Clinical Application of an Augmented Reality Navigation System for Transforaminal Epidural Injection: A Randomized Controlled Trial.

Objectives: Augmented reality (AR) navigation systems are emerging to simplify and enhance the precision of medical procedures. Lumbosacral transforaminal epidural injection is a commonly performed procedure for the treatment and diagnosis of radiculopathy. Accurate needle placement while avoiding critical structures remains a challenge. For this purpose, we conducted a randomized controlled trial for our augmented reality navigation system. Methods: This randomized controlled study involved 28 patients, split between a traditional C-arm guided group (control) and an AR navigation guided group (AR-NAVI), to compare procedure efficiency and radiation exposure. The AR-NAVI group used a real-time tracking system displaying spinal structure and needle position on an AR head-mounted display. The procedural time and C-arm usage (radiation exposure) were measured. Results: All patients underwent successful procedures without complications. The AR-NAVI group demonstrated significantly reduced times and C-arm usage for needle entry to the target point (58.57 ± 33.31 vs. 124.91 ± 41.14, p < 0.001 and 3.79 ± 1.97 vs. 8.86 ± 3.94, p < 0.001). Conclusions: The use of the AR navigation system significantly improved procedure efficiency and safety by reducing time and radiation exposure, suggesting a promising direction for future enhancements and validation.

Robotic system for nasopharyngeal swab sampling based on remote center of motion mechanism.

PURPOSE: In this study, a robotic system is proposed for nasopharyngeal (NP) swab sampling with high safety and efficiency. Most existing swab-sampling robots have more than six degrees of freedom (DOFs). However, not all six DOFs are necessarily required for NP swab sampling. A high number of DOFs can cause safety problems, such as collisions between the robot and patient. METHOD: We developed a new type of robot with four DOFs for NP swab sampling that consists of a two DOFs remote center of motion (RCM) mechanism, a two DOFs insertion mechanism, and a nostril support unit. With the nostril support unit, the robot no longer needs to adjust the insertion position of the swab. The proposed robot enables the insertion orientation and depth to be adjusted according to different postures or facial shapes of the subject. For intuitive and precise remote control of the robot, a dedicated master device for the RCM and a visual feedback system were developed. RESULT: The effectiveness of the robotic system was demonstrated by repeatability, RCM accuracy, tracking accuracy, and in vitro phantom experiments. The average tracking error between the master device and the robot was less than 2 mm. The contact force exerted on the swab prior to reaching the nasopharynx was less than 0.04 N, irrespective of the phantom's pose. CONCLUSION: This study confirmed that the RCM-based robotic system is effective and safe for NP swab sampling while using minimal DOFs.

Augmented Reality-Assisted Navigation System for Transforaminal Epidural Injection.

Purpose: Multiple studies have attempted to demonstrate the benefits of augmented reality (AR)-assisted navigation systems in surgery. Lumbosacral transforaminal epidural injection is an effective treatment commonly used in patients with radiculopathy due to spinal degenerative pathologies. However, few studies have applied AR-assisted navigation systems to this procedure. The study aimed to investigate the safety and effectiveness of an AR-assisted navigation system for transforaminal epidural injection. Patients and Methods: Through a real-time tracking system and a wireless network to the head-mounted display, computed tomography images of the spine and the path of a spinal needle to the target were visualized on a torso phantom with respiration movements installed. From L1/L2 to L5/S1, needle insertions were performed using an AR-assisted system on the left side of the phantom, and the conventional method was performed on the right side. Results: The procedure duration was approximately three times shorter, and the number of radiographs required was reduced in the experimental group compared to the control group. The distance from the needle tips to the target areas in the plan showed no significant difference between the two groups. (AR group 1.7 ± 2.3mm, control group 3.2 ± 2.8mm, P value 0.067). Conclusion: An AR-assisted navigation system may be used to reduce the time required for spinal interventions and ensure the safety of patients and physicians in view of radiation exposure. Further studies are essential to apply AR-assisted navigation systems to spine interventions.

Supercritical CO2-Induced Evolution of Alkali-Activated Slag Cements.

The phase changes in alkali-activated slag samples when exposed to supercritical carbonation were evaluated. Ground granulated blast furnace slag was activated with five different activators. The NaOH, Na2SiO3, CaO, Na2SO4, and MgO were used as activators. C-S-H is identified as the main reaction product in all samples along with other minor reaction products. The X-ray diffractograms showed the complete decalcification of C-S-H and the formation of CaCO3 polymorphs such as calcite, aragonite, and vaterite. The thermal decomposition of carbonated samples indicates a broader range of CO2 decomposition. Formation of highly cross-linked aluminosilicate gel and a reduction in unreacted slag content upon carbonation is observed through 29Si and 27Al NMR spectroscopy. The observations indicate complete decalcification of C-S-H with formation of highly cross-linked aluminosilicates upon sCO2 carbonation. A 20-30% CO2 consumption per reacted slag under supercritical conditions is observed.

Augmented Reality Assisted Surgical Navigation System for Epidural Needle Intervention.

An augmented reality (AR)-assisted surgical navigation system was developed for epidural needle intervention. The system includes three components: a virtual reality-based surgical planning software, a patient and tool tracking system, and an AR-based surgical navigation system. A three-dimensional (3D) path plan for the epidural needle was established on the preoperative computed tomography (CT) image. The plan is then registered to the intraoperative space by 3D models of the target vertebrae using skin markers and real-time tracking information. In the procedure, the plan and tracking information are transmitted to the head-mounted display (HMD) through a wireless network such that the device directly visualizes the plan onto the back surface of the patient. The physician determines the entry point and inserts the needle into the target based on the direct visual guidance of the system. An experiment was conducted to validate the system using two torso phantoms that mimic human respiration. The experimental results demonstrated that the time and the number of X-rays required for needle insertion were significantly decreased by the proposed method (43.6±20.55sec, 2.9±1.3times) compared to those of the conventional fluoroscopy-guided approach (124.5 ± 46.7s, 9.3±2.4times), whereas the average targeting errors were similar in both cases. The proposed system may potentially decrease ionizing radiation exposure not only to the patient but also to the medical team.

Influence of Polyethylene Terephthalate Powder on Hydration of Portland Cement.

The management of plastic waste is a massive challenge and the recycling of plastics for newer applications is a potential solution. This study investigates the feasibility of using polyethylene terephthalate (PET) powder in cementitious composites. The changes in the strength and microstructure of Portland cement incorporating PET powder with different replacement ratios were systematically analyzed through the measurements of compressive strength, isothermal calorimetry, X-ray diffraction, thermogravimetric analysis, and Raman spectroscopy. In addition, the possible chemical changes of cement paste samples were studied upon exposure to different conditions, including deionized water, seawater, and simulated pore solution. Based on the test results and analysis, no apparent chemical changes were observed in the cement paste samples, regardless of the exposure conditions. In contrast, the PET powder incorporated into concrete exhibited remarkable changes, which may have occurred during the mixing process. The results also suggested that the maximum replacement ratio of PET powder should be less than 10% of the binder (by mass) to minimize its influence on cement hydration, due to the interaction between water and PET. The PET-containing samples showed the presence of calcium aluminate hydrates which were absent in the neat paste sample.

CO2 Uptake and Physicochemical Properties of Carbonation-Cured Ternary Blend Portland Cement-Metakaolin-Limestone Pastes.

The feasibility of carbonation curing of ternary blend Portland cement-metakaolin-limestone was investigated. Portland cement was substituted by the combination of metakaolin and limestone at levels of 15%, 30%, and 45% by the mass. The ternary blends were cured with four different combinations of ambient and carbonation curing. The mechanical property, CO2 uptake, and mineralogical variations of the ternary blend pastes were investigated by means of compressive strength test, thermogravimetric analysis, and X-ray diffractometry. In addition, volume of permeable voids and sorptivity of the ternary blends were also presented to provide a fundamental idea of the pore characteristics of the blends. The test results showed that the increasing amount of metakaolin and limestone enhanced the CO2 uptake, reaching 20.7% for the sample with a 45% cement replacement level at 27 d of carbonation. Meanwhile, the compressive strength of the samples was reduced up to 65% upon excessive incorporation of metakaolin and limestone. The samples with a replacement level of 15% exhibited a comparable strength and volume of permeable voids to those of the sample without substitution, proving that the ternary blend Portland cement-metakaolin-limestone can be a viable option toward the development of eco-friendly binders.

Impact of Bio-Carrier Immobilized with Marine Bacteria on Self-Healing Performance of Cement-Based Materials.

The present study evaluated the self-healing efficiency and mechanical properties of mortar specimens incorporating a bio-carrier as a self-healing agent. The bio-carrier was produced by immobilizing ureolytic bacteria isolated from seawater in bottom ash, followed by surface coating with cement powder to prevent loss of nutrients during the mixing process. Five types of specimens were prepared with two methods of incorporating bacteria, and were water cured for 28 days. To investigate the healing ratio, the specimens with predefined cracks were treated by applying a wet-dry cycle in three different conditions, i.e., seawater, tap water, and air for 28 days. In addition, a compression test and a mercury intrusion porosimetry analysis of the specimens were performed to evaluate their physico-mechanical properties. The obtained results showed that the specimen incorporating the bio-carrier had higher compressive strength than the specimen incorporating vegetative cells. Furthermore, the highest healing ratio was observed in specimens incorporating the bio-carrier. This phenomenon could be ascribed by the enhanced bacterial viability by the bio-carrier.

Structural evolution of binder gel in alkali-activated cements exposed to electrically accelerated leaching conditions.

The structural evolution of a binder gel in alkali-activated cements exposed to accelerated leaching conditions is investigated for the first time. Samples incorporating fly ash and/or slag were synthesized and were exposed to electrically accelerated leaching by applying a current density of 5 A/m2. The leaching behavior of the samples greatly depended on the binder gel formed in the samples. The N-A-S-H type gel abundant in fly ash-rich samples showed some extent of dissolution upon accelerated leaching, while slag-rich samples underwent hydration of the anhydrous slag after leaching. The obtained results are discussed in view of the degradation of the binder gel induced by accelerated leaching, and their potential performance under repository conditions where groundwater-induced leaching is the main durability concern.

Utilization of Calcium Carbide Residue Using Granulated Blast Furnace Slag.

The solidification and stabilization of calcium carbide residue (CCR) using granulated blast furnace slag was investigated in this study. CCR binding in hydrated slag was explored by X-ray diffraction, 29Si and 27Al magic angle spinning (MAS) nuclear magnetic resonance (NMR) spectroscopy, and thermodynamic calculations. Mercury intrusion porosimetry and and compressive strength tests assessed the microstructure and mechanical properties of the mixtures of slag and CCR. C-A-S-H gel, ettringite, hemicarbonate, and hydrotalcite were identified as the main phases in the mixture of slag and CCR. The maximum CCR uptake by slag and the highest volume of precipitated solid phases were reached when CCR loading in slag is 7.5% by mass of slag, according to the thermodynamic prediction. This feature is also experimentally observed in the microstructure, which showed an increase in the pore volume at higher CCR loading.

Active Body Pressure Relief System with Time-of-Flight Optical Pressure Sensors for Pressure Ulcer Prevention.

A body pressure relief system was newly developed with optical pressure sensors for pressure ulcer prevention. Unlike a conventional alternating pressure air mattress (APAM), this system automatically regulates air flow into a body supporting mattress with adaptive inflation (or deflation) duration in response to the pressure level in order to reduce skin stress due to prolonged high pressures. The system continuously quantifies the body pressure distribution using time-of-flight (ToF) optical sensors. The proposed pressure sensor, a ToF optical sensor in the air-filled cell, measures changes in surface height of mattress when pressed under body weight, thereby indirectly indicating the interface pressure. Non-contact measurement of optical sensor usually improves the durability and repeatability of the system. The pressure sensor was successfully identified the 4 different-predefined postures, and quantitatively measured the body pressure distribution of them. Duty cycle of switches in solenoid valves was adjusted to 0-50% for pressure relief, which shows that the interface pressure was lower than 32 mmHg for pressure ulcer prevention.

Clinical experience with three-dimensional printing techniques in orthopedic trauma.

BACKGROUND: To report our experiences with the use of three-dimensional (3D) printing in the field of orthopedic trauma. METHODS: This retrospective study enrolled 24 patients from three university teaching hospitals in whom 3D printing technique was applied: 14 patients with acetabular fractures and 10 patients with clavicular shaft fractures. We summarized our experiences with 3D printed bone models. RESULTS: Three-dimensional printed acetabular models improved understanding of complex acetabular anatomy and fracture pattern to plan the optimal positioning of a reduction clamp and the trajectory of screws. Pre-bending of a reconstruction plate could reduce operative time. We also recorded fluoroscopic images of a simulated surgery for percutaneous screw fixation of the acetabular posterior column, with the optimal positioning of the guide wire determined during the simulation used as a reference during the actual operation. This surgical simulation was performed by a resident and served as a helpful training method. For fractures of the clavicle, we identified the optimal position of anatomical plates using 3D printed clavicle models. CONCLUSION: In our experience, 3D printing technique provided surgeons with improved understanding of the fracture pattern and anatomy and was effectively used for preoperative planning, education of surgical trainees, and performing simulations to improve intra-operative technical outcomes.

Ultrasound image based visual servoing for moving target ablation by high intensity focused ultrasound.

BACKGROUND: Although high intensity focused ultrasound (HIFU) is a promising technology for tumor treatment, a moving abdominal target is still a challenge in current HIFU systems. In particular, respiratory-induced organ motion can reduce the treatment efficiency and negatively influence the treatment result. In this research, we present: (1) a methodology for integration of ultrasound (US) image based visual servoing in a HIFU system; and (2) the experimental results obtained using the developed system. MATERIALS AND METHODS: In the visual servoing system, target motion is monitored by biplane US imaging and tracked in real time (40 Hz) by registration with a preoperative 3D model. The distance between the target and the current HIFU focal position is calculated in every US frame and a three-axis robot physically compensates for differences. Because simultaneous HIFU irradiation disturbs US target imaging, a sophisticated interlacing strategy was constructed. RESULTS: In the experiments, respiratory-induced organ motion was simulated in a water tank with a linear actuator and kidney-shaped phantom model. Motion compensation with HIFU irradiation was applied to the moving phantom model. Based on the experimental results, visual servoing exhibited a motion compensation accuracy of 1.7 mm (RMS) on average. Moreover, the integrated system could make a spherical HIFU-ablated lesion in the desired position of the respiratory-moving phantom model. CONCLUSIONS: We have demonstrated the feasibility of our US image based visual servoing technique in a HIFU system for moving target treatment.

Motion compensation for ultrasound thermal imaging using motion-mapped reference model: an in vivo mouse study.

Ultrasound (US)-based thermal imaging is very sensitive to tissue motion, which is a major obstacle to apply US temperature monitoring to noninvasive thermal therapies of in vivo subjects. In this study, we aim to develop a motion compensation method for stable US thermal imaging in in vivo subjects. Based on the assumption that the major tissue motion is approximately periodic caused by respiration, we propose a motion compensation method for change in backscattered energy (CBE) with multiple reference frames. Among the reference frames, the most similar reference to the current frame is selected to subtract the respiratory-induced motions. Since exhaustive reference searching in all stored reference frames can impede real-time thermal imaging, we improve the reference searching by using a motion-mapped reference model. We tested our method in six tumor-bearing mice with high intensity focused ultrasound (HIFU) sonication in the tumor volume until the temperature had increased by 7°C. The proposed motion compensation was evaluated by root-mean-square-error (RMSE) analysis between the estimated temperature by CBE and the measured temperature by thermocouple. As a result, the mean ±SD RMSE in the heating range was 1.1±0.1°C with the proposed method, while the corresponding result without motion compensation was 4.3±2.6°C. In addition, with the idea of motion-mapped reference frame, total processing time to produce a frame of thermal image was reduced in comparison with the exhaustive reference searching, which enabled the motion-compensated thermal imaging in 15 frames per second with 150 reference frames under 50% HIFU duty ratio.

Visual servoing for a US-guided therapeutic HIFU system by coagulated lesion tracking: a phantom study.

BACKGROUND: Applying ultrasound (US)-guided high-intensity focused ultrasound (HIFU) therapy for kidney tumours is currently very difficult, due to the unclearly observed tumour area and renal motion induced by human respiration. In this research, we propose new methods by which to track the indistinct tumour area and to compensate the respiratory tumour motion for US-guided HIFU treatment. METHODS: For tracking indistinct tumour areas, we detect the US speckle change created by HIFU irradiation. In other words, HIFU thermal ablation can coagulate tissue in the tumour area and an intraoperatively created coagulated lesion (CL) is used as a spatial landmark for US visual tracking. Specifically, the condensation algorithm was applied to robust and real-time CL speckle pattern tracking in the sequence of US images. Moreover, biplanar US imaging was used to locate the three-dimensional position of the CL, and a three-actuator system drives the end-effector to compensate for the motion. Finally, we tested the proposed method by using a newly devised phantom model that enables both visual tracking and a thermal response by HIFU irradiation. RESULTS: In the experiment, after generation of the CL in the phantom kidney, the end-effector successfully synchronized with the phantom motion, which was modelled by the captured motion data for the human kidney. The accuracy of the motion compensation was evaluated by the error between the end-effector and the respiratory motion, the RMS error of which was approximately 2 mm. CONCLUSION: This research shows that a HIFU-induced CL provides a very good landmark for target motion tracking. By using the CL tracking method, target motion compensation can be realized in the US-guided robotic HIFU system.

Three-dimensional computer-controlled acoustic pressure scanning and quantification of focused ultrasound.

We propose an automated needle hydrophone-based scanning system to measure high-resolution 3-D acoustic pressure distributions generated by high-intensity focused ultrasound (HIFU). The hardware consists of a host computer, subsystems for HIFU generation, and an oscilloscope to sample the pressure response from a sensor in a water tank. Software was developed to control the hardware subsystems, to search for the initial scan position, and to design the scanning path and volume. A preoperative scanning plan with three perpendicular planes is used to manipulate the position of the HIFU transducer and to automate the acquisition of the spatial acoustic pressure distribution. The post-processing process displays the scanning results, compensates time delays caused by continuous linear scans, and quantifies the focal region. A method to minimize the displacement error induced by the time delay improves the scanning speed of a conventional needle hydrophone-based scanning system. Moreover, a noise-robust, automatic-focus searching algorithm using Gaussian function fitting reduces the total number of iterations and prevents the initial scanning position search from diverging. Finally, the minimum-volume enclosing ellipsoid approximation is used to quantify the size and orientation of the 3-D focal region thresholded by the minimum pressure of interest for various input conditions and to test the reproducibility of the scanning system.