Tamás Haidegger

Electromagnetic Tracking in Medicine—A Review of Technology, Validation, and Applications

Object tracking is a key enabling technology in the context of computer-assisted medical interventions. Allowing the continuous localization of medical instruments and patient anatomy, it is a prerequisite for providing instrument guidance to subsurface anatomical structures. The only widely used technique that enables real-time tracking of small objects without line-of-sight restrictions is electromagnetic (EM) tracking. While EM tracking has been the subject of many research efforts, clinical applications have been slow to emerge. The aim of this review paper is therefore to provide insight into the future potential and limitations of EM tracking for medical use. We describe the basic working principles of EM tracking systems, list the main sources of error, and summarize the published studies on tracking accuracy, precision and robustness along with the corresponding validation protocols proposed. State-of-the-art approaches to error compensation are also reviewed in depth. Finally, an overview of the clinical applications addressed with EM tracking is given. Throughout the paper, we report not only on scientific progress, but also provide a review on commercial systems. Given the continuous debate on the applicability of EM tracking in medicine, this paper provides a timely overview of the state-of-the-art in the field.

Surgery in space: the future of robotic telesurgery

BackgroundThe origins of telemedicine date back to the early 1970s, and combined with the concept of minimally invasive surgery, the idea of surgical robotics was born in the late 1980s based on the principle of providing active telepresence to surgeons. Many research projects were initiated, creating a set of instruments for endoscopic telesurgery, while visionary surgeons built networks for telesurgical patient care, demonstrated transcontinental surgery, and performed procedures in weightlessness. Long-distance telesurgery became the testbed for new medical support concepts of space missions.MethodsThis article provides a complete review of the milestone experiments in the field, and describes a feasible concept to extend telemedicine beyond Earth orbit. With a possible foundation of an extraplanetary human outpost either on the Moon or on Mars, space agencies are carefully looking for effective and affordable solutions for life-support and medical care. The major challenges of surgery in weightlessness are also discussed.ResultsTeleoperated surgical robots have the potential to shape the future of extreme health care both in space and on Earth. Besides the apparent advantages, there are some serious challenges, primarily the difficulty of latency with teleoperation over long distances. Advanced virtualization and augmented-reality techniques should help human operators to adapt better to the special conditions. To meet safety standards and requirements in space, a three-layered architecture is recommended to provide the highest quality of telepresence technically achievable for provisional exploration missions.ConclusionSurgical robotic technology is an emerging interdisciplinary field, with a great potential impact on many areas of health care, including telemedicine. With the proposed three-layered concept—relying only on currently available technology—effective support of long-distance telesurgery and human space missions are both feasible.

Applied ontologies and standards for service robots

Service robotics is an emerging application area for human-centered technologies. The rise of household and personal assistance robots forecasts a human-robot collaborative society. One of the robotics communitys major task is to streamline development trends, work on the harmonization of taxonomies and ontologies, along with the standardization of terms, interfaces and technologies. It is important to keep the scientific progress and public understanding synchronous, through efficient outreach and education. These efforts support the collaboration among research groups, and lead to widely accepted standards, beneficial for both manufacturers and users. This article describes the necessity of developing robotics ontologies and standards focusing on the past and current research efforts. In addition, the paper proposes a roadmap for service robotics ontology development. The IEEE Robotics & Automation Society is sponsoring the working group Ontologies for Robotics and Automation. The efforts of the Working group are presented here, aiming to connect the cutting edge technology with the users of these services-the general public.

Accuracy improvement of a neurosurgical robot system

Neurosurgery was the first field of application for robots in interventional medicine 20 years ago, and since then dozens of research projects have been focusing on brain and spine surgery, differently addressing the challenges of accuracy and effectiveness. We have developed a cooperatively-controlled system to assist with skull base drilling, to improve the safety and quality of neurosurgery while reducing the operating time. This paper presents the entire system, the preliminary results of phantom and cadaver tests and our efforts to improve the accuracy of the components. The residual error of NeuroMate robot calibration was reduced by 24%, while decreasing the noise of the integrated StealthStation navigation system by 53%. An effective optical tracking based patient motion compensation method has been implemented and tested. The results verify the effectiveness of the system and allow for further research. We hope that by improving the accuracy and safety, we can one day introduce this system into clinical use.

Current Capabilities and Development Potential in Surgical Robotics

Commercial surgical robots have been in clinical use since the mid-1990s, supporting surgeons in various tasks. In the past decades, many systems emerged as research platforms, and a few entered the global market. This paper summarizes the currently available surgical systems and research directions in the broader field of surgical robotics. The widely deployed teleoperated manipulators aim to enhance human cognitive and physical skills and provide smart tools for surgeons, while image-guided robotics focus on surpassing human limitations by introducing automated targeting and treatment delivery methods. Both concepts are discussed based on prototypes and commercial systems. Through concrete examples the possible future development paths of surgical robots are illustrated. While research efforts are taking different approaches to improve the capacity of such systems, the aim of this survey is to assess their maturity from the commercialization point of view.

A large-scale assessment of hand hygiene quality and the effectiveness of the “WHO 6-steps”

BackgroundHand hygiene compliance is generally assessed by observation of adherence to the “WHO five moments” using numbers of opportunities as the denominator. The quality of the activity is usually not monitored since there is no established methodology for the routine assessment of hand hygiene technique. The aim of this study was to objectively assess hand rub coverage of staff using a novel imaging technology and to look for patterns and trends in missed areas after the use of WHO’s 6 Step technique.MethodsA hand hygiene education and assessment program targeted 5200 clinical staff over 7 days at the National University Hospital, Singapore. Participants in small groups were guided by professional trainers through 5 educational stations, which included technique-training and UV light assessment supported by digital photography of hands. Objective criteria for satisfactory hand hygiene quality were defined a priori. The database of images created during the assessment program was analyzed subsequently. Patterns of poor hand hygiene quality were identified and linked to staff demographic.ResultsDespite the assessment taking place immediately after the training, only 72% of staff achieved satisfactory coverage. Failure to adequately clean the dorsal and palmar aspects of the hand occurred in 24% and 18% of the instances, respectively. Fingertips were missed by 3.5% of subjects. The analysis based on 4642 records showed that nurses performed best (77% pass), and women performed better than men (75% vs. 62%, p<0.001). Further risk indicators have been identified regarding age and occupation.ConclusionOngoing education and training has a vital role in improving hand hygiene compliance and technique of clinical staff. Identification of typical sites of failure can help to develop improved training.

Force sensing and force control for surgical robots

Abstract Surgical robotics is one of the most dynamically developing areas of biomedical engineering. In the past few decades, Computer Integrated Interventional Medicine has gained significance internationally in the field of surgical procedures. More recently, mechatronic devices have been used for prostatectomy, neurosurgery, nephrectomy, cholecystectomy, orthopedics and radiosurgery. The paper both introduces surgical robotics and the basics of force control. It also provides a review on the different algorithms and control paradigms developed for interventional systems. The application of force sensors and force based control algorithms gives a natural extension to these systems allowing for higher quality human-machine interaction, more realistic sensory feedback and telepresence. Precise and effective control of robotic devices in a changing environment can be realized with force control. Beyond, it can apply important safety features. Different methods are presented to overcome the physical limitations of instrument sensorization, and force control algorithms tailored to medical robotic applications.

Minimally invasive surgical technologies: Challenges in education and training

The laparoscopic revolution has fundamentally changed surgical technology. However, this new technology, with its unique psychomotor adaptations, has been a challenge for both experienced and novice surgeons. This review summarizes the history of practical education and training methods and those currently used to ensure surgeons safely practice these new surgical skills.

Review of tool-tissue interaction models for robotic surgery applications

Besides the motion control issues and problems arising in general robotic applications, control engineers frequently encounter difficulties in designing robotic surgery systems due to the complex environmental constraints present. One of the most challenging problems is caused by the unique behavior of soft tissues under manipulations such as grabbing, cutting and indentation. The appropriate modeling of the interaction between the tools held by the robotic arm and tissues is essential for precise control, yet no generally applicable, universal model has been developed so far. This paper gives an overview of the existing tool-tissue interaction models and possible approaches to the parameterization problem, listing and reviewing several models found in the literature. We reviewed the problem within the frames of a theoretical master-slave teleoperation surgical robot, where exact mathematical model of the soft tissue is essential for effective control over a time-delayed communication channel.

Defining positioning in a core ontology for robotics

Unambiguous definition of spatial position and orientation has crucial importance for robotics. In this paper we propose an ontology about positioning. It is part of a more extensive core ontology being developed by the IEEE RAS Working Group on ontologies for robotics and automation. The core ontology should provide a common ground for further ontology development in the field. We give a brief overview of concepts in the core ontology and then describe an integrated approach for representing quantitative and qualitative position information.