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PubMed1995

Medicine in virtual environments.

Virtual Environments allow a human to interact with a (computer) system in such a way that a high level of presence in a computer-synthesised world is experienced. In principle, all human senses are involved with the interaction. Many applications may benefit from this type of human-machine interfacing, however, few have emerged so far for medicine. In this paper we elaborate on some realistic potential applications of Virtual Environment technology in the field of medicine. These applications can be found in education/training, therapy, surgery, rehabilitation, diagnosis, telemedicine and biomechanics. The value to be added to these applications by VE technology lies in the fact that patient data or patient models may be moderated to the physician in a more intuitive and natural manner. Despite these potentials, the short-term feasibility of these applications can be put into question for various reasons. Firstly, the current generation of display devices have a resolution that may show to be too low to achieve a sufficiently high degree of realism for medical applications. Secondly, there are no commercially-available actuators for tactile and force feedback which the physician desperately need for the simulation of the contact with the (virtual) patient. Thirdly, the enormous computing power required for these applications (still) needs a considerable investment. With these limitations in mind, we believe that we are at the cradle of a whole new generation of VE applications in medicine.

Computer Simulation↗

PubMed1995

[Indications and use of stereolithographic skull reconstructions in oromaxillofacial surgery].

Stereolithography (SLA), a rapid prototyping technique, was introduced in 1991 at the Clinic for Maxillofacial Surgery in Vienna and was adapted, in cooperation with the company Laserform, for our clinical requirements. As a refinement to physical models milled out of polyurethane, which had been used since 1989, this technique offered new applications for preoperative planning in craniomaxillofacial surgery. The proportions of these 3D models correspond 1:1 to the patients dimensions, with a possible accuracy of 0.25 mm. Since 1992 stereolithography has been used in 124 cases, primarily in traumatology, tumor surgery and in craniofacial surgery.

Adult↗

PubMed1995

A formal model for quality assurance in coloproctologic surgery.

In the last 30 years the advanced countries experienced a large growth of financial and social resources devoted to Health Care (HC) [1] The need of better co-ordinating activities of a composite large set of specialists, and the need of avoiding further growth of financial and social resources without reducing benefits, stimulated the growth of Health Care Evaluation (HCE) and Quality Assurance (QA) studies. In this paper we show how system analysis and precise assessment of the clinical process can be largely enhanced by using formal techniques. The proposed methodology takes advantage of positive experiences in computer science. It is based on a formal model of the clinical process that provides the physicians with support for assessing diagnostic procedures in a co-operative surgical environment [7]. Diagnostic, grading, and staging procedures are integrated in a single model that can be formally expressed and analyzed. The approach is exemplified by presenting an elementary model of the diagnosis, grading and staging procedures for the colo-rectal cancer and ulcerative colitis.

Colitis, Ulcerative↗

PubMed1995

[Value of image guided neurosurgery in neuro-oncology].

Brain tumor surgery, stereotactic or by resection, is based on the precise knowledge of the spatial position of the target and of their relationships with the normal brain structures. Modern computed neuroimaging allows image guidance of neurosurgical procedures, using robots driven by the coordinates of the target and of the entry point. We have developped a stereotactic robot as well as a robotized microscope which are guided from digitized images. They are used in routine daily practice and will become part of the standard neurosurgical equipment.

Brain Mapping↗

PubMed1996

Computer-based patient education: observations on effective communication in the clinical setting.

Computer-based patient education materials are becoming more widely used in an attempt to increase the efficacy and efficiency of the delivery of health care. This paper discusses the authors' experiences in designing and implementing interactive multimedia presentations for patient education in an orthopaedic surgery office setting. Content must be chosen carefully to effectively educate without alienating the patient; simple graphics and animation are best for conveying complex medical and surgical concepts. The interface must be simple; both mouse input and touchscreen have proven acceptable and require minimal instruction. Improvements in program design will result in task-oriented evaluation systems that allow the patient to use the information gained to demonstrate understanding.

Communication↗

PubMed1996

Image-guided spine surgery.

Conventional imaging techniques are of limited usefulness in spinal navigation, due to their lack of a "three-dimensional perspective." An interactive image-guided approach has been developed that provides a three-dimensional image-space representation of surgical space, using a specially designed referencing system and computer workstation. The system is described and results from laboratory tests and clinical cases are reported. It is concluded that interactive image-guided stereotaxis can be a valuable tool in spinal localization because of its degree of precision and the increased margin of safety it can offer.

Bone Screws↗

PubMed1996

A technique for interactive image-guided neurosurgical intervention in primary brain tumors.

Interactive image-guided neurosurgical techniques allow safer and more complete cytoreduction of gliomas. This is most significant for low-grade tumors, whose configurations and margins are perhaps better appreciated by reference to registered MR images rather than by reliance on direct visualization using microscopic illumination. Spatially registered electro-physiologic recordings of intraoperative cortical stimulation to map language and motor function can increase the margin of safety for performing radical resections. By individualizing approaches and optimizing results, these technologies promise a new degree of standardization of outcome after resective surgery for all glial tumors.

Brain Mapping↗

PubMed1996

Intraoperative navigation during resection of brain metastases.

This article reviews the authors' experience with image-guided surgery for brain metastases and discusses specifically the impact of the frameless viewing wand system on standard craniotomy techniques for this disorder. Topics discussed include patient selection, interactive image-guided neurosurgical resection of brain metastases, and other image-guided neurosurgical systems.

Brain Mapping↗

PubMed1996

Surgical management of convexity and falcine meningiomas using interactive image-guided surgery systems.

Interactive image-guided surgery systems can provide useful navigation information to assist craniotomy for meningiomas of the convexity and falx. When using MR imaging for navigation, interactive image-guided surgery can provide visualization of the relationship of tumor to venous anatomy, which may reduce the risk of debilitating infarction. Cortical surface anatomy can also be assessed, helping to estimate risk to functionally expressive areas.

Adult↗

PubMed1996

Image-guided surgery for skull base neoplasms using the ISG viewing wand. Anatomic and technical considerations.

Image-guided surgery of the cranial base requires a knowledge of both surgical anatomy and the technical aspects of the particular system being used. The authors report on their experience using the ISG Viewing Wand over the last two years, concentrating on the technical considerations for the use of the system and lessons learned. Image-guided surgical systems may well replace the current forms of intraoperative imaging used for anatomic orientation and localization and are considered a valuable addition to the armamentarium of the skull base surgeon.

Brain Neoplasms↗

PubMed1996

[Computers in a private surgeon's office. "Do it yourself" or "one is never served better than by oneself"].

In an attempt to minimise the administrative work involved in private surgical practice, the author naturally considered the use of computers. After studying the medical software market, he was convinced that most software was better adapted to general practice than to surgery. He concluded that the best person to design a surgical software would be the surgeon himself, provided he was prepared to spend some of his leisure time to develop a computer application. The software developed is a large integrated application facilitating all of the functions necessary to good functioning of the surgical office. It therefore ensures filing of medical records, correspondence, accounts, management of salaries, and appointments, as all of these sectors are related to the surgical activity itself. This approach led to the design of an application, and its functioning and the possibilities provided are described.

Humans↗

PubMed1995

Development of computer systems for endoscopic surgery.

The use of computer technology in endoscopic surgery is a necessity if more advanced and high quality minimal invasive operations are to be performed. Since safety and reliability are a major issue in medical applications, the development of computer systems has to follow a systematic procedure including quality assurance and be supervised by project management as employed in such safety-relevant areas as aerospace and nuclear energy. An overview of the early phases of this development process and of the major tests during the process is presented.

Computer Simulation↗

PubMed1995

[3-dimensional reconstruction for planning surgical reconstruction of tumors in the single kidney].

Organ-sparing renal surgery for renal cell carcinoma has greatly increased in importance over the last few years owing to the widespread application of ultrasound examination. When a normal contralateral kidney is present the indications for organ-sparing surgery are very strict. Our patient presented with a large tumour in a single kidney and, though fully informed about all the risks involved, insisted upon an organ-sparing operation. In planning and execution of the operation we were much assisted by the use of a three-dimensional reconstruction made from the CT scan carried out preoperatively, because this showed the exact position and size of the tumour. We report on the course of the patient's illness and present a simple three-dimensional reconstruction technique.

Carcinoma, Renal Cell↗

PubMed1996

Correlation-based pattern recognition for implantable defibrillators.

An estimated 300,000 Americans die each year from cardiac arrhythmias. Historically, drug therapy or surgery were the only treatment options available for patients suffering from arrhythmias. Recently, implantable arrhythmia management devices have been developed. These devices allow abnormal cardiac rhythms to be sensed and corrected in vivo. Proper arrhythmia classification is critical to selecting the appropriate therapeutic intervention. The classification problem is made more challenging by the power/computation constraints imposed by the short battery life of implantable devices. Current devices utilize heart rate-based classification algorithms. Although easy to implement, rate-based approaches have unacceptably high error rates in distinguishing supraventricular tachycardia (SVT) from ventricular tachycardia (VT). Conventional morphology assessment techniques used in ECG analysis often require too much computation to be practical for implantable devices. In this paper, a computationally-efficient, arrhythmia classification architecture using correlation-based morphology assessment is presented. The architecture classifies individuals heart beats by assessing similarity between an incoming cardiac signal vector and a series of prestored class templates. A series of these beat classifications are used to make an overall rhythm assessment. The system makes use of several new results in the field of pattern recognition. The resulting system achieved excellent accuracy in discriminating SVT and VT.

Arrhythmias, Cardiac↗

PubMed1996

Gangliosides minimize motor disabilities and histopathological changes in cortical lesioned and transplanted rats.

The effect of bovine brain gangliosides was studied in rats lesioned by partial suction of the right somatosensory cortex and also in rats implanted with a piece of fetal brain tissue in this area. In both experiments a group of animals received 30 mg/kg i.p. of gangliosides daily for a period of 7 days after surgery. In lesioned rats, the untreated group showed a lower maintenance on a tight rope test at 7 as well as at 14 days, as compared with a sham-operated group (p < 0.05). In transplanted rats ganglioside treatment prevented the increase of the probability of falls from a horizontal bar at days 7 and 14 post-operations and the probability of slips on a vertical bar at day 7 (p < 0.05). Rats were killed at day 15 and brain coronal sections were obtained. Nuclear area and circularity were measured in a sample of cortical and grafted cells in a computer aid-image analyzer. Ganglioside protection on the normal size and shape of the nuclei in the ipsilateral cortex in lesioned as well as in transplanted rats (p < 0.01) was found. A higher nuclear area in ganglioside than in saline treated grafts was noted. Results suggest a protective action of the gangliosides against the lesion-induced motor dysfunction and secondary cortical cell degeneration.

Animals↗

PubMedDate not supplied

[Application of three-dimensional computer graphics in oncology].

Accurate 3D tumoral volume evaluation is now possible through the combined use and progress of computer graphics technics (3D reconstruction and visualization) and medical imagery (helicoidal TDM scanner). Specific organ and pathology oriented softwares can help answer rapidly to problems posed by oncologic praticians. A new decision support for diagnosis, therapy and follow-up is emerging. First results in liver tumors and hepatic regeneration macroscopic biometrics are presented. Tumoral or organ volumic index will be usable in the follow-up. TNM staging, external conformal radiotherapy for prostatic or brain tumors, drugs cytolytic effects evaluation will take great advantage of these technologies. 3D visualization and matching CT and MRI imagery can help computed assisted surgery.

Computer Graphics↗

PubMed1996

[Computer graphics methods for 3-dimensional imaging of intrapulmonary space-occupying lesions of CT and MRI images].

AIM: To improve the pre-operative planning of interventional procedures in thorax surgery different methods of computer-graphical visualization of intrapulmonary lesions and adjacent anatomical structures based on CT and MR data were realized and compared to each other. DESIGN: In 21 patients with intrapulmonary lesions the image data was segmented by interactive and automatic algorithms and different reconstruction techniques were applied (maximum intensity projection; color-encoded and transparent surfaces; volume rendering). Based on these three-dimensional reconstructions, different views from arbitrary perspectives (including simulated endoscopic images) were generated and animated film sequences of the 3D scene were displayed with 30 frames/second. RESULTS: For all patients under review, a high-quality presentation of the relevant structures was obtained by use of the applied computer-graphical techniques. Even combinations of different visualization methods in one image can be generated with the software we developed. CONCLUSIONS: The various methods for image segmentation allow a fast and comfortable processing even of large data sets. The calculated values of tumor surface and volume can be used for quantitative studies and therapy control. The planning of surgical and interventional procedures can be supported by the simultaneous visualization of the intrathoracic lesion and the surrounding structures.

Aged↗

PubMed1996

[Computer assisted pedicle screw installation. Our first 3 cases].

Pedicle screw fixation is sometimes a difficult surgical procedure relying on anatomical landmarks that may be modified by vertebral asymmetries. A significant incidence of cortex penetration and neuro-vascular complications have been documented. Our study evaluates the usefulness of a computer-aided pedicle installation system and analyses the results for our first 3 clinical cases. The system was used for 3 adolescent patients with idiopathic scoliosis undergoing surgical correction and instrumentation. In all cases, selected vertebrae were reconstructed in 3D pre-operatively. At surgery, the surgeon compared the computer-suggested pedicle location to his own opinion. After pedicular hole drilling was done in the usual fashion, hole positions were confirmed per-operatively with the computer software. Post-operatively, software hole positions were measured and compared to the actual screw axis using CT-Scans. Three dimensional models produced for all selected vertebrae allowed visualization of asymmetrical deformations of the scoliotic vertebrae. All pedicles were correctly detected by the software. Pedicular hole measurements agreed with the actual screws positions on post-op CT-Scans. The computerized surgical assistant can be of value in a clinical situation. These initial results warrant a large scale trial in order to establish accuracy and reliability.

Adolescent↗