Coffee: the key to safer image-guided surgery-a granular jamming cap for non-invasive, rigid fixation of fiducial markers to the patient

Cyclic Loading of Jammed Granular Systems

This article describes the cyclic loading of jammed granular systems represented by vacuum-packed particles in compression and tension, focusing on the influence of the properties of the granular material on the mechanical response. A jammed granular system is represented by a cylindrical sample filled with polymer granules (vacuum-packed particles) and is examined in symmetric cyclic compression and tension for up to 2000 cycles and at selected values of underpressure, i.e., 0.01, 0.04 and 0.07 MPa. Force and displacement are analyzed during the test, as well as changes in granule morphology by means of microscopic observations. The conducted tests indicate that it is possible to acquire repetitive results of maximum forces in the analyzed loading rage with the condition that granules do not plasticize during loading, i.e., they are resistant to damage during loading.

Soft Actuators Made of Discrete Grains

Recent work has demonstrated the potential of actuators consisting of bulk elastomers with phase-changing inclusions for generating high forces and large volumetric expansions. Simultaneously, granular assemblies have been shown to enable tunable properties via different packings, dynamic moduli via jamming, and compatibility with various printing methods via suspension in carrier fluids. Herein, granular actuators are introduced, which represent a new class of soft actuators made of discrete grains. The soft grains consist of a hyperelastic shell and multiple solvent cores. Upon heating, the encapsulated solvent cores undergo liquid-to-gas phase change, inducing rapid and strong volumetric expansion of the hyperelastic shell up to 700%. The grains can be used independently for micro-actuation, or in granular agglomerates for meso- and macroscale actuation, demonstrating the scalability of the granular actuators. Furthermore, the active grains can be suspended in a carrier resin or solvent to enable printable soft actuators via established granular material processing techniques. By combining the advantages of phase-change soft actuation and granularity, this work presents the opportunity to realize soft actuators with tunable bulk properties, compatibility with self-assembly techniques, and on-demand reconfigurability.

Image-guided surgery in otolaryngology: A review of current applications and future directions in head and neck surgery

Image-guided surgery (IGS) has become a widely adopted technology in otolaryngology. Since its introduction nearly three decades ago, IGS technology has developed rapidly and improved real-time intraoperative visualization for a diverse array of clinical indications. As usability, accessibility, and clinical experiences with IGS increase, its potential applications as an adjunct in many surgical procedures continue to expand. Here, we describe the basic components of IGS and review both the current state and future directions of IGS in otolaryngology, with attention to current challenges to its application in surgery of the nonrigid upper aerodigestive tract.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

I.

EXECUTIVE SUMMARY

BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document.

METHODS

ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary.

RESULTS

ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided.

CONCLUSION

This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.

Image-guided cochlear access by non-invasive registration: a cadaveric feasibility study

Image-guided cochlear implant surgery is expected to reduce volume of mastoidectomy, accelerate recovery, and improve safety. The purpose of this study was to investigate the safety and effectiveness of image-guided cochlear implant surgery by a non-invasive registration method, in a cadaveric study. We developed a visual positioning frame that can utilize the maxillary dentition as a registration tool and completed the tunnels experiment on 5 cadaver specimens (8 cases in total). The accuracy of the entry point and the target point were 0.471 ± 0.276 mm and 0.671 ± 0.268 mm, respectively. The shortest distance from the margin of the tunnel to the facial nerve and the ossicular chain were 0.790 ± 0.709 mm and 1.960 ± 0.630 mm, respectively. All facial nerves, tympanic membranes, and ossicular chains were completely preserved. Using this approach, high accuracy was achieved in this preliminary study, suggesting that the non-invasive registration method can meet the accuracy requirements for cochlear implant surgery. Based on the above accuracy, we speculate that our method can also be applied to neurosurgery, orbitofacial surgery, lateral skull base surgery, and anterior skull base surgery with satisfactory accuracy.

A multi-subject accuracy study on granular jamming for non-invasive attachment of fiducial markers to patients

PURPOSE

This short communication describes experimental evaluation of a new granular jamming cap (GJC) recently introduced in Wellborn et al. (Int J Comput Assist Radiol Surg 12(6):1069-1077, 2017). The contributions beyond [8] are (1) to evaluate accuracy across multiple human subjects, and (2) to determine how much of the accuracy improvement is attributable to improved fiducial marker arrangement alone, and how much is due to granular jamming. The motivation for this GJC is to improve the accuracy of image-guidance interfaces in transnasal skull base surgery. Accuracy depends on a rigid connection between tracked fiducial markers and the patient. By molding itself to the unique contours of the individual patient's head and then solidifying, the GJC can firmly attach fiducial markers to a patient, increasing accuracy in the presence of disturbances.

METHODS

A multi-subject study ([Formula: see text]) was performed to evaluate the accuracy of the GJC compared to a clinically used headband-based fixation device, in the presence of simulated accidental bumping (light force and impact events) that could occur in a real-world operating room.

RESULTS

The GJC reduced the average target registration error at the pituitary gland by 66% in our force experiments and 78% in our impact experiments, which were statistically significant reductions ([Formula: see text]). Maximum target registration error was similarly reduced by 55% and 78% in the same two perturbation tests.

CONCLUSION

The GJC increases the accuracy of transnasal image-guidance under force and impact perturbations by more firmly, yet non-invasively, attaching fiducial markers to the patient. We find that granular jamming provides accuracy improvement beyond that associated with improved fiducial marker arrangement.