Ivo Kuhlemann

Transcranial magnetic stimulation reveals complex cognitive control representations in the rostral frontal cortex

Convergent evidence suggests that the lateral frontal cortex is at the heart of a brain network subserving cognitive control. Recent theories assume a functional segregation along the rostro-caudal axis of the lateral frontal cortex based on differences in the degree of complexity of cognitive control. However, the functional contribution of specific rostral and caudal sub-regions remains elusive. Here we investigate the impact of disrupting rostral and caudal target regions on cognitive control processes, using Transcranial Magnetic Stimulation (TMS). Participants performed three different task-switching conditions that assessed differences in the degree of complexity of cognitive control processes, after temporally disrupting rostral, or caudal target regions, or a control region. Disrupting the rostral lateral frontal region specifically impaired behavioral performance of the most complex task-switching condition, in comparison to the caudal target region and the control region. These novel findings shed light on the neuroanatomical architecture supporting control over goal-directed behavior.

WE-G-BRF-09: Force- and Image-Adaptive Strategies for Robotised Placement of 4D Ultrasound Probes

PURPOSE To allow continuous acquisition of high quality 4D ultrasound images for non-invasive live tracking of tumours for IGRT, image- and force-adaptive strategies for robotised placement of 4D ultrasound probes are developed and evaluated. METHODS The developed robotised ultrasound system is based on a 6-axes industrial robot (adept Viper s850) carrying a 4D ultrasound transducer with a mounted force-torque sensor. The force-adaptive placement strategies include probe position control using artificial potential fields and contact pressure regulation by a PD controller strategy. The basis for live target tracking is a continuous minimum contact pressure to ensure good image quality and high patient comfort. This contact pressure can be significantly disturbed by respiratory movements and has to be compensated. All measurements were performed on human subjects under realistic conditions. When performing cardiac ultrasound, rib- and lung shadows are a common source of interference and can disrupt the tracking. To ensure continuous tracking, these artefacts had to be detected to automatically realign the probe. The detection is realised by multiple algorithms based on entropy calculations as well as a determination of the image quality. RESULTS Through active contact pressure regulation it was possible to reduce the variance of the contact pressure by 89.79% despite respiratory motion of the chest. The results regarding the image processing clearly demonstrate the feasibility to detect image artefacts like rib shadows in real-time. CONCLUSION In all cases, it was possible to stabilise the image quality by active contact pressure control and automatically detected image artefacts. This fact enables the possibility to compensate for such interferences by realigning the probe and thus continuously optimising the ultrasound images. This is a huge step towards fully automated transducer positioning and opens the possibility for stable target tracking in ultrasoundguided radiation therapy requiring contact pressure of 5-10 N. This work was supported by the Graduate School for Computing in Medicine and Life Sciences funded by Germanys Excellence Initiative [DFG GSC 235/1].

Towards X-ray free endovascular interventions – using HoloLens for on-line holographic visualisation

A major challenge during endovascular interventions is visualising the position and orientation of the catheter being inserted. This is typically achieved by intermittent X-ray imaging. Since the radiation exposure to the surgeon is considerable, it is desirable to reduce X-ray exposure to the bare minimum needed. Additionally, transferring two-dimensional (2D) X-ray images to 3D locations is challenging. The authors present the development of a real-time navigation framework, which allows a 3D holographic view of the vascular system without any need of radiation. They extract the patients surface and vascular tree from pre-operative computed tomography data and register it to the patient using a magnetic tracking system. The system was evaluated on an anthropomorphic full-body phantom by experienced clinicians using a four-point questionnaire. The average score of the system (maximum of 20) was found to be 17.5. The authors’ approach shows great potential to improve the workflow for endovascular procedures, by simultaneously reducing X-ray exposure. It will also improve the learning curve and help novices to more quickly master the required skills.

Robust inverse kinematics by configuration control for redundant manipulators with seven DoF

This paper presents an optimized, robust inverse kinematics solution in a closed form for redundant manipulators with seven degrees of freedom and zero link offsets like the KUKA LBR iiwa lightweight robot. The computation allows for full range elbow self-motion manifold control, defined by an intuitive angle parameter. Furthermore, by using common configuration parameters, all possible solutions for a single effector pose are taken into account and full arm configuration control is realized. The algorithm was evaluated looking at configuration reliability and continuity for an exemplary, challenging path. The results show that commanded arm configurations are not changing spontaneously inside a trajectory. Even for varying elbow self-motion manifold angles, the joint trajectories stay continuous and the presented algorithm provides consistent solutions. In a second evaluation, the algorithm was implemented in three programming languages and analyzed with respect to computing times. The tests demonstrate short runtimes and overall real-time capability.

GPU-based real-time 3D workspace generation of arbitrary serial manipulators

This paper presents a method to solve - in real time - the three dimensional workspace generation problem for arbitrary serial manipulators. Our approach is based on Monte Carlo simulation, to process a high number of forward kinematics with randomly chosen joint values. This results in an asymptotic coverage of the reachable workspace. Additionally, collision detection is integrated to consider obstacles within the manipulators environment. The method is implemented on the graphics processing unit (GPU), such that an extremely high number of workspace points can be processed in parallel. Tests have shown that this approach is capable to generate acceptable workspace coverage within milliseconds. Furthermore, the workspace is held as a three dimensional texture volume on the graphics memory, allowing for instant visualisation of the workspace during the generation process without the need for further time-intensive data exchange.

Navigation and visualisation with HoloLens in endovascular aortic repair

Abstract Introduction Endovascular aortic repair (EVAR) is a minimal-invasive technique that prevents life-threatening rupture in patients with aortic pathologies by implantation of an endoluminal stent graft. During the endovascular procedure, device navigation is currently performed by fluoroscopy in combination with digital subtraction angiography. This study presents the current iterative process of biomedical engineering within the disruptive interdisciplinary project Nav EVAR, which includes advanced navigation, image techniques and augmented reality with the aim of reducing side effects (namely radiation exposure and contrast agent administration) and optimising visualisation during EVAR procedures. This article describes the current prototype developed in this project and the experiments conducted to evaluate it. Methods The current approach of the Nav EVAR project is guiding EVAR interventions in real-time with an electromagnetic tracking system after attaching a sensor on the catheter tip and displaying this information on Microsoft HoloLens glasses. This augmented reality technology enables the visualisation of virtual objects superimposed on the real environment. These virtual objects include three-dimensional (3D) objects (namely 3D models of the skin and vascular structures) and two-dimensional (2D) objects [namely orthogonal views of computed tomography (CT) angiograms, 2D images of 3D vascular models, and 2D images of a new virtual angioscopy whose appearance of the vessel wall follows that shown in ex vivo and in vivo angioscopies]. Specific external markers were designed to be used as landmarks in the registration process to map the tracking data and radiological data into a common space. In addition, the use of real-time 3D ultrasound (US) is also under evaluation in the Nav EVAR project for guiding endovascular tools and updating navigation with intraoperative imaging. US volumes are streamed from the US system to HoloLens and visualised at a certain distance from the probe by tracking augmented reality markers. A human model torso that includes a 3D printed patient-specific aortic model was built to provide a realistic test environment for evaluation of technical components in the Nav EVAR project. The solutions presented in this study were tested by using an US training model and the aortic-aneurysm phantom. Results During the navigation of the catheter tip in the US training model, the 3D models of the phantom surface and vessels were visualised on HoloLens. In addition, a virtual angioscopy was also built from a CT scan of the aortic-aneurysm phantom. The external markers designed for this study were visible in the CT scan and the electromagnetically tracked pointer fitted in each marker hole. US volumes of the US training model were sent from the US system to HoloLens in order to display them, showing a latency of 259±86 ms (mean±standard deviation). Conclusion The Nav EVAR project tackles the problem of radiation exposure and contrast agent administration during EVAR interventions by using a multidisciplinary approach to guide the endovascular tools. Its current state presents several limitations such as the rigid alignment between preoperative data and the simulated patient. Nevertheless, the techniques shown in this study in combination with fibre Bragg gratings and optical coherence tomography are a promising approach to overcome the problems of EVAR interventions.

Impact of robotic ultrasound image guidance on plan quality in SBRT of the prostate

OBJECTIVE Ultrasound provides good image quality, fast volumetric imaging and is established for abdominal image guidance. Robotic transducer placement may facilitate intrafractional motion compensation in radiation therapy. We consider integration with the CyberKnife and study whether the kinematic redundancy of a seven-degrees-of-freedom robot allows for acceptable plan quality for prostate treatments. METHODS Reference treatment plans were generated for 10 prostate cancer cases previously treated with the CyberKnife. Considering transducer and prostate motion by different safety margins, 10 different robot poses, and 3 different elbow configurations, we removed all beams colliding with robot or transducer. For each combination, plans were generated using the same strict dose constraints and the objective to maximize the target coverage. Additionally, plans for the union of all unblocked beams were generated. RESULTS In 9 cases the planning target coverage with the ultrasound robot was within 1.1 percentage points of the reference coverage. It was 1.7 percentage points for one large prostate. For one preferable robot position, kinematic redundancy decreased the average number of blocked beam directions from 23.1 to 14.5. CONCLUSION The impact of beam blocking can largely be offset by treatment planning and using a kinematically redundant robot. Plan quality can be maintained by carefully choosing the ultrasound robot position and pose. For smaller planning target volumes the difference in coverage is negligible for safety margins of up to 35 mm. Advances in knowledge: Integrating a robot for online intrafractional image guidance based on ultrasound can be realized while maintaining acceptable plan quality for prostate cancer treatments with the CyberKnife.

Robots with seven degrees of freedom: Is the additional DoF worth it?

This paper presents a detailed dexterity analysis of three different kinematics, comparing six-DoF with seven-DoF robots. The KUKA LBR iiwa 7 lightweight robot represents the seven-DoF kinematics, while the KUKA KR 10 is chosen as a common six-DoF robot with comparable workspace dimensions. Furthermore, the LBR iiwa is simulated as a six-jointed robot to allow for a direct comparison of seven- and six-DoF kinematics. Due to this simulation it is possible to isolate the effects of the additional 7th DoF for the first time. The results show that the average dexterity is increased by 16.8% due to the additional 7th joint. Compared to the highest average dexterity of the seven-DoF manipulator, the six-DoF KR 10 outperforms this value by 7.6%.

SU-G-JeP3-03: Effect of Robot Pose On Beam Blocking for Ultrasound Guided SBRT of the Prostate.

PURPOSE Ultrasound presents a fast, volumetric image modality for real-time tracking of abdominal organ motion. How-ever, ultrasound transducer placement during radiation therapy is challenging. Recently, approaches using robotic arms for intra-treatment ultrasound imaging have been proposed. Good and reliable imaging requires placing the transducer close to the PTV. We studied the effect of a seven degrees of freedom robot on the fea-sible beam directions. METHODS For five CyberKnife prostate treatment plans we established viewports for the transducer, i.e., points on the patient surface with a soft tissue view towards the PTV. Choosing a feasible transducer pose and using the kinematic redundancy of the KUKA LBR iiwa robot, we considered three robot poses. Poses 1 to 3 had the elbow point anterior, superior, and inferior, respectively. For each pose and each beam starting point, the pro-jections of robot and PTV were computed. We added a 20 mm margin accounting for organ / beam motion. The number of nodes for which the PTV was partially of fully blocked were established. Moreover, the cumula-tive overlap for each of the poses and the minimum overlap over all poses were computed. RESULTS The fully and partially blocked nodes ranged from 12% to 20% and 13% to 27%, respectively. Typically, pose 3 caused the fewest blocked nodes. The cumulative overlap ranged from 19% to 29%. Taking the minimum overlap, i.e., considering moving the robots elbow while maintaining the transducer pose, the cumulative over-lap was reduced to 16% to 18% and was 3% to 6% lower than for the best individual pose. CONCLUSION Our results indicate that it is possible to identify feasible ultrasound transducer poses and to use the kinematic redundancy of a 7 DOF robot to minimize the impact of the imaging subsystem on the feasible beam directions for ultrasound guided and motion compensated SBRT. Research partially funded by DFG grants ER 817/1-1 and SCHL 1844/3-1.

SU‐G‐JeP3‐08: Robotic System for Ultrasound Tracking in Radiation Therapy

PURPOSE For safe and accurate real-time tracking of tumors for IGRT using 4D ultrasound, it is necessary to make use of novel, high-end force-sensitive lightweight robots designed for human-machine interaction. Such a robot will be integrated into an existing robotized ultrasound system for non-invasive 4D live tracking, using a newly developed real-time control and communication framework. METHODS The new KUKA LWR iiwa robot is used for robotized ultrasound real-time tumor tracking. Besides more precise probe contact pressure detection, this robot provides an additional 7th link, enhancing the dexterity of the kinematic and the mounted transducer. Several integrated, certified safety features create a safe environment for the patients during treatment. However, to remotely control the robot for the ultrasound application, a real-time control and communication framework has to be developed. Based on a client/server concept, client-side control commands are received and processed by a central server unit and are implemented by a client module running directly on the robots controller. Several special functionalities for robotized ultrasound applications are integrated and the robot can now be used for real-time control of the image quality by adjusting the transducer position, and contact pressure. The framework was evaluated looking at overall real-time capability for communication and processing of three different standard commands. RESULTS Due to inherent, certified safety modules, the new robot ensures a safe environment for patients during tumor tracking. Furthermore, the developed framework shows overall real-time capability with a maximum average latency of 3.6 ms (Minimum 2.5 ms; 5000 trials). CONCLUSION The novel KUKA LBR iiwa robot will advance the current robotized ultrasound tracking system with important features. With the developed framework, it is now possible to remotely control this robot and use it for robotized ultrasound tracking applications, including image quality control and target tracking.