Dynamic 3-D virtual fixtures for minimally invasive beating heart procedures

Two-dimensional or 3-D visual guidance is often used for minimally invasive cardiac surgery and diagnosis. This visual guidance suffers from several drawbacks such as limited field of view, loss of signal from time to time, and in some cases, difficulty of interpretation. These limitations become more evident in beating-heart procedures when the surgeon has to perform a surgical procedure in the presence of heart motion. In this paper, we propose dynamic 3-D virtual fixtures (DVFs) to augment the visual guidance system with haptic feedback, to provide the surgeon with more helpful guidance by constraining the surgeon's hand motions thereby protecting sensitive structures. DVFs can be generated from preoperative dynamic magnetic resonance (MR) or computed tomograph (CT) images and then mapped to the patient during surgery. We have validated the feasibility of the proposed method on several simulated surgical tasks using a volunteer's cardiac image dataset. Validation results show that the integration of visual and haptic guidance can permit a user to perform surgical tasks more easily and with reduced error rate. We believe this is the first work presented in the field of virtual fixtures that explicitly considers heart motion.     

Guiding the surgical gesture using an electro-tactile stimulus array on the tongue: a feasibility study

Under conventional "open-" surgery, the physician has to take care of the patient, interact with other clinicians and check several monitoring devices. Nowadays, the computer assisted surgery proposes to integrate 3-D cameras in the operating theatre in order to assist the surgeon in performing minimally invasive surgical punctures. The cameras localize the needle and the computer guides the surgeon towards an intracorporeal clinically defined target. A visualization system (screen) is employed to provide the surgeon with indirect visual spatial information about the intracorporeal positions of the needle. The present work proposes to use another sensory modality to guide the surgeon, thus keeping the visual modality fully dedicated to the surgical gesture. For this, the sensory substitution paradigm using the Bach-y-Rita's "Tongue Display Unit" (TDU) is exploited to provide to the surgeon information of the position tool. The TDU device is composed of a 6 x 6 matrix of electrodes transmitting electrotactile information on the tongue surface. The underlying idea consists in transmitting information about the deviation of the needle movement with regard to a preplanned "optimal" trajectory. We present an experiment assessing the guidance effectiveness of an intracorporeal puncture under TDU guidance with respect to the performance evidenced under a usual visual guidance system.     

Depth-buffer targeting for spatially accurate 3-D visualization of medical images

During interactive image-guided surgery (IIGS), a surgeon uses data from medical images to help guide the surgical procedure. At Vanderbilt University, an IIGS software system called Orion has been developed which is capable of displaying up to four 512 x 512 images and the current surgical position using an active optical tracking system. Orion is capable of displaying data from any tomographic image volume and from any NTSC video image. An additional display module has been implemented to display three-dimensional information as well as the tomographic slices. This provides the surgeon with valuable anatomical information that is not readily obtained from the tomographic slices alone. Before the surgery, a set of rendered images is created, each with a different angular view of the tomographic volume in order to surround the site of surgical interest. The major objectives of the display module are to display the appropriate rendered image from the set, identify the current probe position on the selected image, and provide an indication of distance between the probe and the physical point of the anatomy indicated on the image. This can provide the surgeon with vital information such as distance to blood vessels, tumors, or other critical structures.     

Gold‐Coated Fe3O4 Nanoroses with Five Unique Functions for Cancer Cell Targeting,Imaging, and Therapy

The development of nanomaterials that combine diagnostic and therapeutic functions within a single nanoplatform is extremely important for molecular medicine. Molecular imaging with simultaneous diagnosis and therapy will provide the multimodality needed for accurate diagnosis and targeted therapy. Here, gold‐coated iron oxide (Fe₃O₄@Au) nanoroses with five distinct functions are demonstrated, integrating aptamer‐based targeting, magnetic resonance imaging (MRI), optical imaging, photothermal therapy. and chemotherapy into one single probe. The inner Fe₃O₄ core functions as an MRI agent, while the photothermal effect is achieved through near‐infrared absorption by the gold shell, causing a rapid rise in temperature and also resulting in a facilitated release of the anticancer drug doxorubicin carried by the nanoroses. Where the doxorubicin is released, it is monitored by its fluorescence. Aptamers immobilized on the surfaces of the nanoroses enable efficient and selective drug delivery, imaging, and photothermal effect with high specificity. The five‐function‐embedded nanoroses show great advantages in multimodality.     

Miniature in vivo robots for remote and harsh environments

Long-term human space exploration will require contingencies for emergency medical procedures including some capability to perform surgery. The ability to perform minimally invasive surgery (MIS) would be an important capability. The use of small incisions reduces surgical risk, but also eliminates the ability of the surgeon to view and touch the surgical environment directly. Robotic surgery, or telerobotic surgery, may provide emergency surgical care in remote or harsh environments such as space flight, or extremely forward environments such as battlefields. However, because current surgical robots are large and require extensive support personnel, their implementation has remained limited in forward environments, and they would be difficult, or impossible, to use in space flight or on battlefields. This paper presents experimental analysis of miniature fixed-base and mobile in vivo robots to support MIS surgery in remote and harsh environments. The objective is to develop wireless imaging and task-assisting robots that can be placed inside the abdominal cavity during surgery. Such robots will provide surgical task assistance and enable an on-site or remote surgeon to view the surgical environment from multiple angles. This approach is applicable to long-duration space flight, battlefield situations, and for traditional medical centers and other remote surgical locations.     

Accurate alignment of functional EPI data to anatomical MRI using a physics-based distortion model

Mapping of functional magnetic resonance imaging (fMRI) to conventional anatomical MRI is a valuable step in the interpretation of fMRI activations. One of the main limits on the accuracy of this alignment arises from differences in the geometric distortion induced by magnetic field inhomogeneity. This paper describes an approach to the registration of echo planar image (EPI) data to conventional anatomical images which takes into account this difference in geometric distortion. We make use of an additional spin echo EPI image and use the known signal conservation in spin echo distortion to derive a specialized multimodality nonrigid registration algorithm. We also examine a plausible modification using log-intensity evaluation of the criterion to provide increased sensitivity in areas of low EPI signal. A phantom-based imaging experiment is used to evaluate the behavior of the different criteria, comparing nonrigid displacement estimates to those provided by a imagnetic field mapping acquisition. The algorithm is then applied to a range of nine brain imaging studies illustrating global and local improvement in the anatomical alignment and localization of fMRI activations.     

Miniature in vivo Robots for Remote and Harsh Environments

Long-term human space exploration will require contingencies for emergency medical procedures including some capability to perform surgery. The ability to perform minimally invasive surgery (MIS) would be an important capability. The use of small incisions reduces surgical risk, but also eliminates the ability of the surgeon to view and touch the surgical environment directly. Robotic surgery, or telerobotic surgery, may provide emergency surgical care in remote or harsh environments such as space flight, or extremely forward environments such as battlefields. However, because current surgical robots are large and require extensive support personnel, their implementation has remained limited in forward environments, and they would be difficult, or impossible, to use in space flight or on battlefields. This paper presents experimental analysis of miniature fixed-base and mobile in vivo robots to support MIS surgery in remote and harsh environments. The objective is to develop wireless imaging and task-assisting robots that can be placed inside the abdominal cavity during surgery. Such robots will provide surgical task assistance and enable an on-site or remote surgeon to view the surgical environment from multiple angles. This approach is applicable to long-duration space flight, battlefield situations, and for traditional medical centers and other remote surgical locations.     

可编程性扫描式集成测量头调理电路设计

针对扫描式LVDT电感式集成测量头噪音大、测量精度底等问题。文中采用了一种可编程性且灵活性高的扫描式LVDT电感式集成测量头调理电路,其使用同步解调器和模拟滤波器ADA2200在模拟域中提取位置信息和抑制模拟电路噪声,通过内部集成的高速、16位高精度 A/D 转换器以及其他功能模块的单片机C8051F060对调理电路进行可编程控制和数据采集读取。对所开发电路进行了测试和实验,实验结果达到了预期要求。     

Head‐Mounted Devices for Noninvasive Cancer Imaging and Intraoperative Image‐Guided Surgery

Medical imaging methods have improved the detection of human diseases with increasing accuracy. The ability to probe molecular processes noninvasively or using tissue‐selective imaging agents and nanoparticles has made it possible to localize, identify the stage, and determine the functional status of pathological lesions. The challenges in detecting cancer particularly have driven the development of diverse imaging technologies. While earlier cancer imaging methods enabled preoperative evaluation, the need to track and visualize cancer location in the operating room itself has ushered in new systems capable of providing concurrent images of cancer during surgery. Intraoperative use of conventional clinical imaging modalities is often limited by bulky hardware design, prohibitive cost, lack of real‐time image display, and compatibility with conventional hardware interfaces. For these reasons, focus on fluorescence‐guided surgery (FGS) devices has increased to take advantage of real‐time, high‐resolution, functional imaging with hardware that has become increasingly amenable to miniaturization. In particular, the adaptation of wearable devices for FGS presents hands‐free capability for optimal navigation during cancer surgery. The evolution of head‐mounted devices in the operating room and adaptation for FGS is highlighted. Key challenges to wide clinical adoption of this imaging platform are identified and potential future directions are suggested.     

“All‐in‐One” Nanoparticles for Trimodality Imaging‐Guided Intracellular Photo‐magnetic Hyperthermia Therapy under Intravenous Administration

Great efforts have been devoted so far to combine nano‐magnetic hyperthermia and nano‐photothermal therapy to achieve encouraging additive therapeutic performance in vitro and in vivo with limitation to direct intratumoral injection and no guidance of multimodality molecular imaging. In this study, a novel multifunctional theranostic nanoplatform (MNP@PES‐Cy7/2‐DG) consisting of magnetic nanoparticles (MNPs), poly(3,4‐ethylenedioxythiophene):poly(4‐styrenesulfonate) (PES), Cyanine7 (Cy7), and 2‐deoxyglucose (2‐DG)‐polyethylene glycol is developed. They are then applied to combined photo‐magnetic hyperthermia therapy under intravenous administration that is simultaneously guided by trimodality molecular imaging. Remarkably, nanoparticles are found aggregated mainly in the cytoplasm of tumor cells in vitro and in vivo, and exhibit stealth‐like behavior with a long second‐phase blood circulation half‐life of 20.38 ± 4.18 h. Under the guidance of photoacoustic/near‐infrared fluorescence/magnetic resonance trimodality imaging, tumors can be completely eliminated under intracellular photo‐magnetic hyperthermia therapy with additive therapeutic effect due to precise hyperthermia. This study may promote a further exploration of such a platform for clinical applications.     

Multimodality Radionuclide, Fluorescence, and Bioluminescence Small-Animal Imaging

The imaging of molecular events in the complex physiological interplay between organelles, cells, tissues, and organs in the whole organism is now more practical through the use of small-animal imaging technologies. Radionuclide based molecular imaging using single photon emission computed tomography (SPECT) and positron emission tomography (PET) scanners have been used for imaging intracellular enzymes, receptors, transporters, reporter gene expression, and cell trafficking in small animals such as mice and rats. Sensitive cooled charge-coupled device (CCD) cameras which detect emitted light from fluorescent and bioluminescent probes within an organism have been useful in imaging pathologic changes in diseases such as cancer and infectious disease in small-animal models. Each molecular imaging modality has differing strengths and weaknesses. However, the ability to generate molecular reporter strategies that can be applied in multiple detection systems will likely provide more robust imaging data sets than from any single modality. The ultimate function of multimodality reporter strategies will be to provide information about molecular targets in a continuum of research subjects from cells to small animals to human patients.     

Haptic-Enabled Telementoring Surgery Simulation

Medical surgery involves a high degree of skill and experience, making the learning curve for medical trainees quite long. For instance, in eye cataract surgery, despite it only taking around seven minutes for a well-trained surgeon to perform and having a success rate of 99 percent, medical residents need months to become proficient in this procedure to avoid its typical complications. Medical trainees traditionally have acquired surgical skills through apprenticeships in which trainees observe senior surgeons, then perform under guidance until they achieve mastery. Training often makes use of cadavers or laboratory animals, but this type of training is becoming increasingly difficult to do in many countries due to ethical reasons. An effective alternative is medical simulation, which can enhance understanding, improve performance, and assess competence; in preoperative settings, it assists surgeons in remaining at a high technical skill level. Surgical simulation can provide high-fidelity training that increases the diffusion of innovative and less- invasive procedures while decreasing the surgeon's learning curve.     

Automated atlas integration and interactive three-dimensionalvisualization tools for planning and guidance in functional neurosurgery

Many critical functionally distinct subcortical structures are not distinguishable on anatomical magnetic resonance imaging (MRI) scans. In order to provide the neurosurgeon with this missing information, a deformable volumetric atlas of the basal ganglia and thalamus has been created from the Schaltenbrand and Wahren atlas of cryogenic slices. The volumetric atlas can be automatically deformed to an individual patient's MRI. To facilitate the clinical use of the atlas, a visualization platform has been developed for preoperative and intraoperative use which permits manipulation of the merged atlas and MRI data sets in two- and three-dimensional views. The platform includes graphical tools which allow the visualization of projections of a leukotome and other surgical tools with respect to the atlas data, as well as preregistered images from any other imaging modality. In addition, a graphical interface has been designed to create custom virtual lesions using computer models of neurosurgical tools for intraoperative planning. To date this system has been employed as an adjunct to over 30 functional neurosurgical cases including surgery for movement disorders     

Interactive 3D registration of ultrasound and magnetic resonanceimages based on a magnetic position sensor

The use of stereotactic systems has been one of the main approaches for image-based guidance of the surgical tool within the brain. The main limitation of stereotactic systems is that they are based on preoperative images that might become outdated and invalid during the course of surgery. Ultrasound (US) is considered the most practical and cost-effective intraoperative imaging modality, but US images inherently have a low signal-to-noise ratio. Integrating intraoperative US with stereotactic systems has recently been attempted. In this paper, we present a new system for interactively registering two-dimensional US and three-dimensional magnetic resonance (MR) images. This registration is based on tracking the US probe with a DC magnetic position sensor. We have performed an extensive analysis of the errors of our system by using a custom-built phantom. The registration error between the MR and the position sensor space was found to have a mean value of 1.78 mm and a standard deviation of 0.18 mm. The registration error between US and MR space was dependent on the distance of the target point from the US probe face. For a 3.5-MHz phased one-dimensional array transducer and a depth of 6 cm, the mean value of the registration error was 2.00 mm and the standard deviation was 0.75 mm. The registered MR images were reconstructed using either zeroth-order or first-order interpolation     

Feature-Based Fusion of Medical Imaging Data

The acquisition of multiple brain imaging types for a given study is a very common practice. There have been a number of approaches proposed for combining or fusing multitask or multimodal information. These can be roughly divided into those that attempt to study convergence of multimodal imaging, for example, how function and structure are related in the same region of the brain, and those that attempt to study the complementary nature of modalities, for example, utilizing temporal EEG information and spatial functional magnetic resonance imaging information. Within each of these categories, one can attempt data integration (the use of one imaging modality to improve the results of another) or true data fusion (in which multiple modalities are utilized to inform one another). We review both approaches and present a recent computational approach that first preprocesses the data to compute features of interest. The features are then analyzed in a multivariate manner using independent component analysis. We describe the approach in detail and provide examples of how it has been used for different fusion tasks. We also propose a method for selecting which combination of modalities provides the greatest value in discriminating groups. Finally, we summarize and describe future research topics.     

Intraoperative tumor detection: relative performance of single-element, dual-element, and imaging probes with various collimators

Accurate tumor staging depends on finding all tumor sites, and curative surgery requires the removal of ail cancerous tissue from those sites. One technique for locating tumors is to inject patients before surgery with a radiotracer that is preferentially taken up by cancerous tissue. Then, an intraoperative gamma-sensitive probe is used to locate the tumors. Small (<1-cm diameter) tumors, often undetectable by external imaging and by the standard surgical inspection with sight and touch, can be found with probes, Simple calculations and measurements with radioactive tumor models show that small tumors should be detected by single-element probes, but often such probes fail to detect these small tumors in practice. This discrepancy is often caused by the use of a uniform background to predict probe performance, Real backgrounds are nonuniform and can decrease probe performance dramatically. Dual-element, coincidence, or imaging probes may solve the background problem. The authors devised a method to predict probe performance in a realistic background which includes variations in normal organ uptakes. They predict the relative performance of both existing probes and those in the design stage so that optimal detector and collimator configurations can be determined. The procedure includes a Monte-Carlo-calculated point-response function, a numerical torso phantom, and measured biodistributions of a monoclonal antibody. The Hotelling Trace Value, a measure of tumor-detection performance, is computed from the probe responses in simulated studies.     

Molecular Probe Crossing Blood–Brain Barrier for Bimodal Imaging–Guided Photothermal/Photodynamic Therapies of Intracranial Glioblastoma

Currently, treatment of intracranial diseases still remains a great challenge because the blood–brain barrier (BBB) blocks access of most drugs to the central nervous system. Herein, a theranostic small molecular probe, iRGD‐ICG‐Lys‐DTPA@Gd (iRGD‐ILD), capable of crossing BBB is developed. Owing to the small molecular size and α_vβ₃ integrin receptor–mediated transcytosis, this tailor‐made molecular probe integrating the fluorescence and magnetic resonance imaging functions effectively passes through BBB to target tumor cells even in the early stage of glioblastoma multiforme (GBM), thereby allowing a bimodal imaging–guided therapy of GBM. The reactive oxygen species and heat generated by the ICG moiety under the 808 nm laser irradiation exert photodynamic/photothermal therapeutic effects, which results in significantly inhibited tumor growth and prolonged median survival of C6‐Luc glioma‐bearing mice. Notably, the integration of FDA‐approved clinically available agents, e.g., ICG, DTPA and Gd, into a molecular probe may ensure desirable biocompatibility and biosafety for in vivo applications. Overall, the results highlight the potential of a water‐soluble small molecule as a novel theranostic probe for highly effective GBM treatment.     

Interactive virtual endoscopy in coronary arteries based on multimodality fusion

A novel approach for platform-independent virtual endoscopy in human coronary arteries is presented in this paper. It incorporates previously developed and validated methodology for multimodality fusion of two X-ray angiographic images with pullback data from intravascular ultrasound (IVUS). These modalities pose inherently different challenges than those present in many tomographic modalities that provide parallel slices. The fusion process results in a three- or four-dimensional (3-D/4-D) model of a coronary artery, specifically of its lumen/plaque and media/adventitia surfaces. The model is used for comprehensive quantitative hemodynamic, morphologic, and functional analyses. The resulting quantitative indexes are then used to supplement the model. Platform-independent visualization is achieved through the use of the ISO/IEC-standardized Virtual Reality Modeling Language (VRML). The visualization includes an endoscopic fly-through animation that enables the user to interactively select vessel location and fly-through speed, as well as to display image pixel data or quantification results in 3-D. The presented VRML virtual-endoscopy system is used in research studies of coronary atherosclerosis development, quantitative assessment of coronary morphology and function, and vascular interventions.     

Elucidating Structure and Function In Vivo With Hybrid Fluorescence and Magnetic Resonance Imaging

While the mathematics, physics, and technology behind magnetic resonance (MR) and fluorescence image formation are distinctively different, the two modalities have significant complementary features to impart strong preclinical and clinical application synergies. Traditionally, hybrid MR and fluorescence imaging implied the use of a system where optical and MR signals can be concurrently acquired. In this case, the common geometry allows for the superposition of fluorescence images of cellular and subcellular processes onto anatomical and functional MR images. More recently, a different hybrid imaging paradigm is strongly evolving by utilizing hybrid MR-fluorescence nanoparticles. This approach offers a second paradigm of hybrid visualization where the common underlying contrast enables the coregistration of MR and fluorescence images acquired under different geometries. We review herein progress with the evolving field of multimodality MR and fluorescence imaging and discuss how these strategies offer a highly promising outlook in established and in novel preclinical and clinical applications.