagnosis and prognosis of this disease, it is desirable to evaluate wall shear stress, pressure, deformation and strain in the aneurysm region, based on information provided by medical imaging technologies. METHODS: In this research, we propose a new cyber-physical system composed of in vitro dynamic strain experimental measurements and computational fluid dynamics (CFD) simulation for the diagnosis of cerebral aneurysms. A CFD simulation and a scaled-up membranous silicone model of a cerebral aneurysm were completed, based on patient-specific data recorded in August 2008. In vitro blood flow simulation was realized with the use of a specialized pump. A vision system was also developed to measure the strain at different regions on the model by way of pulsating blood flow circulating inside the model. RESULTS: Experimental results show that distance and area strain maxima were larger near the aneurysm neck (0.042 and 0.052), followed by the aneurysm dome (0.023 and 0.04) and finally the main blood vessel section (0.01 and 0.014). These results were complemented by a CFD simulation for the addition of wall shear stress, oscillatory shear index and aneurysm formation index. Diagnosis results using imaging obtained in August 2008 are consistent with the monitored aneurysm growth in 2011. CONCLUSION: The presented study demonstrates a new experimental platform for measuring dynamic strain within cerebral aneurysms. This platform is also complemented by a CFD simulation for advanced diagnosis and prediction of the growth tendency of an aneurysm in endovascular surgery.

Technical skills measurement based on a cyber-physical system for endovascular surgery simulation.

BACKGROUND: Quantification of medical skills is a challenge, particularly simulator-based training. In the case of endovascular intervention, it is desirable that a simulator accurately recreates the morphology and mechanical characteristics of the vasculature while enabling scoring. METHODS: For this purpose, we propose a cyber-physical system composed of optical sensors for a catheter's body motion encoding, a magnetic tracker for motion capture of an operator's hands, and opto-mechatronic sensors for measuring the interaction of the catheter tip with the vasculature model wall. Two pilot studies were conducted for measuring technical skills, one for distinguishing novices from experts and the other for measuring unnecessary motion. RESULTS: The proficiency levels were measurable between expert and novice and also between individual novice users. The results enabled scoring of the user's proficiency level, using sensitivity, reaction time, time to complete a task and respect for tissue integrity as evaluation criteria. Additionally, unnecessary motion was also measurable. CONCLUSION: The development of cyber-physical simulators for other domains of medicine depend on the study of photoelastic materials for human tissue modelling, and enables quantitative evaluation of skills using surgical instruments and a realistic representation of human tissue.

In vitro three-dimensional aortic vasculature modeling based on sensor fusion between intravascular ultrasound and magnetic tracker.

BACKGROUND: It is desirable to reduce aortic stent graft installation time and the amount of contrast media used for this process. Guidance with augmented reality can achieve this by facilitating alignment of the stent graft with the renal and mesenteric arteries. METHODS: For this purpose, a sensor fusion is proposed between intravascular ultrasound (IVUS) and magnetic trackers to construct three-dimensional virtual reality models of the blood vessels, as well as improvements to the gradient vector flow snake for boundary detection in ultrasound images. In vitro vasculature imaging experiments were done with hybrid probe and silicone models of the vasculature. RESULTS: The dispersion of samples for the magnetic tracker in the hybrid probe increased less than 1 mm when the IVUS was activated. Three-dimensional models of the descending thoracic aorta, with cross-section radius average error of 0.94 mm, were built from the data fusion. CONCLUSION: The development of this technology will enable reduction in the amount of contrast media required for in vivo and real-time three-dimensional blood vessel imaging.

Necesidades de Reversión post-ataranestesia, para cirugía ginecológica electiva en el servicio de anestesiología Hospital Escuelas Dr. Oscar Danilo Rosales Arguello agosto- diciembre 2003 / Needs OF Reversion post - ataranestesia, for surgery ginecológica elective in the service of anesthesiology Schools Hospital Dr. Oscar Danilo Rosale Arguello August - December 2003

Se estudiaron un total de 35 pacientes a los que se les administro anestesia general bajo la téncia ataranestesica a ellos al finalizar la cirugía se les evaluó las condiciones de la recuperación y se tomo la decisión de revertir por medio de el uso de neostigmina/atropina, naloxona, flumazenil, aquellos que ameritaban según valoración por neuroestimulador y Test. de Aldrete observando que el 57.1 prociento pacientes si requiró reversión farmacológica. Los hallazgos encontrados fueron que la ataranestesia requiere una alta frecuencia de reversión, ocurriendo comoplicaciones que en su mayoría son leves y moderadas en los pacientes en que se realizó el estudio...