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Engineering Research Center for Computer Integrated Surgical Systems and Technology1 600.445 Fall 2006Copyright © R. H. Taylor
Applications of Simulation, Morphometrics and
Robotics in Craniofacial Surgery
C. B. Cutting, F. L. Bookstein
R. H. Taylor
In Computer-Integrated Surgery, R. H. Taylor, S. Lavallee, G. Burdea
and R. Mosges, Eds. Cambridge, Mass.: MIT Press, 1996, pp. 641-662.
Click here for preop/postop pictures
Engineering Research Center for Computer Integrated Surgical Systems and Technology2 600.445 Fall 2006Copyright © R. H. Taylor
GOALS• Computer-assisted planning
of craniofacial osteotomies based on optimal approximation to “normal”(i.e., average) skull shape
• Accurate intraoperative tracking and 6-dof positioning of bone fragments
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Engineering Research Center for Computer Integrated Surgical Systems and Technology3 600.445 Fall 2006Copyright © R. H. Taylor
Engineering Research Center for Computer Integrated Surgical Systems and Technology4 600.445 Fall 2006Copyright © R. H. Taylor
Cut and Move Simulators
C. B. Cutting, F. L. Bookstein and R. H. Taylor, "Applications of Simulation, Morphometrics and Robotics in Craniofacial Surgery," in Computer-Integrated Surgery, R. H. Taylor, S. Lavallee, G. Burdea and R. Mosges, Eds. Cambridge, Mass.: MIT Press, 1996, pp. 641-662.
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Engineering Research Center for Computer Integrated Surgical Systems and Technology5 600.445 Fall 2006Copyright © R. H. Taylor
Cut and Move Simulators
C. B. Cutting, F. L. Bookstein and R. H. Taylor, "Applications of Simulation, Morphometrics and Robotics in Craniofacial Surgery," in Computer-Integrated Surgery, R. H. Taylor, S. Lavallee, G. Burdea and R. Mosges, Eds. Cambridge, Mass.: MIT Press, 1996, pp. 641-662.
Engineering Research Center for Computer Integrated Surgical Systems and Technology6 600.445 Fall 2006Copyright © R. H. Taylor
Cut and Move Simulators
[R. A. Robb and D. P. Hanson, "The ANALYZE software system for visualization and analysis in surgery simulation," in Computer Integrated Surgery, E. S. Lavallee, R. Taylor, G. Burdea and R. Mosges, Eds.: MIT Press, 1996, pp. 175-189.
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Engineering Research Center for Computer Integrated Surgical Systems and Technology7 600.445 Fall 2006Copyright © R. H. Taylor
Physical Simulators: Rapid Prototyping
L. Klimek, H.-M. Klein and R. Mosges, "Simulation of Surgical Procedures in the Craniofacial Region," in Computer-Integrated Surgery, R. H. Taylor, S. Lavallee, G. Burdea and R. Mosges, Eds. Cambridge, Mass.: MIT PRess, 1996, pp. 663-669..
Engineering Research Center for Computer Integrated Surgical Systems and Technology8 600.445 Fall 2006Copyright © R. H. Taylor
Video Simulators
L. Klimek, H.-M. Klein and R. Mosges, "Simulation of Surgical Procedures in the Craniofacial Region," in Computer-Integrated Surgery, R. H. Taylor, S. Lavallee, G. Burdea and R. Mosges, Eds. Cambridge, Mass.: MIT PRess, 1996, pp. 663-669..
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Engineering Research Center for Computer Integrated Surgical Systems and Technology9 600.445 Fall 2006Copyright © R. H. Taylor
The ridge curves of the face
Courtesy: Court Cutting
Engineering Research Center for Computer Integrated Surgical Systems and Technology10 600.445 Fall 2006Copyright © R. H. Taylor
Courtesy: Court Cutting
Dr. Cutting’s map of the face
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Engineering Research Center for Computer Integrated Surgical Systems and Technology11 600.445 Fall 2006Copyright © R. H. Taylor
Computer mesh corresponding to Dr.
Cutting’s map
• Point landmarks• Ridge curves• Additional curves along
geodesic lines between landmarks
• Triangular and quadrangular patches
• Take this data for many patients and average to make atlas
Engineering Research Center for Computer Integrated Surgical Systems and Technology12 600.445 Fall 2006Copyright © R. H. Taylor
Click here for digression on skull averaging
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Engineering Research Center for Computer Integrated Surgical Systems and Technology13 600.445 Fall 2006Copyright © R. H. Taylor
Distance!
Fitting Error for Landmark Points
Engineering Research Center for Computer Integrated Surgical Systems and Technology14 600.445 Fall 2006Copyright © R. H. Taylor
Fitting Error for Ridge Curves
Area!
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Engineering Research Center for Computer Integrated Surgical Systems and Technology15 600.445 Fall 2006Copyright © R. H. Taylor
Fitting Error for Surfaces
Volume!
Engineering Research Center for Computer Integrated Surgical Systems and Technology16 600.445 Fall 2006Copyright © R. H. Taylor
Optimization
Given models bone fragments corresponding to parts of an ideal skull, the computer minimizes a weighted sum of these three distance metrics
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Engineering Research Center for Computer Integrated Surgical Systems and Technology17 600.445 Fall 2006Copyright © R. H. Taylor
Engineering Research Center for Computer Integrated Surgical Systems and Technology18 600.445 Fall 2006Copyright © R. H. Taylor
Automated Osteotomy Ranking
• Computer plans all common osteotomies
• Computer optimizes bone fragment motion and computes error score
• Systematically remove osteotomy lines one at a time in score order. Re-optimize positions and rescore
• Show clinician the plans• Clinician picks desired plan
and further refines based on anatomical/clinical knowledge
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Engineering Research Center for Computer Integrated Surgical Systems and Technology19 600.445 Fall 2006Copyright © R. H. Taylor
Engineering Research Center for Computer Integrated Surgical Systems and Technology20 600.445 Fall 2006Copyright © R. H. Taylor
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Engineering Research Center for Computer Integrated Surgical Systems and Technology21 600.445 Fall 2006Copyright © R. H. Taylor
Engineering Research Center for Computer Integrated Surgical Systems and Technology22 600.445 Fall 2006Copyright © R. H. Taylor
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Engineering Research Center for Computer Integrated Surgical Systems and Technology23 600.445 Fall 2006Copyright © R. H. Taylor
Surgical Execution
Engineering Research Center for Computer Integrated Surgical Systems and Technology24 600.445 Fall 2006Copyright © R. H. Taylor
Tripartite Osteotomies
• Proposed by Converse in 1971 to improve flexibility in shaping the midface.
• Abandoned due to technical difficulty of fragment positioning and fixation
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Engineering Research Center for Computer Integrated Surgical Systems and Technology25 600.445 Fall 2006Copyright © R. H. Taylor
Cutting and Grayson Technique: Inter-occlusal stents
Engineering Research Center for Computer Integrated Surgical Systems and Technology26 600.445 Fall 2006Copyright © R. H. Taylor
First Move
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Engineering Research Center for Computer Integrated Surgical Systems and Technology27 600.445 Fall 2006Copyright © R. H. Taylor
Second Move
Engineering Research Center for Computer Integrated Surgical Systems and Technology28 600.445 Fall 2006Copyright © R. H. Taylor
Third Move
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Engineering Research Center for Computer Integrated Surgical Systems and Technology29 600.445 Fall 2006Copyright © R. H. Taylor
Enter robotics …
• Surgeon did notwant help in making the cuts.
• Surgeon did want help in positioning and holding the bone fragments
• Robots can do this
Engineering Research Center for Computer Integrated Surgical Systems and Technology30 600.445 Fall 2006Copyright © R. H. Taylor
But there were some minor concerns …
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Engineering Research Center for Computer Integrated Surgical Systems and Technology31 600.445 Fall 2006Copyright © R. H. Taylor
Our approach: navigation + passive manipulation aid
Engineering Research Center for Computer Integrated Surgical Systems and Technology32 600.445 Fall 2006Copyright © R. H. Taylor
Optical tracking: NDI Optotrak
Accurate (±0.1 mm) tracking of infrared LED markers over approx 1 m3 workspace
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Engineering Research Center for Computer Integrated Surgical Systems and Technology33 600.445 Fall 2006Copyright © R. H. Taylor
Engineering Research Center for Computer Integrated Surgical Systems and Technology34 600.445 Fall 2006Copyright © R. H. Taylor
Passive Manipulation Aid
• LED markers on adjustable manipulation aid, pointer, and patient skull
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Engineering Research Center for Computer Integrated Surgical Systems and Technology35 600.445 Fall 2006Copyright © R. H. Taylor
Passive Manipulation Aid
• Adjustable surgical clamp holds bone forceps
• Six DOF motion with hand-set brakes
• Remote center-of-motion with iso-center in bone
Engineering Research Center for Computer Integrated Surgical Systems and Technology36 600.445 Fall 2006Copyright © R. H. Taylor
Assembled system
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Engineering Research Center for Computer Integrated Surgical Systems and Technology37 600.445 Fall 2006Copyright © R. H. Taylor
• Computer tracked position of tool optically
• Electric particle brake set when reached target
• Computer played tone to give audible feedback when got close to alignment
Brake
OptotrakRigid Bodies
Possible refinement: computer set brakes with audible feedback cue
Engineering Research Center for Computer Integrated Surgical Systems and Technology38 600.445 Fall 2006Copyright © R. H. Taylor
Possible refinement: computer set brakes with audible feedback cue
Results• Were able to achieve
very good alignments (sub-mm)
• Very tedious to use– Brake was too slow– No “d-tent” effect
Brake
OptotrakRigid Bodies
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Engineering Research Center for Computer Integrated Surgical Systems and Technology39 600.445 Fall 2006Copyright © R. H. Taylor
On to clinical use …• For legal reasons, the
IBM hardware was not used clinically.
• Dr. Cutting was able to re-implement the tracking system using a PIXSYS optical tracker
• First case encountered equipment difficulties and was completed manually
PIXSYS (hung from ceiling)
Engineering Research Center for Computer Integrated Surgical Systems and Technology40 600.445 Fall 2006Copyright © R. H. Taylor
2nd Clinical Case
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Engineering Research Center for Computer Integrated Surgical Systems and Technology41 600.445 Fall 2006Copyright © R. H. Taylor
2nd Clinical Case
• Patient had radiation therapy at relatively early age
• As a result bone around one eye socket failed to grow properly
• Goal was to fix this defect
Engineering Research Center for Computer Integrated Surgical Systems and Technology42 600.445 Fall 2006Copyright © R. H. Taylor
2nd Clinical Case
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Engineering Research Center for Computer Integrated Surgical Systems and Technology43 600.445 Fall 2006Copyright © R. H. Taylor
2nd Clinical Case
Engineering Research Center for Computer Integrated Surgical Systems and Technology44 600.445 Fall 2006Copyright © R. H. Taylor
2nd Clinical Case
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Engineering Research Center for Computer Integrated Surgical Systems and Technology45 600.445 Fall 2006Copyright © R. H. Taylor
2nd Clinical Case
Engineering Research Center for Computer Integrated Surgical Systems and Technology46 600.445 Fall 2006Copyright © R. H. Taylor
2nd Clinical Case
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Engineering Research Center for Computer Integrated Surgical Systems and Technology47 600.445 Fall 2006Copyright © R. H. Taylor
2nd Clinical Case: User Interface
Ergonomics!!!
Engineering Research Center for Computer Integrated Surgical Systems and Technology48 600.445 Fall 2006Copyright © R. H. Taylor
2nd Clinical Case: Display
Rendering
AlignmentIndicators
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Engineering Research Center for Computer Integrated Surgical Systems and Technology49 600.445 Fall 2006Copyright © R. H. Taylor
2nd Clinical Case: Display
• Full 3D display
Engineering Research Center for Computer Integrated Surgical Systems and Technology50 600.445 Fall 2006Copyright © R. H. Taylor
2nd Clinical Case: Display
• Full 3D display• Bone fragments
+ slider bars to show alignment
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Engineering Research Center for Computer Integrated Surgical Systems and Technology51 600.445 Fall 2006Copyright © R. H. Taylor
2nd Clinical Case: Display
• Full 3D display• Bone fragments
+ slider bars to show alignment
• Axes + slider bars to show alignment