MRI-powered biomedical devices

Magnetic resonance imaging (MRI) is beneficial for imaging-guided procedures because it provides higher resolution images and better soft tissue contrast than computed tomography (CT), ultrasound, and X-ray. MRI can be used to streamline diagnostics and treatment because it does not require patients to be repositioned between scans of different areas of the body. It is even possible to use MRI to visualize, power, and control medical devices inside the human body to access remote locations and perform minimally invasive procedures. Therefore, MR conditional medical devices have the potential to improve a wide variety of medical procedures; this potential is explored in terms of practical considerations pertaining to clinical applications and the MRI environment. Recent advancements in this field are introduced with a review of clinically relevant research in the areas of interventional tools, endovascular microbots, and closed-loop controlled MRI robots. Challenges related to technology and clinical feasibility are discussed, including MRI based propulsion and control, navigation of medical devices through the human body, clinical adoptability, and regulatory issues. The development of MRI-powered medical devices is an emerging field, but the potential clinical impact of these devices is promising.     

Spectrally encoded fiber-based structured lighting probe for intraoperative 3D imaging

Three dimensional quantification of organ shape and structure during minimally invasive surgery (MIS) could enhance precision by allowing the registration of multi-modal or pre-operative image data (US/MRI/CT) with the live optical image. Structured illumination is one technique to obtain 3D information through the projection of a known pattern onto the tissue, although currently these systems tend to be used only for macroscopic imaging or open procedures rather than in endoscopy. To account for occlusions, where a projected feature may be hidden from view and/or confused with a neighboring point, a flexible multispectral structured illumination probe has been developed that labels each projected point with a specific wavelength using a supercontinuum laser. When imaged by a standard endoscope camera they can then be segmented using their RGB values, and their 3D coordinates calculated after camera calibration. The probe itself is sufficiently small (1.7 mm diameter) to allow it to be used in the biopsy channel of commonly used medical endoscopes. Surgical robots could therefore also employ this technology to solve navigation and visualization problems in MIS, and help to develop advanced surgical procedures such as natural orifice translumenal endoscopic surgery.     

Current state of apheresis technology and its applications

Apheresis is at the forefront of therapeutic approaches for an increasing number of indications caused by formation of pathologic antibodies treated by therapeutic plasma exchange, or through the use of red cell exchanges to overcome complications secondary to sickle cell crises. Likewise, the number of hematopoietic stem cell transplants has continued to grow annually and this is the direct result of the expansion of apheresis collections. Over the years a number of apheresis platforms have been utilized, but as one of the oldest and most widely used systems, the COBE Spectra, has ceased to be used therapeutically and at blood centers for donations there is an active search to find suitable systems that will replace it and have the versatility to perform as many procedures as possible. Computer innovations have made it possible with current apheresis technology to obtain more real-time information of the procedure which permits the operator to adjust parameters not only to optimize the specific procedure but also to safeguard against potential adverse events. The focus of this review is to go over available clinical data describing the operation, outcomes and applications of apheresis platforms, and discuss those systems that are likely to meet clinical demands and those of blood donation centers.     

Strategies to overcome barriers to pneumococcal vaccination in older adults: an integrative review

Health care systems and policy changes have been critical in increasing pneumococcal vaccination rates to current levels. Still, numerous barriers to immunization persist. To assist clinicians caring for older adults, an integrative review of the literature was performed to examine interventions demonstrating efficacy in office settings. Within the 11 studies reviewed, immunization rates increased consistently when health care systems supported organizational changes in clinical procedures and staffing. Data supporting the use of provider reminders were inconsistent, but the availability of information technology to generate reminders and access clinical guidelines modestly increased vaccination rates. Patient reminders (telephone or mail) demonstrated efficacy in multiple studies. Not surprisingly, the literature also supported the nurse's role in enhancing vaccination rates. Findings of this review support the need for sustained organizational change; implications for clinical practice are apparent. Advanced practice nurses can assume leadership roles within change processes as the nation transitions to electronic medical records.     

Navigated CT-guided interventions.

Diagnostic and therapeutic CT- guided percutaneous interventions are clinical routine in interventional radiology. Image-guided navigation systems visualize the internal anatomy during interventions in real time not necessitating continuous image acquisition. Although multiple 3D image-guidance devices have been developed and used by several surgical disciplines in the last few years, they have not yet been fully applied by the interventional radiologist. The aim of this article is to review the currently performed methods of CT-guided percutaneous interventions and to discuss the potential benefits of newly developed 3D- navigation systems.     

PCaGuard: A Software Platform to Support Optimal Management of Prostate Cancer

Background and Objective  Prostate cancer (PCa) is a severe public health issue and the most common cancer worldwide in men. Early diagnosis can lead to early treatment and long-term survival. The addition of the multiparametric magnetic resonance imaging in combination with ultrasound (mpMRI-U/S fusion) biopsy to the existing diagnostic tools improved prostate cancer detection. Use of both tools gradually increases in every day urological practice. Furthermore, advances in the area of information technology and artificial intelligence have led to the development of software platforms able to support clinical diagnosis and decision-making using patient data from personalized medicine. Methods  We investigated the current aspects of implementation, architecture, and design of a health care information system able to handle and store a large number of clinical examination data along with medical images, and produce a risk calculator in a seamless and secure manner complying with data security/accuracy and personal data protection directives and standards simultaneously. Furthermore, we took into account interoperability support and connectivity to legacy and other information management systems. The platform was implemented using open source, modern frameworks, and development tools. Results  The application showed that software platforms supporting patient follow-up monitoring can be effective, productive, and of extreme value, while at the same time, aiding toward the betterment medicine clinical workflows. Furthermore, it removes access barriers and restrictions to specialized care, especially for rural areas, providing the exchange of medical images and patient data, among hospitals and physicians. Conclusion  This platform handles data to estimate the risk of prostate cancer detection using current state-of-the-art in eHealth systems and services while fusing emerging multidisciplinary and intersectoral approaches. This work offers the research community an open architecture framework that encourages the broader adoption of more robust and comprehensive systems in standard clinical practice.     

Navigated CT‐guided interventions

Diagnostic and therapeutic CT‐ guided percutaneous interventions are clinical routine in interventional radiology. Image‐guided navigation systems visualize the internal anatomy during interventions in real time not necessitating continuous image acquisition. Although multiple 3D image‐guidance devices have been developed and used by several surgical disciplines in the last few years, they have not yet been fully applied by the interventional radiologist. The aim of this article is to review the currently performed methods of CT‐guided percutaneous interventions and to discuss the potential benefits of newly developed 3D‐ navigation systems.     

计算机辅助前交叉韧带重建系统改善重建效果的作用

学术背景：计算机辅助外科手术技术已经应用于矫形和创伤外科的诸多领域。近年来,多种计算机导航系统已经被开发用于关节镜下的前交叉韧带重建手术。目的：探讨几种常用的计算机导航手术系统,在改善前交叉韧带重建结果的作用。检索策略：由该论文的研究人员检索PubMed数据库1998-09/2007-09的与导航下前交叉韧带重建相关文献,检索词“navigation,anterior cuciate ligament,reconstruction”,并限定文章语言种类为English。同时,检索计算机辅助骨科手术的有关出版物。共检索到47篇文献,对资料进行初审,纳入标准：①计算机辅助关节镜下前交叉韧带重建手术技术密切相关。②同一领域选择近期发表或在权威杂志上发表的文章。排除标准：重复性研究。文献评价：文献的来源主要是关于计算机辅助关节镜下前交叉韧带重建技术和相关手术系统的应用研究。所选用的38篇文献中,8篇为综述或会议文章,其余30篇均为临床或基础实验研究。资料综合：①尽管现有的关节镜下前交叉韧带重建技术已经取得很好的疗效,但还有一些技术局限性有待改善。②计算机辅助系统特有的精确性、可靠性、安全性和可重复性在矫形和创伤的诸多领域都有应用,并取得了良好的效果。③研究表明,计算机辅助系统通过三维的可视化定位装置,提高了隧道定位的精确度;按照解剖和等距参数,避免了移植腱与股骨髁间窝切迹的撞击,实现了适合于患者个体化的前交叉韧带的准确定位植入。④与提高前交叉韧带重建临床效果有关的新观念,促进了新的计算机辅助系统的开发和改良。结论：计算机辅助手术系统可以改善手术的精确度和可靠性,满足了改善临床结果的要求。     

数字化医学技术与脊柱外科的临床应用

背景：随着现代科学技术尤其是计算机技术和医学技术的迅猛发展,现代脊柱外科进入了一个崭新的时代,呈现出数字化、个性化、显微化、精确化和人工智能化的发展趋势。 目的：探讨数字化技术在脊柱外科中的应用研究进展。 方法：义乖检索词为“脊椎（spine）：腰椎（1umbar）;颈椎（cervical）;数字化（digitization）;脊柱外科（spinaIsurgery）;数‘弘骨科学（digitalorthopedics）;订限元模型（thefiniteelementmodel）：计算机辅助设计（computerassisteddesign,CAD）;微创技术（minimallyinvasivetechnology）;二维重建（threedimensionsreconstruction,3D）：CT：磁八振成像（MRI）：计锋机仿真（computeremulation）;内窥镜（endoscope）：椎间柱（intervertebraldisc）：绛戍内窥镜激光椎间鼎切除术（percutaneousendoscopiclaser-assisteddiscectomy,PELD）”,对有限元、计算机导航技术、微创技术以及医学影像在脊柱外科中的应用文献进行深入分忻,探讨数字化脊柱外科手术的特点,临床效果以及安全性。结果与结论：数字化医学在有限元模型、计算机导航技术、微创技术、医学影像等领域研究进展的基础上,建立独特的脊柱外科新方法,并将其广泛应用于临床骨科。有限元模型最大的优势在于町以反映集体内部的应力变化情况,有限元分析应用于医学生物力学后,取得了很_人的进步与发展。计算机导航技术的：【作原理是利用数字化影像信息通过媒介体输入计算机工作站,经运算处理后重建三维模型影像,通过相关软件,在此影像基础上进行术前计划并模拟进程,通过高解像度的显示屏从各个方位观察到当前的手术入路以及各种参数,完成微创手术。微创脊柱外科采用微小切口或穿刺通道,运用特殊的器械或装置在影像仪器监视下或导航技术的引导下进行于术。医学影像分析作为信息科学技术为基础的交叉学科研究,对脊柱外科的临床诊断和观察具有参考价值。数字化医学高效率、高精度、二维立体地了解疾病的分布、形态、结构,最大程度减少手术创伤,在脊柱外科应用中的前景广阔。     

A Sense of Urgency: Integrating Technology and Informatics in Advance Practice Nursing Education

Health care is embracing technology and informatics systems that support documenting assessment findings, evaluating diagnostic labs and procedures, ordering medical tests, and coding for billing. Although advanced practice nurses possess these essential skills, are they adequately prepared to utilize this technology? In this article, we explore the external forces and current trends driving the use of informatics in health care and the need to integrate this content into the advanced practice nursing education curriculum. Kotter’s sense-of-urgency framework demonstrates the integration of technology into an existing advanced practice nursing curriculum. A hypothetical advanced practice nursing program incorporating technology into specific courses is presented.     

A fluorolaser navigation system to guide linear surgical tool insertion

Purpose

Conventional navigation systems for minimally invasive orthopedic surgery require a secondary monitor to display guidance information generated with CT or MRI images. Newer systems use augmented reality to project surgical plans into binocular glasses. These surgical procedures are often mentally challenging and cumbersome to perform.

Method

A comprehensive surgical navigation system for direct guidance while minimizing radiation exposure was designed and built. System accuracy was evaluated using in vitro needle insertion experiments. The fluoroscopic-based navigation technique is combined with an existing laser guidance technique. As a result, the combined system is capable of surgical planning using two or more X-ray images rather than CT or MRI scans. Guidance information is directly projected onto the patient using two laser beams and not via a secondary monitor.

Results

We performed 15 in vitro needle insertion experiments as well as 6 phantom pedicle screw insertion experiments to validate navigation system accuracy. The planning accuracy of the system was found to be 2.32?mm and 2.28°, while its overall guidance accuracy was found to be 2.40?mm and 2.39°. System feasibility was demonstrated by successfully performing percutaneous pin insertion on phantoms.

Conclusion

Quantitative and qualitative evaluations of the fluorolaser navigation system show that it can support accurate guidance and intuitive surgical tool insertion procedures without preoperative 3D image volumes and registration processes.     

Governance Strategies for Conducting Text Messaging Interventions in Clinical Research

There is increasing interest in medical text messaging interventions being used to achieve positive patient outcomes across a range of clinical research and health practice environments. Short messaging service (SMS) is a low‐cost tool that provides an easy communication route to engage potentially broad populations through text messaging, and is part of the growing social trend toward increased adoption of personal communication technologies by patient populations. Testing the effectiveness and impact of various communication strategies requires navigation of a complex web of clinical and research regulations and oversight mechanisms. We describe a case study of the implementation of SMS to provide bidirectional communications between physicians and patients involved in routine care reminders to illustrate the review processes and governance structures needed. By mapping the regulatory and approval processes required to manage and steward a research study across clinical and community boundaries, we provide a guide for other translational health researchers who may utilize similar kinds of personally owned technology interventions as research tools.     

Combination of the Archimedes Navigation System and cryobiopsy in diagnosis of diffuse lung disease

ObjectiveTo evaluate the efficacy of the Archimedes Navigation System (Broncus Medical, San Jose, CA, USA) for guidance during transbronchial cryobiopsy and the incidence of complications in patients with diffuse lung disease.MethodsHigh-resolution computed tomography and transbronchial cryobiopsy were used to evaluate eight patients with diffuse lung disease. The Archimedes Navigation System was used before cryobiopsy to obtain the best path with which to avoid large vessels. Three to five cryobiopsy specimens were taken from each sampled segment.ResultsPreoperative planning using the Archimedes Navigation System was successfully performed on all eight patients. The probe-to-pleura distance was approximately 10 mm. No cases of pneumothorax occurred, one patient developed moderate bleeding, two developed minor bleeding, and five developed minimal bleeding that stopped spontaneously. A final diagnosis was obtained for seven patients, and ongoing follow-up was being conducted for the last patient at the time of this writing.ConclusionsThis is the first report of combining navigation technology with cryobiopsy to diagnose diffuse lung disease. The Archimedes Navigation System, which provides real-time guidance, is helpful in pre-cryobiopsy planning and diagnosis of diffuse lung disease. Moreover, this system can reduce the pneumothorax rate and bleeding risk by avoiding large vessels.     

Robotic systems for percutaneous needle-guided interventions

Several groups have developed robotic systems for invasive medical procedures. In this article we will focus on selected robotic systems for percutaneous needle-guided interventions using CT or MR imaging. We present six interventional robotic systems designed to work with imaging modalities such as CT, Cone-beam CT and MRI. The details of each system are given along with any phantom, animal, or human trials performed with each particular robot. Although each of these systems has specific features, they are all of great clinical value since they provide very stable needle guidance -- even for angulated approaches, they may allow access to lesions when the width of the CT- or MR- gantry would limit the access for a biopsy needle or other interventional tools such as thermal ablation probes. Then, such a robot may be able to guide the needle into the most promising region of the lesion without the need for a second contrast injection. Thus, more efficacious characterization and treatment, particularly for lesions that are difficult to target, can be anticipated. Although more research and clinical trials are certainly needed, it is, however, our belief that robotic systems will be an important part of future interventions.     

数字及逆向工程技术在复杂骨科应用进展

背景：医学数据可视化技术的快速发展及不断对医学领域地渗透,尤其使脊柱外科在诊断和治疗上发生了根本性地改变,朝着＂精确化、个性化、微创化＂方向发展,已成为临床骨科治疗中不可或缺的重要手段。目的：通过对数字技术在复杂骨科应用进展,明确研究突破口。方法：由第一作者在PubMed数据库、万方数据库、维普数据、中国知网库检索,时间范围为1990/2011。检索词为＂个性化的定位导航模板,数字解剖模型,螺钉内固定术,逆向工程技术,快速成型技术＂。纳入标准为导航模板制备工艺及技术的研究、有限元相关理论的研究、实验及临床应用。排除标准为与此文目的无关、较陈旧的文献和重复同类研究。结果与结论：利用数字化技术重建的导航模板为骨科螺钉内固定的定位、定向固定提供了一种新的方法。通过数字化重建技术可以制作个体化导航模板,将模板紧密贴合于相应的解剖结构上进行导航穿刺,即可完成对术区的准确定位和定向。对复杂骨科手术,尤其是解剖结构畸形变的患者有着不可替代的意义。为临床手术设计奠定良好的基础,提高准确性和安全性。     

Toward Fluoro-Free Interventions: Using Radial Intracardiac Ultrasound for Vascular Navigation

Transcatheter cardiovascular interventions have the advantage of patient safety, reduced surgery time and minimal trauma to the patient's body. Transcathether interventions, which are performed percutaneously, are limited by the lack of direct line of sight with the procedural tools and the patient anatomy. Therefore, such interventional procedures rely heavily on image guidance for navigating toward and delivering therapy at the target site. Vascular navigation via the inferior vena cava, from the groin to the heart, is an imperative part of most transcatheter cardiovascular interventions including heart valve repair surgeries and ablation therapy. Traditionally, the inferior vena cava is navigated using fluoroscopic techniques such as venography and computed tomography venography. These X-ray–based techniques can have detrimental effects on the patient as well as the surgical team, causing increased radiation exposure, leading to risk of cancer, fetal defects and eye cataracts. The use of a heavy lead apron has also been reported to cause back pain and spine issues, thus leading to interventionalist's disc disease. We propose the use of a catheter-based ultrasound augmented with electromagnetic tracking technology to generate a vascular roadmap in real time and perform navigation without harmful radiation. In this pilot study, we used spatially tracked intracardiac echocardiography to reconstruct a vessel from a phantom in a 3-D virtual environment. We illustrate how the proposed ultrasound-based navigation will appear in a virtual environment, by navigating a tracked guidewire within the vessels in the phantom without any radiation-based imaging. The geometric accuracy is assessed using a computed tomography scan of the phantom, with a Dice coefficient of 0.79. The average distance between the surfaces of the two models comes out to be 1.7 ± 1.12 mm.     

Recovering the X-ray projection geometry for three-dimensional tomographic reconstruction with additional sensors: attached camera versus external navigation system

Three-dimensional tomographic reconstruction using intra-operative mobile C-arms could provide physicians with new and exciting tools for image-guided surgery. Recovery of the projection geometry of mobile X-ray systems is a crucial step for such reconstruction procedures. Recent work on medical imaging describes the use of optical or electro-magnetic sensor systems in order to navigate surgical instruments. These systems can also be used for the estimation of C-arm motion, and therefore for the recovery of the projection geometry of the X-ray C-arm. In this case, the mathematical problem that needs to be solved is equivalent to the hand-eye calibration well studied by both the computer vision and robotics community. We first study the recovery of the motion and projection geometry using five different hand-eye calibration methods proposed in the literature. The optical navigation system POLARIS from Northern Digital Inc. was used in our experiments. The results of the estimated motion and projection geometry using the five hand-eye calibration methods are compared with the same results obtained using an off-the-shelf CCD camera attached to the mobile C-arm. The experimental results include three-dimensional tomographic reconstruction results using our mobile C-arm. We show that even though the motion of the C-arm is more precisely recovered using the navigation system, the projection geometry is better estimated using the attached CCD camera.     

Image fusion and navigation platforms for percutaneous image-guided interventions

Image-guided interventional procedures, particularly image guided biopsy and ablation, serve an important role in the care of the oncology patient. The need for tumor genomic and proteomic profiling, early tumor response assessment and confirmation of early recurrence are common scenarios that may necessitate successful biopsies of targets, including those that are small, anatomically unfavorable or inconspicuous. As image-guided ablation is increasingly incorporated into interventional oncology practice, similar obstacles are posed for the ablation of technically challenging tumor targets. Navigation tools, including image fusion and device tracking, can enable abdominal interventionalists to more accurately target challenging biopsy and ablation targets. Image fusion technologies enable multimodality fusion and real-time co-displays of US, CT, MRI, and PET/CT data, with navigational technologies including electromagnetic tracking, robotic, cone beam CT, optical, and laser guidance of interventional devices. Image fusion and navigational platform technology is reviewed in this article, including the results of studies implementing their use for interventional procedures. Pre-clinical and clinical experiences to date suggest these technologies have the potential to reduce procedure risk, time, and radiation dose to both the patient and the operator, with a valuable role to play for complex image-guided interventions.