[Surgery 4.0-are we ready?] / Wie weit ist Chirugie 4.0?

The increasing networking of data systems in medicine is not only leading to modern interdisciplinarity in the sense of cooperation between different medical departments, but also poses new challenges regarding the building and room infrastructure. The surgical operating room of the future expands or augments its reality, away from the pure building characteristics, towards an intelligent and communicative space platform. The building infrastructure (operating theatre) serves as sensor and actuator. Thus, it is possible to inform about missing diagnostics as well as to register them directly in the contextualization of the planned surgical intervention or to integrate them into the processes. Integrated operating theatres represent a comprehensive computer platform based on a corresponding system architecture with software-based protocols. An underlying modular system consisting of various modules for image acquisition and analysis, interaction and visualization supports the integration and merging of heterogeneous data that are generated in a hospital operation. Integral building data (e.g., air conditioning, lighting control, device registration) are merged with patient-related data (age, type of illness, concomitant diseases, existing diagnostic CT and MRI images). New systems coming onto the market, as well as already existing systems will have to be measured by the extent to which they will be able to guarantee this integration of information-similar to the development from mobile phone to smartphone. Cost reduction should not be the only legitimizing argument for the market launch, but the vision of a new quality of surgical perception and action.

Toward knowledge-based liver surgery: holistic information processing for surgical decision support.

PURPOSE: Malignant neoplasms of the liver are among the most frequent cancers worldwide. Given the diversity of options for liver cancer therapy, the choice of treatment depends on various parameters including patient condition, tumor size and location, liver function, and previous interventions. To address this issue, we present the first approach to treatment strategy planning based on holistic processing of patient-individual data, practical knowledge (i.e., case knowledge), and factual knowledge (e.g., clinical guidelines and studies). METHODS: The contributions of this paper are as follows: (1) a formalized dynamic patient model that incorporates all the heterogeneous data acquired for a specific patient in the whole course of disease treatment; (2) a concept for formalizing factual knowledge; and (3) a technical infrastructure that enables storing, accessing, and processing of heterogeneous data to support clinical decision making. RESULTS: Our patient model, which currently covers 602 patient-individual parameters, was successfully instantiated for 184 patients. It was sufficiently comprehensive to serve as the basis for the formalization of a total of 72 rules extracted from studies on patients with colorectal liver metastases or hepatocellular carcinoma. For a subset of 70 patients with these diagnoses, the system derived an average of [Formula: see text] assertions per patient. CONCLUSION: The proposed concept paves the way for holistic treatment strategy planning by enabling joint storing and processing of heterogeneous data from various information sources.

Interventional real-time ultrasound imaging with an integrated electromagnetic field generator.

PURPOSE: Ultrasound (US) guided procedures are frequently performed for diagnosis and treatment of many diseases. However, there are safety and procedure duration limitations in US-guided interventions due to poor image quality and inadequate visibility of medical instruments in the field of view. To address this issue, we propose an interventional imaging system based on a mobile electromagnetic (EM) field generator (FG) attached to a US probe. METHODS: A standard US probe was integrated with an EM FG to allow combined movement of the FG with real-time imaging to achieve (1) increased tracking accuracy for medical instruments are located near the center of the tracking volume, (2) increased robustness because the FG is distant to large metallic objects, and (3) reduced setup complexity since time-consuming placement of the FG is not required. The new integrated US-FG imaging system was evaluated by assessing tracking and calibration accuracy in a clinical setting. To demonstrate clinical applicability, the prototype US-EMFG probe was tested in needle puncture procedures. RESULTS: The mobile EMFG attached to a US probe yielded sub-millimeter tracking accuracy despite the presence of metal close to the FG. Calibration errors were in the range of 1-2 mm. In an initial phantom study on US-guided needle punctures, targeting errors of about 3 mm were achieved. CONCLUSION: A combined US-EMFG probe is feasible and effective for tracking medical instruments relative to US images with high accuracy and robustness while keeping hardware complexity low.

MITK-US: real-time ultrasound support within MITK.

PURPOSE: Intra-procedural acquisition of the patient anatomy is a key technique in the context of computer-assisted interventions (CAI). Ultrasound (US) offers major advantages as an interventional imaging modality because it is real time and low cost and does not expose the patient or physician to harmful radiation. To advance US-related research, the purpose of this paper was to develop and evaluate an open-source framework for US-based CAI applications. MATERIALS AND METHODS: We developed the open-source software module MITK-US for acquiring and processing US data as part of the well-known medical imaging interaction toolkit (MITK). To demonstrate its utility, we applied the module to implement a new concept for US-guided needle insertion. Performance of the US module was assessed by determining frame rate and latency for both a simple sample application and a more complex needle guidance system. RESULTS: MITK-US has successfully been used to implement both sample applications. Modern laptops achieve frame rates above 24 frames per second. Latency is measured to be approximately 250 ms or less. CONCLUSION: MITK-US can be considered a viable rapid prototyping environment for US-based CAI applications.

Electromagnetic tracking for US-guided interventions: standardized assessment of a new compact field generator.

PURPOSE: One of the main challenges related to electromagnetic tracking in the clinical setting is a placement of the field generator (FG) that optimizes the reliability and accuracy of sensor localization. Recently, a new mobile FG for the NDI Aurora(®) tracking system has been presented. This Compact FG is the first FG that can be attached directly to an ultrasound (US) probe. The purpose of this study was to assess the precision and accuracy of the Compact FG in the presence of nearby mounted US probes. MATERIALS AND METHODS: Six different US probes were mounted onto the Compact FG by means of a custom-designed mounting adapter. To assess precision and accuracy of the Compact FG, we employed a standardized assessment protocol. Utilizing a specifically manufactured plate, we measured positional data on three levels of distances from the FG as well as rotational data. RESULTS: While some probes had negligible influence on tracking accuracy two probes increased the mean distance error up to 1.5 mm compared with a reference measurement of 0.5 mm. The jitter error consistently stayed below 0.2 mm in all cases. The mean relative error in orientation was found to be smaller than 3°. CONCLUSION: Attachment of an US probe to the Compact FG does not have a critical influence on tracking accuracy in most cases. Clinical benefit of this promising mobile FG must be shown in future studies.

The teaching of empathy for high school and college students: testing Rogerian methods with the Interpersonal Reactivity Index.

The teachability of empathy is discussed with particular regard to developmental issues. One hundred and four high school and college students were administered Davis's (1980) Interpersonal Reactivity Index (IRI) both before and after a standard course of Rogerian-based peer facilitation skills training. The IRI offers four independent subscales which measure the cognitive and affective components of empathy. Statistically significant findings indicate greater developmental readiness for learning empathic communication in the college sample, particularly for subscales measuring Empathic Concern and Perspective Taking. A group of untrained college students taking a course in behavioral psychology showed no progress on any IRI subscales. Although college females began with higher empathy scores, both genders were equally teachable. Implications for prevention and counseling readiness are discussed, along with suggestions for future research.