Michael D. M. Kutzer

Intraoperative Image-based Multiview 2D/3D Registration for Image-Guided Orthopaedic Surgery: Incorporation of Fiducial-Based C-Arm Tracking and GPU-Acceleration

Intraoperative patient registration may significantly affect the outcome of image-guided surgery (IGS). Image-based registration approaches have several advantages over the currently dominant point-based direct contact methods and are used in some industry solutions in image-guided radiation therapy with fixed X-ray gantries. However, technical challenges including geometric calibration and computational cost have precluded their use with mobile C-arms for IGS. We propose a 2D/3D registration framework for intraoperative patient registration using a conventional mobile X-ray imager combining fiducial-based C-arm tracking and graphics processing unit (GPU)-acceleration. The two-stage framework 1) acquires X-ray images and estimates relative pose between the images using a custom-made in-image fiducial, and 2) estimates the patient pose using intensity-based 2D/3D registration. Experimental validations using a publicly available gold standard dataset, a plastic bone phantom and cadaveric specimens have been conducted. The mean target registration error (mTRE) was 0.34±0.04 mm (success rate: 100%, registration time: 14.2 s) for the phantom with two images 90° apart, and 0.99±0.41 mm (81%, 16.3 s) for the cadaveric specimen with images 58.5° apart. The experimental results showed the feasibility of the proposed registration framework as a practical alternative for IGS routines.

Design of a new cable-driven manipulator with a large open lumen: Preliminary applications in the minimally-invasive removal of osteolysis

A dexterous manipulator (DM) with a large open lumen is presented. The manipulator is designed for surgical applications with a preliminary focus on the removal of osteolysis formed behind the acetabular shell of primary total hip arthroplasties (THAs). The manipulator is constructed from two nested superelastic nitinol tubes enabling lengthwise channels for drive cables. Notches in the nested assembly provide reliable bending under applied cable tension producing kinematics that can be effectively modeled as a series of rigid vertebrae connected using pin joints. The manipulator is controlled in plane with two independently actuated cables in a pull-pull configuration. For the purpose of the procedure, the manipulator is mounted on a Z-θ stage adding a translational and rotational degree of freedom (DOF) along the axis of the manipulator. Preliminary experimental results demonstrate the initial modeling and control of the manipulator.

Design of a new independently-mobile reconfigurable modular robot

A new self-reconfigurable robot is presented. The robot is a hybrid chain/lattice design with several novel features. An active mechanical docking mechanism provides inter-module connection, along with optical and electrical interface. The docking mechanisms function additionally as driven wheels. Internal slip rings provide unlimited rotary motion to the wheels, allowing the modules to move independently by driving on flat surfaces, or in assemblies negotiating more complex terrain. Modules in the system are mechanically homogeneous, with three identical docking mechanisms within a module. Each mechanical dock is driven by a high torque actuator to enable movement of large segments within a multi-module structure, as well as low-speed driving. Preliminary experimental results demonstrate locomotion, mechanical docking, and lifting of a single module.

Constrained workspace generation for snake-like manipulators with applications to minimally invasive surgery

Osteolysis is a debilitating condition that can occur behind the acetabular component of total hip replacements due to wear of the polyethylene liner. Conventional treatment techniques suggest replacing the component, while less-invasive approaches attempt to access and clean the lesion through the screw holes in the component. However, current rigid tools have been shown to access at most 50% of the lesion. Using a recently developed dexterous manipulator, we have adapted a group-theoretic convolution framework to define the manipulators workspace and its ability to fully explore a lesion. We compared this with the experimental exploration of a printed model of the lesion. This convolution approach successfully contains the experimental results and shows over 98.8% volumetric coverage of a complex lesion. The results suggest this manipulator as a possible solution to accessing much of the area unreachable to the conventional less-invasive technique.

M 3 Express: A low-cost independently-mobile reconfigurable modular robot

This paper presents M3Express (Modular-Mobile-Multirobot), a new design for a low-cost modular robot. The robot is self-mobile, with three independently driven wheels that also serve as connectors. The new connectors can be automatically operated, and are based on stationary magnets coupled to mechanically actuated ferromagnetic yoke pieces. Extensive use is made of plastic castings, laser cut plastic sheets, and low-cost motors and electronic components. Modules interface with a host PC via Bluetooth® radio. An off-board camera, along with a set of modules and a control PC form a convenient, low-cost system for rapidly developing and testing control algorithms for modular reconfigurable robots. Experimental results demonstrate mechanical docking, connector strength, and accuracy of dead reckoning locomotion.

A continuum manipulator made of interlocking fibers

A new type of continuum manipulator is presented, in which the body of the device is made up of identical, repeated interlocking fibers. A working prototype is demonstrated. Basic models describing the kinematics and mechanical properties of the device are developed, and their predictions are compared with the performance of the physical prototype. Advantages of the interlocking design include improved strength due to better load distribution, controllable stiffness, and a large open lumen.

Piecewise-rigid 2D-3D registration for pose estimation of snake-like manipulator using an intraoperative x-ray projection

Background: Snake-like dexterous manipulators may offer significant advantages in minimally-invasive surgery in areas not reachable with conventional tools. Precise control of a wire-driven manipulator is challenging due to factors such as cable deformation, unknown internal (cable friction) and external forces, thus requiring correcting the calibration intraoperatively by determining the actual pose of the manipulator. Method: A method for simultaneously estimating pose and kinematic configuration of a piecewise-rigid object such as a snake-like manipulator from a single x-ray projection is presented. The method parameterizes kinematics using a small number of variables (e.g., 5), and optimizes them simultaneously with the 6 degree-of-freedom pose parameter of the base link using an image similarity between digitally reconstructed radiographs (DRRs) of the manipulator’s attenuation model and the real x-ray projection. Result: Simulation studies assumed various geometric magnifications (1.2–2.6) and out-of-plane angulations (0°–90°) in a scenario of hip osteolysis treatment, which demonstrated the median joint angle error was 0.04° (for 2.0 magnification, ±10° out-of-plane rotation). Average computation time was 57.6 sec with 82,953 function evaluations on a mid-range GPU. The joint angle error remained lower than 0.07° while out-of-plane rotation was 0°–60°. An experiment using video images of a real manipulator demonstrated a similar trend as the simulation study except for slightly larger error around the tip attributed to accumulation of errors induced by deformation around each joint not modeled with a simple pin joint. Conclusions: The proposed approach enables high precision tracking of a piecewise-rigid object (i.e., a series of connected rigid structures) using a single projection image by incorporating prior knowledge about the shape and kinematic behavior of the object (e.g., each rigid structure connected by a pin joint parameterized by a low degree polynomial basis). Potential applications of the proposed approach include pose estimation of vertebrae in spine and a series of electrodes in coronary sinus catheter. Improvement of GPU performance is expected to further augment computational speed.

Patient-specific finite element modeling for femoral bone augmentation

The aim of this study was to provide a fast and accurate finite element (FE) modeling scheme for predicting bone stiffness and strength suitable for use within the framework of a computer-assisted osteoporotic femoral bone augmentation surgery system. The key parts of the system, i.e. preoperative planning and intraoperative assessment of the augmentation, demand the finite element model to be solved and analyzed rapidly. Available CT scans and mechanical testing results from nine pairs of osteoporotic femur bones, with one specimen from each pair augmented by polymethylmethacrylate (PMMA) bone cement, were used to create FE models and compare the results with experiments. Correlation values of R(2)=0.72-0.95 were observed between the experiments and FEA results which, combined with the fast model convergence (~3 min for ~250,000 degrees of freedom), makes the presented modeling approach a promising candidate for the intended application of preoperative planning and intraoperative assessment of bone augmentation surgery.

Cable length estimation for a compliant surgical manipulator

This paper presents a method for estimating drive cable length in an underactuated, hyper-redundant, snake-like manipulator. The continuum manipulator was designed for the surgical removal of osteolysis behind total hip arthroplasties. Two independently actuated cables in a pull-pull configuration control the compliant manipulator in a single plane. Using a previously developed kinematic model, we present a method for estimating drive cable displacement for a given manipulator configuration. This calibrated function is then inverted to explore the ability to achieve local manipulator configurations from prescribed drive cable displacements without the use of continuous visual feedback. Results demonstrate an effectiveness in predicting drive cable lengths from manipulator configurations. Preliminary results also show an ability to achieve manipulator configurations from prescribed cable lengths with reasonable accuracy without continuous visual feedback.

Subject-specific planning of femoroplasty: An experimental verification study

The risk of osteoporotic hip fractures may be reduced by augmenting susceptible femora with acrylic polymethylmethacrylate (PMMA) bone cement. Grossly filling the proximal femur with PMMA has shown promise, but the augmented bones can suffer from thermal necrosis or cement leakage, among other side effects. We hypothesized that, using subject-specific planning and computer-assisted augmentation, we can minimize cement volume while increasing bone strength and reducing the risk of fracture. We mechanically tested eight pairs of osteoporotic femora, after augmenting one from each pair following patient-specific planning reported earlier, which optimized cement distribution and strength increase. An average of 9.5(±1.7) ml of cement was injected in the augmented set. Augmentation significantly (P<0.05) increased the yield load by 33%, maximum load by 30%, yield energy by 118%, and maximum energy by 94% relative to the non-augmented controls. Also predicted yield loads correlated well (R(2)=0.74) with the experiments and, for augmented specimens, cement profiles were predicted with an average surface error of <2 mm, further validating our simulation techniques. Results of the current study suggest that subject-specific planning of femoroplasty reduces the risk of hip fracture while minimizing the amount of cement required.