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Haegelen C, Baumgarten C, Houvenaghel JF, Zhao Y, Péron J, Drapier S, Jannin P, Morandi X. Functional atlases for analysis of motor and neuropsychological outcomes after medial globus pallidus and subthalamic stimulation. PLoS One 2018; 13:e0200262. [PMID: 30005077 PMCID: PMC6044526 DOI: 10.1371/journal.pone.0200262] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 06/24/2018] [Indexed: 11/18/2022] Open
Abstract
Anatomical atlases have been developed to improve the targeting of basal ganglia in deep brain stimulation. However, the sole anatomy cannot predict the functional outcome of this surgery. Deep brain stimulation is often a compromise between several functional outcomes: motor, fluency and neuropsychological outcomes in particular. In this study, we have developed anatomo-clinical atlases for the targeting of subthalamic and medial globus pallidus deep brain stimulation. The activated electrode coordinates of 42 patients implanted in the subthalamic nucleus and 29 patients in the medial globus pallidus were studied. The atlas was built using the representation of the volume of tissue theoretically activated by the stimulation. The UPDRS score was used to represent the motor outcome. The Stroop test was represented as well as semantic and phonemic fluencies. For the subthalamic nucleus, best motor outcomes were obtained when the supero-lateral part of the nucleus was stimulated whereas the semantic fluency was impaired in this same region. For the medial globus pallidus, best outcomes were obtained when the postero ventral part of the nucleus was stimulated whereas the phonemic fluency was impaired in this same region. There was no significant neuropsychological impairment. We have proposed new anatomo-clinical atlases to visualize the motor and neuropsychological consequences at 6 months of subthalamic nucleus and pallidal stimulation in patients with Parkinson's disease.
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Affiliation(s)
- Claire Haegelen
- Department of Neurosurgery, CHU Pontchaillou, Rennes, France
- INSERM, LTSI U1099, Faculté de Médecine, Rennes, France
- University of Rennes I, Rennes, France
- * E-mail:
| | - Clément Baumgarten
- INSERM, LTSI U1099, Faculté de Médecine, Rennes, France
- University of Rennes I, Rennes, France
| | - Jean-François Houvenaghel
- Department of Neurology, CHU Pontchaillou, Rennes, France
- Behavior and Basal Ganglia host team 4712, University of Rennes 1, Rennes, France
| | - Yulong Zhao
- INSERM, LTSI U1099, Faculté de Médecine, Rennes, France
- University of Rennes I, Rennes, France
| | - Julie Péron
- Swiss Centre for Affective Sciences, Geneva, Switzerland
| | - Sophie Drapier
- Department of Neurology, CHU Pontchaillou, Rennes, France
- Behavior and Basal Ganglia host team 4712, University of Rennes 1, Rennes, France
| | - Pierre Jannin
- INSERM, LTSI U1099, Faculté de Médecine, Rennes, France
- University of Rennes I, Rennes, France
| | - Xavier Morandi
- Department of Neurosurgery, CHU Pontchaillou, Rennes, France
- INSERM, LTSI U1099, Faculté de Médecine, Rennes, France
- University of Rennes I, Rennes, France
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52
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Gibaud B, Forestier G, Feldmann C, Ferrigno G, Gonçalves P, Haidegger T, Julliard C, Katić D, Kenngott H, Maier-Hein L, März K, de Momi E, Nagy DÁ, Nakawala H, Neumann J, Neumuth T, Rojas Balderrama J, Speidel S, Wagner M, Jannin P. Toward a standard ontology of surgical process models. Int J Comput Assist Radiol Surg 2018; 13:1397-1408. [PMID: 30006820 DOI: 10.1007/s11548-018-1824-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/05/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE The development of common ontologies has recently been identified as one of the key challenges in the emerging field of surgical data science (SDS). However, past and existing initiatives in the domain of surgery have mainly been focussing on individual groups and failed to achieve widespread international acceptance by the research community. To address this challenge, the authors of this paper launched a European initiative-OntoSPM Collaborative Action-with the goal of establishing a framework for joint development of ontologies in the field of SDS. This manuscript summarizes the goals and the current status of the international initiative. METHODS A workshop was organized in 2016, gathering the main European research groups having experience in developing and using ontologies in this domain. It led to the conclusion that a common ontology for surgical process models (SPM) was absolutely needed, and that the existing OntoSPM ontology could provide a good starting point toward the collaborative design and promotion of common, standard ontologies on SPM. RESULTS The workshop led to the OntoSPM Collaborative Action-launched in mid-2016-with the objective to develop, maintain and promote the use of common ontologies of SPM relevant to the whole domain of SDS. The fundamental concept, the architecture, the management and curation of the common ontology have been established, making it ready for wider public use. CONCLUSION The OntoSPM Collaborative Action has been in operation for 24 months, with a growing dedicated membership. Its main result is a modular ontology, undergoing constant updates and extensions, based on the experts' suggestions. It remains an open collaborative action, which always welcomes new contributors and applications.
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Affiliation(s)
| | | | - Carolin Feldmann
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Paulo Gonçalves
- Instituto Politécnico de Castelo Branco, Castelo Branco, Portugal.,IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Tamás Haidegger
- Antal Bejczy Center for Intelligent Robotics, Óbuda University, Budapest, Hungary.,Austrian Center for Medical Innovation and Technology (ACMIT), Wiener Neustadt, Austria
| | - Chantal Julliard
- Inserm, LTSI - UMR_S 1099, Univ Rennes, Rennes, France.,LIRMM, Université de Montpellier, Montpellier, France.,Stryker GmbH, Freiburg, Germany
| | - Darko Katić
- Karlsruhe Institute of Technology, Institute for Anthropomatics and Robotics, Karlsruhe, Germany.,ArtiMinds Robotics GmbH, Karlsruhe, Germany
| | - Hannes Kenngott
- Department of General, Abdominal and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Lena Maier-Hein
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Keno März
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Dénes Ákos Nagy
- Antal Bejczy Center for Intelligent Robotics, Óbuda University, Budapest, Hungary.,Austrian Center for Medical Innovation and Technology (ACMIT), Wiener Neustadt, Austria
| | | | - Juliane Neumann
- Innovation Center Computer Assisted Surgery, Leipzig University, Leipzig, Germany
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery, Leipzig University, Leipzig, Germany
| | | | | | - Martin Wagner
- Department of General, Abdominal and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Pierre Jannin
- Inserm, LTSI - UMR_S 1099, Univ Rennes, Rennes, France
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Dergachyova O, Morandi X, Jannin P. Knowledge transfer for surgical activity prediction. Int J Comput Assist Radiol Surg 2018; 13:1409-1417. [PMID: 29687177 DOI: 10.1007/s11548-018-1768-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/11/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Lack of annotated training data hinders automatic recognition and prediction of surgical activities necessary for situation-aware operating rooms. We propose using knowledge transfer to compensate for data deficit and improve prediction. METHODS We used two approaches to extract and transfer surgical process knowledge. First, we encoded semantic information about surgical terms using word embedding. Secondly, we passed knowledge between different clinical datasets of neurosurgical procedures using transfer learning. RESULTS The combination of two methods provided 22% improvement of activity prediction. We also made several pertinent observations about surgical practices based on the results of the performed transfer. CONCLUSION Word embedding boosts learning process. Transfer learning was shown to be more effective than a simple combination of data, especially for less similar procedures.
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Affiliation(s)
- Olga Dergachyova
- INSERM, U1099, 35000, Rennes, France. .,Université de Rennes 1, LTSI, 35000, Rennes, France.
| | - Xavier Morandi
- INSERM, U1099, 35000, Rennes, France.,Université de Rennes 1, LTSI, 35000, Rennes, France.,Département de Neurochirurgie, CHU Rennes, 35000, Rennes, France
| | - Pierre Jannin
- INSERM, U1099, 35000, Rennes, France.,Université de Rennes 1, LTSI, 35000, Rennes, France
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54
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Holden MS, Zhao Y, Haegelen C, Essert C, Fernandez-Vidal S, Bardinet E, Ungi T, Fichtinger G, Jannin P. Self-guided training for deep brain stimulation planning using objective assessment. Int J Comput Assist Radiol Surg 2018; 13:1129-1139. [DOI: 10.1007/s11548-018-1753-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
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Forestier G, Riffaud L, Petitjean F, Henaux PL, Jannin P. Surgical skills: Can learning curves be computed from recordings of surgical activities? Int J Comput Assist Radiol Surg 2018; 13:629-636. [PMID: 29502229 DOI: 10.1007/s11548-018-1713-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/16/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE Surgery is one of the riskiest and most important medical acts that are performed today. The need to improve patient outcomes and surgeon training, and to reduce the costs of surgery, has motivated the equipment of operating rooms with sensors that record surgical interventions. The richness and complexity of the data that are collected call for new methods to support computer-assisted surgery. The aim of this paper is to support the monitoring of junior surgeons learning their surgical skill sets. METHODS Our method is fully automatic and takes as input a series of surgical interventions each represented by a low-level recording of all activities performed by the surgeon during the intervention (e.g., cut the skin with a scalpel). Our method produces a curve describing the process of standardization of the behavior of junior surgeons. Given the fact that junior surgeons receive constant feedback from senior surgeons during surgery, these curves can be directly interpreted as learning curves. RESULTS Our method is assessed using the behavior of a junior surgeon in anterior cervical discectomy and fusion surgery over his first three years after residency. They revealed the ability of the method to accurately represent the surgical skill evolution. We also showed that the learning curves can be computed by phases allowing a finer evaluation of the skill progression. CONCLUSION Preliminary results suggest that our approach constitutes a useful addition to surgical training monitoring.
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Affiliation(s)
- Germain Forestier
- IRIMAS, University of Haute-Alsace, Mulhouse, France. .,Faculty of Information Technology, Monash University, Melbourne, Australia.
| | - Laurent Riffaud
- Department of Neurosurgery, Univ. Hospital, Univ Rennes, Inserm, LTSI (Laboratoire Traitement du Signal et de l'Image) - UMR_S 1099, 35000, Rennes, France
| | - François Petitjean
- Faculty of Information Technology, Monash University, Melbourne, Australia
| | - Pierre-Louis Henaux
- Department of Neurosurgery, Univ. Hospital, Univ Rennes, Inserm, LTSI (Laboratoire Traitement du Signal et de l'Image) - UMR_S 1099, 35000, Rennes, France
| | - Pierre Jannin
- Univ Rennes, Inserm, LTSI (Laboratoire Traitement du Signal et de l'Image) - UMR_S 1099, 35000, Rennes, France
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56
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Reinke A, Eisenmann M, Onogur S, Stankovic M, Scholz P, Full PM, Bogunovic H, Landman BA, Maier O, Menze B, Sharp GC, Sirinukunwattana K, Speidel S, van der Sommen F, Zheng G, Müller H, Kozubek M, Arbel T, Bradley AP, Jannin P, Kopp-Schneider A, Maier-Hein L. How to Exploit Weaknesses in Biomedical Challenge Design and Organization. Medical Image Computing and Computer Assisted Intervention – MICCAI 2018 2018. [DOI: 10.1007/978-3-030-00937-3_45] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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57
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Forestier G, Petitjean F, Senin P, Riffaud L, Henaux PL, Jannin P. Finding discriminative and interpretable patterns in sequences of surgical activities. Artif Intell Med 2017; 82:11-19. [PMID: 28943333 DOI: 10.1016/j.artmed.2017.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 08/28/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Surgery is one of the riskiest and most important medical acts that is performed today. Understanding the ways in which surgeries are similar or different from each other is of major interest to understand and analyze surgical behaviors. This article addresses the issue of identifying discriminative patterns of surgical practice from recordings of surgeries. These recordings are sequences of low-level surgical activities representing the actions performed by surgeons during surgeries. MATERIALS AND METHOD To discover patterns that are specific to a group of surgeries, we use the vector space model (VSM) which is originally an algebraic model for representing text documents. We split long sequences of surgical activities into subsequences of consecutive activities. We then compute the relative frequencies of these subsequences using the tf*idf framework and we use the Cosine similarity to classify the sequences. This process makes it possible to discover which patterns discriminate one set of surgeries recordings from another set. RESULTS Experiments were performed on 40 neurosurgeries of anterior cervical discectomy (ACD). The results demonstrate that our method accurately identifies patterns that can discriminate between (1) locations where the surgery took place, (2) levels of expertise of surgeons (i.e., expert vs. intermediate) and even (3) individual surgeons who performed the intervention. We also show how the tf*idf weight vector can be used to both visualize the most interesting patterns and to highlight the parts of a given surgery that are the most interesting. CONCLUSIONS Identifying patterns that discriminate groups of surgeon is a very important step in improving the understanding of surgical processes. The proposed method finds discriminative and interpretable patterns in sequences of surgical activities. Our approach provides intuitive results, as it identifies automatically the set of patterns explaining the differences between the groups.
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Affiliation(s)
- Germain Forestier
- MIPS EA 2332, University of Haute-Alsace, Mulhouse, France; Faculty of Information Technology, Monash University, Melbourne, Australia.
| | - François Petitjean
- Faculty of Information Technology, Monash University, Melbourne, Australia.
| | - Pavel Senin
- Los Alamos National Laboratory, Los Alamos, NM 87544, United States.
| | - Laurent Riffaud
- INSERM MediCIS, Unit U1099 LTSI, University of Rennes 1, Rennes, France; Department of Neurosurgery, Pontchaillou University Hospital, Rennes, France.
| | - Pierre-Louis Henaux
- INSERM MediCIS, Unit U1099 LTSI, University of Rennes 1, Rennes, France; Department of Neurosurgery, Pontchaillou University Hospital, Rennes, France.
| | - Pierre Jannin
- INSERM MediCIS, Unit U1099 LTSI, University of Rennes 1, Rennes, France.
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58
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Maier-Hein L, Vedula SS, Speidel S, Navab N, Kikinis R, Park A, Eisenmann M, Feussner H, Forestier G, Giannarou S, Hashizume M, Katic D, Kenngott H, Kranzfelder M, Malpani A, März K, Neumuth T, Padoy N, Pugh C, Schoch N, Stoyanov D, Taylor R, Wagner M, Hager GD, Jannin P. Surgical data science for next-generation interventions. Nat Biomed Eng 2017; 1:691-696. [PMID: 31015666 DOI: 10.1038/s41551-017-0132-7] [Citation(s) in RCA: 185] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Lena Maier-Hein
- Division Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany.
| | - Swaroop S Vedula
- The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Stefanie Speidel
- Division Translational Surgical Oncology, National Center for Tumor Diseases (NCT), 01307, Dresden, Germany
| | - Nassir Navab
- Computer Aided Medical Procedures, Technical University of Munich, 80333, Munich, Germany.,Department of Computer Science, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Ron Kikinis
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02215, USA.,Department of Computer Science, University of Bremen, 28359, Bremen, Germany.,Fraunhofer MEVIS, 28359, Bremen, Germany
| | - Adrian Park
- Department of Surgery, Anne Arundel Health System, Annapolis, MD, 21401, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Matthias Eisenmann
- Division Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Hubertus Feussner
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Germain Forestier
- Department of Computer Science, University of Haute-Alsace, 68093, Mulhouse, France
| | - Stamatia Giannarou
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, SW7 2AZ, UK
| | - Makoto Hashizume
- Department of Advanced Medical Initiatives, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Darko Katic
- Institute for Anthropomatics and Robotics, Karlsruhe Institute of Technolgoy (KIT), 76131, Karlsruhe, Germany
| | - Hannes Kenngott
- Department for General, Visceral and Transplant Surgery, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Michael Kranzfelder
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Anand Malpani
- The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, MD, 21218, USA.,Department of Computer Science, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Keno März
- Division Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, 04103, Leipzig, Germany
| | - Nicolas Padoy
- ICube, University of Strasbourg, CNRS, IHU, 67081, Strasbourg, France
| | - Carla Pugh
- Department of Surgery, University of Wisconsin, Madison, WI, 53792, USA
| | - Nicolai Schoch
- Engineering Mathematics and Computing Lab (EMCL), IWR, Heidelberg University, 69120, Heidelberg, Germany
| | - Danail Stoyanov
- Centre for Medical Image Computing (CMIC) and Department of Computer Science, University College London, London, WC1E 6BT, UK
| | - Russell Taylor
- Department of Computer Science, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Martin Wagner
- Department for General, Visceral and Transplant Surgery, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Gregory D Hager
- The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, MD, 21218, USA. .,Department of Computer Science, The Johns Hopkins University, Baltimore, MD, 21218, USA.
| | - Pierre Jannin
- Université de Rennes 1, 35065, Rennes, France. .,INSERM, 35043, Rennes, France.
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Forestier G, Petitjean F, Riffaud L, Jannin P. Automatic matching of surgeries to predict surgeons' next actions. Artif Intell Med 2017; 81:3-11. [PMID: 28343742 DOI: 10.1016/j.artmed.2017.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 03/07/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE More than half a million surgeries are performed every day worldwide, which makes surgery one of the most important component of global health care. In this context, the objective of this paper is to introduce a new method for the prediction of the possible next task that a surgeon is going to perform during surgery. MATERIAL AND METHOD We formulate the problem as finding the optimal registration of a partial sequence to a complete reference sequence of surgical activities. We propose an efficient algorithm to find the optimal partial alignment and a prediction system using maximum a posteriori probability estimation and filtering. We also introduce a weighting scheme allowing to improve the predictions by taking into account the relative similarity between the current surgery and a set of pre-recorded surgeries. RESULTS Our method is evaluated on two types of neurosurgical procedures: lumbar disc herniation removal and anterior cervical discectomy. Results show that our method outperformed the state of the art by predicting the next task that the surgeon will perform with 95% accuracy. CONCLUSIONS This work shows that, even from the low-level description of surgeries and without other sources of information, it is often possible to predict the next surgical task when the conditions are consistent with the previously recorded surgeries. We also showed that our method is able to assess when there is actually a large divergence between the predictions and decide that it is not reasonable to make a prediction.
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Affiliation(s)
- Germain Forestier
- MIPS, University of Haute-Alsace, Mulhouse, France; Faculty of Information Technology, Monash University, Melbourne, Australia.
| | - François Petitjean
- Faculty of Information Technology, Monash University, Melbourne, Australia.
| | - Laurent Riffaud
- INSERM MediCIS, Unit U1099 LTSI, University of Rennes 1, Rennes, France; Department of Neurosurgery, Pontchaillou University Hospital, Rennes, France.
| | - Pierre Jannin
- INSERM MediCIS, Unit U1099 LTSI, University of Rennes 1, Rennes, France.
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Pujol S, Cabeen R, Sébille SB, Yelnik J, François C, Fernandez Vidal S, Karachi C, Zhao Y, Cosgrove GR, Jannin P, Kikinis R, Bardinet E. In vivo Exploration of the Connectivity between the Subthalamic Nucleus and the Globus Pallidus in the Human Brain Using Multi-Fiber Tractography. Front Neuroanat 2017; 10:119. [PMID: 28154527 PMCID: PMC5243825 DOI: 10.3389/fnana.2016.00119] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/25/2016] [Indexed: 11/13/2022] Open
Abstract
The basal ganglia is part of a complex system of neuronal circuits that play a key role in the integration and execution of motor, cognitive and emotional function in the human brain. Parkinson’s disease is a progressive neurological disorder of the motor circuit characterized by tremor, rigidity, and slowness of movement. Deep brain stimulation (DBS) of the subthalamic nucleus and the globus pallidus pars interna provides an efficient treatment to reduce symptoms and levodopa-induced side effects in Parkinson’s disease patients. While the underlying mechanism of action of DBS is still unknown, the potential modulation of white matter tracts connecting the surgical targets has become an active area of research. With the introduction of advanced diffusion MRI acquisition sequences and sophisticated post-processing techniques, the architecture of the human brain white matter can be explored in vivo. The goal of this study is to investigate the white matter connectivity between the subthalamic nucleus and the globus pallidus. Two multi-fiber tractography methods were used to reconstruct pallido-subthalamic, subthalamo-pallidal and pyramidal fibers in five healthy subjects datasets of the Human Connectome Project. The anatomical accuracy of the tracts was assessed by four judges with expertise in neuroanatomy, functional neurosurgery, and diffusion MRI. The variability among subjects was evaluated based on the fractional anisotropy and mean diffusivity of the tracts. Both multi-fiber approaches enabled the detection of complex fiber architecture in the basal ganglia. The qualitative evaluation by experts showed that the identified tracts were in agreement with the expected anatomy. Tract-derived measurements demonstrated relatively low variability among subjects. False-negative tracts demonstrated the current limitations of both methods for clinical decision-making. Multi-fiber tractography methods combined with state-of-the-art diffusion MRI data have the potential to help identify white matter tracts connecting DBS targets in functional neurosurgery intervention.
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Affiliation(s)
- Sonia Pujol
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA
| | - Ryan Cabeen
- Department of Computer Science, Brown University, Providence RI, USA
| | - Sophie B Sébille
- Institut du Cerveau et de la Moëlle Epinière, INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, University of Paris 06, UMR S 1127 Paris, France
| | - Jérôme Yelnik
- Institut du Cerveau et de la Moëlle Epinière, INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, University of Paris 06, UMR S 1127 Paris, France
| | - Chantal François
- Institut du Cerveau et de la Moëlle Epinière, INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, University of Paris 06, UMR S 1127 Paris, France
| | - Sara Fernandez Vidal
- Institut du Cerveau et de la Moëlle Epinière, INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, University of Paris 06, UMR S 1127Paris, France; Centre de Neuro-Imagerie de Recherche, Institut du Cerveau et de la Moëlle EpinièreParis, France
| | - Carine Karachi
- Institut du Cerveau et de la Moëlle Epinière, INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, University of Paris 06, UMR S 1127Paris, France; Department of Neurosurgery, Pitié-Salpêtrière HospitalParis, France
| | - Yulong Zhao
- LTSI, Inserm UMR 1099 - Université de Rennes Rennes, France
| | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA
| | - Pierre Jannin
- LTSI, Inserm UMR 1099 - Université de Rennes Rennes, France
| | - Ron Kikinis
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA
| | - Eric Bardinet
- Institut du Cerveau et de la Moëlle Epinière, INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, University of Paris 06, UMR S 1127Paris, France; Centre de Neuro-Imagerie de Recherche, Institut du Cerveau et de la Moëlle EpinièreParis, France
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61
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Baumgarten C, Zhao Y, Sauleau P, Malrain C, Jannin P, Haegelen C. Improvement of Pyramidal Tract Side Effect Prediction Using a Data-Driven Method in Subthalamic Stimulation. IEEE Trans Biomed Eng 2016; 64:2134-2141. [PMID: 27959795 DOI: 10.1109/tbme.2016.2638018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE subthalamic nucleus deep brain stimulation (STN DBS) is limited by the occurrence of a pyramidal tract side effect (PTSE) induced by electrical activation of the pyramidal tract. Predictive models are needed to assist the surgeon during the electrode trajectory preplanning. The objective of the study was to compare two methods of PTSE prediction based on clinical assessment of PTSE induced by STN DBS in patients with Parkinson's disease. METHODS two clinicians assessed PTSE postoperatively in 20 patients implanted for at least three months in the STN. The resulting dataset of electroclinical tests was used to evaluate two methods of PTSE prediction. The first method was based on the volume of tissue activated (VTA) modeling and the second one was a data-driven-based method named Pyramidal tract side effect Model based on Artificial Neural network (PyMAN) developed in our laboratory. This method was based on the nonlinear correlation between the PTSE current threshold and the 3-D electrode coordinates. PTSE prediction from both methods was compared using Mann-Whitney U test. RESULTS 1696 electroclinical tests were used to design and compare the two methods. Sensitivity, specificity, positive- and negative-predictive values were significantly higher with the PyMAN method than with the VTA-based method (P < 0.05). CONCLUSION the PyMAN method was more effective than the VTA-based method to predict PTSE. SIGNIFICANCE this data-driven tool could help the neurosurgeon in predicting adverse side effects induced by DBS during the electrode trajectory preplanning.
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Monge F, Shakir DI, Lejeune F, Morandi X, Navab N, Jannin P. Acquisition models in intraoperative positron surface imaging. Int J Comput Assist Radiol Surg 2016; 12:691-703. [PMID: 27714566 DOI: 10.1007/s11548-016-1487-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Intraoperative imaging aims at identifying residual tumor during surgery. Positron Surface Imaging (PSI) is one of the solutions to help surgeons in a better detection of resection margins of brain tumor, leading to an improved patient outcome. This system relies on a tracked freehand beta probe, using [Formula: see text]F-based radiotracer. Some acquisition models have been proposed in the literature in order to enhance image quality, but no comparative validation study has been performed for PSI. METHODS In this study, we investigated the performance of different acquisition models by considering validation criteria and normalized metrics. We proposed a reference-based validation framework to perform the comparative study between acquisition models and a basic method. We estimated the performance of several acquisition models in light of four validation criteria: efficiency, computational speed, spatial accuracy and tumor contrast. RESULTS Selected acquisition models outperformed the basic method, albeit with the real-time aspect compromised. One acquisition model yielded the best performance among all according to the validation criteria: efficiency (1-Spe: 0.1, Se: 0.94), spatial accuracy (max Dice: 0.77) and tumor contrast (max T/B: 5.2). We also found out that above a minimum threshold value of the sampling rate, the reconstruction quality does not vary significantly. CONCLUSION Our method allowed the comparison of different acquisition models and highlighted one of them according to our validation criteria. This novel approach can be extended to 3D datasets, for validation of future acquisition models dedicated to intraoperative guidance of brain surgery.
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Affiliation(s)
- Frédéric Monge
- LTSI INSERM, UMR 1099, Campus de Villejean, Université de Rennes 1, 2, Avenue du Pr. Léon Bernard, 35043, Rennes Cedex, France.
| | | | | | - Xavier Morandi
- LTSI INSERM, UMR 1099, Campus de Villejean, Université de Rennes 1, 2, Avenue du Pr. Léon Bernard, 35043, Rennes Cedex, France.,CHU Rennes, Service de Neurochirurgie, Rennes, 35000, France
| | - Nassir Navab
- CAMP, Technische Universität München, Munich, Germany
| | - Pierre Jannin
- LTSI INSERM, UMR 1099, Campus de Villejean, Université de Rennes 1, 2, Avenue du Pr. Léon Bernard, 35043, Rennes Cedex, France
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Houvenaghel JF, Duprez J, Argaud S, Naudet F, Dondaine T, Robert GH, Drapier S, Haegelen C, Jannin P, Drapier D, Vérin M, Sauleau P. Influence of subthalamic deep-brain stimulation on cognitive action control in incentive context. Neuropsychologia 2016; 91:519-530. [PMID: 27664297 DOI: 10.1016/j.neuropsychologia.2016.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/23/2016] [Accepted: 09/20/2016] [Indexed: 01/24/2023]
Abstract
Subthalamic nucleus deep-brain stimulation (STN-DBS) is an effective treatment in Parkinson's disease (PD), but can have cognitive side effects, such as increasing the difficulty of producing appropriate responses when a habitual but inappropriate responses represent strong alternatives. STN-DBS also appears to modulate representations of incentives such as monetary rewards. Furthermore, conflict resolution can be modulated by incentive context. We therefore used a rewarded Simon Task to assess the influence of promised rewards on cognitive action control in 50 patients with PD, half of whom were being treated with STN-DBS. Results were analyzed according to the activation-suppression model. We showed that STN-DBS (i) favored the expression of motor impulsivity, as measured with the Barratt Impulsiveness Scale, (ii) facilitated the expression of incentive actions as observed with a greater increase in speed according to promised reward in patients with versus without DBS and (iii) may increase impulsive action selection in an incentive context. In addition, analysis of subgroups of implanted patients suggested that those who exhibited the most impulsive action selection had the least severe disease. This may indicate that patients with less marked disease are more at risk of developing impulsivity postoperatively. Finally, in these patients, incentive context increased the difficulty of resolving conflict situations. As a whole, the current study revealed that in patients with PD, STN-DBS affects the cognitive processes involved in conflict resolution, reward processing and the influence of promised rewards on conflict resolution.
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Affiliation(s)
- Jean-François Houvenaghel
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France; Department of Neurology, Rennes University Hospital, Rennes, France.
| | - Joan Duprez
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France
| | - Soizic Argaud
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France; "Neuroscience of Emotion and Affective Dynamics" Laboratory, Department of Psychology and Educational Sciences/Swiss Center for Affective Sciences, Campus Biotech, University of Geneva, Geneva, Switzerland
| | - Florian Naudet
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France; Clinical Investigation Center (INSERM 0203), Department of Pharmacology, Rennes University Hospital, Rennes, France; Department of Psychiatry, Rennes University Hospital, Rennes, France
| | - Thibaut Dondaine
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France
| | - Gabriel Hadrien Robert
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France; Department of Psychiatry, Rennes University Hospital, Rennes, France
| | - Sophie Drapier
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France; Department of Neurology, Rennes University Hospital, Rennes, France
| | - Claire Haegelen
- Department of Neurosurgery, Rennes University Hospital, Rennes, France; "MediCIS" laboratory (UMR 1099 LTSI), INSERM/University of Rennes, Rennes, France
| | - Pierre Jannin
- "MediCIS" laboratory (UMR 1099 LTSI), INSERM/University of Rennes, Rennes, France
| | - Dominique Drapier
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France; Department of Psychiatry, Rennes University Hospital, Rennes, France
| | - Marc Vérin
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France; Department of Neurology, Rennes University Hospital, Rennes, France
| | - Paul Sauleau
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France; Department of Neurophysiology, Rennes University Hospital, Rennes, France
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Bouget D, Allan M, Stoyanov D, Jannin P. Vision-based and marker-less surgical tool detection and tracking: a review of the literature. Med Image Anal 2016; 35:633-654. [PMID: 27744253 DOI: 10.1016/j.media.2016.09.003] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 06/26/2016] [Accepted: 09/05/2016] [Indexed: 11/16/2022]
Abstract
In recent years, tremendous progress has been made in surgical practice for example with Minimally Invasive Surgery (MIS). To overcome challenges coming from deported eye-to-hand manipulation, robotic and computer-assisted systems have been developed. Having real-time knowledge of the pose of surgical tools with respect to the surgical camera and underlying anatomy is a key ingredient for such systems. In this paper, we present a review of the literature dealing with vision-based and marker-less surgical tool detection. This paper includes three primary contributions: (1) identification and analysis of data-sets used for developing and testing detection algorithms, (2) in-depth comparison of surgical tool detection methods from the feature extraction process to the model learning strategy and highlight existing shortcomings, and (3) analysis of validation techniques employed to obtain detection performance results and establish comparison between surgical tool detectors. The papers included in the review were selected through PubMed and Google Scholar searches using the keywords: "surgical tool detection", "surgical tool tracking", "surgical instrument detection" and "surgical instrument tracking" limiting results to the year range 2000 2015. Our study shows that despite significant progress over the years, the lack of established surgical tool data-sets, and reference format for performance assessment and method ranking is preventing faster improvement.
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Affiliation(s)
- David Bouget
- Medicis team, INSERM U1099, Université de Rennes 1 LTSI, 35000 Rennes, France.
| | - Max Allan
- Center for Medical Image Computing. University College London, WC1E 6BT London, United Kingdom.
| | - Danail Stoyanov
- Center for Medical Image Computing. University College London, WC1E 6BT London, United Kingdom.
| | - Pierre Jannin
- Medicis team, INSERM U1099, Université de Rennes 1 LTSI, 35000 Rennes, France.
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Baumgarten C, Zhao Y, Sauleau P, Malrain C, Jannin P, Haegelen C. Image-guided preoperative prediction of pyramidal tract side effect in deep brain stimulation: proof of concept and application to the pyramidal tract side effect induced by pallidal stimulation. J Med Imaging (Bellingham) 2016; 3:025001. [PMID: 27413769 DOI: 10.1117/1.jmi.3.2.025001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 06/13/2016] [Indexed: 11/14/2022] Open
Abstract
Deep brain stimulation of the medial globus pallidus (GPm) is a surgical procedure for treating patients suffering from Parkinson's disease. Its therapeutic effect may be limited by the presence of pyramidal tract side effect (PTSE). PTSE is a contraction time-locked to the stimulation when the current spreading reaches the motor fibers of the pyramidal tract within the internal capsule. The objective of the study was to propose a preoperative predictive model of PTSE. A machine learning-based method called PyMAN (PTSE model based on artificial neural network) accounting for the current used in stimulation, the three-dimensional electrode coordinates and the angle of the trajectory, was designed to predict the occurrence of PTSE. Ten patients implanted in the GPm have been tested by a clinician to create a labeled dataset of the stimulation parameters that trigger PTSE. The kappa index value between the data predicted by PyMAN and the labeled data was 0.78. Further evaluation studies are desirable to confirm whether PyMAN could be a reliable tool for assisting the surgeon to prevent PTSE during the preoperative planning.
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Affiliation(s)
- Clement Baumgarten
- French Institute of Health and Medical Research, UMR 1099, 2 avenue du Pr. Léon Bernard, Rennes Cedex 35043, France; University of Rennes 1, Treatment of Signal and Imaging Laboratory, 2 avenue du Pr. Léon Bernard, Rennes Cedex 35043, France
| | - Yulong Zhao
- French Institute of Health and Medical Research, UMR 1099, 2 avenue du Pr. Léon Bernard, Rennes Cedex 35043, France; University of Rennes 1, Treatment of Signal and Imaging Laboratory, 2 avenue du Pr. Léon Bernard, Rennes Cedex 35043, France
| | - Paul Sauleau
- Rennes University Hospital , Department of Neurology, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
| | - Cecile Malrain
- Rennes University Hospital , Department of Neurology, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
| | - Pierre Jannin
- French Institute of Health and Medical Research, UMR 1099, 2 avenue du Pr. Léon Bernard, Rennes Cedex 35043, France; University of Rennes 1, Treatment of Signal and Imaging Laboratory, 2 avenue du Pr. Léon Bernard, Rennes Cedex 35043, France
| | - Claire Haegelen
- French Institute of Health and Medical Research, UMR 1099, 2 avenue du Pr. Léon Bernard, Rennes Cedex 35043, France; University of Rennes 1, Treatment of Signal and Imaging Laboratory, 2 avenue du Pr. Léon Bernard, Rennes Cedex 35043, France; Rennes University Hospital, Department of Neurosurgery, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
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66
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Sauleau P, Drapier S, Duprez J, Houvenaghel JF, Dondaine T, Haegelen C, Drapier D, Jannin P, Robert G, Le Jeune F, Vérin M. Weight Gain following Pallidal Deep Brain Stimulation: A PET Study. PLoS One 2016; 11:e0153438. [PMID: 27070317 PMCID: PMC4829218 DOI: 10.1371/journal.pone.0153438] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/29/2016] [Indexed: 12/18/2022] Open
Abstract
The mechanisms behind weight gain following deep brain stimulation (DBS) surgery seem to be multifactorial and suspected depending on the target, either the subthalamic nucleus (STN) or the globus pallidus internus (GPi). Decreased energy expenditure following motor improvement and behavioral and/or metabolic changes are possible explanations. Focusing on GPi target, our objective was to analyze correlations between changes in brain metabolism (measured with PET) and weight gain following GPi-DBS in patients with Parkinson's disease (PD). Body mass index was calculated and brain activity prospectively measured using 2-deoxy-2[18F]fluoro-D-glucose PET four months before and four months after the start of GPi-DBS in 19 PD patients. Dopaminergic medication was included in the analysis to control for its possible influence on brain metabolism. Body mass index increased significantly by 0.66 ± 1.3 kg/m2 (p = 0.040). There were correlations between weight gain and changes in brain metabolism in premotor areas, including the left and right superior gyri (Brodmann area, BA 6), left superior gyrus (BA 8), the dorsolateral prefrontal cortex (right middle gyrus, BAs 9 and 46), and the left and right somatosensory association cortices (BA 7). However, we found no correlation between weight gain and metabolic changes in limbic and associative areas. Additionally, there was a trend toward a correlation between reduced dyskinesia and weight gain (r = 0.428, p = 0.067). These findings suggest that, unlike STN-DBS, motor improvement is the major contributing factor for weight gain following GPi-DBS PD, confirming the motor selectivity of this target.
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Affiliation(s)
- Paul Sauleau
- “Behavior and Basal Ganglia” research unit (EA 4712), University of Rennes 1, Avenue Léon Bernard, Rennes, France
- Department of Neurophysiology, Rennes University Hospital, rue Henri Le Guilloux, Rennes, France
- * E-mail:
| | - Sophie Drapier
- “Behavior and Basal Ganglia” research unit (EA 4712), University of Rennes 1, Avenue Léon Bernard, Rennes, France
- Department of Neurology, Rennes University Hospital, rue Henri Le Guilloux, Rennes, France
| | - Joan Duprez
- “Behavior and Basal Ganglia” research unit (EA 4712), University of Rennes 1, Avenue Léon Bernard, Rennes, France
| | - Jean-François Houvenaghel
- “Behavior and Basal Ganglia” research unit (EA 4712), University of Rennes 1, Avenue Léon Bernard, Rennes, France
- Department of Neurology, Rennes University Hospital, rue Henri Le Guilloux, Rennes, France
| | - Thibaut Dondaine
- “Behavior and Basal Ganglia” research unit (EA 4712), University of Rennes 1, Avenue Léon Bernard, Rennes, France
| | - Claire Haegelen
- Department of Neurosurgery, Rennes University Hospital, rue Henri Le Guilloux, Rennes, France
- “MediCIS” laboratory (UMR 1099 LTSI), INSERM, University of Rennes 1, Avenue Léon Bernard, Rennes, France
| | - Dominique Drapier
- “Behavior and Basal Ganglia” research unit (EA 4712), University of Rennes 1, Avenue Léon Bernard, Rennes, France
- Department of Psychiatry, Rennes University Hospital, avenue du Général Leclerc, Rennes, France
| | - Pierre Jannin
- Department of Neurosurgery, Rennes University Hospital, rue Henri Le Guilloux, Rennes, France
| | - Gabriel Robert
- “Behavior and Basal Ganglia” research unit (EA 4712), University of Rennes 1, Avenue Léon Bernard, Rennes, France
- Department of Psychiatry, Rennes University Hospital, avenue du Général Leclerc, Rennes, France
| | - Florence Le Jeune
- “Behavior and Basal Ganglia” research unit (EA 4712), University of Rennes 1, Avenue Léon Bernard, Rennes, France
- Department of Oncology, Eugene Marquis Center, Avenue de la Bataille Flandres-Dunkerque, Rennes, France
| | - Marc Vérin
- “Behavior and Basal Ganglia” research unit (EA 4712), University of Rennes 1, Avenue Léon Bernard, Rennes, France
- Department of Neurology, Rennes University Hospital, rue Henri Le Guilloux, Rennes, France
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67
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Dergachyova O, Bouget D, Huaulmé A, Morandi X, Jannin P. Automatic data-driven real-time segmentation and recognition of surgical workflow. Int J Comput Assist Radiol Surg 2016; 11:1081-9. [PMID: 26995598 DOI: 10.1007/s11548-016-1371-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 02/26/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE With the intention of extending the perception and action of surgical staff inside the operating room, the medical community has expressed a growing interest towards context-aware systems. Requiring an accurate identification of the surgical workflow, such systems make use of data from a diverse set of available sensors. In this paper, we propose a fully data-driven and real-time method for segmentation and recognition of surgical phases using a combination of video data and instrument usage signals, exploiting no prior knowledge. We also introduce new validation metrics for assessment of workflow detection. METHODS The segmentation and recognition are based on a four-stage process. Firstly, during the learning time, a Surgical Process Model is automatically constructed from data annotations to guide the following process. Secondly, data samples are described using a combination of low-level visual cues and instrument information. Then, in the third stage, these descriptions are employed to train a set of AdaBoost classifiers capable of distinguishing one surgical phase from others. Finally, AdaBoost responses are used as input to a Hidden semi-Markov Model in order to obtain a final decision. RESULTS On the MICCAI EndoVis challenge laparoscopic dataset we achieved a precision and a recall of 91 % in classification of 7 phases. CONCLUSION Compared to the analysis based on one data type only, a combination of visual features and instrument signals allows better segmentation, reduction of the detection delay and discovery of the correct phase order.
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Affiliation(s)
- Olga Dergachyova
- INSERM, U1099, Rennes, 35000, France. .,Université de Rennes 1, LTSI, Rennes, 35000, France.
| | - David Bouget
- INSERM, U1099, Rennes, 35000, France.,Université de Rennes 1, LTSI, Rennes, 35000, France
| | - Arnaud Huaulmé
- INSERM, U1099, Rennes, 35000, France.,Université de Rennes 1, LTSI, Rennes, 35000, France.,Université Joseph Fourier, TIMC-IMAG UMR 5525, Grenoble, 38041, France
| | - Xavier Morandi
- INSERM, U1099, Rennes, 35000, France.,Université de Rennes 1, LTSI, Rennes, 35000, France.,CHU Rennes, Département de Neurochirurgie, Rennes, 35000, France
| | - Pierre Jannin
- INSERM, U1099, Rennes, 35000, France.,Université de Rennes 1, LTSI, Rennes, 35000, France
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Claude G, Gouranton V, Caillaud B, Gibaud B, Arnaldi B, Jannin P. Synthesis and Simulation of Surgical Process Models. Stud Health Technol Inform 2016; 220:63-70. [PMID: 27046555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Virtual Reality for surgical training is mainly focused on technical surgical skills. We work on providing a novel approach to the use of Virtual Reality focusing on the procedural aspects. Our system relies on a specific work-flow generating a model of the procedure from real case surgery observation in the operating room. This article presents the different technologies created in the context of our project and their relations as other components of our workflow.
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Affiliation(s)
| | | | - Benoit Caillaud
- Inria/IRISA, Campus de Beaulieu, F-35042 Rennes cedex, France
| | - Bernard Gibaud
- INSERM, UMR 1099, Université de Rennes 1, LTSI F-35043 Rennes, France
| | - Bruno Arnaldi
- INSA de Rennes, IRISA/Inria, F-35042 Rennes cedex, France
| | - Pierre Jannin
- INSERM, UMR 1099, Université de Rennes 1, LTSI F-35043 Rennes, France
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Katić D, Julliard C, Wekerle AL, Kenngott H, Müller-Stich BP, Dillmann R, Speidel S, Jannin P, Gibaud B. Erratum to: LapOntoSPM: an ontology for laparoscopic surgeries and its application to surgical phase recognition. Int J Comput Assist Radiol Surg 2015; 11:679. [PMID: 26704373 DOI: 10.1007/s11548-015-1314-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Darko Katić
- Humanoids and Intelligence Systems Lab, Institute for Anthropomatics and Robotics, Karlsruhe Institute of Technology (KIT), 76131, Karlsruhe, Germany.
| | - Chantal Julliard
- Humanoids and Intelligence Systems Lab, Institute for Anthropomatics and Robotics, Karlsruhe Institute of Technology (KIT), 76131, Karlsruhe, Germany
| | - Anna-Laura Wekerle
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, 69120, Heidelberg, Germany
| | - Hannes Kenngott
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, 69120, Heidelberg, Germany
| | - Beat Peter Müller-Stich
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, 69120, Heidelberg, Germany
| | - Rüdiger Dillmann
- Humanoids and Intelligence Systems Lab, Institute for Anthropomatics and Robotics, Karlsruhe Institute of Technology (KIT), 76131, Karlsruhe, Germany
| | - Stefanie Speidel
- Humanoids and Intelligence Systems Lab, Institute for Anthropomatics and Robotics, Karlsruhe Institute of Technology (KIT), 76131, Karlsruhe, Germany
| | - Pierre Jannin
- INSERM, UMR 1099, 35000, Rennes, France
- Université de Rennes 1, LTSI, 35000, Rennes, France
| | - Bernard Gibaud
- INSERM, UMR 1099, 35000, Rennes, France
- Université de Rennes 1, LTSI, 35000, Rennes, France
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Ory S, Le Jeune F, Haegelen C, Vicente S, Philippot P, Dondaine T, Jannin P, Drapier S, Drapier D, Sauleau P, Vérin M, Péron J. Pre-frontal-insular-cerebellar modifications correlate with disgust feeling blunting after subthalamic stimulation: A positron emission tomography study in Parkinson's disease. J Neuropsychol 2015; 11:378-395. [PMID: 26670087 DOI: 10.1111/jnp.12094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 10/26/2015] [Indexed: 12/01/2022]
Abstract
Subthalamic nucleus (STN) deep brain stimulation (DBS) has recently advanced our understanding of the major role played by this basal ganglion in human emotion. Research indicates that STN DBS can induce modifications in all components of emotion, and neuroimaging studies have shown that the metabolic modifications correlated with these emotional disturbances following surgery are both task- and sensory input-dependent. Nevertheless, to date, these modifications have not been confirmed for all emotional components, notably subjective emotional experience, or feelings. To identify the neural network underlying the modification of feelings following STN DBS, we assessed 16 patients with Parkinson's disease before and after surgery, using both subjective assessments of emotional experience and 18 [F]fluorodeoxyglucose positron emission tomography (18 FDG-PET). The patients viewed six film excerpts intended to elicit happy, angry, fearful, sad, disgusted, and neutral feelings, and they self-rated the intensity of these feelings. After DBS, there was a significant reduction in the intensity of the disgust feeling. Correlations were observed between decreased disgust experience and cerebral glucose metabolism (FDG uptake) in the bilateral pre-frontal cortices (orbitofrontal, dorsolateral, and inferior frontal gyri), bilateral insula, and right cerebellum. We suggest that the STN contributes to the synchronization process underlying the emergence of feelings.
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Affiliation(s)
- Sophie Ory
- 'Behaviour and Basal Ganglia' Research Unit, University of Rennes 1, Rennes University Hospital, France.,Neurology Department, Rennes University Hospital, France
| | - Florence Le Jeune
- 'Behaviour and Basal Ganglia' Research Unit, University of Rennes 1, Rennes University Hospital, France.,Nuclear Medicine Department, Eugène Marquis Centre, Rennes, France
| | - Claire Haegelen
- MediCIS, INSERM, Faculty of Medicine, University of Rennes I, France.,Neurosurgery Department, Rennes University Hospital, France
| | - Siobhan Vicente
- UMR CNRS 7295, Centre for Research on Cognition and Learning, Poitiers, France
| | - Pierre Philippot
- Department of Psychology, University of Louvain-La-Neuve, Belgium
| | - Thibaut Dondaine
- 'Behaviour and Basal Ganglia' Research Unit, University of Rennes 1, Rennes University Hospital, France
| | - Pierre Jannin
- MediCIS, INSERM, Faculty of Medicine, University of Rennes I, France
| | - Sophie Drapier
- 'Behaviour and Basal Ganglia' Research Unit, University of Rennes 1, Rennes University Hospital, France.,Neurology Department, Rennes University Hospital, France
| | - Dominique Drapier
- 'Behaviour and Basal Ganglia' Research Unit, University of Rennes 1, Rennes University Hospital, France.,Adult Psychiatry Department, Guillaume Régnier Hospital, Rennes, France
| | - Paul Sauleau
- 'Behaviour and Basal Ganglia' Research Unit, University of Rennes 1, Rennes University Hospital, France.,Physiology Department, Rennes University Hospital, France
| | - Marc Vérin
- 'Behaviour and Basal Ganglia' Research Unit, University of Rennes 1, Rennes University Hospital, France.,Neurology Department, Rennes University Hospital, France
| | - Julie Péron
- 'Neuroscience of Emotion and Affective Dynamics' Laboratory, Department of Psychology and Swiss Centre for Affective Sciences, University of Geneva, Switzerland
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Bouget D, Benenson R, Omran M, Riffaud L, Schiele B, Jannin P. Detecting Surgical Tools by Modelling Local Appearance and Global Shape. IEEE Trans Med Imaging 2015; 34:2603-2617. [PMID: 26625340 DOI: 10.1109/tmi.2015.2450831] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Detecting tools in surgical videos is an important ingredient for context-aware computer-assisted surgical systems. To this end, we present a new surgical tool detection dataset and a method for joint tool detection and pose estimation in 2d images. Our two-stage pipeline is data-driven and relaxes strong assumptions made by previous works regarding the geometry, number, and position of tools in the image. The first stage classifies each pixel based on local appearance only, while the second stage evaluates a tool-specific shape template to enforce global shape. Both local appearance and global shape are learned from training data. Our method is validated on a new surgical tool dataset of 2 476 images from neurosurgical microscopes, which is made freely available. It improves over existing datasets in size, diversity and detail of annotation. We show that our method significantly improves over competitive baselines from the computer vision field. We achieve 15% detection miss-rate at 10(-1) false positives per image (for the suction tube) over our surgical tool dataset. Results indicate that performing semantic labelling as an intermediate task is key for high quality detection.
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Despinoy F, Bouget D, Forestier G, Penet C, Zemiti N, Poignet P, Jannin P. Unsupervised Trajectory Segmentation for Surgical Gesture Recognition in Robotic Training. IEEE Trans Biomed Eng 2015; 63:1280-91. [PMID: 26513773 DOI: 10.1109/tbme.2015.2493100] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dexterity and procedural knowledge are two critical skills that surgeons need to master to perform accurate and safe surgical interventions. However, current training systems do not allow us to provide an in-depth analysis of surgical gestures to precisely assess these skills. Our objective is to develop a method for the automatic and quantitative assessment of surgical gestures. To reach this goal, we propose a new unsupervised algorithm that can automatically segment kinematic data from robotic training sessions. Without relying on any prior information or model, this algorithm detects critical points in the kinematic data that define relevant spatio-temporal segments. Based on the association of these segments, we obtain an accurate recognition of the gestures involved in the surgical training task. We, then, perform an advanced analysis and assess our algorithm using datasets recorded during real expert training sessions. After comparing our approach with the manual annotations of the surgical gestures, we observe 97.4% accuracy for the learning purpose and an average matching score of 81.9% for the fully automated gesture recognition process. Our results show that trainees workflow can be followed and surgical gestures may be automatically evaluated according to an expert database. This approach tends toward improving training efficiency by minimizing the learning curve.
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Houvenaghel JF, Le Jeune F, Dondaine T, Esquevin A, Robert GH, Péron J, Haegelen C, Drapier S, Jannin P, Lozachmeur C, Argaud S, Duprez J, Drapier D, Vérin M, Sauleau P. Reduced Verbal Fluency following Subthalamic Deep Brain Stimulation: A Frontal-Related Cognitive Deficit? PLoS One 2015; 10:e0140083. [PMID: 26448131 PMCID: PMC4598145 DOI: 10.1371/journal.pone.0140083] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 09/21/2015] [Indexed: 11/19/2022] Open
Abstract
Objective The decrease in verbal fluency in patients with Parkinson’s disease (PD) undergoing subthalamic nucleus deep brain stimulation (STN-DBS) is usually assumed to reflect a frontal lobe-related cognitive dysfunction, although evidence for this is lacking. Methods To explore its underlying mechanisms, we combined neuropsychological, psychiatric and motor assessments with an examination of brain metabolism using F-18 fluorodeoxyglucose positron emission tomography, in 26 patients with PD, 3 months before and after surgery. We divided these patients into two groups, depending on whether or not they exhibited a postoperative deterioration in either phonemic (10 patients) or semantic (8 patients) fluency. We then compared the STN-DBS groups with and without verbal deterioration on changes in clinical measures and brain metabolism. Results We did not find any neuropsychological change supporting the presence of an executive dysfunction in patients with a deficit in either phonemic or semantic fluency. Similarly, a comparison of patients with or without impaired fluency on brain metabolism failed to highlight any frontal areas involved in cognitive functions. However, greater changes in cognitive slowdown and apathy were observed in patients with a postoperative decrease in verbal fluency. Conclusions These results suggest that frontal lobe-related cognitive dysfunction could play only a minor role in the postoperative impairment of phonemic or semantic fluency, and that cognitive slowdown and apathy could have a more decisive influence. Furthermore, the phonemic and semantic impairments appeared to result from the disturbance of distinct mechanisms.
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Affiliation(s)
- Jean-François Houvenaghel
- “Behaviour and Basal Ganglia” research unit (EA 4712), University of Rennes, Rennes, France
- Department of Neurology, Rennes University Hospital, Rennes, France
- * E-mail:
| | - Florence Le Jeune
- “Behaviour and Basal Ganglia” research unit (EA 4712), University of Rennes, Rennes, France
- Department of Nuclear Medicine, Eugène Marquis Hospital, Rennes, France
| | - Thibaut Dondaine
- “Behaviour and Basal Ganglia” research unit (EA 4712), University of Rennes, Rennes, France
| | - Aurore Esquevin
- Department of Neuroradiology, Rennes University Hospital, Rennes, France
| | - Gabriel Hadrien Robert
- “Behaviour and Basal Ganglia” research unit (EA 4712), University of Rennes, Rennes, France
- Department of Psychiatry, Rennes University Hospital, Rennes, France
| | - Julie Péron
- “Behaviour and Basal Ganglia” research unit (EA 4712), University of Rennes, Rennes, France
- ‘Neuroscience of Emotion and Affective Dynamics’ laboratory, Department of Psychology, and Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Claire Haegelen
- Department of Neurosurgery, Rennes University Hospital, Rennes, France
- “MediCIS” laboratory (UMR 1099 LTSI), Inserm/University of Rennes, Rennes, France
| | - Sophie Drapier
- “Behaviour and Basal Ganglia” research unit (EA 4712), University of Rennes, Rennes, France
- Department of Neurology, Rennes University Hospital, Rennes, France
| | - Pierre Jannin
- “MediCIS” laboratory (UMR 1099 LTSI), Inserm/University of Rennes, Rennes, France
| | - Clément Lozachmeur
- “Behaviour and Basal Ganglia” research unit (EA 4712), University of Rennes, Rennes, France
- Department of Psychiatry, Rennes University Hospital, Rennes, France
| | - Soizic Argaud
- “Behaviour and Basal Ganglia” research unit (EA 4712), University of Rennes, Rennes, France
- ‘Neuroscience of Emotion and Affective Dynamics’ laboratory, Department of Psychology, and Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Joan Duprez
- “Behaviour and Basal Ganglia” research unit (EA 4712), University of Rennes, Rennes, France
| | - Dominique Drapier
- “Behaviour and Basal Ganglia” research unit (EA 4712), University of Rennes, Rennes, France
- Department of Psychiatry, Rennes University Hospital, Rennes, France
| | - Marc Vérin
- “Behaviour and Basal Ganglia” research unit (EA 4712), University of Rennes, Rennes, France
- Department of Neurology, Rennes University Hospital, Rennes, France
| | - Paul Sauleau
- “Behaviour and Basal Ganglia” research unit (EA 4712), University of Rennes, Rennes, France
- Department of Neurophysiology, Rennes University Hospital, Rennes, France
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Uemura M, Jannin P, Yamashita M, Tomikawa M, Akahoshi T, Obata S, Souzaki R, Ieiri S, Hashizume M. Procedural surgical skill assessment in laparoscopic training environments. Int J Comput Assist Radiol Surg 2015; 11:543-52. [PMID: 26253582 DOI: 10.1007/s11548-015-1274-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 07/21/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to identify detailed differences in laparoscopic surgical processes between expert and novice surgeons in a training environment and demonstrate that surgical process modeling can be used for such detailed analysis. METHODS Eleven expert surgeons each of whom had performed [Formula: see text] laparoscopic procedures were compared with 10 young surgeons each of whom had performed [Formula: see text] laparoscopic procedures, and five medical students. Each examinee performed a specific skill assessment task. During tasks, instrument motion was monitored using a video capture system. From the video, the corresponding workflow was recorded by labeling the surgeons' activities according to a predefined terminology. Activities represented manual work steps performed during the task, described by a combination of a verb (representing the action), a tool, and the involved structure. The results were described as the number of occurrences (times), average duration (seconds), total duration (seconds), minimal duration (seconds), maximal duration (seconds), and occupancy percentage (%). RESULTS The terminology for describing the processes of this task included 10 actions, six tools, four structures, and three events for each hand. There were 63 combinations of different possible activities; significant differences in 12 activities were observed between the expert and novice groups (young surgeons and medical students). The expert group performed the task with fewer occurrences and shorter duration than did the novice group in the left hand. CONCLUSIONS We identified differences in surgical process between experts and novices in laparoscopic surgical simulation. Our proposed method would be useful for education and training in laparoscopic surgery.
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Affiliation(s)
- Munenori Uemura
- Department of Advanced Medical Initiatives, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Pierre Jannin
- INSERM, U1099, 35000, Rennes, France
- LTSI, Université de Rennes 1, 35000, Rennes, France
| | - Makoto Yamashita
- Department of Advanced Medical Initiatives, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Morimasa Tomikawa
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Tomohiko Akahoshi
- Department of Advanced Medical Initiatives, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Obata
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Ryota Souzaki
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Satoshi Ieiri
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Makoto Hashizume
- Department of Advanced Medical Initiatives, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan
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Katić D, Julliard C, Wekerle AL, Kenngott H, Müller-Stich BP, Dillmann R, Speidel S, Jannin P, Gibaud B. LapOntoSPM: an ontology for laparoscopic surgeries and its application to surgical phase recognition. Int J Comput Assist Radiol Surg 2015; 10:1427-34. [PMID: 26062794 DOI: 10.1007/s11548-015-1222-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 05/01/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The rise of intraoperative information threatens to outpace our abilities to process it. Context-aware systems, filtering information to automatically adapt to the current needs of the surgeon, are necessary to fully profit from computerized surgery. To attain context awareness, representation of medical knowledge is crucial. However, most existing systems do not represent knowledge in a reusable way, hindering also reuse of data. Our purpose is therefore to make our computational models of medical knowledge sharable, extensible and interoperational with established knowledge representations in the form of the LapOntoSPM ontology. To show its usefulness, we apply it to situation interpretation, i.e., the recognition of surgical phases based on surgical activities. METHODS Considering best practices in ontology engineering and building on our ontology for laparoscopy, we formalized the workflow of laparoscopic adrenalectomies, cholecystectomies and pancreatic resections in the framework of OntoSPM, a new standard for surgical process models. Furthermore, we provide a rule-based situation interpretation algorithm based on SQWRL to recognize surgical phases using the ontology. RESULTS The system was evaluated on ground-truth data from 19 manually annotated surgeries. The aim was to show that the phase recognition capabilities are equal to a specialized solution. The recognition rates of the new system were equal to the specialized one. However, the time needed to interpret a situation rose from 0.5 to 1.8 s on average which is still viable for practical application. CONCLUSION We successfully integrated medical knowledge for laparoscopic surgeries into OntoSPM, facilitating knowledge and data sharing. This is especially important for reproducibility of results and unbiased comparison of recognition algorithms. The associated recognition algorithm was adapted to the new representation without any loss of classification power. The work is an important step to standardized knowledge and data representation in the field on context awareness and thus toward unified benchmark data sets.
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Affiliation(s)
- Darko Katić
- Karlsruhe Institute of Technology (KIT), Adenauerring 2, 76131, Karlsruhe, Germany,
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Morineau T, Riffaud L, Morandi X, Villain J, Jannin P. Work domain constraints for modelling surgical performance. Int J Comput Assist Radiol Surg 2015; 10:1589-97. [PMID: 25735734 DOI: 10.1007/s11548-015-1166-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/16/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Three main approaches can be identified for modelling surgical performance: a competency-based approach, a task-based approach, both largely explored in the literature, and a less known work domain-based approach. The work domain-based approach first describes the work domain properties that constrain the agent's actions and shape the performance. This paper presents a work domain-based approach for modelling performance during cervical spine surgery, based on the idea that anatomical structures delineate the surgical performance. This model was evaluated through an analysis of junior and senior surgeons' actions. METHOD Twenty-four cervical spine surgeries performed by two junior and two senior surgeons were recorded in real time by an expert surgeon. According to a work domain-based model describing an optimal progression through anatomical structures, the degree of adjustment of each surgical procedure to a statistical polynomial function was assessed. RESULTS Each surgical procedure showed a significant suitability with the model and regression coefficient values around 0.9. However, the surgeries performed by senior surgeons fitted this model significantly better than those performed by junior surgeons. Analysis of the relative frequencies of actions on anatomical structures showed that some specific anatomical structures discriminate senior from junior performances. CONCLUSION The work domain-based modelling approach can provide an overall statistical indicator of surgical performance, but in particular, it can highlight specific points of interest among anatomical structures that the surgeons dwelled on according to their level of expertise.
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Affiliation(s)
- Thierry Morineau
- Centre de Recherches en Psychologie, Cognition et Communication (CRPCC), EA1285, Université de Bretagne-Sud, Centre Yves Coppens, 56000, Vannes, France.
| | - Laurent Riffaud
- Department of Neurosurgery, Pontchaillou University Hospital, 35033, Rennes Cedex 9, France.,Laboratoire de Traitement du Signal et de l'Image (LTSI), Inserm, UMR 1099, MediCIS Team, Université de Rennes 1, 35000, Rennes, France
| | - Xavier Morandi
- Department of Neurosurgery, Pontchaillou University Hospital, 35033, Rennes Cedex 9, France.,Laboratoire de Traitement du Signal et de l'Image (LTSI), Inserm, UMR 1099, MediCIS Team, Université de Rennes 1, 35000, Rennes, France
| | - Jonathan Villain
- Laboratoire de Mathématique de Bretagne Atlantique (LMBA), UMR 6205, Université de Bretagne-Sud, 56000, Vannes, France
| | - Pierre Jannin
- Laboratoire de Traitement du Signal et de l'Image (LTSI), Inserm, UMR 1099, MediCIS Team, Université de Rennes 1, 35000, Rennes, France
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Langner-Lemercier S, Drapier S, Naudet F, Le Clanche N, Houvenaghel JF, Sauleau P, Jannin P, Haegelen C, Le Jeune F, Vérin M. Preoperative brain metabolism and quality of life after subthalamic nucleus stimulation in Parkinson's disease. J Neurol 2015; 262:881-9. [PMID: 25634679 DOI: 10.1007/s00415-015-7647-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/08/2015] [Accepted: 01/13/2015] [Indexed: 10/24/2022]
Abstract
Subthalamic nucleus deep brain stimulation (STN-DBS) has been proven to improve health-related quality of life (HRQoL) in patients with Parkinson's disease (PD) presenting medically refractory motor complications and dyskinesia. However, some patients fail to benefit from STN-DBS despite rigorous preoperative selection. We postulated that they have a particular, clinically ineloquent, brain metabolism before surgery. We divided 40 stimulated PD patients into two groups (responders vs. nonresponders) depending on whether they reported or not a clinically significant improvement in their quality of life 1 year after surgery. We retrospectively compared their preoperative brain metabolism on the basis of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) scans. We also analyzed their neuropsychological and psychiatric profiles before and after surgery. All 40 patients met the STN-DBS selection criteria, but only 50% of them had significantly improved 1 year after surgery. Preoperative PET scans showed that metabolism was higher in the left insula, both inferior frontal gyri and left precentral gyrus in nonresponders than in responders. Clinically, postoperative motor scores were similar in both groups, but a worsening of the depression score was observed among nonresponders. PET imaging revealed that nonresponders were characterized by distinctive brain functioning pre-surgery, in regions involved in associative and limbic circuits, as a result of PD-related degeneration. STN-DBS may have interfered with this already abnormal circuitry, leading to the occurrence of complex nonmotor symptoms reducing quality of life. Preoperative brain metabolism could be a useful biomarker for anticipating STN-DBS efficacy in terms of HRQoL in the context of advanced PD.
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Affiliation(s)
- Sophie Langner-Lemercier
- Department of Neurology, Rennes University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes Cedex 9, France,
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Michinov E, Jamet E, Dodeler V, Haegelen C, Jannin P. Assessing neurosurgical non-technical skills: an exploratory study of a new behavioural marker system. J Eval Clin Pract 2014; 20:582-8. [PMID: 24798683 DOI: 10.1111/jep.12152] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2014] [Indexed: 12/17/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The management of non-technical skills is a major factor affecting teamwork quality and patient safety. This article presents a behavioural marker system for assessing neurosurgical non-technical skills (BMS-NNTS). We tested the BMS during deep brain stimulation surgery. METHOD We developed the BMS in three stages. First, we drew up a provisional assessment tool based on the literature and observation tools developed for other surgical specialties. We then analysed videos made in an operating room (OR) during deep brain stimulation operations in order to ensure there were no significant omissions from the skills list. Finally, we used five videos of operations to identify the behavioural markers of non-technical skills in verbal communications. RESULTS Analyses of more than six hours of observations revealed 3515 behaviours from which we determined the neurosurgeon's non-technical skills behaviour pattern. The neurosurgeon frequently engaged in explicit coordination, situation awareness and leadership behaviours. In addition, the neurosurgeon's behaviours differed according to the stage of the operation and the OR staff members with whom she was communicating. CONCLUSIONS Our behavioural marker system provides a structured approach to assessing non-technical skills in the field of neurosurgery. It can also be transferred to other surgical specialties and used in surgeon training curricula.
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Affiliation(s)
- Estelle Michinov
- Department of Psychology, CRPCC (E.A. 1285), University of Rennes 2, Rennes, France
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Maier-Hein L, Groch A, Bartoli A, Bodenstedt S, Boissonnat G, Chang PL, Clancy NT, Elson DS, Haase S, Heim E, Hornegger J, Jannin P, Kenngott H, Kilgus T, Müller-Stich B, Oladokun D, Röhl S, Dos Santos TR, Schlemmer HP, Seitel A, Speidel S, Wagner M, Stoyanov D. Comparative validation of single-shot optical techniques for laparoscopic 3-D surface reconstruction. IEEE Trans Med Imaging 2014; 33:1913-1930. [PMID: 24876109 DOI: 10.1109/tmi.2014.2325607] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Intra-operative imaging techniques for obtaining the shape and morphology of soft-tissue surfaces in vivo are a key enabling technology for advanced surgical systems. Different optical techniques for 3-D surface reconstruction in laparoscopy have been proposed, however, so far no quantitative and comparative validation has been performed. Furthermore, robustness of the methods to clinically important factors like smoke or bleeding has not yet been assessed. To address these issues, we have formed a joint international initiative with the aim of validating different state-of-the-art passive and active reconstruction methods in a comparative manner. In this comprehensive in vitro study, we investigated reconstruction accuracy using different organs with various shape and texture and also tested reconstruction robustness with respect to a number of factors like the pose of the endoscope as well as the amount of blood or smoke present in the scene. The study suggests complementary advantages of the different techniques with respect to accuracy, robustness, point density, hardware complexity and computation time. While reconstruction accuracy under ideal conditions was generally high, robustness is a remaining issue to be addressed. Future work should include sensor fusion and in vivo validation studies in a specific clinical context. To trigger further research in surface reconstruction, stereoscopic data of the study will be made publically available at www.open-CAS.com upon publication of the paper.
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D’Albis T, Haegelen C, Essert C, Fernández-Vidal S, Lalys F, Jannin P. PyDBS: an automated image processing workflow for deep brain stimulation surgery. Int J Comput Assist Radiol Surg 2014; 10:117-28. [DOI: 10.1007/s11548-014-1007-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/09/2014] [Indexed: 11/28/2022]
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Xiao Y, Jannin P, D'Albis T, Guizard N, Haegelen C, Lalys F, Vérin M, Collins DL. Investigation of morphometric variability of subthalamic nucleus, red nucleus, and substantia nigra in advanced Parkinson's disease patients using automatic segmentation and PCA-based analysis. Hum Brain Mapp 2014; 35:4330-44. [PMID: 24652699 DOI: 10.1002/hbm.22478] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 01/07/2014] [Accepted: 01/16/2014] [Indexed: 01/02/2023] Open
Abstract
Subthalamic nucleus (STN) deep brain stimulation (DBS) is an effective surgical therapy to treat Parkinson's disease (PD). Conventional methods employ standard atlas coordinates to target the STN, which, along with the adjacent red nucleus (RN) and substantia nigra (SN), are not well visualized on conventional T1w MRIs. However, the positions and sizes of the nuclei may be more variable than the standard atlas, thus making the pre-surgical plans inaccurate. We investigated the morphometric variability of the STN, RN and SN by using label-fusion segmentation results from 3T high resolution T2w MRIs of 33 advanced PD patients. In addition to comparing the size and position measurements of the cohort to the Talairach atlas, principal component analysis (PCA) was performed to acquire more intuitive and detailed perspectives of the measured variability. Lastly, the potential correlation between the variability shown by PCA results and the clinical scores was explored.
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Affiliation(s)
- Yiming Xiao
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
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Despinoy F, Sánchez A, Zemiti N, Jannin P, Poignet P. Comparative Assessment of a Novel Optical Human-Machine Interface for Laparoscopic Telesurgery. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/978-3-319-07521-1_3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Abstract
PURPOSE Surgery is continuously subject to technological and medical innovations that are transforming daily surgical routines. In order to gain a better understanding and description of surgeries, the field of surgical process modelling (SPM) has recently emerged. The challenge is to support surgery through the quantitative analysis and understanding of operating room activities. Related surgical process models can then be introduced into a new generation of computer-assisted surgery systems. METHODS In this paper, we present a review of the literature dealing with SPM. This methodological review was obtained from a search using Google Scholar on the specific keywords: "surgical process analysis", "surgical process model" and "surgical workflow analysis". RESULTS This paper gives an overview of current approaches in the field that study the procedural aspects of surgery. We propose a classification of the domain that helps to summarise and describe the most important components of each paper we have reviewed, i.e., acquisition, modelling, analysis, application and validation/evaluation. These five aspects are presented independently along with an exhaustive list of their possible instantiations taken from the studied publications. CONCLUSION This review allows a greater understanding of the SPM field to be gained and introduces future related prospects.
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Affiliation(s)
- Florent Lalys
- University of Rennes I, LTSI, 35000 , Rennes, France,
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Gentric JC, Trelhu B, Jannin P, Riffaud L, Ferré JC, Gauvrit JY. Development of workflow task analysis during cerebral diagnostic angiographies: time-based comparison of junior and senior tasks. J Neuroradiol 2013; 40:342-7. [PMID: 23827385 DOI: 10.1016/j.neurad.2013.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 01/15/2013] [Accepted: 01/22/2013] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Assessing neuroradiologists' skills in the operating room (OR) is difficult and often subjective. This study used a workflow time-based task analysis approach while performing cerebral angiography. METHODS Eight angiographies performed by a senior neuroradiologist and eight performed by a junior neuroradiologist were compared. Dedicated software with specific terminology was used to record the tasks. Procedures were subdivided into phases, each comprising multiple tasks. Each task was defined as a triplet, associating an action, an instrument and an anatomical structure. The duration of each task was the metric. Total duration of the procedure, task duration and the number of times a task was repeated were identified. The focus was on tasks using fluoroscopy and for moving the X-ray table/tube. RESULTS The total duration of tasks to complete the entire procedure was longer for the junior operators than for the seniors (P=0.012). The mean duration per task during the navigation phase was 86s for the juniors and 43s for the seniors (P=0.002). The total and mean durations of tasks involving the use of fluoroscopy were also longer for the juniors (P=0.002 and P=0.033, respectively). For tasks involving the table/tube, the total and mean durations were again longer for the juniors (P=0.019 and P=0.082, respectively). CONCLUSION This approach allows reliable skill assessment in the radiology OR and comparison of junior and senior competencies during cerebral diagnostic angiography. This new tool can improve the quality and safety of procedures, and facilitate the learning process for neuroradiologists.
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Affiliation(s)
- Jean-Christophe Gentric
- Department of radiology, Brest university hospital, Brest, France; Inserm, U746, faculty of medicine, Rennes, France; INRIA, VisAGeS Unit/Project, Rennes, France; CNRS, UMR 6074, IRISA, university of Rennes 1, Rennes, France.
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Forestier G, Lalys F, Riffaud L, Louis Collins D, Meixensberger J, Wassef SN, Neumuth T, Goulet B, Jannin P. Multi-site study of surgical practice in neurosurgery based on surgical process models. J Biomed Inform 2013; 46:822-9. [PMID: 23810856 DOI: 10.1016/j.jbi.2013.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 06/11/2013] [Accepted: 06/12/2013] [Indexed: 11/26/2022]
Abstract
Surgical Process Modelling (SPM) was introduced to improve understanding the different parameters that influence the performance of a Surgical Process (SP). Data acquired from SPM methodology is enormous and complex. Several analysis methods based on comparison or classification of Surgical Process Models (SPMs) have previously been proposed. Such methods compare a set of SPMs to highlight specific parameters explaining differences between populations of patients, surgeons or systems. In this study, procedures performed at three different international University hospitals were compared using SPM methodology based on a similarity metric focusing on the sequence of activities occurring during surgery. The proposed approach is based on Dynamic Time Warping (DTW) algorithm combined with a clustering algorithm. SPMs of 41 Anterior Cervical Discectomy (ACD) surgeries were acquired at three Neurosurgical departments; in France, Germany, and Canada. The proposed approach distinguished the different surgical behaviors according to the location where surgery was performed as well as between the categorized surgical experience of individual surgeons. We also propose the use of Multidimensional Scaling to induce a new space of representation of the sequences of activities. The approach was compared to a time-based approach (e.g. duration of surgeries) and has been shown to be more precise. We also discuss the integration of other criteria in order to better understand what influences the way the surgeries are performed. This first multi-site study represents an important step towards the creation of robust analysis tools for processing SPMs. It opens new perspectives for the assessment of surgical approaches, tools or systems as well as objective assessment and comparison of surgeon's expertise.
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Lalys F, Haegelen C, D'albis T, Jannin P. Analysis of electrode deformations in deep brain stimulation surgery. Int J Comput Assist Radiol Surg 2013; 9:107-17. [PMID: 23780571 DOI: 10.1007/s11548-013-0911-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 06/06/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Deep brain stimulation (DBS) surgery is used to reduce motor symptoms when movement disorders are refractory to medical treatment. Post-operative brain morphology can induce electrode deformations as the brain recovers from an intervention. The inverse brain shift has a direct impact on accuracy of the targeting stage, so analysis of electrode deformations is needed to predict final positions. METHODS DBS electrode curvature was evaluated in 76 adults with movement disorders who underwent bilateral stimulation, and the key variables that affect electrode deformations were identified. Non-linear modelling of the electrode axis was performed using post-operative computed tomography (CT) images. A mean curvature index was estimated for each patient electrode. Multivariate analysis was performed using a regression decision tree to create a hierarchy of predictive variables. The identification and classification of key variables that determine electrode curvature were validated with statistical analysis. RESULTS The principal variables affecting electrode deformations were found to be the date of the post-operative CT scan and the stimulation target location. The main pathology, patient's gender, and disease duration had a smaller although important impact on brain shift. CONCLUSIONS The principal determinants of electrode location accuracy during DBS procedures were identified and validated. These results may be useful for improved electrode targeting with the help of mathematical models.
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Affiliation(s)
- Florent Lalys
- Unite INSERM U1099 LTSI, Equipe Medicis, Faculté de médecine, Université Rennes I, 2 Av. du Pr Leon Bernard, 35043 , Rennes, France,
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Kersten-Oertel M, Jannin P, Collins DL. The state of the art of visualization in mixed reality image guided surgery. Comput Med Imaging Graph 2013; 37:98-112. [PMID: 23490236 DOI: 10.1016/j.compmedimag.2013.01.009] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 01/04/2013] [Accepted: 01/23/2013] [Indexed: 11/26/2022]
Abstract
This paper presents a review of the state of the art of visualization in mixed reality image guided surgery (IGS). We used the DVV (data, visualization processing, view) taxonomy to classify a large unbiased selection of publications in the field. The goal of this work was not only to give an overview of current visualization methods and techniques in IGS but more importantly to analyze the current trends and solutions used in the domain. In surveying the current landscape of mixed reality IGS systems, we identified a strong need to assess which of the many possible data sets should be visualized at particular surgical steps, to focus on novel visualization processing techniques and interface solutions, and to evaluate new systems.
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Affiliation(s)
- Marta Kersten-Oertel
- Department of Biomedical Engineering, McGill University, McConnell Brain Imaging Center, Montreal Neurological Institute, Montréal, Canada.
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88
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Linte CA, Davenport KP, Cleary K, Peters C, Vosburgh KG, Navab N, Edwards PE, Jannin P, Peters TM, Holmes DR, Robb RA. On mixed reality environments for minimally invasive therapy guidance: systems architecture, successes and challenges in their implementation from laboratory to clinic. Comput Med Imaging Graph 2013; 37:83-97. [PMID: 23632059 PMCID: PMC3796657 DOI: 10.1016/j.compmedimag.2012.12.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 11/16/2012] [Accepted: 12/24/2012] [Indexed: 11/21/2022]
Abstract
Mixed reality environments for medical applications have been explored and developed over the past three decades in an effort to enhance the clinician's view of anatomy and facilitate the performance of minimally invasive procedures. These environments must faithfully represent the real surgical field and require seamless integration of pre- and intra-operative imaging, surgical instrument tracking, and display technology into a common framework centered around and registered to the patient. However, in spite of their reported benefits, few mixed reality environments have been successfully translated into clinical use. Several challenges that contribute to the difficulty in integrating such environments into clinical practice are presented here and discussed in terms of both technical and clinical limitations. This article should raise awareness among both developers and end-users toward facilitating a greater application of such environments in the surgical practice of the future.
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Lalys F, Haegelen C, Mehri M, Drapier S, Vérin M, Jannin P. Anatomo-clinical atlases correlate clinical data and electrode contact coordinates: Application to subthalamic deep brain stimulation. J Neurosci Methods 2013; 212:297-307. [DOI: 10.1016/j.jneumeth.2012.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 10/31/2012] [Accepted: 11/02/2012] [Indexed: 10/27/2022]
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Morineau T, Morandi X, Le Moëllic N, Jannin P. A cognitive engineering framework for the specification of information requirements in medical imaging: application in image-guided neurosurgery. Int J Comput Assist Radiol Surg 2012; 8:291-300. [PMID: 22790514 DOI: 10.1007/s11548-012-0781-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 06/21/2012] [Indexed: 11/27/2022]
Abstract
PURPOSE This study proposes a framework coming from cognitive engineering, which makes it possible to define what information content has to be displayed or emphasised from medical imaging, for assisting clinicians according to their level of expertise in the domain. METHOD We designed a rating scale to assess visualisation systems in image-guided neurosurgery with respect to the depiction of the neurosurgical work domain. This rating scale was based on a neurosurgical work domain analysis. This scale has been used to evaluate visualisation modes among neurosurgeons, residents and engineers. We asked five neurosurgeons, ten medical residents and ten engineers to rate two visualisation modes from the same data (2D MR image vs. 3D computerised image). With this method, the amount of abstract and concrete work domain information displayed by each visualisation mode can be measured. RESULTS A global difference in quantities of perceived information between both images was observed. Surgeons and medical residents perceived significantly more information than engineers for both images. Unlike surgeons, however, the amount of information perceived by residents and engineers significantly decreased as information abstraction increased. CONCLUSIONS We demonstrated the possibility of measuring the amount of work domain information displayed by different visualisation modes of medical imaging according to different user profiles. Engineers in charge of the design of medical image-guided surgical systems did not perceive the same set of information as surgeons or even medical residents. This framework can constitute a user-oriented approach to evaluate the amount of perceived information from image-guided surgical systems and support their design from a cognitive engineering point of view.
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Affiliation(s)
- T Morineau
- CRPCC laboratory, LESTIC Team, Yves Coppens Centre, Université de Bretagne-Sud, 56000 Vannes, France.
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92
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Lalys F, Bouget D, Riffaud L, Jannin P. Automatic knowledge-based recognition of low-level tasks in ophthalmological procedures. Int J Comput Assist Radiol Surg 2012; 8:39-49. [PMID: 22528057 DOI: 10.1007/s11548-012-0685-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Surgical process models (SPMs) have recently been created for situation-aware computer-assisted systems in the operating room. One important challenge in this area is the automatic acquisition of SPMs. The purpose of this study is to present a new method for the automatic detection of low-level surgical tasks, that is, the sequence of activities in a surgical procedure, from microscope video images only. The level of granularity that we addressed in this work is symbolized by activities formalized by triplets <action, surgical tool, anatomical structure> . METHODS Using the results of our latest work on the recognition of surgical phases in cataract surgeries, and based on the hypothesis that most activities occur in one or two phases only, we created a light-weight ontology, formalized as a hierarchical decomposition into phases and activities. Information concerning the surgical tools, the areas where tools are used and three other visual cues were detected through an image-based approach and combined with the information of the current surgical phase within a knowledge-based recognition system. Knowing the surgical phases before the activity, recognition allows supervised classification to be adapted to the phase. Multiclass Support Vector Machines were chosen as a classification algorithm. RESULTS Using a dataset of 20 cataract surgeries, and identifying 25 possible pairs of activities, a frame-by-frame recognition rate of 64.5 % was achieved with the proposed system. CONCLUSIONS The addition of human knowledge to traditional bottom-up approaches based on image analysis appears to be promising for low-level task detection. The results of this work could be used for the automatic indexation of post-operative videos.
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Affiliation(s)
- Florent Lalys
- MedICIS, INSERM, U1099, Faculté de Médecine CS 34317, University of Rennes I, 2 Av. du Pr Leon Bernard, 35043, Rennes Cedex, France.
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93
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Abstract
Mixed reality visualizations are increasingly studied for use in image guided surgery (IGS) systems, yet few mixed reality systems have been introduced for daily use into the operating room (OR). This may be the result of several factors: the systems are developed from a technical perspective, are rarely evaluated in the field, and/or lack consideration of the end user and the constraints of the OR. We introduce the Data, Visualization processing, View (DVV) taxonomy which defines each of the major components required to implement a mixed reality IGS system. We propose that these components be considered and used as validation criteria for introducing a mixed reality IGS system into the OR. A taxonomy of IGS visualization systems is a step toward developing a common language that will help developers and end users discuss and understand the constituents of a mixed reality visualization system, facilitating a greater presence of future systems in the OR. We evaluate the DVV taxonomy based on its goodness of fit and completeness. We demonstrate the utility of the DVV taxonomy by classifying 17 state-of-the-art research papers in the domain of mixed reality visualization IGS systems. Our classification shows that few IGS visualization systems' components have been validated and even fewer are evaluated.
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Affiliation(s)
- Marta Kersten-Oertel
- McConell Brain Imaging Center at the Montreal Neurological Institute (MNI), 3801 University St, Montre´al, QC H3A 2B4, Canada.
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94
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Linte CA, Davenport KP, Cleary K, Peters C, Vosburgh KG, Edwards P, Jannin P, Peters TM, Holmes Iii DR, Robb RA. Augmented environments for minimally invasive therapy: implementation barriers from technology to practice. Stud Health Technol Inform 2012; 173:263-269. [PMID: 22356999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Augmented environments for medical applications have been explored and developed in an effort to enhance the clinician's view of anatomy and facilitate the performance of minimally invasive procedures. These environments must faithfully represent the real surgical field and require seamless integration of pre- and intra-operative imaging, surgical instrument tracking and display technology into a common framework centered around the patient. However, few image guidance environments have been successfully translated into clinical use. Several challenges that contribute to the slow progress of integrating such environments into clinical practice are discussed here in terms of both technical and clinical limitations.
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Affiliation(s)
- C A Linte
- Biomedical Imaging Resource, Mayo Clinic, Rochester, MN, USA
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95
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Bouget D, Lalys F, Jannin P. Surgical tools recognition and pupil segmentation for cataract surgical process modeling. Stud Health Technol Inform 2012; 173:78-84. [PMID: 22356962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In image-guided surgery, a new generation of Computer-Assisted-Surgical (CAS) systems based on information from the Operating Room (OR) has recently been developed to improve situation awareness in the OR. Our main project is to develop an application-dependant framework able to extract high-level tasks (surgical phases) using microscope videos data only. In this paper, we present two methods: one method to segment the pupil and one to extract and recognize surgical tools. We show how both methods improve the accuracy of the framework for analysis of cataract surgery videos, to detect eight surgical phases.
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Affiliation(s)
- David Bouget
- INSERM, U746, Faculté de médecine CS 34317, F-35043 Rennes Cedex, France.
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96
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Lalys F, Riffaud L, Bouget D, Jannin P. A framework for the recognition of high-level surgical tasks from video images for cataract surgeries. IEEE Trans Biomed Eng 2011; 59:966-76. [PMID: 22203700 DOI: 10.1109/tbme.2011.2181168] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The need for a better integration of the new generation of computer-assisted-surgical systems has been recently emphasized. One necessity to achieve this objective is to retrieve data from the operating room (OR) with different sensors, then to derive models from these data. Recently, the use of videos from cameras in the OR has demonstrated its efficiency. In this paper, we propose a framework to assist in the development of systems for the automatic recognition of high-level surgical tasks using microscope videos analysis. We validated its use on cataract procedures. The idea is to combine state-of-the-art computer vision techniques with time series analysis. The first step of the framework consisted in the definition of several visual cues for extracting semantic information, therefore, characterizing each frame of the video. Five different pieces of image-based classifiers were, therefore, implemented. A step of pupil segmentation was also applied for dedicated visual cue detection. Time series classification algorithms were then applied to model time-varying data. Dynamic time warping and hidden Markov models were tested. This association combined the advantages of all methods for better understanding of the problem. The framework was finally validated through various studies. Six binary visual cues were chosen along with 12 phases to detect, obtaining accuracies of 94%.
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Affiliation(s)
- F Lalys
- U1099 Institut National de la Santé et de la Recherche Médicale and the Faculté de Médecine, University of Rennes I, Rennes, France.
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97
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Forestier G, Lalys F, Riffaud L, Trelhu B, Jannin P. Classification of surgical processes using dynamic time warping. J Biomed Inform 2011; 45:255-64. [PMID: 22120773 DOI: 10.1016/j.jbi.2011.11.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 11/09/2011] [Accepted: 11/10/2011] [Indexed: 10/15/2022]
Abstract
In the creation of new computer-assisted intervention systems, Surgical Process Models (SPMs) are an emerging concept used for analyzing and assessing surgical interventions. SPMs represent Surgical Processes (SPs) which are formalized as symbolic structured descriptions of surgical interventions using a pre-defined level of granularity and a dedicated terminology. In this context, one major challenge is the creation of new metrics for the comparison and the evaluation of SPs. Thus, correlations between these metrics and pre-operative data are used to classify surgeries and highlight specific information on the surgery itself and on the surgeon, such as his/her level of expertise. In this paper, we explore the automatic classification of a set of SPs based on the Dynamic Time Warping (DTW) algorithm. DTW is used to compute a similarity measure between two SPs that focuses on the different types of activities performed during surgery and their sequencing, by minimizing time differences. Indeed, it turns out to be a complementary approach to the classical methods that only focus on differences in the time and the number of activities. Experiments were carried out on 24 lumbar disk herniation surgeries to discriminate the surgeons level of expertise according to a prior classification of SPs. Supervised and unsupervised classification experiments have shown that this approach was able to automatically identify groups of surgeons according to their level of expertise (senior and junior), and opens many perspectives for the creation of new metrics for comparing and evaluating surgeries.
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98
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Neumuth T, Loebe F, Jannin P. Similarity metrics for surgical process models. Artif Intell Med 2011; 54:15-27. [PMID: 22056273 DOI: 10.1016/j.artmed.2011.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 08/18/2011] [Accepted: 10/04/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this work is to introduce a set of similarity metrics for comparing surgical process models (SPMs). SPMs are progression models of surgical interventions that support quantitative analyses of surgical activities, supporting systems engineering or process optimization. METHODS AND MATERIALS Five different similarity metrics are presented and proven. These metrics deal with several dimensions of process compliance in surgery, including granularity, content, time, order, and frequency of surgical activities. The metrics were experimentally validated using 20 clinical data sets each for cataract interventions, craniotomy interventions, and supratentorial tumor resections. The clinical data sets were controllably modified in simulations, which were iterated ten times, resulting in a total of 600 simulated data sets. The simulated data sets were subsequently compared to the original data sets to empirically assess the predictive validity of the metrics. RESULTS We show that the results of the metrics for the surgical process models correlate significantly (p<0.001) with the induced modifications and that all metrics meet predictive validity. The clinical use of the metrics was exemplarily, as demonstrated by assessment of the learning curves of observers during surgical process model acquisition. CONCLUSION Measuring similarity between surgical processes is a complex task. However, metrics for computing the similarity between surgical process models are needed in many uses in the field of medical engineering. These metrics are essential whenever two SPMs need to be compared, such as during the evaluation of technical systems, the education of observers, or the determination of surgical strategies. These metrics are key figures that provide a solid base for medical decisions, such as during validation of sensor systems for use in operating rooms in the future.
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Affiliation(s)
- Thomas Neumuth
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Germany.
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Riffaud L, Neumuth T, Morandi X, Trantakis C, Meixensberger J, Burgert O, Trelhu B, Jannin P. Recording of surgical processes: a study comparing senior and junior neurosurgeons during lumbar disc herniation surgery. Neurosurgery 2011; 67:325-32. [PMID: 21099555 DOI: 10.1227/neu.0b013e3181f741d7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Evaluating surgical practice in the operating room is difficult, and its assessment is largely subjective. OBJECTIVE Recording of standardized spine surgery processes was conducted to ascertain whether any significant differences in surgical practice could be observed between senior and junior neurosurgeons. METHODS Twenty-four procedures of lumbar discectomies were consecutively recorded by a senior neurosurgeon. In 12 cases, surgery was entirely performed by a senior neurosurgeon with the aid of a resident, and in the 12 remaining cases, surgery was performed by a resident with the aid of a senior neurosurgeon. The data recorded were general parameters (operating time for the whole procedure and for each step), and general and specific parameters of the surgeon's activities (number of manual gestures, number and duration of actions performed, use of the instruments, and use of interventions on anatomic structures). The Mann-Whitney U test was used for comparison between the 2 groups of neurosurgeons. RESULTS The operating time was statistically lower for the group of senior surgeons. The seniors statistically demonstrated greater economy in time and in gestures during the closure step, for sewing and for the use of scissors, needle holders, and forceps. The senior surgeons statistically worked for a shorter time on the skin and used fewer manual gestures on the thoracolumbalis fascia. The number of changes in microscope position was also statistically lower for this group. CONCLUSION There is a relationship between surgical practice, as determined by a method of objective measurement using observation software, and surgical experience: gesture economy evolves with seniority.
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Affiliation(s)
- Laurent Riffaud
- Department of Neurosurgery, Rennes University Hospital, INSERM, U746, Faculty of Medicine, INRIA, VisAGeS Unit/Project, CNRS, UMR 6074, IRISA, University of Rennes I, Rennes, France.
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100
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de Guibert C, Maumet C, Jannin P, Ferré JC, Tréguier C, Barillot C, Le Rumeur E, Allaire C, Biraben A. Abnormal functional lateralization and activity of language brain areas in typical specific language impairment (developmental dysphasia). ACTA ACUST UNITED AC 2011; 134:3044-58. [PMID: 21719430 DOI: 10.1093/brain/awr141] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Atypical functional lateralization and specialization for language have been proposed to account for developmental language disorders, yet results from functional neuroimaging studies are sparse and inconsistent. This functional magnetic resonance imaging study compared children with a specific subtype of specific language impairment affecting structural language (n = 21), to a matched group of typically developing children using a panel of four language tasks neither requiring reading nor metalinguistic skills, including two auditory lexico-semantic tasks (category fluency and responsive naming) and two visual phonological tasks based on picture naming. Data processing involved normalizing the data with respect to a matched pairs paediatric template, groups and between-groups analysis, and laterality indices assessment within regions of interest using single and combined task analysis. Children with specific language impairment exhibited a significant lack of left lateralization in all core language regions (inferior frontal gyrus-opercularis, inferior frontal gyrus-triangularis, supramarginal gyrus and superior temporal gyrus), across single or combined task analysis, but no difference of lateralization for the rest of the brain. Between-group comparisons revealed a left hypoactivation of Wernicke's area at the posterior superior temporal/supramarginal junction during the responsive naming task, and a right hyperactivation encompassing the anterior insula with adjacent inferior frontal gyrus and the head of the caudate nucleus during the first phonological task. This study thus provides evidence that this subtype of specific language impairment is associated with atypical lateralization and functioning of core language areas.
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