Matteo Fusaglia

Bio: Matteo Fusaglia is an academic researcher from University of Bern. The author has contributed to research in topics: Artificial intelligence & Medicine. The author has an hindex of 6, co-authored 15 publications receiving 161 citations. Previous affiliations of Matteo Fusaglia include Netherlands Cancer Institute.

Laparoscopic image-based navigation for microwave ablation of liver tumors-A multi-center study

Abstract: Stereotactic navigation technology has been proposed to augment accuracy in targeting intrahepatic lesions for local ablation therapy. This retrospective study evaluated accuracy, efficacy, and safety when using laparoscopic image-guided microwave ablation (LIMA) for malignant liver tumors. All patients treated for malignant liver lesions using LIMA at two European centers between 2013 and 2015 were included for analysis. A landmark-based registration technique was applied for intraoperative tumor localization and positioning of ablation probes. Intraoperative efficiency of the procedure was measured as number of registration attempts and time needed to achieve sufficient registration accuracy. Technical accuracy was assessed as Fiducial Registration Error (FRE). Outcome at 90 days including mortality, postoperative morbidity, rates of incomplete ablations, and early intrahepatic recurrences were reported. In 34 months, 54 interventions were performed comprising a total of 346 lesions (median lesions per patient 3 (1–25)). Eleven patients had concomitant laparoscopic resections of the liver or the colorectal primary tumor. Median time for registration was 4:38 min (0:26–19:34). Average FRE was 8.1 ± 2.8 mm. Follow-up at 90 days showed one death, 24% grade I/II, and 4% grade IIIa complications. Median length of hospital stay was 2 days (1–11). Early local recurrence was 9% per lesion and 32% per patient. Of these, 63% were successfully re-ablated within 6 months. LIMA does not interfere with the intraoperative workflow and results in low complication and early local recurrence rates, even when simultaneously targeting multiple lesions. LIMA may represent a valid therapy option for patients with extensive hepatic disease within a multimodal treatment approach.

MR-to-US Registration Using Multiclass Segmentation of Hepatic Vasculature with a Reduced 3D U-Net.

Abstract: Accurate hepatic vessel segmentation and registration using ultrasound (US) can contribute to beneficial navigation during hepatic surgery. However, it is challenging due to noise and speckle in US imaging and liver deformation. Therefore, a workflow is developed using a reduced 3D U-Net for segmentation, followed by non-rigid coherent point drift (CPD) registration. By means of electromagnetically tracked US, 61 3D volumes were acquired during surgery. Dice scores of 0.77, 0.65 and 0.66 were achieved for segmentation of all vasculature, hepatic vein and portal vein respectively. This compares to inter-observer variabilities of 0.85, 0.88 and 0.74 respectively. Target registration error at a tumor lesion of interest was lower (7.1 mm) when registration is performed either on the hepatic or the portal vein, compared to using all vasculature (8.9 mm). Using clinical data, we developed a workflow consisting of multi-class segmentation combined with selective non-rigid registration that leads to sufficient accuracy for integration in computer assisted liver surgery.

A Novel Ultrasound-Based Registration for Image-Guided Laparoscopic Liver Ablation.

Abstract: Background Patient-to-image registration is a core process of image-guided surgery (IGS) systems. We present a novel registration approach for application in laparoscopic liver surgery, which reconstructs in real time an intraoperative volume of the underlying intrahepatic vessels through an ultrasound (US) sweep process. Methods An existing IGS system for an open liver procedure was adapted, with suitable instrument tracking for laparoscopic equipment. Registration accuracy was evaluated on a realistic phantom by computing the target registration error (TRE) for 5 intrahepatic tumors. The registration work flow was evaluated by computing the time required for performing the registration. Additionally, a scheme for intraoperative accuracy assessment by visual overlay of the US image with preoperative image data was evaluated. Results The proposed registration method achieved an average TRE of 7.2 mm in the left lobe and 9.7 mm in the right lobe. The average time required for performing the registration was 12 minutes. A positive correlation was found between the intraoperative accuracy assessment and the obtained TREs. Conclusions The registration accuracy of the proposed method is adequate for laparoscopic intrahepatic tumor targeting. The presented approach is feasible and fast and may, therefore, not be disruptive to the current surgical work flow.

U-Net and Its Variants for Medical Image Segmentation: A Review of Theory and Applications

Abstract: U-net is an image segmentation technique developed primarily for image segmentation tasks. These traits provide U-net with a high utility within the medical imaging community and have resulted in extensive adoption of U-net as the primary tool for segmentation tasks in medical imaging. The success of U-net is evident in its widespread use in nearly all major image modalities, from CT scans and MRI to X-rays and microscopy. Furthermore, while U-net is largely a segmentation tool, there have been instances of the use of U-net in other applications. Given that U-net’s potential is still increasing, this narrative literature review examines the numerous developments and breakthroughs in the U-net architecture and provides observations on recent trends. We also discuss the many innovations that have advanced in deep learning and discuss how these tools facilitate U-net. In addition, we review the different image modalities and application areas that have been enhanced by U-net.

Recent Development of Augmented Reality in Surgery: A Review

Abstract: Introduction. The development augmented reality devices allow physicians to incorporate data visualization into diagnostic and treatment procedures to improve work efficiency, safety, and cost and to enhance surgical training. However, the awareness of possibilities of augmented reality is generally low. This review evaluates whether augmented reality can presently improve the results of surgical procedures. Methods. We performed a review of available literature dating from 2010 to November 2016 by searching PubMed and Scopus using the terms “augmented reality” and “surgery.” Results. The initial search yielded 808 studies. After removing duplicates and including only journal articles, a total of 417 studies were identified. By reading of abstracts, 91 relevant studies were chosen to be included. 11 references were gathered by cross-referencing. A total of 102 studies were included in this review. Conclusions. The present literature suggest an increasing interest of surgeons regarding employing augmented reality into surgery leading to improved safety and efficacy of surgical procedures. Many studies showed that the performance of newly devised augmented reality systems is comparable to traditional techniques. However, several problems need to be addressed before augmented reality is implemented into the routine practice.

A systematic review of robotic-assisted liver resection and meta-analysis of robotic versus laparoscopic hepatectomy for hepatic neoplasms

Abstract: Background Robotic-assisted liver resection (RALR) was introduced as procedures of overcoming the limitations of traditional laparoscopic liver resection (LLR). The aim of this review was to evaluate the surgical results of RALR from all published studies and the results of comparative studies of RALR versus LLR for hepatic neoplasm.

Stimulants and Attention-Deficit/Hyperactivity Disorder—Reply

Abstract: To the Editor: The Contempo Update on attention-deficit/ hyperactivity disorder (ADHD) by Dr Wilens and colleagues presented pharmacologic treatment options. However, in discussing the use of stimulant medications, the authors did not address risks of addiction, tolerance, or habituation. I would like to know if the authors think that these risks are significant enough to warrant having patients sign a treatment contract acknowledging the risks and the conditions of ongoing care. I would also be interested in whether they think patients receiving stimulant treatment should be evaluated monthly in the office prior to refills and, if not, what other refill mechanisms they would recommend.