Strategy for automatic ultrasound (US) probe positioning in robot-assisted ultrasound guided radiation therapy.

Objective. As part of image-guided radiotherapy, ultrasound-guided radiotherapy is currently already in use and under investigation for robot assisted systems Ipsen 2021. It promises a real-time tumor localization during irradiation (intrafractional) without extra dose. The ultrasound probe is held and guided by a robot. However, there is a lack of basic safety mechanisms and interaction strategies to enable a safe clinical procedure. In this study we investigate potential positioning strategies with safety mechanisms for a safe robot-human-interaction.Approach. A compact setup of ultrasound device, lightweight robot, tracking camera, force sensor and control computer were integrated in a software application to represent a potential USgRT setup. For the realization of a clinical procedure, positioning strategies for the ultrasound head with the help of the robot were developed, implemented, and tested. In addition, basic safety mechanisms for the robot have been implemented, using the integrated force sensor, and have been tested by intentional collisions.Main results. Various positioning methods from manual guidance to completely automated procedures were tested. Robot-guided methods achieved higher positioning accuracy and were faster in execution compared to conventional hand-guided methods. The developed safety mechanisms worked as intended and the detected collision force were below 20 N.Significance. The study demonstrates the feasibility of a new approach for safe robotic ultrasound imaging, with a focus on abdominal usage (liver, prostate, kidney). The safety measures applied here can be extended to other human-robot interactions and present the basic for further studies in medical applications.

A Platform and Multisided Market for Translational, Software-Defined Medical Procedures in the Operating Room (OP 4.1): Proof-of-Concept Study.

BACKGROUND: Although digital and data-based technologies are widespread in various industries in the context of Industry 4.0, the use of smart connected devices in health care is still in its infancy. Innovative solutions for the medical environment are affected by difficult access to medical device data and high barriers to market entry because of proprietary systems. OBJECTIVE: In the proof-of-concept project OP 4.1, we show the business viability of connecting and augmenting medical devices and data through software add-ons by giving companies a technical and commercial platform for the development, implementation, distribution, and billing of innovative software solutions. METHODS: The creation of a central platform prototype requires the collaboration of several independent market contenders, including medical users, software developers, medical device manufacturers, and platform providers. A dedicated consortium of clinical and scientific partners as well as industry partners was set up. RESULTS: We demonstrate the successful development of the prototype of a user-centric, open, and extensible platform for the intelligent support of processes starting with the operating room. By connecting heterogeneous data sources and medical devices from different manufacturers and making them accessible for software developers and medical users, the cloud-based platform OP 4.1 enables the augmentation of medical devices and procedures through software-based solutions. The platform also allows for the demand-oriented billing of apps and medical devices, thus permitting software-based solutions to fast-track their economic development and become commercially successful. CONCLUSIONS: The technology and business platform OP 4.1 creates a multisided market for the successful development, implementation, distribution, and billing of new software solutions in the operating room and in the health care sector in general. Consequently, software-based medical innovation can be translated into clinical routine quickly, efficiently, and cost-effectively, optimizing the treatment of patients through smartly assisted procedures.

Development of a robot-assisted ultrasound-guided radiation therapy (USgRT).

PURPOSE: Radiation treatment is improved by the use of image-guided workflows. This work pursues the approach of using ultrasound (US) as a real-time imaging modality. The primary focus of this study is to develop and test a breathing and motion control for a robotic-guided US transducer. All control functions of the robot and the US image processing were then integrated into one software platform enabling US-guided radiation therapy. METHODS: The robot (KUKA LBR iiwa 7 R800) and the US image processing workflows were integrated into the Medical Interaction Toolkit (MITK) (Nolden et al. in Int J Comput Assist Radiol Surg 8(4):607-620, 2013). The positions of the US probe were tracked with an optical tracking system. As a main function of robot positioning control, a highly sensitive breathing and motion compensation method was developed using KUKA's robotic application programming interface. The resulting autonomous robot motions were tested by the use of defined breathing patterns with two volunteers. Furthermore, a filter pipeline for 3D US image processing with MITK was developed. Thus, image registration of US images and previously acquired planning image data was enabled. RESULTS: The implemented breathing and motion compensation feature was successful with the addition of the remote rotating, translating capability of the US probe. Desired force applied to the US probe, and thus to the patient, is stable and enables a continuous US imaging. The developed filter pipeline for image processing facilitates registration and display of planning data and US image data in one graphical user interface. CONCLUSION: A stable and robust method for motion compensation for robot-assisted US imaging was developed and tested successfully. This is a first step toward the safe use of autonomous robot motions in interaction with patients. Furthermore, main software components were integrated into a single platform and used with the purpose of ultrasound-guided radiation therapy.

Modulation of substrate-membrane interactions by linear poly(2-methyl-2-oxazoline) spacers revealed by X-ray reflectivity and ellipsometry.

Hydrated polymer interlayers between planar lipid membranes and solid substrates provide a water reservoir and thus maintain a finite membrane-substrate distance. Linear polymer spacers attached to lipid head groups (lipopolymer tethers) can be used as a defined model of oligo- and polysaccharides covalently anchored on cell surfaces (glycocalyx). They can offer a unique advantage over membranes physisorbed on polymer films (called polymer-cushioned membranes), owing to their ability to control both the length and density of polymer chains. In this study, a lipopolymer tether composed of a stable ether lipid moiety and a hydrophilic poly(2-methyl-2-oxazoline) spacer with a length of 60 monomer units is used to fabricate supported membranes by the successive deposition of proximal (lower) and distal (upper) leaflets. Using specular X-ray reflectivity and ellipsometry, we systematically investigate how the lateral density of polymer chains influences the membrane-substrate interactions. The combination of two types of reflectivity techniques under various conditions enables the calculation of quantitative force-distance relationships. Such artificial membrane systems can be considered as a half-model of cell-cell contacts mediated via the glycocalyx, which reveals the influence of polymer chain density on the interplay of interfacial forces at biological interfaces.

Structure of synthetic transmembrane lipid membranes at the solid/liquid interface studied by specular X-ray reflectivity.

We fabricated a new class of supported membranes based on monolayers of artificial bola (transmembrane) lipids. The lipids used in this study are symmetric bola lipids with two phosphocholine head groups, which resemble natural archaea lipids. To prevent bending of the hydrocarbon chains, stiff triple bonds are inserted in the middle of the hydrocarbon cores. The formation of homogeneous "monolayers" of transmembrane lipids over macroscopic areas can be monitored with fluorescence microscopy. Structures of such supported monolayers in bulk water were characterized with specular X-ray reflectivity using high energy X-ray radiation, which guarantees a high transmission through bulk water. Here, the vertical structure of single monolayers could be resolved from reconstructed electron density profiles. To verify the structural model suggested by the specular reflectivity, we also performed small- and wide-angle X-ray scattering of transmembrane lipid suspensions. The wide-angle patterns reflect a distorted chain-chain correlation, while the small-angle scattering allowed us to model an electron density profile which is consistent with the profile calculated from specular reflectivity.

Solving Interoperability in Translational Health. Perspectives of Students from the International Partnership in Health Informatics Education (IPHIE) 2016 Master Class.

BACKGROUND: In the summer of 2016 an international group of biomedical and health informatics faculty and graduate students gathered for the 16th meeting of the International Partnership in Health Informatics Education (IPHIE) masterclass at the University of Utah campus in Salt Lake City, Utah. This international biomedical and health informatics workshop was created to share knowledge and explore issues in biomedical health informatics (BHI). OBJECTIVE: The goal of this paper is to summarize the discussions of biomedical and health informatics graduate students who were asked to define interoperability, and make critical observations to gather insight on how to improve biomedical education. METHODS: Students were assigned to one of four groups and asked to define interoperability and explore potential solutions to current problems of interoperability in health care. RESULTS: We summarize here the student reports on the importance and possible solutions to the "interoperability problem" in biomedical informatics. Reports are provided from each of the four groups of highly qualified graduate students from leading BHI programs in the US, Europe and Asia. CONCLUSION: International workshops such as IPHIE provide a unique opportunity for graduate student learning and knowledge sharing. BHI faculty are encouraged to incorporate into their curriculum opportunities to exercise and strengthen student critical thinking to prepare our students for solving health informatics problems in the future.

Electrical impedance tomography system based on active electrodes.

Electrical impedance tomography (EIT) can image the distribution of ventilated lung tissue, and is thus a promising technology to help monitor patient breathing to help selection of mechanical ventilation parameters. Two key difficulties in EIT instrumentation make such monitoring difficult: (1) EIT data quality depends on good electrode contact and is sensitive to changes in contact quality, and (2) EIT electrodes are difficult and time consuming to place on patients. This paper presents the design and initial tests of an active electrode-based system to address these difficulties. Our active electrode EIT system incorporates an active electrode belt, a central voltage-driven current source, central analog to digital converters and digital to analog converters, a central FPGA-based demodulator and controller. The electrode belt is designed incorporating 32 active electrodes, each of which contains the electronic amplifiers, switches and associated logic. Tests show stable device performance with a convenient ease of use and good imaging ability in volunteer tests.

Dissipative structure formation in lipid/lipopolymer monolayers.

We study the formation of dissipative microstructures in monomolecular films of surfactant mixtures, which occur near the three-phase contact line during Langmuir-Blodgett transfer onto a solid substrate. Continuous stripes parallel to the transfer direction are generated over several centimeters, indicating the phase separation of phospholipids and lipids with polymer head groups (lipopolymers). The systematic variation of transfer conditions revealed that transfer speed and subphase viscosity determine the stripe-to-stripe distance from several micrometers to submicrometers. To account for the physical mechanism of such pattern formation, we characterize the local film thickness and the membrane composition in the vicinity of the three-phase contact line using imaging ellipsometry and fluorescence microscopy. At relatively slow rates of substrate lifting, the power law exponent that we found between the interstripe distance and the transfer speed suggests that the stripe formation is due to spinodal decomposition, which can be accounted under the framework of the Cahn-Hilliard equation, whereas at relatively high rates, the distance is found to be proportional to the substrate speed, suggesting a dominant effect of the shear force on the stripe formation.

Interferometric tracking of optically trapped probes behind structured surfaces: A phase correction method.

We investigate the influence of an additional scatterer on the tracking signal of an optically trapped particle. The three-dimensional particle position is recorded interferometrically with nanometer precision by using a quadrant photodiode in the back focal plane of a detection lens. A phase disturbance underneath the sample leads to incorrect position signals. The resulting interaction potential and forces are therefore erroneous as well. We present a procedure to correct for the disturbance by measuring its interferometric signal. We prove the applicability of our phase correction approach by generating a defined displacement of the trapped probe.

Compact liquid-crystal-polymer Fourier-transform spectrometer.

We present the optical design and realization of a low-resolution liquid-crystal (LC) Fourier-transform spectrometer (FTS). This FTS is based on a polarization interferometer that has a Wollaston prism made of a LC material as a key component. It has a compact design, a good acceptance angle, and low temperature dependence and can be fabricated with cost-effective LC technology. Because the LC is polymerized, it is robust, and the temperature dependence is drastically reduced. The performance of a compact handheld version of the spectrometer and the characteristics (angular dependence, resolution, stray light, and temperature dependence) will be discussed.