The analysis of medical images has been woven into the fabric of the pattern analysis and machine intelligence (PAMI) community since the earliest days of these Transactions. Initially, the efforts in this area were seen as applying pattern analysis and computer vision techniques to another interesting dataset. However, over the last two to three decades, the unique nature of the problems presented within this area of study have led to the development of a new discipline in its own right. Examples of these include: the types of image information that are acquired, the fully three-dimensional image data, the nonrigid nature of object motion and deformation, and the statistical variation of both the underlying normal and abnormal ground truth. In this paper, we look at progress in the field over the last 20 years and suggest some of the challenges that remain for the years to come.

https://hal.inria.fr/inria-00615100/document

Medical image analysis: progress over two decades and the challenges ahead

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140673607604577.pdf

The operation of the century: total hip replacement

This paper provides a broad overview of medical robot systems used in surgery. After introducing basic concepts of computer-integrated surgery, surgical CAD/CAM, and surgical assistants, it discusses some of the major design issues particular to medical robots. It then illustrates these issues and the broader themes introduced earlier with examples of current surgical CAD/CAM and surgical assistant systems. Finally, it provides a brief synopsis of current research challenges and closes with a few thoughts on the research/industry/clinician teamwork that is essential for progress in the field.

/pdf/medical-robotics-in-computer-integrated-surgery-551rsaf1dd.pdf

Medical robotics in computer-integrated surgery

A robot system for use in surgical procedures has two movable arms each carried on a wheeled base with each arm having a six of degrees of freedom of movement and an end effector which can be rolled about its axis and an actuator which can slide along the axis for operating different tools adapted to be supported by the effector. Each end effector including optical force sensors for detecting forces applied to the tool by engagement with the part of the patient. A microscope is located at a position for viewing the part of the patient. The position of the tool tip can be digitized relative to fiducial markers visible in an MRI experiment. The workstation and control system has a pair of hand-controllers simultaneously manipulated by an operator to control movement of a respective one or both of the arms. The image from the microscope is displayed on a monitor in 2D and stereoscopically on a microscope viewer. A second MRI display shows an image of the part of the patient the real-time location of the tool. The robot is MRI compatible and can be configured to operate within a closed magnet bore. The arms are driven about vertical and horizontal axes by piezoelectric motors.

Microsurgical robot system

A surgical apparatus includes a surgical device, configured to be manipulated by a user to perform a procedure on a patient, and a computer system. The computer system is programmed to implement control parameters for controlling the surgical device to provide at least one of haptic guidance to the user and a limit on user manipulation of the surgical device, based on a relationship between an anatomy of the patient and at least one of a position, an orientation, a velocity, and an acceleration of a portion of the surgical device, and to adjust the control parameters in response to movement of the anatomy during the procedure.

Haptic guidance system and method

KneeNavTMACL, a CT-based surgical navigation system, is used to demonstrate two fundamental requirements for a practical computer-assisted surgical device: 1) it can guide the surgeon with the accuracy required for successful graft placement, and 2) this guidance can be achieved through a simple and intuitive interface. A series of ACL reconstruction preparation procedures were performed on foambone models using traditional arthroscopic techniques. Half of the procedures were done using conventional techniques, the other half were performed with KneeNavTMACL guidance. Resulting tunnel and femoral graft site locations were measured via radiographic and computer means, and the two techniques are compared. Ease of system use is also assessed.

/pdf/a-computer-assisted-acl-reconstruction-system-assessment-of-4hqcp99lcw.pdf

A Computer-Assisted ACL Reconstruction System Assessment of Two Techniques of Graft Positioning in ACL Reconstruction

Augmented reality is a display technique that combines supplemental information with the real world environment. Augmented reality systems are on the verge of being used everyday in medical training, preoperative planning, preoperative and intraoperative data visualization, and intraoperative tool guidance. The basic technologies of augmented reality are discussed, augmented reality systems currently being used in the medical domain are examined, and some future uses of these systems in orthopaedic applications are explored.

Augmented reality and its future in orthopaedics : Computer assisted orthopaedic surgery: Medical robotics and image guided surgery

Background: Rehabilitation plays an important role to improve the outcomes of total knee arthroplasty (TKA). Evidence about the appropriate dose of exercise to recover gait dysfunction after TKA is limited. We posed the research question: In patients during the post-acute stage after TKA, is increased dose of exercise associated with larger improvements in gait parameters such as step length and single support time?
Methods: This was a secondary analysis from two randomized studies on exercise after TKA to investigate dosedependence of gait parameters in response to exercise. Participants were 50 years or older who underwent unilateral TKA at least two months prior. They participated in 2 months of supervised exercises followed by 4 months of a home exercise program. The primary outcome was change in gait parameters from baseline to 6 months. Participants were divided in three groups according to the dose of exercise: group 1 (light-to-moderate intensity exercise), group 2 (high intensity + functional exercise), and group 3 (high intensity + functional + balance exercise). Jonckheere-Terpstra test was used to test if the magnitude of changes in gait parameters increased from group 1 to group 3 in an ordered fashion.
Results: Increased dose of exercise was associated with progressive increases in step length in the operatedlimb (p=0.008) and decreases in step length in the non-operated limb (p=0.011). Increased dose of exercise was associated with ordinal decreases in loading response time (p=0.049) and increases in single-leg support time (p=0.021) on the operated- limb, but not on the non-operated-limb. Increased dose of exercise was associated with decreases in unloading time on the non-operated-limb (p=0.011) but not on the operated-limb (p=0.400).
Conclusions: Significant dose-response of exercise on gait parameters support the promotion of more intensive exercise programs that combine functional and balance training programs after TKA.

https://www.longdom.org/open-access/doseassociated-changes-in-gait-parameters-in-response-to-exerciseprograms-after-total-knee-arthroplasty-secondary-analysis-of-tworandomized-studies-2329-9096-1000311.pdf

Dose-Associated Changes in Gait Parameters in Response to Exercise Programs after Total Knee Arthroplasty: Secondary Analysis of Two Randomized Studies.

Background Diagnosis of adverse local tissue reaction (ALTR) in metal-on-polyethylene (MoP) total hip arthroplasty (THA) secondary to head-neck taper corrosion is challenging. The purpose of this study is to compare differences between asymptomatic and symptomatic ALTR in an observational cohort, including presentation, metal ion differences, and metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) findings. Methods We performed a retrospective review of an observational cohort of 492 MoP THA patients at increased risk of developing ALTR. Ninety-four patients underwent revision arthroplasty for ALTR. Patients were stratified into symptomatic and asymptomatic ALTR groups. Presentation, metal ion levels, and imaging findings were compared. Results For patients with confirmed ALTR, 41% were asymptomatic. There was a statistically significant difference in the serum chromium levels between symptomatic and asymptomatic ALTR patients (2.2 μg/L vs 3.1 μg/L, P = .05). There was no statistically significant difference between the serum cobalt levels or MRI findings in these 2 groups. We observed that extracapsular disease associated with ALTR could be misinterpreted as trochanteric bursitis. Conclusion Almost half of the MoP THA ALTR cases identified were asymptomatic. Cobalt levels could not differentiate between symptomatic and asymptomatic pseudotumor formation. Symptomatic and asymptomatic MoP ALTRs have similar MARS MRI characteristics. Our findings suggest that it is essential to risk stratify patients who could potentially have ALTR based on implant type, symptoms, ion levels, and MARS MRI.

Anthony M. DiGioia

Papers

A Computer-Assisted ACL Reconstruction System Assessment of Two Techniques of Graft Positioning in ACL Reconstruction

Augmented reality and its future in orthopaedics : Computer assisted orthopaedic surgery: Medical robotics and image guided surgery

Dose-Associated Changes in Gait Parameters in Response to Exercise Programs after Total Knee Arthroplasty: Secondary Analysis of Two Randomized Studies.

Comparison of Asymptomatic and Symptomatic Adverse Local Tissue Reaction in Patients With Head-Neck Taper Corrosion.

Computer-Assisted Orthopaedic Surgery for the Hip