Oliver Burgert

A simple and accurate method for computer-aided transapical aortic valve replacement

BACKGROUND AND PURPOSE Transapical aortic valve replacement (TAVR) is a recent minimally invasive surgical treatment technique for elderly and high-risk patients with severe aortic stenosis. In this paper, a simple and accurate image-based method is introduced to aid the intra-operative guidance of TAVR procedure under 2-D X-ray fluoroscopy. METHODS The proposed method fuses a 3-D aortic mesh model and anatomical valve landmarks with live 2-D fluoroscopic images. The 3-D aortic mesh model and landmarks are reconstructed from interventional X-ray C-arm CT system, and a target area for valve implantation is automatically estimated using these aortic mesh models. Based on template-based tracking approach, the overlay of visualized 3-D aortic mesh model, landmarks and target area of implantation is updated onto fluoroscopic images by approximating the aortic root motion from a pigtail catheter motion without contrast agent. Also, a rigid intensity-based registration algorithm is used to track continuously the aortic root motion in the presence of contrast agent. Furthermore, a sensorless tracking of the aortic valve prosthesis is provided to guide the physician to perform the appropriate placement of prosthesis into the estimated target area of implantation. RESULTS Retrospective experiments were carried out on fifteen patient datasets from the clinical routine of the TAVR. The maximum displacement errors were less than 2.0mm for both the dynamic overlay of aortic mesh models and image-based tracking of the prosthesis, and within the clinically accepted ranges. Moreover, high success rates of the proposed method were obtained above 91.0% for all tested patient datasets. CONCLUSION The results showed that the proposed method for computer-aided TAVR is potentially a helpful tool for physicians by automatically defining the accurate placement position of the prosthesis during the surgical procedure.

Application fields for the new Object Management Group (OMG) Standards Case Management Model and Notation (CMMN) and Decision Management Notation (DMN) in the perioperative field

PurposeMedical processes can be modeled using different methods and notations. Currently used modeling systems like Business Process Model and Notation (BPMN) are not capable of describing the highly flexible and variable medical processes in sufficient detail.MethodsWe combined two modeling systems, Business Process Management (BPM) and Adaptive Case Management (ACM), to be able to model non-deterministic medical processes. We used the new Standards Case Management Model and Notation (CMMN) and Decision Management Notation (DMN).ResultsFirst, we explain how CMMN, DMN and BPMN could be used to model non-deterministic medical processes. We applied this methodology to model 79 cataract operations provided by University Hospital Leipzig, Germany, and four cataract operations provided by University Eye Hospital Tuebingen, Germany. Our model consists of 85 tasks and about 20 decisions in BPMN. We were able to expand the system with more complex situations that might appear during an intervention.ConclusionAn effective modeling of the cataract intervention is possible using the combination of BPM and ACM. The combination gives the possibility to depict complex processes with complex decisions. This combination allows a significant advantage for modeling perioperative processes.

A model-guided peri-operative information systems approach

Model-guided Therapy and Surgical Workflow Systems are two interrelated research fields, which have been developed separately in the last years. To make full use of both technologies, it is necessary to integrate them and connect them to Hospital Information Systems. We propose a framework for integration of Model-guided Therapy in Hospital Information Systems based on the Electronic Medical Record, and a task-based Workflow Management System, which is suitable for clinical end users. Two prototypes - one based on Business Process Modeling Language, one based on the scrum-board - are presented. From the experience with these prototypes, we developed a novel personalized visualization system for Surgical Workflows and Model-guided Therapy. Key challenges for further development are automated situation detection and a common communication infrastructure.

Interactive Learning in Smart Learning Ecosystems

The increasing heterogeneity of students at German Universities of Applied Sciences and the growing importance of digitalization call for a rethinking of teaching and learning within higher education. In the next years, changing the learning ecosystem by developing and reflecting upon new teaching and learning techniques using methods of digitalization will be both – most relevant and very challenging. The following article introduces two different learning scenarios, which exemplify the implementation of new educational models that allow discontinuity of time and place, technology and process in teaching and learning. Within a Blended Learning approach, the first learning scenario aims at adapting and individualizing the knowledge transfer in the course Foundations of Computer Science by providing knowledge individually and situation-specifically. The second learning scenario proposes a web-based tool to facilitate digital learning environments and thus digital learning communities and the possibility of computer-supported learning. The overall aim of both learning scenarios is to enhance learning for diverse groups by providing a different smart learning ecosystem in stepping away from a teacher-based to a student-centered approach. Both learning scenarios exemplarily represent the educational vision of Reutlingen University – its development into an Interactive University.

Design, implementation and operation of a reading center platform for clinical studies.

Clinical reading centers provide expertise for consistent, centralized analysis of medical data gathered in a distributed context. Accordingly, appropriate software solutions are required for the involved communication and data management processes. In this work, an analysis of general requirements and essential architectural and software design considerations for reading center information systems is provided. The identified patterns have been applied to the implementation of the reading center platform which is currently operated at the Center of Ophthalmology of the University Hospital of Tübingen.

A workflow management system for the perioperative area supporting all actors

Information systems, which support the workflow in the clinical area, are currently limited to organizational processes. This work shows a first approach of an information system supporting all actors in the perioperative area. The first prototype and proof of concept was a task manager, giving all actors information about their task and the task of all other actors during an intervention. Based on this initial task manager, we implemented an information system based on a workflow engine controlling all processes and all information necessary for the intervention. A second part was the development of a perioperative process visualization which was developed based on a user centered approach jointly with clinicians and OR members.

Design and first implementation of business process visualization for a task manager supporting the workflow in an operating room

An operating room is a stressful work environment. Nevertheless, all involved persons have to work safely as there is no space for mistakes. To ensure a high level of concentration and seamless interaction, all involved persons have to know their own tasks and the tasks of their colleagues. The entire team must work synchronously at all times. To optimize the overall workflow, a task manager supporting the team was developed. In parallel, a common conceptual design of a business process visualization was developed, which makes all relevant information accessible in real-time during a surgery. In this context an overview of all processes in the operating room was created and different concepts for the graphical representation of these user-dependent processes were developed. This paper describes the concept of the task manager as well as the general concept in the field of surgery.