Image-guided surgery and medical robotics in the cranial area

Current Applications of Dynamic Navigation System in Endodontics: A Scoping Review

This scoping review (SCR) was conducted to map the existing literature on dynamic navigation system (DNS), to examine the extent, range, and nature of research activity. Additionally, this SCR disseminates research findings, determines the value of conducting a full systematic review with meta-analysis, and identifies gaps in the existing literature and future directions. This SCR followed Arksey and O'Malley's five stages framework. The electronic search was performed in PubMed (Medline), Scopus (Elsevier), and Web of Science (Clarivate Analytics) databases using a search strategy. Five themes emerged during the descriptive analysis that captured the DNS application in endodontics. The DNS has been explored for creating access cavities (8/18, 44.44%), locating calcified canals (4/18, 22.2%), microsurgery (3/18, 16.6%), post removal (2/18, 11.1%), and intraosseous anesthesia (1/18, 5.5%). Out of the 18 studies included, 12 are in vitro (66.6%), five are in vivo (case report) (27.7%), and one is ex vivo (5.5%). The DNS demonstrated accuracy and efficiency in performing minimally invasive access cavities, locating calcified canals, and performing endodontic microsurgery, and it helped target the site for intraosseous anesthesia.

As low as diagnostically acceptable dose imaging in maxillofacial trauma: a reference quality approach

OBJECTIVES

As-low-as-diagnostically-acceptable (ALADA) doses are substantially lower than current diagnostic reference levels. To improve dose management, a reference quality approach was tested in which phantom quality metrics of a clinical ALADA dose reference protocol were used to benchmark potential ALADA dose protocols for various scanner models.

METHODS

Spatial resolution, contrast resolution, contrast-to-noise ratio (CNR) and subjective noise and sharpness were evaluated for a clinical ALADA dose reference protocol at 80 kV and 40 mA (CTDIvol 2.66 mGy) and compared with test protocols of two CT scanners at 100 kV and 35 mA (3.08-3.44 mGy), 80 kV and 54-61 mA (2.65 mGy), 80 kV and 40 mA (1.73-1.92 mGy), and 80 kV and 21-23 mA (1.00-1.03 mGy) using different kernels, filtered backprojection and iterative reconstructions. The test protocols with the lowest dose showing quality metrics non-inferior to the reference protocol were verified in a cadaver study by determining the diagnostic accuracy of detection of maxillofacial fractures and CNR of the optical nerve and rectus inferior muscle.

RESULTS

36 different image series were analysed in the phantom study. Based on the phantom quality metrics, potential ALADA dose protocols at 1.73-1.92 mGy were selected. Compared with the reference images, the selected protocols showed non-inferiority in the detection and classification of maxillofacial fractures and non-inferior CNR of orbital soft tissues in the cadaver study.

CONCLUSIONS

Reference quality metrics from clinical ALADA dose protocols may be used to guide selection of potential ALADA dose protocols of different CT scanners.

Assessment of the Accuracy of Two Different Dynamic Navigation System Registration Methods for Dental Implant Placement in the Posterior Area: An In Vitro Study

Purpose: To compare the U-tube and cusp dynamic navigation system registration methods in the use of dental implant placement, and to assess the influence of the location of missing teeth on these registrations. Methods: 32 resin mandible models and 64 implants were utilized, with implants being placed using one of the two registration methods selected at random. Accuracy was measured through the superimposition of the final and planned implant positions. Angular deviation, 3D entry deviation, and 3D apex deviation were analyzed. Results: The overall mean 3D deviation was 1.089 ± 0.515 mm at the entry point and 1.174 ± 0.531 mm at the apex point, and mean angular deviation was 1.970 ± 1.042 degrees. No significant difference (p > 0.05) was observed when comparing these two registration methods. However, the U-tube method showed significant difference when assessing the location of missing teeth (without distal-extension absence and distal-extension absence), whereas cusp registration was unaffected. Conclusions: Both the U-tube and cusp dynamic navigation system registration methods are accurate when implemented in vitro. Besides, the cusp registration technique can also overcome several of the limitations of the U-tube approach and the accuracy of it was not influenced by the location of the missing teeth, highlighting it as a method worthy of further clinical research.

Clinical Application of Augmented Reality in Computerized Skull Base Surgery

Cranial base tactics comprise the regulation of tiny and complicated structures in the domains of otology, rhinology, neurosurgery, and maxillofacial medical procedure. Basic nerves and veins are in the nearness of these buildings. Increased the truth is a coming innovation that may reform the cerebral basis approach by supplying vital physical and navigational facts brought together in a solitary presentation. In any case, the awareness and acknowledgment of prospective results of expanding reality frameworks in the cerebral base region are really poor. This article targets examining the handiness of expanded reality frameworks in cranial foundation medical procedures and emphasizes the obstacles that present innovation encounters and their prospective adjustments. A specialized perspective on distinct strategies used being produced of an improved realty framework is furthermore offered. The newest item offers an expansion in interest in expanded reality frameworks that may motivate more secure and practical procedures. In any case, a couple of concerns have to be cared to before that can be for the vast part fused into normal practice.

Semi-autonomous image-guided brain tumour resection using an integrated robotic system: A bench-top study

BACKGROUND

Complete brain tumour resection is an extremely critical factor for patients' survival rate and long-term quality of life. This paper introduces a prototype medical robotic system that aims to automatically detect and clean up brain tumour residues after the removal of tumour bulk through conventional surgery.

METHODS

We focus on the development of an integrated surgical robotic system for image-guided robotic brain surgery. The Behavior Tree framework is explored to coordinate cross-platform medical subtasks.

RESULTS

The integrated system was tested on a simulated laboratory platform. Results and performance indicate the feasibility of supervised semi-automation for residual brain tumour ablation in a simulated surgical cavity with sub-millimetre accuracy. The modularity in the control architecture allows straightforward integration of further medical devices.

CONCLUSIONS

This work presents a semi-automated laboratory setup, simulating an intraoperative robotic neurosurgical procedure with real-time endoscopic image guidance and provides a foundation for the future transition from engineering approaches to clinical application.

Novel robotic systems and future directions

Robot-assistance is increasingly used in surgical practice. We performed a nonsystematic literature review using PubMed/MEDLINE and Google for robotic surgical systems and compiled information on their current status. We also used this information to predict future about the direction of robotic systems based on various robotic systems currently being developed. Currently, various modifications are being made in the consoles, robotic arms, cameras, handles and instruments, and other specific functions (haptic feedback and eye tracking) that make up the robotic surgery system. In addition, research for automated surgery is actively being carried out. The development of future robots will be directed to decrease the number of incisions and improve precision. With the advent of artificial intelligence, a more practical form of robotic surgery system can be introduced and will ultimately lead to the development of automated robotic surgery system.

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

PURPOSE

Accurate image guidance requires a rigid connection between tracked fiducial markers and the patient, which cannot be guaranteed by current non-invasive attachment techniques. We propose a new granular jamming approach to firmly, yet non-invasively, connect fiducials to the patient.

METHODS

Our granular jamming cap surrounds the head and conforms to the contours of the patient's skull. When a vacuum is drawn, the device solidifies in a manner conceptually like a vacuum-packed bag of ground coffee, providing a rigid structure that can firmly hold fiducial markers to the patient's skull. By using the new Polaris Krios optical tracker, we can also use more fiducials in advantageous configurations to reduce registration error.

RESULTS

We tested our new approach against a clinically used headband-based fiducial fixation device under perturbations that could reasonably be expected to occur in a real-world operating room. In bump testing, we found that the granular jamming cap reduced average TRE at the skull base from 2.29 to 0.56 mm and maximum TRE at the same point from 7.65 to 1.30 mm. Clinically significant TRE reductions were also observed in head repositioning and static force testing experiments.

CONCLUSION

The granular jamming cap concept increases the robustness and accuracy of image-guided sinus and skull base surgery by more firmly attaching fiducial markers to the patient's skull.

Ultralow-dose computed tomography imaging for surgery of midfacial and orbital fractures using ASIR and MBIR

The influence of dose reductions on diagnostic quality using a series of high-resolution ultralow-dose computed tomography (CT) scans for computer-assisted planning and surgery including the most recent iterative reconstruction algorithms was evaluated and compared with the fracture detectability of a standard cranial emergency protocol. A human cadaver head including the mandible was artificially prepared with midfacial and orbital fractures and scanned using a 64-multislice CT scanner. The CT dose index volume (CTDIvol) and effective doses were calculated using application software. Noise was evaluated as the standard deviation in Hounsfield units within an identical region of interest in the posterior fossa. Diagnostic quality was assessed by consensus reading of a craniomaxillofacial surgeon and radiologist. Compared with the emergency protocol at CTDIvol 35.3 mGy and effective dose 3.6 mSv, low-dose protocols down to CTDIvol 1.0 mGy and 0.1 mSv (97% dose reduction) may be sufficient for the diagnosis of dislocated craniofacial fractures. Non-dislocated fractures may be detected at CTDIvol 2.6 mGy and 0.3 mSv (93% dose reduction). Adaptive statistical iterative reconstruction (ASIR) 50 and 100 reduced average noise by 30% and 56%, and model-based iterative reconstruction (MBIR) by 93%. However, the detection rate of fractures could not be improved due to smoothing effects.

Accuracy of a flapless protocol for computer-guided zygomatic implant placement in human cadavers: expectations and reality

BACKGROUND

This work evaluated the accuracy and safety of a protocol for minimally-invasive flapless zygomatic implant placement that uses computer-guided stereolithographic mucosa-supported surgical templates.

METHODS

A total of six zygomatic implants were placed in three formalin-fixed human cadaver heads, with edentulous and severely atrophic posterior maxillae. CT scans of each cadaver head were performed after zygomatic implant placement, to evaluate the lateral error (LE) at implant tip and base, and the angular error (AE) of the implant body.

RESULTS

Excluding the implant placed outside the drilling channel, the LE at the implant base was less than 1 mm in all cases. The average LE at the tip was 3.86 mm, and the AE was less than 6° in all cases, with an average of 4.5°.

CONCLUSION

Computer-guided minimally-invasive flapless zygomatic implant surgery remains challenging. Careful planning and perfect stability of the surgical guide are essential.

Computerized implant-dentistry: Advances toward automation

Advancements in the field of implantology such as three-dimensional imaging, implant-planning software, computer-aided-design/computer-aided-manufacturing (CAD/CAM) technology, computer-guided, and navigated implant surgery have led to the computerization of implant-dentistry. This three-dimensional computer-generated implant-planning and surgery has not only enabled accurate preoperative evaluation of the anatomic limitations but has also facilitated preoperative planning of implant positions along with virtual implant placement and subsequently transferring the virtual treatment plans onto the surgical phase via static (guided) or dynamic (navigated) systems aided by CAD/CAM technology. Computerized-implant-dentistry being highly predictable and minimally invasive in nature has also allowed implant placement in patients with medical comorbidities (e.g. radiation therapy, blood dyscrasias), in patients with complex problems following a significant alteration of the bony anatomy as a result of benign or malignant pathology of the jaws or trauma and in patients with other physical and emotional problems. With significant achievements accomplished in the field of computerized implant-dentistry, attempts are now been made toward complete automation of implant-dentistry.

Positional calibration of an ultrasound image-guided robotic breast biopsy system

OBJECTIVES

Precision biopsy of small lesions is essential in providing high-quality patient diagnosis and management. Localization depends on high-quality imaging. We have developed a dedicated, fully automatic volume breast ultrasound (US) imaging system for early breast cancer detection. This work focuses on development of an image-guided robotic biopsy system that is integrated with the volume breast US system for performing minimally invasive breast biopsies. The objective of this work was to assess the positional accuracy of the robotic system for breast biopsy.

METHODS

We have adapted a compact robotic arm for performing breast biopsy. The arm incorporates a force torque sensor and is modified to accommodate breast biopsy sampling needles mounted on the robot end effector. Volume breast US images are used as input to a targeting algorithm that provides the physician with control of biopsy device guidance and trajectory optimization. In this work, the positional accuracy was evaluated using (1) a light-emitting diode (LED) mounted on the end effector and (2) a LED mounted on the end of a biopsy needle, each of which was imaged for each robot controller position as part of mapping the positional accuracy throughout a volume that would contain the breast. We measured the error in each location and the cumulative error.

RESULTS

Robotic device performance over the volume provided mean accuracy ± SD of 0.76 ± 0.13 mm (end effector) and 0.55 ± 0.13 mm (needle sample location), sufficient for a targeting accuracy within ±1 mm, which is suitable for clinical use. Depth positioning error also was small: 0.38 ± 0.03 mm. Reproducibility was excellent with less than 0.5% variation.

CONCLUSIONS

Overall accuracy and reproducibility of the compact robotic device were excellent, well within clinical biopsy performance requirements. Volume breast US data provide high-quality input to a biopsy sampling algorithm under physician control. Robotic devices may provide more precise device placement, assisting physicians with biopsy procedures.

Perk Station--Percutaneous surgery training and performance measurement platform

MOTIVATION

Image-guided percutaneous (through the skin) needle-based surgery has become part of routine clinical practice in performing procedures such as biopsies, injections and therapeutic implants. A novice physician typically performs needle interventions under the supervision of a senior physician; a slow and inherently subjective training process that lacks objective, quantitative assessment of the surgical skill and performance. Shortening the learning curve and increasing procedural consistency are important factors in assuring high-quality medical care.

METHODS

This paper describes a laboratory validation system, called Perk Station, for standardized training and performance measurement under different assistance techniques for needle-based surgical guidance systems. The initial goal of the Perk Station is to assess and compare different techniques: 2D image overlay, biplane laser guide, laser protractor and conventional freehand. The main focus of this manuscript is the planning and guidance software system developed on the 3D Slicer platform, a free, open source software package designed for visualization and analysis of medical image data.

RESULTS

The prototype Perk Station has been successfully developed, the associated needle insertion phantoms were built, and the graphical user interface was fully implemented. The system was inaugurated in undergraduate teaching and a wide array of outreach activities. Initial results, experiences, ongoing activities and future plans are reported.

3D endoscopic approach for endonasal sinus surgery

Functional endoscopic sinus surgery (FESS) is a minimal invasive approach adopted in case of chronic sinusitis (inflammation of the paranasal sinuses). The paranasal sinuses are hollow structures within the bones surrounding the nasal cavity. During FESS the surgeon moves the endoscope and other surgical instruments within the nasal cavity following specific paths to approach each one of the paranasal sinuses. The purpose of this study was to reconstruct these paths to access the paranasal sinuses using volumetric CT data. The results will be used for Finite Element modeling and simulations for Robot Assisted Endonasal Surgery.