Needle insertion planning for obstacle avoidance in robotic biopsy

Understanding the underlying pathology in different tissues and organs is crucial when fighting pandemics like COVID-19. During conventional autopsy, large tissue sample sets of multiple organs can be collected from cadavers. However, direct contact with an infectious corpse is associated with the risk of disease transmission and relatives of the deceased might object to a conventional autopsy. To overcome these drawbacks, we consider minimally invasive autopsies with robotic needle placement as a practical alternative. One challenge in needle based biopsies is avoidance of dense obstacles, including bones or embedded medical devices such as pacemakers. We demonstrate an approach for automated planning and visualising suitable needle insertion points based on computed tomography (CT) scans. Needle paths are modeled by a line between insertion and target point and needle insertion path occlusion from obstacles is determined by using central projections from the biopsy target to the surface of the skin. We project the maximum and minimum CT attenuation, insertion depth, and standard deviation of CT attenuation along the needle path and create two-dimensional intensity-maps projected on the skin. A cost function considering these metrics is introduced and minimized to find an optimal biopsy needle path. Furthermore, we disregard insertion points without sufficient room for needle placement. For visualisation, we display the color-coded cost function so that suitable points for needle insertion become visible. We evaluate our system on 10 post mortem CTs with six biopsy targets in abdomen and thorax annotated by medical experts. For all patients and targets an optimal insertion path is found. The mean distance to the target ranges from (49.9 ± 12.9)mm for the spleen to (90.1 ± 25.8)mm for the pancreas. © 2021 by Walter de Gruyter Berlin/Boston.

Needle insertion planning for obstacle avoidance in robotic biopsy

Introduction Understanding the underlying pathology in different tissues is crucial when fighting a pandemic like COVID-19. During a conventional autopsy, large tissue sample sets of multiple organs can be collected from cadavers. However, direct contact with an infectious corpse is associated with the risk of disease transmission and relatives of the deceased might object to an conventional autopsy. To overcome these drawbacks, we consider minimally invasive autopsies with robotic needle placement as practical alternative. One challenge in needle based biopsies is the avoidance of dense obstacles including bones or embedded medical devices such as pacemakers. We demonstrate an approach for planning and visualizing suitable needle insertion points based on post mortem CT scans. Methods The needle paths are modeled by a line between insertion and target point. We project the maximum and minimum CT intensity, insertion depth, and standard deviation of CT intensity along the needle path and create two-dimensional intensity-maps projected on the skin. A cost function considering these metrics is introduced and minimized to find an optimal biopsy needle path. Furthermore, we disregard insertion points without sufficient room for needle placement. For visualization, we segment the surface of the corpse and display a colormap of a function depending on the estimated metrics such that viable points for needle insertion become visible. Results We evaluate our system on CTs of 10 corpses with six biopsy targets in the abdomen and thorax annotated by medical experts. For all patients and targets an optimal insertion path could be found. The mean distance to the target ranges from (49. 9 ± 12. 9) mm for the spleen to (90. 1 ± 25. 8) mm for the pancreas. Conclusion Robots are a valuable tool for minimally invasive needle biopsies from infectious corpses and allow for pre-planned needle insertion. We developed a tool for visualizing and optimizing for viable needle insertion points. Depending on the type of needle insertion, the objective function can be adjusted for optimal needle insertion points.

[SARS-CoV-2-associated deaths in adult persons up to 50 years of age]. / SARS-CoV-2-assoziierte Todesfälle von erwachsenen Personen bis 50 Jahre: Eine retrospektive Auswertung der COVID-19-assoziierten Todesfälle im Jahr 2020 im Institut für Rechtsmedizin Hamburg, Deutschland.

INTRODUCTION: Several evaluations of deaths in persons of advanced age associated with SARS-CoV­2 can be found in the international literature. The aim of this work was the evaluation of deaths associated with SARS-CoV­2 of persons of younger or middle age (up to 50 years) at the Institute of Legal Medicine in Hamburg, Germany, with presentation of frequency, comorbidities and disease courses. MATERIAL AND METHODS: A total of 735 SARS-CoV-2-associated cases of decedents with registered addresses in Hamburg were evaluated in 2020 at the Institute of Legal Medicine in Hamburg, Germany, using various examination methods. The selection and performance of the respective methods was based on the consent given by the relatives. In addition, more autopsies of decedents with a registered address outside Hamburg and positive SARS-CoV­2 detection were performed. RESULTS AND CONCLUSION: Of the 735 decedents 9 with a registered Hamburg address and 3 of the deaths studied with an external registered address (n = 12; 7 men and 5 women) were aged 50 years or younger, with an average age of 39.8 years. Essentially, there were cardiovascular, neurological, and malignant pre-existing diseases, as well as obesity. The SARS-CoV­2 was detected post-mortem for the first time in two cases; these were found to have a virus-independent cause of death. Of the individuals 7 died from COVID-19 pneumonia, 3 individuals from the consequences of the necessary intensive medical treatment.Several studies have demonstrated an association between obesity and severe SARS-CoV-2-related disease progression, particularly in younger patients and this was confirmed in the legal medicine study population.

Brain pathology of COVID-19

Coronavirus disease 2019 (COVID-19) is caused by the infection with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). SARS-CoV-2 affects multiple organ systems including the central nervous system (CNS) where it leads to CNS dysfunction (Neuro COVID-19). Mechanisms of SARS-CoV-2 neuropathogenesis including the targeting of the brain and elucidation of the sequence of events underlying CNS damage are only poorly understood. We and others have investigated this by neuropathological deep phenotyping using morphological methods and molecular neuropathology in representative cohorts of patients dying from/with COVID-19 and in adequate control cohorts. Our studies show that Neuro COVID-19 is characterized by a compartmentalized and region-specific perivascular glial and neuroinflammatory response with activation of microglia which is found in nearly all patients dying from/with COVID-19. Conversely, SARS-CoV-2 and SARS-CoV-2 viral proteins can only be found in low amounts in a subset of COVID-19 patients' brains. In the presentation, it will be illustrated how neuropathological deep phenotyping can contribute to elucidate disease mechanisms in Neuro COVID-19.

Determinants of health-related quality of life among homeless individuals during the COVID-19 pandemic.

OBJECTIVE: To clarify which variables are associated with the health-related quality of life (HRQoL) among homeless individuals during the COVID-19 pandemic. STUDY DESIGN: Cross-sectional research. METHODS: Data were taken from the Hamburg survey of homeless individuals (n = 151). HRQoL was assessed using the EQ-5D tool. More precisely, the EQ-5D-5L questionnaire was used to quantify problems in five health dimensions (i.e. mobility, self-care, usually activities, pain/discomfort, anxiety/depression), and its visual analog scale (EQ-VAS) was used to record the according self-rated health status. Explanatory variables include sex, age, education, marital status, country of origin, health insurance, and chronic alcohol consumption. RESULTS: With regard to HRQoL, most frequently, problems were reported as pain/discomfort (47.3%), followed by anxiety/depression (32.4%), mobility (29.7%), usual activities (20.7%) and self-care (4.6%). The mean EQ-VAS score was 75.34 (SD 22.23; range 1-100), and the mean EQ-5D-5L index was 0.84 (SD 0.23; range 0.32-1). Regressions showed increasing problems in mobility and self-care with higher age, whereas EQ-VAS was positively associated with younger age. Furthermore, EQ-5D-5L index was positively associated with younger age and higher education. Summarized, among this cohort, a higher age is associated with a lower HRQoL. CONCLUSION: Remarkably high EQ-VAS values and rather few problems in the five dimensions investigated here were reported among the homeless individuals during the COVID-19 pandemic particularly compared with the general population. Moreover, study findings particularly stress the link between higher age and lower HRQoL among homeless individuals. This knowledge is important to address homeless individuals at risk of poor HRQoL. Longitudinal studies are required to confirm the given findings.

COVID-19 lungs in post-mortem computed tomography.

Post-mortem computed tomography (PMCT) is a rapid and noninvasive diagnostic tool for important contributions to the identification of pulmonary findings in the deceased with pneumonia, including cases of coronavirus disease 2019 (COVID-19). Although computed tomography (CT) shows a high sensitivity for pneumonia in living persons, it is relatively unspecific for COVID-19 pneumonia clinically. Typical CT findings for viral pneumonia therefore require confirmation by PCR tests (polymerase chain reaction tests), even if lung infections with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) show characteristic patterns, most frequently ground glass opacities (GGO) and a combination of GGO and air space consolidations. In the consecutive autopsy series of SARS-CoV­2 deaths from Hamburg, Germany, the most frequent cause of death was and still is COVID-19 pneumonia. Typical findings were frequently found in the PMCT in SARS-CoV-2-associated deaths, which were taken into account when classifying the death as COVID-19.