1
|
Moreno V, Curto B, García-Esteban JA, Serrano FJ, Alonso Hernández P, Hernández Zaballos F, Juanes JA. Software Suite Training Tool for MSK Exploration and Botulinum Toxin Infiltration Based on Ultrasound Imaging for the Spasticity Treatment. J Med Syst 2019; 43:238. [PMID: 31214849 DOI: 10.1007/s10916-019-1331-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/08/2019] [Indexed: 11/26/2022]
Abstract
Nowadays, one of the choice techniques for the spasticity treatment is the ultrasound-guided infiltration of Botulinum Toxin, because it is safe and effective. In order to medical professionals can carry out this technique, they need training and education. One of the safest and most time-free ways to facilitate the acquisition of practical medical skills is through simulators. In this paper we present an innovative technological environment, which includes an ultrasound simulator for training in muscle exploration and infiltration. The simulation platform will guide health professionals, with great realism and high degree of interactivity, in the autonomous training of all the tasks involved in the spasticity treatment procedure by infiltration of Botulinum Toxin, without the need for a real patient or costly phantoms.
Collapse
Affiliation(s)
- V Moreno
- Universidad de Salamanca, Salamanca, Spain.
| | - B Curto
- Universidad de Salamanca, Salamanca, Spain
| | | | | | | | | | - J A Juanes
- Universidad de Salamanca, Salamanca, Spain
| |
Collapse
|
2
|
Baust JM, Rabin Y, Polascik TJ, Santucci KL, Snyder KK, Van Buskirk RG, Baust JG. Defeating Cancers' Adaptive Defensive Strategies Using Thermal Therapies: Examining Cancer's Therapeutic Resistance, Ablative, and Computational Modeling Strategies as a means for Improving Therapeutic Outcome. Technol Cancer Res Treat 2018; 17:1533033818762207. [PMID: 29566612 PMCID: PMC5871056 DOI: 10.1177/1533033818762207] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Diverse thermal ablative therapies are currently in use for the treatment of cancer. Commonly applied with the intent to cure, these ablative therapies are providing promising success rates similar to and often exceeding "gold standard" approaches. Cancer-curing prospects may be enhanced by deeper understanding of thermal effects on cancer cells and the hosting tissue, including the molecular mechanisms of cancer cell mutations, which enable resistance to therapy. Furthermore, thermal ablative therapies may benefit from recent developments in computer hardware and computation tools for planning, monitoring, visualization, and education. METHODS Recent discoveries in cancer cell resistance to destruction by apoptosis, autophagy, and necrosis are now providing an understanding of the strategies used by cancer cells to avoid destruction by immunologic surveillance. Further, these discoveries are now providing insight into the success of the diverse types of ablative therapies utilized in the clinical arena today and into how they directly and indirectly overcome many of the cancers' defensive strategies. Additionally, the manner in which minimally invasive thermal therapy is enabled by imaging, which facilitates anatomical features reconstruction, insertion guidance of thermal probes, and strategic placement of thermal sensors, plays a critical role in the delivery of effective ablative treatment. RESULTS The thermal techniques discussed include radiofrequency, microwave, high-intensity focused ultrasound, laser, and cryosurgery. Also discussed is the development of thermal adjunctive therapies-the combination of drug and thermal treatments-which provide new and more effective combinatorial physical and molecular-based approaches for treating various cancers. Finally, advanced computational and planning tools are also discussed. CONCLUSION This review lays out the various molecular adaptive mechanisms-the hallmarks of cancer-responsible for therapeutic resistance, on one hand, and how various ablative therapies, including both heating- and freezing-based strategies, overcome many of cancer's defenses, on the other hand, thereby enhancing the potential for curative approaches for various cancers.
Collapse
Affiliation(s)
- John M Baust
- 1 CPSI Biotech, Owego, NY, USA.,2 Institute of Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA
| | - Yoed Rabin
- 3 Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Thomas J Polascik
- 4 Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kimberly L Santucci
- 1 CPSI Biotech, Owego, NY, USA.,2 Institute of Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA
| | - Kristi K Snyder
- 1 CPSI Biotech, Owego, NY, USA.,2 Institute of Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA
| | - Robert G Van Buskirk
- 1 CPSI Biotech, Owego, NY, USA.,2 Institute of Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA.,5 Department of Biological Sciences, Binghamton University, Binghamton, NY, USA
| | - John G Baust
- 2 Institute of Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA.,5 Department of Biological Sciences, Binghamton University, Binghamton, NY, USA
| |
Collapse
|
3
|
Joshi P, Sehrawat A, Rabin Y. The role of exposure time in computerized training of prostate cryosurgery: performance comparison of surgical residents with engineering students. Int J Comput Assist Radiol Surg 2018; 13:541-549. [PMID: 29396685 DOI: 10.1007/s11548-017-1700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aims at the evaluation of a prototype of a computerized trainer for cryosurgery-the controlled destruction of cancer tumors by freezing. The hypothesis in this study is that computer-based cryosurgery training for an optimal cryoprobe layout is essentially a matter of exposure time, rather than trainee background or the specific computer-generated planning target. Key geometric features under considerations are associated with spatial limitations on cryoprobes placement and the match between the resulted thermal field and the unique anatomy of the prostate. METHODS All experiments in this study were performed on the cryosurgery trainer-a prototype platform for computerized cryosurgery training, which has been presented previously. Among its key features, the cryosurgery trainer displays the prostate shape and its contours and provides a distance measurement tool on demand, in order to address spatial constraints during ultrasound imaging guidance. Another unique feature of the cryosurgery trainer is an output movie, displaying the simulated thermal field at the end of the cryoprocedure. RESULTS The current study was performed on graduate engineering students having no formal background in medicine, and the results were benchmarked against data obtained on surgical residents having no experience with cryosurgery. Despite fundamental differences in background and experience, neither group displayed superior performance when it comes to cryoprobe layout planning. CONCLUSIONS This study demonstrates that computer-based training of an optimal cryoprobe layout is feasible. This study demonstrates that the training quality is essentially related to the training exposure time, rather than to a specific planning strategy from those investigated.
Collapse
Affiliation(s)
- Purva Joshi
- Department of Mechanical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA
| | - Anjali Sehrawat
- Department of Mechanical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA
| | - Yoed Rabin
- Department of Mechanical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA.
| |
Collapse
|
4
|
Joshi P, Sehrawat A, Rabin Y. Computerized Planning of Prostate Cryosurgery and Shape Considerations. Technol Cancer Res Treat 2017; 16:1272-1283. [PMID: 28731368 PMCID: PMC5762061 DOI: 10.1177/1533034617716041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The current study aims to explore possible relationships between various prostate shapes and the difficulty in creating a computer-based plan for cryosurgery. This research effort is a part of an ongoing study to develop computational means in order to improve cryosurgery training and education. This study uses a computerized planner-a key building block of a recently developed prototype for cryosurgery training. The quality of planning is measured by the overall defect volume, a proprietary concept which refers to undercooled areas internal to the target region and overcooled areas external to it. Results of this study numerically confirm that the overall defect volume decreases with an increasing number of cryoprobes, regardless of the geometry of the prostate. However, the number of cryoprobes required to achieve the smallest possible defect may be unrealistically high (<30). Results of this study also demonstrate that the optimal cryoprobe layout is associated with a smaller defect for symmetric prostate geometries and, independently, for prostate models that better resemble a sphere. Furthermore, a smaller defect is typically achieved when the urethra passes through the center of the prostate model. This study proposes to create a cryoprobe convex hull for the purpose of initial planning, which is a subdomain similar in shape to the prostate but at a reduced size. Parametric studies indicate that a cryoprobe convex hull contracted by 7 to 9 mm in all directions from the prostate capsule serves as a quasi-optimal initial condition for planning, that is, a preselected number of cryoprobes placed in the cryoprobe convex hull yields favorable results for optimization. The cryoprobe convex hull could accelerate computer-based planning, while also being adopted as a concept for traditional cryosurgery training, when computerized means are absent.
Collapse
Affiliation(s)
- Purva Joshi
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Anjali Sehrawat
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Yoed Rabin
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| |
Collapse
|
5
|
Rabin Y, Shimada K, Joshi P, Sehrawat A, Keelan R, Wilfong DM, McCormick JT. A Computerized Tutor Prototype for Prostate Cryotherapy: Key Building Blocks and System Evaluation. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2017; 10066:100660Z. [PMID: 28717259 PMCID: PMC5510662 DOI: 10.1117/12.2257151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This paper focuses on the evaluation of a prototype for a computer-based tutoring system for prostate cryosurgery, while reviewing its key building blocks and their benchmark performance. The tutoring system lists geometrical constraints of cryoprobe placement, displays a rendered shape of the prostate, simulates cryoprobe insertion, enables distance measurements, simulates the corresponding thermal history, and evaluates the mismatch between the target region shape and a pre-selected planning isotherm. The quality of trainee planning is measured in comparison with a computer-generated plan, created for each case study by a previously developed planning algorithm, known as bubble-packing. While the tutoring level in this study aims only at geometrical constraints on cryoprobe placement and the resulting thermal history, it creates a unique opportunity to gain insight into the process outside of the operation room. System validation of the tutor has been performed by collecting training data from surgical residents, having no prior experience or advanced knowledge of cryotherapy. Furthermore, the system has been evaluated by graduate engineering students having no formal education in medicine. In terms of match between a planning isotherm and the target region shape, results demonstrate medical residents' performance improved from 4.4% in a pretest to 37.8% in a posttest over a course of 50 minutes of training (within 10% margins from a computer-optimized plan). Comparing those results with the performance of engineering students indicates similar results, suggesting that planning of the cryoprobe layout essentially revolves around geometric considerations.
Collapse
Affiliation(s)
- Yoed Rabin
- Department of Mechanical Engineering, Carnegie Mellon University,
5000 Forbes Avenue, Pittsburgh, PA 15213
- The STAR Center, Allegheny Health Network, 4900 Friendship Avenue,
Pittsburgh, PA 15224
| | - Kenji Shimada
- Department of Mechanical Engineering, Carnegie Mellon University,
5000 Forbes Avenue, Pittsburgh, PA 15213
| | - Purva Joshi
- Department of Mechanical Engineering, Carnegie Mellon University,
5000 Forbes Avenue, Pittsburgh, PA 15213
| | - Anjali Sehrawat
- Department of Mechanical Engineering, Carnegie Mellon University,
5000 Forbes Avenue, Pittsburgh, PA 15213
| | - Robert Keelan
- Department of Mechanical Engineering, Carnegie Mellon University,
5000 Forbes Avenue, Pittsburgh, PA 15213
| | - Dona M. Wilfong
- The STAR Center, Allegheny Health Network, 4900 Friendship Avenue,
Pittsburgh, PA 15224
| | - James T. McCormick
- Department of General Surgery, Allegheny General Hospital, 320 East
North Avenue, Pittsburgh, PA 15212
| |
Collapse
|