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Seddighi N, Chen YC, Merryweather AS, Foreman KB, Kuntz A, Battaglia E, Zhang H, Taylor E, Wong B, Fino PC. The Impact of Design Factors on User Behavior in a Virtual Hospital Room to Explore Fall Prevention Strategies. HERD 2024:19375867241238434. [PMID: 38591574 DOI: 10.1177/19375867241238434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
OBJECTIVES Falls in hospitals pose a significant safety risk, leading to injuries, prolonged hospitalization, and lasting complications. This study explores the potential of augmented reality (AR) technology in healthcare facility design to mitigate fall risk. BACKGROUND Few studies have investigated the impact of hospital room layouts on falls due to the high cost of building physical prototypes. This study introduces an innovative approach using AR technology to advance methods for healthcare facility design efficiently. METHODS Ten healthy participants enrolled in this study to examine different hospital room designs in AR. Factors of interest included room configuration, door type, exit side of the bed, toilet placement, and the presence of IV equipment. AR trackers captured trajectories of the body as participants navigated through these AR hospital layouts, providing insights into user behavior and preferences. RESULTS Door type influenced the degree of backward and sideways movement, with the presence of an IV pole intensifying the interaction between door and room type, leading to increased sideways and backward motion. Participants displayed varying patterns of backward and sideways travel depending on the specific room configurations they encountered. CONCLUSIONS AR can be an efficient and cost-effective method to modify room configurations to identify important design factors before conducting physical testing. The results of this study provide valuable insights into the effect of environmental factors on movement patterns in simulated hospital rooms. These results highlight the importance of considering environmental factors, such as the type of door and bathroom location, when designing healthcare facilities.
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Affiliation(s)
- Nooshin Seddighi
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Ying-Ching Chen
- Department of Entertainment Arts and Engineering, University of Utah, Salt Lake City, UT, USA
| | - Andrew S Merryweather
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
- Amazon, LLC, Seattle, WA, USA
| | - K Bo Foreman
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Alan Kuntz
- Kahlert School of Computing, University of Utah, Salt Lake City, UT, USA
- Robotics Center, University of Utah, Salt Lake City, UT, USA
| | - Edoardo Battaglia
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
- Robotics Center, University of Utah, Salt Lake City, UT, USA
| | - Haohan Zhang
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
- Robotics Center, University of Utah, Salt Lake City, UT, USA
| | | | - Bob Wong
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
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2
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Kuntz A, Emerson M, Ertop TE, Fried I, Fu M, Hoelscher J, Rox M, Akulian J, Gillaspie EA, Lee YZ, Maldonado F, Webster RJ, Alterovitz R. Autonomous medical needle steering in vivo. Sci Robot 2023; 8:eadf7614. [PMID: 37729421 DOI: 10.1126/scirobotics.adf7614] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 08/21/2023] [Indexed: 09/22/2023]
Abstract
The use of needles to access sites within organs is fundamental to many interventional medical procedures both for diagnosis and treatment. Safely and accurately navigating a needle through living tissue to a target is currently often challenging or infeasible because of the presence of anatomical obstacles, high levels of uncertainty, and natural tissue motion. Medical robots capable of automating needle-based procedures have the potential to overcome these challenges and enable enhanced patient care and safety. However, autonomous navigation of a needle around obstacles to a predefined target in vivo has not been shown. Here, we introduce a medical robot that autonomously navigates a needle through living tissue around anatomical obstacles to a target in vivo. Our system leverages a laser-patterned highly flexible steerable needle capable of maneuvering along curvilinear trajectories. The autonomous robot accounts for anatomical obstacles, uncertainty in tissue/needle interaction, and respiratory motion using replanning, control, and safe insertion time windows. We applied the system to lung biopsy, which is critical for diagnosing lung cancer, the leading cause of cancer-related deaths in the United States. We demonstrated successful performance of our system in multiple in vivo porcine studies achieving targeting errors less than the radius of clinically relevant lung nodules. We also demonstrated that our approach offers greater accuracy compared with a standard manual bronchoscopy technique. Our results show the feasibility and advantage of deploying autonomous steerable needle robots in living tissue and how these systems can extend the current capabilities of physicians to further improve patient care.
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Affiliation(s)
- Alan Kuntz
- Kahlert School of Computing and Robotics Center, University of Utah, Salt Lake City, UT 84112, USA
| | - Maxwell Emerson
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Tayfun Efe Ertop
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Inbar Fried
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Mengyu Fu
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Janine Hoelscher
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Margaret Rox
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Jason Akulian
- Department of Medicine, Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Erin A Gillaspie
- Department of Medicine and Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Yueh Z Lee
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Fabien Maldonado
- Department of Medicine and Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Robert J Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Ron Alterovitz
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Rox M, Esser DS, Smith ME, Ertop TE, Emerson M, Maldonado F, Gillaspie EA, Kuntz A, Webster RJ. Toward Continuum Robot Tentacles for Lung Interventions: Exploring Folding Support Disks. IEEE Robot Autom Lett 2023; 8:3494-3501. [PMID: 37333046 PMCID: PMC10270676 DOI: 10.1109/lra.2023.3267006] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 06/20/2023]
Abstract
Toward the future goal of creating a lung surgery system featuring multiple tentacle-like robots, we present a new folding concept for continuum robots that enables them to squeeze through openings smaller than the robot's nominal diameter (e.g., the narrow space between adjacent ribs). This is facilitated by making the disks along the robot's backbone foldable. We also demonstrate that such a robot can feature not only straight, but also curved tendon routing paths, thereby achieving a diverse family of conformations. We find that the foldable robot performs comparably, from a kinematic perspective, to an identical non-folding continuum robot at varying deployment lengths. This work paves the way for future applications with a continuum robot that can fold and fit through smaller openings, with the potential to reduce invasiveness during surgical tasks.
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Affiliation(s)
- Margaret Rox
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, 37203
| | - Daniel S Esser
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, 37203
| | - Mariana E Smith
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, 37203
| | - Tayfun Efe Ertop
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, 37203
| | - Maxwell Emerson
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, 37203
| | - Fabien Maldonado
- Department of Medicine and Thoracic Surgery at the Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Erin A Gillaspie
- Department of Medicine and Thoracic Surgery at the Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Alan Kuntz
- Robotics Center and the Kahlert School of Computing at the University of Utah, Salt Lake City, UT 84112, USA
| | - Robert J Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, 37203
- Department of Medicine and Thoracic Surgery at the Vanderbilt University Medical Center, Nashville, TN 37212, USA
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4
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Gothuey I, Jeannin M, Bouzegaou R, Kuntz A, Salamin V. Psychopathological characteristics of patients eligible for a diacethylmorphine prescription program: an ecological pilot study. Eur Psychiatry 2022. [PMCID: PMC9564752 DOI: 10.1192/j.eurpsy.2022.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Agonist opiate treatments with diacethylmorphin (DAM) for heroin addiction have proven their effectiveness for a long time. But few studies focused on psychiatric troubles among the treated patients. As a new DAM program will open in Freiburg in Switzerland, in order to assess the eligibility to this program, we consider the psychiatric dimension using the Addition Severity Index French translation (IGT).
Objectives
Assessing the patient eligibility for the DAM programm and describing psychopathological characteristics
Methods
Assessing eligibility for a Dam program in Switzerland is based on some criteria defined by OFSP: Be adult, failure of at least two previous addiction treatments, intravenous consumption. In addition, the included patients (N=10) passed an interview with a trained examiner, to fill the addiction severity index scale (multidimensional psychometric scale). The result of the psychiatric dimension of IGT was compared with the psychiatric diagnosis in the medical file to assess the internal reliability of the descriptive method. Statistical method for little sample, mean, median, descriptive datas and Fisher test were applied.
Results
All kind of affective disorders, were the most representative psychiatric trouble in the studied population (47%) followed by personality disorders (32%) and severe anxiety troubles (21%). The psychiatric dimensional evaluation of IGT was consistent with the description file psychiatric diagnosis. In a surprising way, we found no psychosis spectrum troubles who could explained the previous treatment failure.
Conclusions
Affective disorders are overrepresented in our sample of addicted patient included in the DAM program. These troubles stay often underestimated. The have to be properly treated
Disclosure
No significant relationships.
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Fried I, Hoelscher J, Fu M, Emerson M, Ertop TE, Rox M, Granna J, Kuntz A, Akulian JA, Webster RJ, Alterovitz R. Design Considerations for a Steerable Needle Robot to Maximize Reachable Lung Volume. IEEE Int Conf Robot Autom 2021; 2021:10.1109/icra48506.2021.9561342. [PMID: 34721939 PMCID: PMC8553157 DOI: 10.1109/icra48506.2021.9561342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Steerable needles that are able to follow curvilinear trajectories and steer around anatomical obstacles are a promising solution for many interventional procedures. In the lung, these needles can be deployed from the tip of a conventional bronchoscope to reach lung lesions for diagnosis. The reach of such a device depends on several design parameters including the bronchoscope diameter, the angle of the piercing device relative to the medial axis of the airway, and the needle's minimum radius of curvature while steering. Assessing the effect of these parameters on the overall system's clinical utility is important in informing future design choices and understanding the capabilities and limitations of the system. In this paper, we analyze the effect of various settings for these three robot parameters on the percentage of the lung that the robot can reach. We combine Monte Carlo random sampling of piercing configurations with a Rapidly-exploring Random Trees based steerable needle motion planner in simulated human lung environments to asymptotically accurately estimate the volume of sites in the lung reachable by the robot. We highlight the importance of each parameter on the overall system's reachable workspace in an effort to motivate future device innovation and highlight design trade-offs.
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Affiliation(s)
- Inbar Fried
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Janine Hoelscher
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Mengyu Fu
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Maxwell Emerson
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Tayfun Efe Ertop
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Margaret Rox
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Josephine Granna
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Alan Kuntz
- School of Computing and the Robotics Center, University of Utah, Salt Lake City, UT 84112, USA
| | - Jason A. Akulian
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27514, USA
| | - Robert J. Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Ron Alterovitz
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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6
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Hoelscher J, Fu M, Fried I, Emerson M, Ertop TE, Rox M, Kuntz A, Akulian JA, Webster RJ, Alterovitz R. Backward Planning for a Multi-Stage Steerable Needle Lung Robot. IEEE Robot Autom Lett 2021; 6:3987-3994. [PMID: 33937523 PMCID: PMC8087253 DOI: 10.1109/lra.2021.3066962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lung cancer is one of the deadliest types of cancer, and early diagnosis is crucial for successful treatment. Definitively diagnosing lung cancer typically requires biopsy, but current approaches either carry a high procedural risk for the patient or are incapable of reaching many sites of clinical interest in the lung. We present a new sampling-based planning method for a steerable needle lung robot that has the potential to accurately reach targets in most regions of the lung. The robot comprises three stages: a transorally deployed bronchoscope, a sharpened piercing tube (to pierce into the lung parenchyma from the airways), and a steerable needle able to navigate to the target. Planning for the sequential deployment of all three stages under health safety concerns is a challenging task, as each stage depends on the previous one. We introduce a new backward planning approach that starts at the target and advances backwards toward the airways with the goal of finding a piercing site reachable by the bronchoscope. This new strategy enables faster performance by iteratively building a single search tree during the entire computation period, whereas previous forward approaches have relied on repeating this expensive tree construction process many times. Additionally, our method further reduces runtime by employing biased sampling and sample rejection based on geometric constraints. We evaluate this approach using simulation-based studies in anatomical lung models. We demonstrate in comparison with existing techniques that the new approach (i) is more likely to find a path to a target, (ii) is more efficient by reaching targets more than 5 times faster on average, and (iii) arrives at lower-risk paths in shorter time.
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Affiliation(s)
- Janine Hoelscher
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Mengyu Fu
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Inbar Fried
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Maxwell Emerson
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Tayfun Efe Ertop
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Margaret Rox
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Alan Kuntz
- School of Computing and the Robotics Center, University of Utah, Salt Lake City, UT 84112, USA
| | - Jason A Akulian
- Division of Pulmonary Diseases and Critical Care Medicine at the University of North Carolina at Chapel Hill, NC 27599, USA
| | - Robert J Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Ron Alterovitz
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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7
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Rox M, Emerson M, Ertop TE, Fried I, Fu M, Hoelscher J, Kuntz A, Granna J, Mitchell J, Lester M, Maldonado F, Gillaspie EA, Akulian JA, Alterovitz R, Webster RJ. Decoupling Steerability from Diameter: Helical Dovetail Laser Patterning for Steerable Needles. IEEE Access 2020; 8:181411-181419. [PMID: 35198341 PMCID: PMC8863302 DOI: 10.1109/access.2020.3028374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The maximum curvature of a steerable needle in soft tissue is highly sensitive to needle shaft stiffness, which has motivated use of small diameter needles in the past. However, desired needle payloads constrain minimum shaft diameters, and shearing along the needle shaft can occur at small diameters and high curvatures. We provide a new way to adjust needle shaft stiffness (thereby enhancing maximum curvature, i.e. "steerability") at diameters selected based on needle payload requirements. We propose helical dovetail laser patterning to increase needle steerability without reducing shaft diameter. Experiments in phantoms and ex vivo animal muscle, brain, liver, and inflated lung tissues demonstrate high steerability in soft tissues. These experiments use needle diameters suitable for various clinical scenarios, and which have been previously limited by steering challenges without helical dovetail patterning. We show that steerable needle targeting remains accurate with established controllers and demonstrate interventional payload delivery (brachytherapy seeds and radiofrequency ablation) through the needle. Helical dovetail patterning decouples steerability from diameter in needle design. It enables diameter to be selected based on clinical requirements rather than being carefully tuned to tissue properties. These results pave the way for new sensors and interventional tools to be integrated into high-curvature steerable needles.
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Affiliation(s)
- Margaret Rox
- Department of Mechanical Engineering and the Vanderbilt Institute for Surgery and Engineering at Vanderbilt University, Nashville, TN 37203, USA
| | - Maxwell Emerson
- Department of Mechanical Engineering and the Vanderbilt Institute for Surgery and Engineering at Vanderbilt University, Nashville, TN 37203, USA
| | - Tayfun Efe Ertop
- Department of Mechanical Engineering and the Vanderbilt Institute for Surgery and Engineering at Vanderbilt University, Nashville, TN 37203, USA
| | - Inbar Fried
- Department of Computer Science at the University of North Carolina at Chapel Hill, NC 27599, USA
| | - Mengyu Fu
- Department of Computer Science at the University of North Carolina at Chapel Hill, NC 27599, USA
| | - Janine Hoelscher
- Department of Computer Science at the University of North Carolina at Chapel Hill, NC 27599, USA
| | - Alan Kuntz
- Robotics Center and the School of Computing at the University of Utah, Salt Lake City, UT 84112, USA
| | - Josephine Granna
- Department of Mechanical Engineering and the Vanderbilt Institute for Surgery and Engineering at Vanderbilt University, Nashville, TN 37203, USA
| | - Jason Mitchell
- Department of Mechanical Engineering and the Vanderbilt Institute for Surgery and Engineering at Vanderbilt University, Nashville, TN 37203, USA
| | - Michael Lester
- Department of Medicine and Thoracic Surgery at the Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Fabien Maldonado
- Department of Medicine and Thoracic Surgery at the Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Erin A Gillaspie
- Department of Medicine and Thoracic Surgery at the Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Jason A Akulian
- Division of Pulmonary Diseases and Critical Care Medicine at the University of North Carolina at Chapel Hill, NC 27599, USA
| | - Ron Alterovitz
- Department of Computer Science at the University of North Carolina at Chapel Hill, NC 27599, USA
| | - Robert J Webster
- Department of Mechanical Engineering and the Vanderbilt Institute for Surgery and Engineering at Vanderbilt University, Nashville, TN 37203, USA
- Department of Medicine and Thoracic Surgery at the Vanderbilt University Medical Center, Nashville, TN 37212, USA
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Ertop TE, Emerson M, Rox M, Granna J, Maldonado F, Gillaspie E, Lester M, Kuntz A, Rucker C, Fu M, Hoelscher J, Fried I, Alterovitz R, Webster R. STEERABLE NEEDLE TRAJECTORY FOLLOWING IN THE LUNG: TORSIONAL DEADBAND COMPENSATION AND FULL POSE ESTIMATION WITH 5DOF FEEDBACK FOR NEEDLES PASSING THROUGH FLEXIBLE ENDOSCOPES. Proc ASME Dyn Syst Control Conf 2020; 2020:V001T05A003. [PMID: 35284151 PMCID: PMC8916686 DOI: 10.1115/dscc2020-3163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Bronchoscopic diagnosis and intervention in the lung is a new frontier for steerable needles, where they have the potential to enable minimally invasive, accurate access to small nodules that cannot be reliably accessed today. However, the curved, flexible bronchoscope requires a much longer needle than prior work has considered, with complex interactions between the needle and bronchoscope channel, introducing new challenges in steerable needle control. In particular, friction between the working channel and needle causes torsional windup along the bronchoscope, the effects of which cannot be directly measured at the tip of thin needles embedded with 5 degree-of-freedom magnetic tracking coils. To compensate for these effects, we propose a new torsional deadband-aware Extended Kalman Filter to estimate the full needle tip pose including the axial angle, which defines its steering direction. We use the Kalman Filter estimates with an established sliding mode controller to steer along desired trajectories in lung tissue. We demonstrate that this simple torsional deadband model is sufficient to account for the complex interactions between the needle and endoscope channel for control purposes. We measure mean final targeting error of 1.36 mm in phantom tissue and 1.84 mm in ex-vivo porcine lung, with mean trajectory following error of 1.28 mm and 1.10 mm, respectively.
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Affiliation(s)
| | - Maxwell Emerson
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212
| | - Margaret Rox
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212
| | - Josephine Granna
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212
| | | | - Erin Gillaspie
- Vanderbilt University Medical Center, Nashville, TN 37212
| | - Michael Lester
- Vanderbilt University Medical Center, Nashville, TN 37212
| | - Alan Kuntz
- Robotics Center and School of Computing, University of Utah, Salt Lake City, UT 84112
| | - Caleb Rucker
- The Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, TN 37996
| | - Mengyu Fu
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Janine Hoelscher
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Inbar Fried
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Ron Alterovitz
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Robert Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212
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Ferguson JM, Pitt B, Kuntz A, Granna J, Kavoussi NL, Nimmagadda N, Barth EJ, Herrell SD, Webster RJ. Comparing the accuracy of the da Vinci Xi and da Vinci Si for image guidance and automation. Int J Med Robot 2020; 16:1-10. [DOI: 10.1002/rcs.2149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 12/19/2022]
Affiliation(s)
- James M. Ferguson
- Department of Mechanical Engineering Vanderbilt University Nashville Tennessee USA
- Vanderbilt Institute for Surgery and Engineering (VISE) Nashville Tennessee USA
| | - Bryn Pitt
- Department of Mechanical Engineering Vanderbilt University Nashville Tennessee USA
- Vanderbilt Institute for Surgery and Engineering (VISE) Nashville Tennessee USA
| | - Alan Kuntz
- Robotics Center and School of Computing, University of Utah Salt Lake City Utah USA
| | - Josephine Granna
- Department of Mechanical Engineering Vanderbilt University Nashville Tennessee USA
- Vanderbilt Institute for Surgery and Engineering (VISE) Nashville Tennessee USA
| | - Nicholas L. Kavoussi
- Vanderbilt Institute for Surgery and Engineering (VISE) Nashville Tennessee USA
- Vanderbilt University Medical Center Nashville Tennessee USA
| | - Naren Nimmagadda
- Vanderbilt Institute for Surgery and Engineering (VISE) Nashville Tennessee USA
- Vanderbilt University Medical Center Nashville Tennessee USA
| | - Eric J. Barth
- Department of Mechanical Engineering Vanderbilt University Nashville Tennessee USA
- Vanderbilt Institute for Surgery and Engineering (VISE) Nashville Tennessee USA
| | - Stanley Duke Herrell
- Vanderbilt Institute for Surgery and Engineering (VISE) Nashville Tennessee USA
- Vanderbilt University Medical Center Nashville Tennessee USA
| | - Robert J. Webster
- Department of Mechanical Engineering Vanderbilt University Nashville Tennessee USA
- Vanderbilt Institute for Surgery and Engineering (VISE) Nashville Tennessee USA
- Vanderbilt University Medical Center Nashville Tennessee USA
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Ferguson JM, Pitt EB, Remirez AA, Siebold MA, Kuntz A, Kavoussi NL, Barth EJ, Herrell SD, Webster RJ. Toward Practical and Accurate Touch-Based Image Guidance for Robotic Partial Nephrectomy. ACTA ACUST UNITED AC 2020; 2:196-205. [DOI: 10.1109/tmrb.2020.2989661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Concentric tube robots, composed of nested pre-curved tubes, have the potential to perform minimally invasive surgery at difficult-to-reach sites in the human body. In order to plan motions that safely perform surgeries in constrained spaces that require avoiding sensitive structures, the ability to accurately estimate the entire shape of the robot is needed. Many state-of-the-art physics-based shape models are unable to account for complex physical phenomena and subsequently are less accurate than is required for safe surgery. In this work, we present a learned model that can estimate the entire shape of a concentric tube robot. The learned model is based on a deep neural network that is trained using a mixture of simulated and physical data. We evaluate multiple network architectures and demonstrate the model's ability to compute the full shape of a concentric tube robot with high accuracy.
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Affiliation(s)
- Alan Kuntz
- Robotics Center and the School of Computing, University of Utah, Salt Lake City, UT, 84112 USA
| | - Armaan Sethi
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599 USA
| | - Robert J Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, 37235 USA
| | - Ron Alterovitz
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599 USA
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12
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Fu M, Kuntz A, Salzman O, Alterovitz R. Toward Asymptotically-Optimal Inspection Planning via Efficient Near-Optimal Graph Search. Robot Sci Syst 2020; 2019. [PMID: 32318619 DOI: 10.15607/rss.2019.xv.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Inspection planning, the task of planning motions that allow a robot to inspect a set of points of interest, has applications in domains such as industrial, field, and medical robotics. Inspection planning can be computationally challenging, as the search space over motion plans grows exponentially with the number of points of interest to inspect. We propose a novel method, Incremental Random Inspection-roadmap Search (IRIS), that computes inspection plans whose length and set of successfully inspected points asymptotically converge to those of an optimal inspection plan. IRIS incrementally densifies a motion planning roadmap using sampling-based algorithms, and performs efficient near-optimal graph search over the resulting roadmap as it is generated. We demonstrate IRIS's efficacy on a simulated planar 5DOF manipulator inspection task and on a medical endoscopic inspection task for a continuum parallel surgical robot in cluttered anatomy segmented from patient CT data. We show that IRIS computes higher-quality inspection plans orders of magnitudes faster than a prior state-of-the-art method.
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Affiliation(s)
- Mengyu Fu
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Alan Kuntz
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Oren Salzman
- Robotics Institute, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Ron Alterovitz
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Kuntz A, Fu M, Alterovitz R. Planning High-Quality Motions for Concentric Tube Robots in Point Clouds via Parallel Sampling and Optimization. Rep U S 2020; 2019:2205-2212. [PMID: 32355572 DOI: 10.1109/iros40897.2019.8968172] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We present a method that plans motions for a concentric tube robot to automatically reach surgical targets inside the body while avoiding obstacles, where the patient's anatomy is represented by point clouds. Point clouds can be generated intra-operatively via endoscopic instruments, enabling the system to update obstacle representations over time as the patient anatomy changes during surgery. Our new motion planning method uses a combination of sampling-based motion planning methods and local optimization to efficiently handle point cloud data and quickly compute high quality plans. The local optimization step uses an interior point optimization method, ensuring that the computed plan is feasible and avoids obstacles at every iteration. This enables the motion planner to run in an anytime fashion, i.e., the method can be stopped at any time and the best solution found up until that point is returned. We demonstrate the method's efficacy in three anatomical scenarios, including two generated from endoscopic videos of real patient anatomy.
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Affiliation(s)
- Alan Kuntz
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Mengyu Fu
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Ron Alterovitz
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Kuntz A, Bowen C, Alterovitz R. Fast Anytime Motion Planning in Point Clouds by Interleaving Sampling and Interior Point Optimization. Springer Proceedings in Advanced Robotics 2020. [DOI: 10.1007/978-3-030-28619-4_63] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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15
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Niyaz S, Kuntz A, Salzman O, Alterovitz R, Srinivasa SS. Optimizing Motion-Planning Problem Setup via Bounded Evaluation with Application to Following Surgical Trajectories. Rep U S 2019; 2019:1355-1362. [PMID: 32318314 PMCID: PMC7172036 DOI: 10.1109/iros40897.2019.8968575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A motion-planning problem's setup can drastically affect the quality of solutions returned by the planner. In this work we consider optimizing these setups, with a focus on doing so in a computationally-efficient fashion. Our approach interleaves optimization with motion planning, which allows us to consider the actual motions required of the robot. Similar prior work has treated the planner as a black box: our key insight is that opening this box in a simple-yet-effective manner enables a more efficient approach, by allowing us to bound the work done by the planner to optimizer-relevant computations. Finally, we apply our approach to a surgically-relevant motion-planning task, where our experiments validate our approach by more-efficiently optimizing the fixed insertion pose of a surgical robot.
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Affiliation(s)
- Sherdil Niyaz
- Paul G. Allen School of Computer Science and Engineering, University of Washington
| | - Alan Kuntz
- Department of Computer Science, University of North Carolina at Chapel Hill
| | - Oren Salzman
- The Robotics Institute, Carnegie Mellon University School of Computer Science
| | - Ron Alterovitz
- Department of Computer Science, University of North Carolina at Chapel Hill
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Amack S, Rox M, Mitchell J, Ertop TE, Emerson M, Kuntz A, Maldonado F, Akulian J, Gafford J, Alterovitz R, Webster RJ. Design and Control of a Compact, Modular Robot for Transbronchial Lung Biopsy. Proc SPIE Int Soc Opt Eng 2019; 10951:109510I. [PMID: 35250147 PMCID: PMC8898049 DOI: 10.1117/12.2513967] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Lung cancer is one of the most prevalent and deadly forms of cancer, claiming more than 154,000 lives in the USA per year. Accurate targeting and biopsy of pulmonary abnormalities is key for early diagnosis and successful treatment. Many cancerous lesions originate in the peripheral regions of the lung which are not directly accessible from the bronchial tree, thereby requiring percutaneous approaches to collect biopsies, which carry a higher risk of pneumothorax, hemorrhage, and death in extreme cases. In prior work, our group proposed a concept for accessing the peripheral lung through the airways, via a bronchscope deployed steerable needle. In this paper, we present a more compact, modular, multi-stage robot, designed to deploy a steerable needle through a standard flexible bronchoscope, to retrieve biopsies from lesions in the peripheral regions of the lung. The robot has several stages that can control a steerable biopsy needle, as well as concentric tubes, which act as an aiming conduit. The functionality of this robot is demonstrated via closed-loop lesion targeting in a CT scanner. The steerable needle is controlled using a previously proposed sliding mode controller, based on feedback from a magnetic tracker embedded in the steerable needle's tip. Towards developing a clinically viable platform, this system builds on prior work through its modular, compact form factor, and workflow-conscious design that provides precise homing and the ability to interchange tools as needed.
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Affiliation(s)
- Stephanie Amack
- Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Margaret Rox
- Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Jason Mitchell
- Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Tayfun Efe Ertop
- Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Maxwell Emerson
- Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Alan Kuntz
- Computer Science, University of North Carolina at Chapel Hill, NC, USA
| | - Fabien Maldonado
- Interventional Pulmonology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jason Akulian
- Interventional Pulmonology, University of North Carolina at Chapel Hill, NC, USA
| | - Joshua Gafford
- Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Ron Alterovitz
- Computer Science, University of North Carolina at Chapel Hill, NC, USA
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Fu M, Kuntz A, Webster RJ, Alterovitz R. Safe Motion Planning for Steerable Needles Using Cost Maps Automatically Extracted from Pulmonary Images. Rep U S 2019; 2018:4942-4949. [PMID: 31105985 DOI: 10.1109/iros.2018.8593407] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lung cancer is the deadliest form of cancer, and early diagnosis is critical to favorable survival rates. Definitive diagnosis of lung cancer typically requires needle biopsy. Common lung nodule biopsy approaches either carry significant risk or are incapable of accessing large regions of the lung, such as in the periphery. Deploying a steerable needle from a bronchoscope and steering through the lung allows for safe biopsy while improving the accessibility of lung nodules in the lung periphery. In this work, we present a method for extracting a cost map automatically from pulmonary CT images, and utilizing the cost map to efficiently plan safe motions for a steerable needle through the lung. The cost map encodes obstacles that should be avoided, such as the lung pleura, bronchial tubes, and large blood vessels, and additionally formulates a cost for the rest of the lung which corresponds to an approximate likelihood that a blood vessel exists at each location in the anatomy. We then present a motion planning approach that utilizes the cost map to generate paths that minimize accumulated cost while safely reaching a goal location in the lung.
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Affiliation(s)
- Mengyu Fu
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Alan Kuntz
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Robert J Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Ron Alterovitz
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Kuntz A, Torres LG, Feins RH, Webster RJ, Alterovitz R. Motion Planning for a Three-Stage Multilumen Transoral Lung Access System. Rep U S 2015; 2015:3255-3261. [PMID: 26942041 DOI: 10.1109/iros.2015.7353829] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Lung cancer is the leading cause of cancer-related death, and early-stage diagnosis is critical to survival. Biopsy is typically required for a definitive diagnosis, but current low-risk clinical options for lung biopsy cannot access all biopsy sites. We introduce a motion planner for a multilumen transoral lung access system, a new system that has the potential to perform safe biopsies anywhere in the lung, which could enable more effective early-stage diagnosis of lung cancer. The system consists of three stages in which a bronchoscope is deployed transorally to the lung, a concentric tube robot pierces through the bronchial tubes into the lung parenchyma, and a steerable needle deploys through a properly oriented concentric tube and steers through the lung parenchyma to the target site while avoiding anatomical obstacles such as significant blood vessels. A sampling-based motion planner computes actions for each stage of the system and considers the coupling of the stages in an efficient manner. We demonstrate the motion planner's fast performance and ability to compute plans with high clearance from obstacles in simulated anatomical scenarios.
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Affiliation(s)
- Alan Kuntz
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Luis G Torres
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Richard H Feins
- Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Robert J Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Ron Alterovitz
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Torres LG, Kuntz A, Gilbert HB, Swaney PJ, Hendrick RJ, Webster RJ, Alterovitz R. A Motion Planning Approach to Automatic Obstacle Avoidance during Concentric Tube Robot Teleoperation. IEEE Int Conf Robot Autom 2015; 2015:2361-2367. [PMID: 26413381 DOI: 10.1109/icra.2015.7139513] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Concentric tube robots are thin, tentacle-like devices that can move along curved paths and can potentially enable new, less invasive surgical procedures. Safe and effective operation of this type of robot requires that the robot's shaft avoid sensitive anatomical structures (e.g., critical vessels and organs) while the surgeon teleoperates the robot's tip. However, the robot's unintuitive kinematics makes it difficult for a human user to manually ensure obstacle avoidance along the entire tentacle-like shape of the robot's shaft. We present a motion planning approach for concentric tube robot teleoperation that enables the robot to interactively maneuver its tip to points selected by a user while automatically avoiding obstacles along its shaft. We achieve automatic collision avoidance by precomputing a roadmap of collision-free robot configurations based on a description of the anatomical obstacles, which are attainable via volumetric medical imaging. We also mitigate the effects of kinematic modeling error in reaching the goal positions by adjusting motions based on robot tip position sensing. We evaluate our motion planner on a teleoperated concentric tube robot and demonstrate its obstacle avoidance and accuracy in environments with tubular obstacles.
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Affiliation(s)
- Luis G Torres
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Alan Kuntz
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Hunter B Gilbert
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Philip J Swaney
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Richard J Hendrick
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Robert J Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Ron Alterovitz
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Besson J, Beck T, Wiesbeck G, Hämmig R, Kuntz A, Abid S, Stohler R. Opioid maintenance therapy in Switzerland: an overview of the Swiss IMPROVE study. Swiss Med Wkly 2014; 144:w13933. [PMID: 24706398 DOI: 10.4414/smw.2014.13933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Switzerland's drug policy model has always been unique and progressive, but there is a need to reassess this system in a rapidly changing world. The IMPROVE study was conducted to gain understanding of the attitudes and beliefs towards opioid maintenance therapy (OMT) in Switzerland with regards to quality and access to treatment. To obtain a "real-world" view on OMT, the study approached its goals from two different angles: from the perspectives of the OMT patients and of the physicians who treat patients with maintenance therapy. The IMPROVE study collected a large body of data on OMT in Switzerland. This paper presents a small subset of the dataset, focusing on the research design and methodology, the profile of the participants and the responses to several key questions addressed by the questionnaires. METHODS IMPROVE was an observational, questionnaire-based cross-sectional study on OMT conducted in Switzerland. Respondents consisted of OMT patients and treating physicians from various regions of the country. Data were collected using questionnaires in German and French. Physicians were interviewed by phone with a computer-based questionnaire. Patients self-completed a paper-based questionnaire at the physicians' offices or OMT treatment centres. RESULTS A total of 200 physicians and 207 patients participated in the study. Liquid methadone and methadone tablets or capsules were the medications most commonly prescribed by physicians (60% and 20% of patient load, respectively) whereas buprenorphine use was less frequent. Patients (88%) and physicians (83%) were generally satisfied with the OMT currently offered. The current political framework and lack of training or information were cited as determining factors that deter physicians from engaging in OMT. About 31% of OMT physicians interviewed were ≥60 years old, indicating an ageing population. Diversion and misuse were considered a significant problem in Switzerland by 45% of the physicians. CONCLUSION The subset of IMPROVE data presented gives a present-day, real-life overview of the OMT landscape in Switzerland. It represents a valuable resource for policy makers, key opinion leaders and drug addiction researchers and will be a useful basis for improving the current Swiss OMT model.
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Affiliation(s)
- J Besson
- CHUV, Rue St-Martin 7, 1003, Lausanne, SWITZERLAND;
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Michaud S, Kuntz A, Dupas D, Campion L, Bouchot O, Pfister C, Rigaud J. [Multicentric evaluation of a self-screening questionnaire for occupational bladder cancer]. Prog Urol 2013; 23:977-85. [PMID: 24090782 DOI: 10.1016/j.purol.2013.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/21/2012] [Revised: 03/14/2013] [Accepted: 04/08/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Evaluate a self-screening questionnaire for bladder cancer of occupational origin and analyse an influence of exposure to a carcinogen bladder tumor on prognosis. PATIENTS AND METHODS Five hundred and thirty-one patients followed, between 2005 and 2010, for bladder cancer in two university centers have received a self-screening questionnaire derived from questionnaire KVP 08. Patients who responded positively to at least one of the items were considered to have a self-screening questionnaire "positive". Patients were finally invited to take an appointment for consultation in occupational pathology. RESULTS The response rate to self-screening questionnaire was 39.9% (212/531). It was "positive" in 82 cases (38.7%). Among the 82 patients with a self-screening questionnaire "positive", 46 patients consulted in occupational pathology (56%). Occupational exposure to a bladder carcinogen was documented in 91.3% of cases. Among the 22 patients who consulted in occupational pathology with a self-screening questionnaire "negative", an occupational exposure to a bladder carcinogen was documented in 13.6% of cases. The sensibility of the self-screening questionnaire was 91.3%, the specificity 86.4% and the accuracy 89.7%. The relative risk to have an occupational exposure if the self-screening questionnaire was "positive" was 6.69. The analysis of groups "positive" versus "negative" does not reveal any statistically significant difference in terms of tumor aggressiveness and disease-free survival. CONCLUSION The self-screening questionnaire was considered relevant with good reliability for detection of occupational exposure to a bladder carcinogen.
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Affiliation(s)
- S Michaud
- Clinique urologique, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France
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Ladner J, Kuntz A, Mauviard E, Hurtebize P, Maupas JL, Caillard JF. Prise en charge de leur propre santé chez les médecins libéraux : une étude transversale en Haute-Normandie, 2008. Rev Epidemiol Sante Publique 2010. [DOI: 10.1016/j.respe.2010.06.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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23
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Guimond J, Khan S, Kuntz A. Best and promising practices in diabetes education. Can J Diabetes 2009. [DOI: 10.1016/s1499-2671(09)33021-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
14148 Background: Chemoradiotherapy has replaced radical surgery as the initial treatment of choice for anal squamous cell carcinoma (ASCC). Optimal chemotherapy regimen for ASCC in HIV positive patients is not yet defined. The addition of mitomycin C to 5-FU and radiotherapy in the past improves local control, colostomy-free, and even disease-free survival in large tumors. The concern is hematologic toxicity if use in HIV positive patients. We report 2 cases safely using low dose mitomycin C, capecitabine and concurrent XRT. One of these patients has ESRD, which the use of cisplatin is not an option. Methods: 2 HIV positive patients, (CD4 range 106–113, at diagnosis of ASCC) were treated with low dose of mitomycin C on day 1 for 2 cycles (5mg flat dose), day 1–7 capecitabine titrated up to 1.5 gm/m2 divided b.i.d, and concurrent XRT (total dose 5040 cGy). Prior to treatment, 1 patient was diagnosed with squamous cell carcinoma in-situ and the other with stage 1 squamous cell carcinoma. 1 patient has end stage renal disease with SCr between 10 and 12 mg/dl at the time of treatment. Results: Both patients completed treatment. No grade 3 or 4 hematologic or gastrointestinal toxicities were noted. No hand-foot syndrome was observed probably due to low dose of capecitabine. Both patients are still alive and remain in remission (16–18 months post treatment). Conclusions: Our 2 cases suggest that the use of low dose mitomycin C in addition to capecitabine and XRT is well tolerated and is efficacious in HIV-positive patients with ASCC. No significant financial relationships to disclose.
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Affiliation(s)
- R. Wadleigh
- US Department of Veterans Affairs, Washington, DC
| | - K. Dinh
- US Department of Veterans Affairs, Washington, DC
| | - J. Manning
- US Department of Veterans Affairs, Washington, DC
| | - A. Kuntz
- US Department of Veterans Affairs, Washington, DC
| | - R. Dorn
- US Department of Veterans Affairs, Washington, DC
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Kuntz A, Clement HW, Lehnert W, van Calker D, Hennighausen K, Gerlach M, Schulz E. Effects of secretin on extracellular amino acid concentrations in rat hippocampus. J Neural Transm (Vienna) 2004; 111:931-9. [PMID: 15206007 DOI: 10.1007/s00702-003-0082-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [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: 07/27/2003] [Accepted: 09/22/2003] [Indexed: 10/26/2022]
Abstract
In 1998, Horvath et al. (1998) observed a marked improvement in speech, eye contact, and attention in autistic children five weeks after treatment with secretin, which ocurred in the course of an endoscopic investigation. Since autism is hypothesized to be a hypoglutamatergic disorder we investigated the in vivo effects of secretin on extracellular amino acids in the rat brain. Studies were carried out on freely moving rats with microdialysis probes in the hippocampus. Amino acids were examined using tandem mass spectroscopy and HPLC/fluorometric detection. Following secretin injection (8.7 microg/kg i.p.), considerable increases in microdialysate glutamate and gamma-aminobutyric acid (GABA) levels were observed; other amino acids were not affected. The observed increased microdialysate concentrations of glutamate and GABA following secretin application may explain the results of the Horvath study.
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Affiliation(s)
- A Kuntz
- Department of Child and Adolescent Psychiatry, University Children's Hospital, Germany
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27
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Simpson SH, Johnson JA, Biggs C, Biggs RS, Kuntz A, Semchuk W, Taylor JG, Farris KB, Tsuyuki RT. Practice-based research: lessons from community pharmacist participants. Pharmacotherapy 2001; 21:731-9. [PMID: 11401185 DOI: 10.1592/phco.21.7.731.34570] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We designed this project to determine community pharmacists' opinions regarding the challenges and motivations of their recent participation in a pharmacy practice-based research study At the conclusion of a randomized, multicenter study, 87 community pharmacist-investigators were sent a questionnaire that explored four areas: motivating factors to participate, barriers to participation, communication tools used by study coordinators, and design issues for future studies. Fifty-eight (67%) completed questionnaires were returned. Key factors motivating participation in the study were desire to improve the profession and opportunity to learn. Time was the greatest barrier to participation. Pharmacy practice-based research has two distinct advantages. First, it translates clinical knowledge into direct application in the community. Second, it provides needed data to demonstrate the value of enhanced pharmacy practice. Thorough understanding of pharmacists' opinions is necessary to optimize the design of future studies.
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Affiliation(s)
- S H Simpson
- EPICORE Center, Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Abstract
Amphibians provide an unparalleled opportunity to integrate studies of development and evolution through the investigation of the fossil record of larval stages. The pattern of vertebral development in modern frogs strongly resembles that of Paleozoic labyrinthodonts in the great delay in the ossification of the vertebrae, with the centra forming much later than the neural arches. Slow ossification of the trunk vertebrae in frogs and the absence of ossification in the tail facilitate the rapid loss of the tail during metamorphosis, and may reflect retention of the pattern in their specific Paleozoic ancestors. Salamanders and caecilians ossify their centra at a much earlier stage than frogs, which resembles the condition in Paleozoic lepospondyls. The clearly distinct patterns and rates of vertebral development may indicate phylogenetic separation between the ultimate ancestors of frogs and those of salamanders and caecilians within the early radiation of ancestral tetrapods. This divergence may date from the Lower Carboniferous. Comparison with the molecular regulation of vertebral development described in modern mammals and birds suggests that the rapid chondrification of the centra in salamanders relative to that of frogs may result from the earlier migration of sclerotomal cells expressing Pax1 to the area surrounding the notochord.
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Affiliation(s)
- R L Carroll
- Redpath Museum, McGill University, 859 Sherbrooke St. West, Montreal H3A 2K6, Canada.
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29
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Kuntz A, Fehrenbach FJ, Reichart P. [Necrotizing ulcerous gingivitis and progressive periodontitis in HIV infection]. Dtsch Z Mund Kiefer Gesichtschir 1987; 11:157-63. [PMID: 3330476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Reichart PA, Gelderblom HR, Becker J, Kuntz A. AIDS and the oral cavity. The HIV-infection: virology, etiology, origin, immunology, precautions and clinical observations in 110 patients. Int J Oral Maxillofac Surg 1987; 16:129-53. [PMID: 3110311 DOI: 10.1016/s0901-5027(87)80122-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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31
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Becker J, Kuntz A, Reichart P. [Closure of oroantral perforations with hydroxylapatite ceramic]. Dtsch Z Mund Kiefer Gesichtschir 1987; 11:92-5. [PMID: 3482525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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32
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Kuntz A, Reichart P. [Significance of AIDS in dental practice]. Niedersachs Zahnarztebl 1986; 21:338-42. [PMID: 2945160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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33
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Kuntz E, Kuntz A. [Prohibition of practice for dentists with unfavorable hepatitis B serology]. MMW Munch Med Wochenschr 1978; 120:1407-10. [PMID: 101799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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36
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Kuntz A. Histological variations in autonomic ganglia and ganglion cells associated with age and disease. Am J Pathol 1938; 14:783-796.3. [PMID: 19970418 PMCID: PMC1964965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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