Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Medical Robotics
Medical Image Processing
LECTURE 1
1. Whats in a surgery
2. Technical tools in CS
3. CAS systems
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Preoperative planning
determine the surgical approach
elaborate intraoperative plan (path, tools, implants)
Surgery
prepare patient and assess condition
acquire intraoperative images, adapt and execute plan
Postoperative follow-up
exams, lab tests, images to be corroborated
CAS, Spring 2001
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Treatment procedures
Invasive
neurosurgery: tumor removal
hear surgery: clogged arteries, transplants
orthopaedic surgery: spine, hip replacement, knee,
fractures
gall bladder removal, prostate, various cancers
Non-invasive
radiation therapy
kidney stone pulverization
CAS, Spring 2001
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Intraoperative
X-ray fluoroscopy, ultrasound
video images (laparoscopy, arthorscopy)
Open MR
CAS, Spring 2001
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X-ray Fluoroscopy
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Series of parallel
slices 2mm apart
Single slice
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Good imaging of
soft tissue
CAS, Spring 2001
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Functional imaging:
colors indicate
electrical activity
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Surgical approaches
Open surgery
area of interest directly exposed by cutting
direct sight and touch of anatomy by surgeon
direct access but causes additional damage
Closed surgery
Diagnostic surgery
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Laparoscopic surgery
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Brain surgery
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Determination
information integration
judgement, decision, execution
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Surgical Needs
Augment the surgeons capabilities with better
quantitative planning, execution, and integration
Support for image-guided surgery
Passive and active devices for accurate spatial positioning,
tracking, and execution
Modeling, planning, viewing, diagnosis systems
Systems integration: from diagnosis to post-op
Improve current practice and enable new procedures
Simulation and training systems
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Devices
mostly passive and non-invasive (supports)
laparoscopic camera,
some real-time tracking
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Image processing
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Real-time tracking
optical, video, electromagnetic devices
navigation tools
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Robotic devices
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instrument
Passive markers
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Active markers
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Intraoperative execution
passive, semi-active, active robot
real time tracking
intraoperative imaging (fluoroscopy, ultrasound)
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Research
very active, very interdisciplinary
a few dozen systems tested in-vitro
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Image-guide navigation
Purpose
accurate placement of instruments with respect to
imaged anatomy for several procedures
Problem addressed
provide 3D vision of unseen structures
replace static 2D fluoroscopy or larger openings
improve precision of biopsies, screw placements
Scope
non-invasive
creates surface model from preop images
registration of images to anatomy by direct contact
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Image-guided navigation
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Status
In clinical use
Over 7,000 neurosurgeries performed with
commercial systems
Gaining popularity in pedicle screw insertion
Decreased the misplacement rate from 10-40%
to 5-18% (clinical study of 700 cases)
More clinical applications under development
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Problem addressed
complications in canal preparation and implant fixation
improve positioning accuracy and surface finish
Scope
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ORTHODOC Planning
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ROBODOC robot
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ROBODOC procedure
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ROBODOC cutting
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ROBODOC History
Developed by IBM Research and Integrated
Surgical Systems
First active surgical robot
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Problem addressed
cumbersome, unintuitive, and unsteady camera
positioning
Scope
non-invasive intraoperative device
video images interpreted by surgeon
Benefits
direct camera manipulation; stability, precise targeting
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LARS characteristics
Designed at IBM Research, 1993. Similar
commercial devices available (AESOP)
Custom redundant 7 degree-of-freedom robot
Holds laparoscopic camera
Fulcrum motions: no motion at point of entry
Mouse-like controls on surgical scissors
Position memory and replay
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Stereotactic Radiosurgery
Purpose
plan and deliver precise radiation doses
Problem addressed
precise positioning and dosing of radiation to avoid
healthy organ damage
Scope
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Stereotactic Radiosurgery
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CYBERKNIFE system
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CYBERKNIFE system
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Stereotactic Radiosurgery
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Differences
system performace requirements
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Cadaver studies
system refinement
In-vivo experiments
first animal and human trials
Clinical trials
double blind studies, Hospital and FDA protocols
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Summary
Great potential for robots and computers inside
and outside the operating room
Great research and commercial interest,
especially in the past 3 years
Just the beginning of the road: many things
remain to be invented
Great role for applied computer science:
image processing, geometric planning, registration,
graphics, vision, real-time systems, robotics, etc.
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