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BACKGROUND: Accurate prosthesis placement in arthroplasty is an important factor in the long-term success of these interventions. Many types of guidance technology have been described to date often suffering from high costs, complex theater integration, time inefficiency, and problems with day-to-day usability. We present a novel, intraoperative robotics platform, capable of rapid, real-time manufacture of low-cost patient-specific guides while overcoming many of the issues with existing approaches. METHODS: A prototype robotics platform was assessed in a 24-specimen cadaveric trial during sequential simulated shoulder arthroplasty procedures. The platform consisted of a tableside robot with sterile drapes and sterile disposable components. The robot itself comprised a 3D optical scanner, a 3-axis sterile robotic drill, and a 2-axis receptacle into which the disposable consumables were inserted. The consumable was composed of a region of rapidly setting moldable material and a clip allowing it to be reversibly attached to the robot. Computed tomographic (CT) imaging was obtained for all cadaveric specimens, and a surgical plan was created focusing on glenoid component position-specifically, guidewire position to allow for accurate glenoid preparation before implant insertion. Intraoperatively, for every specimen, the relevant osseous anatomy was exposed and humeral and glenoid preparation undertaken in the usual manner. The sterile disposable was used to create a mold of the joint surface. Once set, the mold was inserted into the robot and an optical scan of the surface was undertaken followed by automatic surface registration with the CT data and surgical plan. An automatic guide hole was subsequently drilled into the molded blank, which was removed from the robot and placed back into the patient, with the melded surface ensuring exact replacement. The guidewire was then driven through the guide hole in accordance with the preoperative plan. RESULTS: The novel robotic platform achieved average angular accuracies of 1.9° (standard deviation [SD] 1.3) version and 1.2° (SD 0.7) inclination with positional accuracy of 1.1 mm (SD 0.7) compared to a preoperative plan. DISCUSSION: We have described a novel robotics platform that is able to reliably produce patient-specific intraoperative guides to allow for accurate guidewire placement. Guidance is provided using a portable intraoperative device. The results suggest achieved accuracy levels may be equivalent to those seen in other existing guidance technologies; however, eventual in vivo trials and analysis is required. This technology has potential transferability to improve accuracy in other areas of arthroplasty.
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Artroplastía de Reemplazo de Hombro , Robótica , Articulación del Hombro , Cirugía Asistida por Computador , Artroplastia , Artroplastía de Reemplazo de Hombro/métodos , Cadáver , Humanos , Imagenología Tridimensional/métodos , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/cirugía , Cirugía Asistida por Computador/métodosRESUMEN
BACKGROUND: The research and development of augmented-reality (AR) technologies in surgical applications has seen an evolution of the traditional user-interfaces (UI) utilised by clinicians when conducting robot-assisted orthopaedic surgeries. The typical UI for such systems relies on surgeons managing 3D medical imaging data in the 2D space of a touchscreen monitor, located away from the operating site. Conversely, AR can provide a composite view overlaying the real surgical scene with co-located virtual holographic representations of medical data, leading to a more immersive and intuitive operator experience. MATERIALS AND METHODS: This work explores the integration of AR within an orthopaedic setting by capturing and replicating the UI of an existing surgical robot within an AR head-mounted display worn by the clinician. The resulting mixed-reality workflow enabled users to simultaneously view the operating-site and real-time holographic operating informatics when carrying out a robot-assisted patellofemoral-arthroplasty (PFA). Ten surgeons were recruited to test the impact of the AR system on procedure completion time and operating surface roughness. RESULTS AND DISCUSSION: The integration of AR did not appear to require subjects to significantly alter their surgical techniques, which was demonstrated by non-significant changes to the study's clinical metrics, with a statistically insignificant mean increase in operating time (+0.778 s, p = 0.488) and a statistically insignificant change in mean surface roughness (p = 0.274). Additionally, a post-operative survey indicated a positive consensus on the usability of the AR system without incurring noticeable physical distress such as eyestrain or fatigue. CONCLUSIONS: Overall, these study results demonstrated a successful integration of AR technologies within the framework of an existing robot-assisted surgical platform with no significant negative effects in two quantitative metrics of surgical performance, and a positive outcome relating to user-centric and ergonomic evaluation criteria.
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Realidad Aumentada , Procedimientos Ortopédicos , Ortopedia , Procedimientos Quirúrgicos Robotizados , Cirugía Asistida por Computador , Humanos , Imagenología Tridimensional , Proyectos PilotoRESUMEN
The purpose of this manuscript is to present a review of laboratory experiments (including methodology and results) that use biochar, a specific carbon obtained by a pyrolysis process from different feedstocks, as an alternative material for heavy metal adsorption from groundwater. In recent years, many studies have been conducted regarding the application of innovative materials to water decontamination to develop a more sustainable approach to remediation processes. The use of biochar for groundwater remediation has particularly attracted the interest of researchers because it permits the reuse of materials that would be otherwise disposed of, in accordance with circular economy, and reduces the generation of greenhouse gases if compared to the use of virgin materials. A review of the different approaches and results reported in the current literature could be useful because when applying remediation technologies at the field scale, a preliminary phase in which the suitability of the adsorbent is evaluated at the lab scale is often necessary. This paper is therefore organised with a short description of the involved metals and of the biochar production and composition. A comprehensive analysis of the current knowledge related to the use of biochar in groundwater remediation at the laboratory scale to obtain the characteristic parameters of the process that are necessary for the upscaling of the technology at the field scale is also presented. An overview of the results achieved using different experimental conditions, such as the chemical properties and dosage of biochar as well as heavy metal concentrations with their different values of pH, is reported. At the end, numerical studies useful for the interpretation of the experiment results are introduced.
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The accuracy of the implant's post-operative position and orientation in reverse shoulder arthroplasty is known to play a significant role in both clinical and functional outcomes. Whilst technologies such as navigation and robotics have demonstrated superior radiological outcomes in many fields of surgery, the impact of augmented reality (AR) assistance in the operating room is still unknown. Malposition of the glenoid component in shoulder arthroplasty is known to result in implant failure and early revision surgery. The use of AR has many promising advantages, including allowing the detailed study of patient-specific anatomy without the need for invasive procedures such as arthroscopy to interrogate the joint's articular surface. In addition, this technology has the potential to assist surgeons intraoperatively in aiding the guidance of surgical tools. It offers the prospect of increased component placement accuracy, reduced surgical procedure time, and improved radiological and functional outcomes, without recourse to the use of large navigation or robotic instruments, with their associated high overhead costs. This feasibility study describes the surgical workflow from a standardised CT protocol, via 3D reconstruction, 3D planning, and use of a commercial AR headset, to AR-assisted k-wire placement. Post-operative outcome was measured using a high-resolution laser scanner on the patient-specific 3D printed bone. In this proof-of-concept study, the discrepancy between the planned and the achieved glenoid entry point and guide-wire orientation was approximately 3 mm with a mean angulation error of 5°.
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Contaminants removal stoked inside low permeability zones of aquifers is one of the most important challenge of groundwater remediation process today. Low permeability layers can be considered persistent secondary sources of contamination because they release pollutants by molecular diffusion after primary source of contamination is reduced, causing long plum tails (Back-Diffusion). In this study, the Groundwater Circulation Well (GCW) system was investigated as an alternative remediation technology to the low efficient traditional pumping technologies to restore contaminated low permeability layers of aquifers. The GCW system creates vertical groundwater circulation cells by drawing groundwater through a screen of a multi-screen well and discharging it through another screen. The suitability of this technology to remediate contaminated low permeability zones was investigated by laboratory test and numerical simulations. The collected data were used to calibrate a model created to simulate the Back-Diffusion process and to evaluate the effect of different pumping technologies on the depletion time of that process. Results show that the efficiency of the GCW is dependent on the position and on the geometry of the low permeability zones, however the GCW system appears more suitable to restore contaminated low permeability layers of aquifers than the traditional pumping technology.
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Agua Subterránea , Contaminantes Químicos del Agua , Difusión , Permeabilidad , Pozos de AguaRESUMEN
When several persons perform a physical task jointly, such as transporting an object together, the interaction force that each person experiences is the sum of the forces applied by all other persons on the same object. Therefore, there is a fundamental ambiguity about the origin of the force that each person experiences. This study investigated the ability of a dyad (two persons) to identify the direction of a small force produced by a haptic device and applied to a jointly held object. In this particular task, the dyad might split the force produced by the haptic device (the external force) in an infinite number of ways, depending on how the two partners interacted physically. A major objective of this study was to understand how the two partners coordinated their action to perceive the direction of the third force that was applied to the jointly held object. This study included a condition where each participant responded independently and another one where the two participants had to agree upon a single negotiated response. The results showed a broad range of behaviors. In general, the external force was not split in a way that would maximize the joint performance. In fact, the external force was often split very unequally, leaving one person without information about the external force. However, the performance was better than expected in this case, which led to the discovery of an unanticipated strategy whereby the person who took all the force transmitted this information to the partner by moving the jointly held object. When the dyad could negotiate the response, we found that the participant with less force information tended to switch his or her response more often.
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Conducta Cooperativa , Percepción , Análisis y Desempeño de Tareas , Adulto , Femenino , Humanos , Masculino , Modelos Teóricos , Adulto JovenRESUMEN
Low-permeability lenses represent potential sources of long-term release when filled from contaminant solute through direct contact with dissolved plumes. The redistribution of contaminant from low to high permeability aquifer zones (Back-Diffusion) was studied. Redistribution causes a long plume tail, commonly regarded as one of the main obstacles to effective groundwater remediation. Laboratory tests were performed to reproduce the redistribution process and to investigate the effect of pumping water on the remediation time of these contaminated low-permeability lenses. The test section used is representative of clay/silt lenses (k≈1∗10-10m/s/k≈1∗10-7m/s) in a sand aquifer (k≈1∗10-3m/s). Hence, an image analysis procedure was used to estimate the diffusive flux of contaminant released by these low-permeability zones. The proposed technique was validated performing a mass balance of a lens saturated by a known quantity of tracer. For each test, performed using a different groundwater velocity, the diffusive fluxes of contaminant released by lenses were compared and the remediation times of the low-permeability zones calculated. For each lens, the obtained remediation timeframes were used to define an analytical relation vs groundwater velocity and the coefficients of these relations were matched to grain size of the low-permeability lenses. Results show that an increase of the velocity field is not useful to diminish the total depletion times as the process mainly diffusive. This is significant when the remediation approach relies on pumping technology.
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In this study, the long-term tailing derived from the storage process of contaminants in low-permeability zones is investigated. The release from these areas in the groundwater can be considered a long-term source that often undermines remediation efforts. An Image Analysis technique is used to analyze the process and evaluate the concentrations of a tracer at different points of the test section. Furthermore, the diffusive flux from the low-permeability lenses is determined. To validate the proposed technique, the results are compared with samples, and the diffusive fluxes resulting from the low-permeability zones of the reconstructed aquifer are compared with a theoretical approach.
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Low-cost gaming technology offers promising devices for the rehabilitation of stroke patients at home. While several attempts have been made to use low-cost motion tracking devices (Kinect) or balance boards (Wii Board), the potential of low-cost haptic devices has yet to be explored in this context. The objective of this study was to investigate whether it is possible to influence postural stability with a low-cost device despite its technical limitations, and to explore the most promising modes of haptic interaction to increase and decrease postural stability. Two groups of younger subjects used a high-end (Omega.3) and a low-cost (Falcon) device respectively. A third group of older subjects used the Falcon. We show that light touch contact with the device improves stability, whereas the force tasks decrease it. The effects of the different tasks are consistent in the two age groups. Although there are differences in the participants' interaction with the two devices, the effect of the devices on postural stability is comparable. We conclude that a low-cost haptic device can be used to increase or decrease postural stability of healthy subjects with an age similar to that of typical stroke patients, in a safe and controllable way.