Bridging the gap: robotic applications in cerebral aneurysms neurointerventions - a systematic review

Cerebral aneurysm is a life-threatening condition, which requires high precision during the neurosurgical procedures. Increasing progress of evaluating modern devices in medicine have led to common usage of robotic systems in many fields, including cranial aneurysm operations. However, currently no systematic review describes up-to date knowledge of this topic. Following PRISMA guidelines, we have independently screened and extracted works from seven databases. Only studies fulfilling inclusion criteria were presented in this study. Device used, operation time, complications, aneurysm type and patient demographics were extracted from each work. We identified a total of 995 articles from databases. We have found six original works and one supplementary article eligible for this synthesis. Majority of works (4/6) have implemented CorPath GRX in cerebral aneurysm procedures. The procedures involved diverse aneurysm locations, utilizing flow diverters, stents, or coiling. One study described implementation of robot-assist on 117 patients and compared results to randomized clinical trials. One work with a small patient cohort described use of the magnetically-controlled microguidewire in the coiling procedures, without any complications. Additionally, one case-series study described use of a robotic arm for managing intraoperative aneurysm rupture. Currently, robotical devices for cerebral aneurysm treatment mainly lack jailing and haptic feedback feature. Further development of these devices will certainly be beneficial for operators and patients, allowing for more precise and remote surgeries.

Machine Meets Brain: A Systematic Review of Effectiveness of Robotically Performed Cerebral Angiography Interventions

BACKGROUND

Stroke is a leading cause of death in the United States, with significant economic and human costs. Early diagnosis and rapid treatment are critical for preventing stroke-related morbidity and mortality. However, accessibility to neurointerventional medical centers remains a challenge for many Americans, highlighting the need for innovative solutions to improve stroke management.

METHODS

This systematic review adhered to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines and included 5 medical databases to identify relevant studies on robotically assisted cerebral angiography (RCA). Studies focusing on in-human robotic intracranial cerebral angiography were included. A bias assessment was conducted using appropriate tools for randomized controlled trials (RCTs) and non-RCTs.

RESULTS

A total of 7 studies met the inclusion criteria, with 1 RCT and 6 non-RCTs included in the analysis. Robotic systems such as CorPath GRX, Magellan robot, YDHB-NS01, VIR-2 (vascular interventional robot), and RobEnt were evaluated. The studies reported various success rates, procedure times, and complications associated with robotically assisted procedures. Overall, the robotic interventions demonstrated promising results in terms of safety and efficacy, with comparable outcomes to manual methods. Despite the promising findings, several limitations were identified, including technical issues with the robotic systems, the high costs, and limited long-term data. Future research should focus on standardizing protocols, conducting larger trials with longer follow-up periods, and assessing cost-effectiveness to determine the role of RCA in clinical practice.

CONCLUSIONS

RCA shows potential as a valuable tool in neuroendovascular interventions. Addressing the technical challenges and conducting further research will be crucial to fully realize the clinical benefits of this innovative technology and improve patient outcomes in stroke management.

Mobile applications in radiology: own study based on polish data

As the number of smartphones increases, so does the number of medical apps. Medical mobile applications are widely used in many medical fields by both patients and doctors. However, there are still few approved mobile applications that can be used in the diagnostic-therapeutic process and radiological apps are affected as well. We conducted our research by classifying radiological applications from the Google Play® store into appropriate categories, according to our own qualification system developed by researchers for the purposes of this study. In addition, we also evaluated apps from the App Store®. The radiology application rating system we created has not been previously used in other articles. Out of 228 applications from the Google Play store, only 6 of them were classified as "A" category with the highest standard. Apps from the App Store (157) were not categorized due to the lack of download counts, which was necessary in our app-rating system. The vast majority of applications are for educational purposes and are not used in clinical practice. This is due to the need of obtaining special permits and certificates from relevant institutions in order to use them in medical practice. We recommend applications from the Google Play store that have been classified in the "A" category, evaluating them as the most valuable. App Store apps data is described and presented in the form of diagrams and tables.

Multi-Label Classification of Chest X-ray Abnormalities Using Transfer Learning Techniques

In recent years, deep neural networks have enabled countless innovations in the field of image classification. Encouraged by success in this field, researchers worldwide have demonstrated how to use Convolutional Neural Network techniques in medical imaging problems. In this article, the results were obtained through the use of the EfficientNet in the task of classifying 14 different diseases based on chest X-ray images coming from the NIH (National Institutes of Health) ChestX-ray14 dataset. The approach addresses dataset imbalances by introducing a custom split to ensure fair representation. Binary cross entropy loss is utilized to handle the multi-label difficulty. The model architecture comprises an EfficientNet backbone for feature extraction, succeeded by sequential layers including GlobalAveragePooling, Dense, and BatchNormalization. The main contribution of this paper is a proposed solution that outperforms previous state-of-the-art deep learning models average area under the receiver operating characteristic curve-AUC-ROC (score: 84.28%). The usage of the transfer-learning technique and traditional deep learning engineering techniques was shown to enable us to obtain such results on consumer-class GPUs (graphics processing units).

Chest X-ray Foreign Objects Detection Using Artificial Intelligence

Diagnostic imaging has become an integral part of the healthcare system. In recent years, scientists around the world have been working on artificial intelligence-based tools that help in achieving better and faster diagnoses. Their accuracy is crucial for successful treatment, especially for imaging diagnostics. This study used a deep convolutional neural network to detect four categories of objects on digital chest X-ray images. The data were obtained from the publicly available National Institutes of Health (NIH) Chest X-ray (CXR) Dataset. In total, 112,120 CXRs from 30,805 patients were manually checked for foreign objects: vascular port, shoulder endoprosthesis, necklace, and implantable cardioverter-defibrillator (ICD). Then, they were annotated with the use of a computer program, and the necessary image preprocessing was performed, such as resizing, normalization, and cropping. The object detection model was trained using the You Only Look Once v8 architecture and the Ultralytics framework. The results showed not only that the obtained average precision of foreign object detection on the CXR was 0.815 but also that the model can be useful in detecting foreign objects on the CXR images. Models of this type may be used as a tool for specialists, in particular, with the growing popularity of radiology comes an increasing workload. We are optimistic that it could accelerate and facilitate the work to provide a faster diagnosis.

What Is Machine Learning, Artificial Neural Networks and Deep Learning?-Examples of Practical Applications in Medicine

Machine learning (ML), artificial neural networks (ANNs), and deep learning (DL) are all topics that fall under the heading of artificial intelligence (AI) and have gained popularity in recent years. ML involves the application of algorithms to automate decision-making processes using models that have not been manually programmed but have been trained on data. ANNs that are a part of ML aim to simulate the structure and function of the human brain. DL, on the other hand, uses multiple layers of interconnected neurons. This enables the processing and analysis of large and complex databases. In medicine, these techniques are being introduced to improve the speed and efficiency of disease diagnosis and treatment. Each of the AI techniques presented in the paper is supported with an example of a possible medical application. Given the rapid development of technology, the use of AI in medicine shows promising results in the context of patient care. It is particularly important to keep a close eye on this issue and conduct further research in order to fully explore the potential of ML, ANNs, and DL, and bring further applications into clinical use in the future.

Usability of Mobile Solutions Intended for Diagnostic Images-A Systematic Review

Despite the growing popularity of mobile devices, they still have not found widespread use in medicine. This is due to the procedures in a given place, differences in the availability of mobile devices between individual institutions or lack of appropriate legal regulations and accreditation by relevant institutions. Numerous studies have been conducted and compared the usability of mobile solutions designed for diagnostic images evaluation on various mobile devices and applications with classic stationary descriptive stations. This study is an attempt to compare the usefulness of currently available mobile applications which are used in the medical industry, focusing on imaging diagnostics. As a consequence of the healthcare sector's diversity, it is also not possible to design a universal mobile application, which results in a multitude of software available on the market and makes it difficult to reliably compile and compare studies included in this systematic review. Despite these differences, it was possible to identify both positive and negative features of portable methods analyzing radiological images. The mobile application of the golden mean in hospital infrastructure should be widely available, with convenient and simple usage. Our future research will focus on development in the use of mobile devices and applications in the medical sector.

The surgical management of heart failure: heart transplantation in the era of SARS-CoV-2 pandemic

Purpose

End-stage heart failure (HF) is a major global clinical problem with a growing number of patients worldwide. Heart transplantation (HTx) and mechanical circulatory support (MCS) represent the two most effective procedural options for the treatment of end-stage HF. HTx remains the treatment of choice in patients who reach maximal medical therapy, but, remain incapacitated by their symptoms.

The COVID-19 pandemic caused by SARS-CoV-2 has significantly affected the delivery of medical care across all specialties, therefore, it is not a surprise that the number of HTx has drastically diminished worldwide during the pandemic.

We developed in our Center of Heart Diseases effective safety measures and team approach in order to perform HTx with excellent outcomes.

Methods

All patients with reduced ejection fraction, heart failure at presentation and had been adequately investigated had been evaluated by a multidisciplinary team and when appropriate entered into a waiting list for HTx.

Results

From March2020 to March 2021, 96 patients underwent orthotopic HTx. The age range was 33 - 66 yrs and a median of 54 yr. Both donor and recipient were tested for SARS-CoV-2 within 48 hrs of the procedure, and none tested positive. All recipients were regularly tested following the procedure, too, and none were positive. 53 patients with INTERMACS 4 class have been treated, 31 with INTERMACS 3 class and 11 patients with INTERMACS 2. Only one patient with INTERMACS 1 underwent HTx. 6 (10%) patients died within the first 30 days following HTx.

All staff caring for those patients were screened for SARS-CoV-2 at regular intervals. There was liberal use of PPE at all stages of the care of the patients, with strict hand hygiene.

All surviving patients were subjected to the normal protocol of post-operative management in terms of immunosuppression and other medications.

Conclusion

Heart transplantation remains the treatment of choice for advanced heart failure. About 85% of heart transplant patients survive one year following the procedure thus giving them a better quality of life. We have shown that successful heart transplantation may be performed during the SARS-CoV-2 pandemic.

Funding Acknowledgement

Type of funding sources: None.

Physical and Computer Modelling of Blood Flow in a Systemic-to-pulmonary Shunt

The aim of this work was the application of computer and physical in vitro simulation methods for estimating surgery procedure hemodynamics. The modified Blalock-Taussig (mB-T) palliative surgical procedure is performed to increase the pulmonary blood flow in children with congenital heart defects. Such a systemic-to-pulmonary shunt yields substantial modification in the blood flow within the large blood vessels. The objective of the present study was to investigate basic characteristics of the flow, flow pattern and pressure-flow efficiency, before and after opening of the mB-T graft.

Methods

The model was based on the vessel geometry obtained from the Visible Human Project and included the arch of aorta, the three arteries branching from the arch, the pulmonary trunck, and the left and right pulmonary arteries. The graft was added between the left subclavian artery and the left pulmonary artery. The glass model of the vessels was produced and investigated in a physical model of the cardiovascular system with an artificial ventricular device as the blood pump. Flow rate and hydrostatic pressure were measured at the inlet to and outlets from the glass model and in a few points within the system. Laser flow visualization was also performed. Computer simulations were done using the boundary conditions from the physical model.

Results

The opening of the mB-T graft changed flow distribution in all branches (including inflow). A complex flow pattern with large eddies and channelling of the flow in the vicinity of the graft and within it was observed in flow visualization and in computer simulations. Because of that complexity the local measurements of hydrostatic pressure at the vessel wall could not predict the average flow rate. The reversed flow in the graft was observed during the systole.

Conclusions

The complex flow pattern developed in the physical model of the mB-T graft. The channelling of the flow and the formation of large eddies may yield high shear stress and modify blood properties. The rigid wall model can describe only some flow characteristics observed in vivo. Computer simulation is a very fast and accurate method which permits earlier qualification of cardiac surgeons on how to change cardiac vascular blood flow after operations.

Robln Heart 2003 - Present State of the Polish Telemanipulator Project for Cardiac Surgery Assistance

The Polish telemanipulator (Robin Heart), for use in cardiac surgery, has been realized by the Foundation of Cardiac Surgery Development in Zabrze, Poland, in cooperation with specialists from the Technical University of Lodz and Warsaw University of Technology. The brief history of robotic surgery and fundamental advantages of employing robots in this field--safe, reliable and repeatable operative results with less patient pain, trauma and recovery time--follow the assumptions of the Polish Cardio-Robot project. The cardiac surgery robot, Robin Heart, is an original construction with a segment type structure which allows the various combination of its parts for different types of surgery. The telemanipulator for cardiac surgery will consist of two arms equipped with tools and one arm holding the camera. Several models suitable for surgeon contact systems, using the experience of centers designing the artificial hand and haptic systems have been worked out. The detailed mechanical analysis and original construction of main parts of the robot and development of the surgical planning system are presented in further sections.

Structural Changes in Pericardium Tissue Modified with Tannic Acid

Introduction

Structural modification of proteins, mainly collagen in connective tissues, is important in the manufacture of tissue-derived biomaterials. Natural compounds like genipin or tannic acid (TA) have been proposed instead of glutaraldehyde which shows cytotoxic effects on the processed tissue. Furthermore, calcification of glutaraldehyde-treated tissue limits the functional lifetime of bioprostheses. TA is known to form numerous hydrogen bonds with proteins. The purpose of our study was to investigate structural changes in porcine pericardium upon chemical modification with tannic acid.

Methods

Porcine pericardium tissue (PP) was soaked in 2% TA for 4, 24 or 48 hours. Changes in tissue structure were studied using electrophoresis (SDS-PAGE) and histological examination. Structural stability of PP tissue was evaluated by SDS/NaCl extraction method and enzymatic digestion with pancreatin.

Results

TA-modification of PP caused a time-dependent decrease in the number of peptides extracted from tissue. Microscopic studies revealed no significant morphological differences between native and TA-modified tissues, except for the native pancreatin-digested tissue where lack of both cells and low molecular peptides was observed.

Conclusion

Modification of PP with TA causes the structural changes leading to an increase in the tissue resistance to SDS/NaCl extraction and enzymatic digestion, providing experimental evidence for the higher structural stability of TA-treated tissue.

Computer and Physical Modeling of Blood Circulation Pump Support for a New Field of Application in Palliative Surgery

Objectives

One of the most popular palliative procedures performed to increase pulmonary blood flow in children with congenital heart defects is a shunt operation (Blalock-Taussig graft or Glenn procedure), which creates the new blood channel to the pulmonary artery. The main problem with this kind of surgery is poor shunt effectiveness and the lack of possibility to regulate the flow. The aim of this work is to use advanced computer simulation methods to study the effectiveness of a new idea to introduce a small axial blood pump into a Blalock-Taussig (B-T) or Glenn shunt in order to control the blood flow and prevent any increase in the graft stenosis.

Methods

Physical and computer 3-D simulation based on a finite element mesh (FEM) model was applied. Studies for optimization of the shunt and hybrid shunt with pump were performed for different stages of the disease.

Results and Conclusion

The graft with the axial pump creates good conditions for the vascular system and pulmonary artery blood flow as well as regulating blood pressure under variable conditions caused by palliative procedures. Its use permits the afterload of the left heart ventricle to be decreased. A palliative procedure is only a temporary solution. When a child grows, while the graft size is fixed, the blood flow through this graft may be not sufficient under changing hemodynamic conditions. The use of an axial pump for regulating the blood flow volume, during palliative procedures, allows to obtain the optimal flow conditions in pulmonary artery and safely wait on the final cardiac surgery correction later. However, the use of a pump mounted inside the graft increased hemodynamic resistance, which caused the flow to decrease up to 70% in the graft when the axial pump was not working.

State of the art in medical robotics in Poland: development of the Robin Heart and other robots

The first Polish project in medical robotics began in 2000. Now, a decade later, the Robin Heart surgical telemanipulator has the potential to become widely used in many branches of surgery. The original robot and mechatronic tools have successfully completed the required laboratory tests and animal studies. The Foundation of Cardiac Surgery Development in Zabrze, Poland, has launched a series of large-scale educational and awareness-raising activities aiming to promote medical robotics in Poland. At present, works on a rehabilitation robot are in progress in two centers. This article is an attempt to summarize the advances in medical robotics in Poland, to present the most interesting achievements to date and to discuss the prospects for further development.

Norwood with right ventricle-to-pulmonary artery conduit is more effective than Norwood with Blalock-Taussig shunt for hypoplastic left heart syndrome: mathematic modeling of hemodynamics

OBJECTIVE

The introduction of right ventricle to pulmonary artery (RV-PA) conduit in the Norwood procedure for hypoplastic left heart syndrome resulted in a higher survival rate in many centers. A higher diastolic aortic pressure and a higher mean coronary perfusion pressure were suggested as the hemodynamic advantage of this source of pulmonary blood flow. The main objective of this study was the comparison of two models of Norwood physiology with different types of pulmonary blood flow sources and their hemodynamics.

METHOD

Based on anatomic details obtained from echocardiographic assessment and angiographic studies, two three-dimensional computer models of post-Norwood physiology were developed. The finite-element method was applied for computational hemodynamic simulations. Norwood physiology with RV-PA 5-mm conduit and Blalock-Taussig shunt (BTS) 3.5-mm shunt were compared. Right ventricle work, wall stress, flow velocity, shear rate stress, energy loss and turbulence eddy dissipation were analyzed in both models.

RESULTS

The total work of the right ventricle after Norwood procedure with the 5-mm RV-PA conduit was lower in comparison to the 3.5-mm BTS while establishing an identical systemic blood flow. The Qp/Qs ratio was higher in the BTS group.

CONCLUSIONS

Hemodynamic performance after Norwood with the RV-PA conduit is more effective than after Norwood with BTS. Computer simulations of complicated hemodynamics after the Norwood procedure could be helpful in establishing optimal post-Norwood physiology.

Polish cardio-robot ‘Robin Heart’. System description and technical evaluation

BACKGROUND

This paper presents the mechanical structure and control system of the Polish cardio-robot Robin Heart (RIH).

METHODS

The Polish project with cardiac surgery robots started in 2000. It was supported by the team from the Foundation of Cardiac Surgery Development, Zabrze, in cooperation with research centers in Lodz and Warsaw. So far three prototypes, RH0, 1 & 2, of the Robin Heart robots family have been designed, constructed and tested. In addition many diagnostic systems have been constructed to aid with the assessment of robot performance.

RESULTS

The main focus of this article examines the technical evaluation of our prototypes, based on laboratory test results of both the mechanical and control aspects of the telemanipulator systems.

CONCLUSIONS

The presented test results of both mechanical and electrical aspects of Robin Heart telemanipulator systems, show significant progress both in a mechanical and control viewpoint, along with an improvement in the characterisation of the test parameters.

The influence of physical and chemical agents on photooxidation of porcine pericardial collagen

Photooxidation is a method of tissue fixation resulting in protein crosslinking due to illumination in the presence of a dye. The aim of the study was to evaluate the impact of dyes, photooxidation time and the type of applied light on the porcine pericardial collagen crosslinking. The collagen modifications were evaluated on the basis of pericardial sensitivity to pepsin digestion. The hydrolysate components were evaluated qualitatively and quantitatively. All hydrolysates contained collagen alpha chains, their aggregates and degradation products. Methylene blue and methylene green-mediated 4 h photooxidation in the presence of visible light caused similar decrease in pericardium sensitivity to pepsin. However, both fixation types generated remarkable amounts of alpha chain degradation products. The prolongation of photooxidation time to 8 h did not increase the pericardial sample resistance to pepsin. Moreover, these sample hydrolysates revealed an elevated alpha chain content. Violet light mediated photooxidation did not alter pericardial sensitivity to pepsin when compared with fixation under visible light. Nevertheless, violet light fixed tissues displayed a decrease in collagen degradation products. The application of violet light in photooxidation of porcine pericardium will probably allow to obtain enzyme resistant bioprostheses with better mechanical properties compared with those obtained after visible light mediated process.

[Methods of collagenous tissue fixation in the preparation of bioprostheses]

The use of biological materials in construction of bioprostheses requires the application of different chemical or physical procedures of fixation increasing bioprostheses resistance to enzymatic or chemical degradation and reducing their antigenicity. Methods typically concentrate on creating additional intra- and intermolecular chemical bonds between collagen molecules. This review focuses on the various methods of stabilization of collagenous tissues including chemical fixatives and physical agents.

The analysis of driving mode influence on energy dissipation in pneumatic artificial heart chambers

The energy dissipated in blood or on a total artificial heart (TAH) chamber's elements directly or indirectly decreases the biological or technical safety of the TAH's work. The energetic analysis of the Polish total artificial heart (POLTAH) external work with the objective of estimating the valve and membrane roles in energy dissipation has been performed. The simulation of left and right artificial heart chamber work under physiological conditions using a self-constructed physical model of the circulatory system has been performed for the full systole percent and frequency range and for different valves. The total energy dissipated on valves equals 15-30% of the chambers' work value. Energy losses on valves are influenced by the driving mode. The usage of inappropriate systolic and diastolic times increases the value of the energy dissipated on the membrane and on valves in the overall energy balance. The absolute value of the energy dissipated on the valves increases with the increase of the cycle time and depends on the valve type. The energy dissipated on the outlet valve decreases with the frequency (if the remaining driving parameters are kept constant) and for 150 bpm is nearly 3 times lower than that for 30 bpm. The energy dissipated on the membrane equals 10-50% of the TAH's work during systole, depending on the driving parameters. The filling process is assisted by the pressure from the atrium, and a great amount of energy during the diastolic period is consumed by the start of the membrane movement. We have also estimated the influence of the driving parameters on the valves' functions, measuring the acoustic wave intensity. The conclusions drawn are of a general character; they are applicable to all membrane, pneumatically powered blood pumps.