Component-based software for dynamic configuration and control of computer assisted intervention systems: Release 1.0.

This paper presents the rationale for the use of a component-based architecture for computer-assisted intervention (CAI) systems, including the ability to reuse components and to easily develop distributed systems. We introduce three additional capabilities, however, that we believe are especially important for research and development of CAI systems. The first is the ability to deploy components among different processes (as conventionally done) or within the same process (for optimal real-time performance), without requiring source-level modifications to the component. This is particularly relevant for real-time video processing, where the use of multiple processes could cause perceptible delays in the video stream. The second key feature is the ability to dynamically reconfigure the system. In a system composed of multiple processes on multiple computers, this allows one process to be restarted (e.g., after correcting a problem) and reconnected to the rest of the system, which is more convenient than restarting the entire distributed application and enables better fault recovery. The third key feature is the availability of run-time tools for data collection, interactive control, and introspection, and offline tools for data analysis and playback. The above features are provided by the open-source cisst software package, which forms the basis for the Surgical Assistant Workstation (SAW) framework. A complex computer-assisted intervention system for retinal microsurgery is presented as an example that relies on these features. This system integrates robotics, stereo microscopy, force sensing, and optical coherence tomography (OCT) imaging to transcend the current limitations of vitreoretinal surgery.

Prototyping a Hybrid Cooperative and Tele-robotic Surgical System for Retinal Microsurgery.

This paper presents the design of a tele-robotic microsurgical platform designed for development of cooperative and tele-operative control schemes, sensor based smart instruments, user interfaces and new surgical techniques with eye surgery as the driving application. The system is built using the distributed component-based cisst libraries and the Surgical Assistant Workstation framework. It includes a cooperatively controlled EyeRobot2, a da Vinci Master manipulator, and a remote stereo visualization system. We use constrained optimization based virtual fixture control to provide Virtual Remote-Center-of-Motion (vRCM) and haptic feedback. Such system can be used in a hybrid setup, combining local cooperative control with remote tele-operation, where an experienced surgeon can provide hand-over-hand tutoring to a novice user. In another scheme, the system can provide haptic feedback based on virtual fixtures constructed from real-time force and proximity sensor information.

Implementation of a real-time multi-channel gateway server in ubiquitous integrated biotelemetry system for emergency care (UIBSEC).

We developed a gateway server to support various types of bio-signal monitoring devices for ubiquitous emergency healthcare in a reliable, effective, and scalable way. The server provides multiple channels supporting real-time N-to-N client connections. We applied our system to four types of health monitoring devices including a 12-channel electrocardiograph (ECG), oxygen saturation (SpO(2)), and medical imaging devices (a ultrasonograph and a digital skin microscope). Different types of telecommunication networks were tested: WIBRO, CDMA, wireless LAN, and wired internet. We measured the performance of our system in terms of the transmission rate and the number of simultaneous connections. The results show that the proposed network communication strategy can be successfully applied to the ubiquitous emergency healthcare service by providing a fast rate enough for real-time video transmission and multiple connections among patients and medical personnel.

Implementation of the relay server for the ubiquitous integrated biotelemetry system for emergency care (UIBSEC) based on 3.5G HSDPA technology.

When an emergent case occurs, to give proper and immediate emergency treatment to a patient is as important as to transfer him or her to the hospital as early as possible. For this circumstance where first aid usually happens in an ambulance, we developed the Ubiquitous Integrated Biotelemetry System for Emergency Care (UIBSEC) based on wireless 3.5G HSDPA module in order to provide more proper and active medical care to a patient. For this system we performed experimental tests on the HSDPA module to measure practical performance values with respect to throughput and RTT (round-trip-time) and compared the result with the theoretical specifications. In the course of developing this system we created the C#-based Network Solution Library (NSL) which helps drastically reducing the overhead. We applied this library to components of the UIBSEC - two kinds of clients and one central server - and confirmed that it works smoothly in wireless networks and it is useful in the future development process of network applications.

Preliminary study of motion artifact rejection for NIBP measurement in an ambulance.

Motion artifact resulting from patient's movement is a significant source for disturbing accurate noninvasive blood pressure (NIBP) measurement. In an ambulance, patients are exposed to unstable circumstances due to vehicle's movement and vibration during emergency transportation. Since NIBP is indirectly measured using oscillometry based on the change of cuff pressure, it can be affected by motion artifact much more than other biosignals. In this paper, we developed a new NIBP system with improved accuracy by measuring acceleration of the system caused by patient's motion. The NIBP module including a 3-axis accelerometer was directly mounted on a cuff to minimize the interference induced through connecting tube. The results show that the proposed NIBP system has the capability to reject the interference of motion artifact effectively in an ambulance.

HSDPA (3.5G)-based ubiquitous integrated biotelemetry system for emergency care.

We have developed the second prototype system of Ubiquitous Integrated Biotelemetry System for Emergency Care(UIBSEC) using a HSDPA(High Speed Downlink Packet Access) modem to be used by emergency rescuers to get directions from medical doctors in providing emergency medical services for patients in ambulance. Five vital bio-signal instrumentation modules have been implemented, which include noninvasive arterial blood pressure (NIBP), arterial oxygen saturation (SaO2), 6-channel electro-cardiogram(ECG), blood glucose level, and body temperature and real-time motion picture of the patient and GPS information are also taken. Measured patient data, captured motion picture and GPS information are then transferred to a doctor's PC through the HSDPA and TCP/IP networks using stand-alone HSDPA modem. Most prominent feature of the developed system is that it is based on the HSDPA backbone networks available in Korea now, through which we will be able to establish a ubiquitous emergency healthcare service system.

Comparison of Porous Polyethylene Sheet(Medpor(R)) with Titanium Dynamic Mesh in the Treatment of Blow Out Fracture

The records of the patients with orbital wall fracture were reviewed from March 1997 through February 2001 in the department of plastic and reconstructive surgery, Yeungnam university medical center. One hundred thirty nine patients with blow out fracture were repaired by using porous polyethylene(Medpor(R)) or titanium dynamic mesh. Surgical effect of titanium dynamic mesh was evaluated and compared with that of Medpor(R) in the reconstruction of orbital wall fracture after follow up period of six months. The incidence of the orbital wall fracture was more common in men than in women. The traffic accident was most common cause of the fracture and the most common combined fracture was nasal bone fracture. The sites of fractures were the orbital floor in 51 patients, the medial wall in 18 patients, and both the medial wall and floor in 38 patients. Medpor(R) is easy to handle, shape, contour and position. Titanium dynamic mesh is good device in that it has for good structural stability, excellent strength, high biocompatibility and can be fixed easily. In conclusion, Medpor(R) was suitable for local defect in small fracture and titanium dynamic mesh was suitable for large defect in compound fracture

Reconstruction of Alopecia by Scalp Expansion

Tissue expansion has been used for several decades in plastic and reconstructive surgery. Recently tissue expansion of the hair bearing scalp provides an excellent surgical option for the treatment of wide alopecia. During the period 1990 to 2001, 34 patients, 37 cases of wide alopecia with various causes were treated using tissue expansion. Choice of the size, shape, and the numbers of the expander was done by a senior author. The capsule of the expanded tissue remained intact and transposition flaps were use to redistribute expanded scalp. For three patients, serial expansion was performed to completely remove the remaining alopecia. Another patients with male pattern baldness were also successfully treated using tissue expansion technique. In conclusion, tissue expansion for alopecia is a simple, safe, and reliable method and provides excellent aesthetic results. It is the treatment of choice for wide alopecia due to burn, tumor excision, traffic accident and even for male pattern baldness.