Relevance of motion-related assessment metrics in laparoscopic surgery

INTRODUCTION: Motion metrics have become an important source of information when addressing the assessment of surgical expertise. However, their direct relationship with the different surgical skills has not been fully explored. The purpose of this study is to investigate the relevance of motion-related metrics in the evaluation processes of basic psychomotor laparoscopic skills, as well as their correlation with the different abilities sought to measure. METHODS: A framework for task definition and metric analysis is proposed. An explorative survey was first conducted with a board of experts to identify metrics to assess basic psychomotor skills. Based on the output of that survey, three novel tasks for surgical assessment were designed. Face and construct validation study was performed, with focus on motion-related metrics. Tasks were performed by 42 participants (16 novices, 22 residents and 4 experts). Movements of the laparoscopic instruments were registered with the TrEndo tracking system and analyzed. RESULTS: Time, path length and depth showed construct validity for all three tasks. Motion smoothness and idle time also showed validity for tasks involving bi-manual coordination and tasks requiring a more tactical approach respectively. Additionally, motion smoothness and average speed showed a high internal consistency, proving them to be the most task-independent of all the metrics analyzed. CONCLUSION: Motion metrics are complementary and valid for assessing basic psychomotor skills, and their relevance depends on the skill being evaluated. A larger clinical implementation, combined with quality performance information, will give more insight on the relevance of the results shown in this study.

A critical force constant of the structural phase transition in quartz

Long wavelength optical phonons of quartz were analyzed by a Born-Von Karman model not previously used. It was found that only one force constant associated with the turning of the Si-O bonds has a critical effect on the soft-mode frequency and the α-β transition in quartz. The square of the soft-mode frequency was found to depend linearly on this force constant which has the temperature dependence K(T)= -5.33+225.3x10-4(851-T)2/3 in units of 104 dyn/cm2.

A new set of integrals of motion to propagate the perturbed two-body problem

A formulation of the perturbed two-body problem that relies on a new set of orbital elements is presented. The proposed method represents a generalization of the special perturbation method published by Peláez et al. (Celest Mech Dyn Astron 97(2):131?150,2007) for the case of a perturbing force that is partially or totally derivable from a potential. We accomplish this result by employing a generalized Sundman time transformation in the framework of the projective decomposition, which is a known approach for transforming the two-body problem into a set of linear and regular differential equations of motion. Numerical tests, carried out with examples extensively used in the literature, show the remarkable improvement of the performance of the new method for different kinds of perturbations and eccentricities. In particular, one notable result is that the quadratic dependence of the position error on the time-like argument exhibited by Peláez?s method for near-circular motion under the J2 perturbation is transformed into linear.Moreover, themethod reveals to be competitive with two very popular elementmethods derived from theKustaanheimo-Stiefel and Sperling-Burdet regularizations.

Nonrigid Motion Compensation of Free Breathing Acquired Myocardial Perfusion Data

In this work, we present a novel method to compensate the movement in images acquired during free breathing using first-pass gadolinium enhanced, myocardial perfusion magnetic resonance imaging (MRI). First, we use independent component analysis (ICA) to identify the optimal number of independent components (ICs) that separate the breathing motion from the intensity change induced by the contrast agent. Then, synthetic images are created by recombining the ICs, but other then in previously published work (Milles et al. 2008), we omit the component related to motion, and therefore, the resulting reference image series is free of motion. Motion compensation is then achieved by using a multi-pass non-rigid image registration scheme. We tested our method on 15 distinct image series (5 patients) consisting of 58 images each and we validated our method by comparing manually tracked intensity profiles of the myocardial sections to automatically generated ones before and after registration. The average correlation to the manually obtained curves before registration 0:89 0:11 was increased to 0:98 0:02

On the structure of the floating zone in melting

Floating zone melting is used in crystal growth and purification of high melting materials. The use of a reduced gravity environment will remove the constraint imposed on the length of the zone by the hydrostatic pressure. The equilibrium of the fioatmg zone may involve, (1)Hydrostatic forces, when the zone rotates as a whole. (2)Convective driving forces, when the zone is stationary but fluid property gradients appear.(3) Hydrodynamic forces, when some parts of the zone are set into motion with respect to others. The last effects are considered in this paper. The flow pattern of a floating zone held between two discs in relative motion is complicated, and thence the solution of the problem is difficult even assuming a constant property-newtonian liquid Nevertheless, when a small parameter appears m the problem, the complete flow field can be split into zones where simple solutions are found. To illustrate this approach, the spin up from rest of an initially cylindrical floating zone is considered with detail. Here the small parameter is the time elapsed from the impulsive starting of motion. Since the problem which has been considered, as well as some others which can be tackled by use of similar methods, concern the viscous layer close to either plate, they can be simulated experimentally in the ground laboratory with short floating zones. Procedures to produce these zones are indicated.

Flight dynamics and stability of kites in steady and unsteady wind conditions

The flight dynamics and stability of a kite with a single main line flying in steady and unsteady wind conditions are discussed. A simple dynamic model with five degrees of freedom is derived with the aid of Lagrangian formulation, which explicitly avoids any constraint force in the equations of motion. The longitudinal and lateral–directional modes and stability of the steady flight under constant wind conditions are analyzed by using both numerical and analytical methods. Taking advantage of the appearance of small dimensionless parameters in the model, useful analytical formulas for stable-designed kites are found. Under nonsteady wind-velocity conditions, the equilibrium state disappears and periodic orbits occur. The kite stability and an interesting resonance phenomenon are explored with the aid of a numerical method based on Floquet theory.

The application of biomechanics to penalty corner drag-flick training: a case of Study

The penalty corner is one of the most important game situations in field hockey with one third of all goals resulting from this tactical situation. The aim of this study was to develop and apply a training method, based on previous studies, to improve the drag- flick skill on a young top-class field hockey player. A young top-class player exercised three times per week using specific drills over a four week period. A VICON optoelectronic system (Oxford Metrics, Oxford, UK) was employed to capture twenty drag-flicks, with six cameras sampling at 250 Hz, prior and after the training period. In order to analyze pre- and post-test differences a dependent t-test was carried out. Angular velocities and the kinematic sequence were similar to previous studies. The player improved (albeit not significantly) the angular velocity of the stick. The player increased front foot to the ball at T1 (p < 0.01) and the drag-flick distances. The range of motion from the front leg decreased from T1 to T6 after the training period (p < 0.01). The specific training sessions conducted with the player improved some features of this particular skill. This article shows how technical knowledge can help with the design of training programs and whether some drills are more effective than others.

Wave-like Disturbances on the Downstream Wall of an Open Cavity

This contribution presents results of an incompressible two-dimensional flow over an open cavity of fixed aspect ratio (length/depth) L/D = 2 and the coupling between the three dimensional low frequency oscillation mode confined in the cavity and the wave-like disturbances evolving on the downstream wall of the cavity in the form of Tollmien-Schlichting waves. BiGlobal instability analysis is conducted to search the global disturbances superimposed upon a two-dimensional steady basic flow. The base solution is computed by the integration of the laminar Navier-Stokes equations in primitive variable formulation, while the eigenvalue problem (EVP) derived from the discretization of the linearized equations of motion in the BiGlobal framework is solved using an iterative procedure. The formulation of the BiGlobal EVP for the unbounded flow in the open cavity problem introduces additional difficulties regarding the flow-through boundaries. Local analysis has been utilized for the determination of the proper boundary conditions in the upper limit of the downstream region

Conceptual framework for the design, implementation and validation of psychomotor skills’ assessment systems in minimally invasive surgery

Las técnicas de cirugía de mínima invasión (CMI) se están consolidando hoy en día como alternativa a la cirugía tradicional, debido a sus numerosos beneficios para los pacientes. Este cambio de paradigma implica que los cirujanos deben aprender una serie de habilidades distintas de aquellas requeridas en cirugía abierta. El entrenamiento y evaluación de estas habilidades se ha convertido en una de las mayores preocupaciones en los programas de formación de cirujanos, debido en gran parte a la presión de una sociedad que exige cirujanos bien preparados y una reducción en el número de errores médicos. Por tanto, se está prestando especial atención a la definición de nuevos programas que permitan el entrenamiento y la evaluación de las habilidades psicomotoras en entornos seguros antes de que los nuevos cirujanos puedan operar sobre pacientes reales. Para tal fin, hospitales y centros de formación están gradualmente incorporando instalaciones de entrenamiento donde los residentes puedan practicar y aprender sin riesgos. Es cada vez más común que estos laboratorios dispongan de simuladores virtuales o simuladores físicos capaces de registrar los movimientos del instrumental de cada residente. Estos simuladores ofrecen una gran variedad de tareas de entrenamiento y evaluación, así como la posibilidad de obtener información objetiva de los ejercicios. Los diferentes estudios de validación llevados a cabo dan muestra de su utilidad; pese a todo, los niveles de evidencia presentados son en muchas ocasiones insuficientes. Lo que es más importante, no existe un consenso claro a la hora de definir qué métricas son más útiles para caracterizar la pericia quirúrgica. El objetivo de esta tesis doctoral es diseñar y validar un marco de trabajo conceptual para la definición y validación de entornos para la evaluación de habilidades en CMI, en base a un modelo en tres fases: pedagógica (tareas y métricas a emplear), tecnológica (tecnologías de adquisición de métricas) y analítica (interpretación de la competencia en base a las métricas). Para tal fin, se describe la implementación práctica de un entorno basado en (1) un sistema de seguimiento de instrumental fundamentado en el análisis del vídeo laparoscópico; y (2) la determinación de la pericia en base a métricas de movimiento del instrumental. Para la fase pedagógica se diseñó e implementó un conjunto de tareas para la evaluación de habilidades psicomotoras básicas, así como una serie de métricas de movimiento. La validación de construcción llevada a cabo sobre ellas mostró buenos resultados para tiempo, camino recorrido, profundidad, velocidad media, aceleración media, economía de área y economía de volumen. Adicionalmente, los resultados obtenidos en la validación de apariencia fueron en general positivos en todos los grupos considerados (noveles, residentes, expertos). Para la fase tecnológica, se introdujo el EVA Tracking System, una solución para el seguimiento del instrumental quirúrgico basado en el análisis del vídeo endoscópico. La precisión del sistema se evaluó a 16,33ppRMS para el seguimiento 2D de la herramienta en la imagen; y a 13mmRMS para el seguimiento espacial de la misma. La validación de construcción con una de las tareas de evaluación mostró buenos resultados para tiempo, camino recorrido, profundidad, velocidad media, aceleración media, economía de área y economía de volumen. La validación concurrente con el TrEndo® Tracking System por su parte presentó valores altos de correlación para 8 de las 9 métricas analizadas. Finalmente, para la fase analítica se comparó el comportamiento de tres clasificadores supervisados a la hora de determinar automáticamente la pericia quirúrgica en base a la información de movimiento del instrumental, basados en aproximaciones lineales (análisis lineal discriminante, LDA), no lineales (máquinas de soporte vectorial, SVM) y difusas (sistemas adaptativos de inferencia neurodifusa, ANFIS). Los resultados muestran que en media SVM presenta un comportamiento ligeramente superior: 78,2% frente a los 71% y 71,7% obtenidos por ANFIS y LDA respectivamente. Sin embargo las diferencias estadísticas medidas entre los tres no fueron demostradas significativas. En general, esta tesis doctoral corrobora las hipótesis de investigación postuladas relativas a la definición de sistemas de evaluación de habilidades para cirugía de mínima invasión, a la utilidad del análisis de vídeo como fuente de información y a la importancia de la información de movimiento de instrumental a la hora de caracterizar la pericia quirúrgica. Basándose en estos cimientos, se han de abrir nuevos campos de investigación que contribuyan a la definición de programas de formación estructurados y objetivos, que puedan garantizar la acreditación de cirujanos sobradamente preparados y promocionen la seguridad del paciente en el quirófano. Abstract Minimally invasive surgery (MIS) techniques have become a standard in many surgical sub-specialties, due to their many benefits for patients. However, this shift in paradigm implies that surgeons must acquire a complete different set of skills than those normally attributed to open surgery. Training and assessment of these skills has become a major concern in surgical learning programmes, especially considering the social demand for better-prepared professionals and for the decrease of medical errors. Therefore, much effort is being put in the definition of structured MIS learning programmes, where practice with real patients in the operating room (OR) can be delayed until the resident can attest for a minimum level of psychomotor competence. To this end, skills’ laboratory settings are being introduced in hospitals and training centres where residents may practice and be assessed on their psychomotor skills. Technological advances in the field of tracking technologies and virtual reality (VR) have enabled the creation of new learning systems such as VR simulators or enhanced box trainers. These systems offer a wide range of tasks, as well as the capability of registering objective data on the trainees’ performance. Validation studies give proof of their usefulness; however, levels of evidence reported are in many cases low. More importantly, there is still no clear consensus on topics such as the optimal metrics that must be used to assess competence, the validity of VR simulation, the portability of tracking technologies into real surgeries (for advanced assessment) or the degree to which the skills measured and obtained in laboratory environments transfer to the OR. The purpose of this PhD is to design and validate a conceptual framework for the definition and validation of MIS assessment environments based on a three-pillared model defining three main stages: pedagogical (tasks and metrics to employ), technological (metric acquisition technologies) and analytical (interpretation of competence based on metrics). To this end, a practical implementation of the framework is presented, focused on (1) a video-based tracking system and (2) the determination of surgical competence based on the laparoscopic instruments’ motionrelated data. The pedagogical stage’s results led to the design and implementation of a set of basic tasks for MIS psychomotor skills’ assessment, as well as the definition of motion analysis parameters (MAPs) to measure performance on said tasks. Validation yielded good construct results for parameters such as time, path length, depth, average speed, average acceleration, economy of area and economy of volume. Additionally, face validation results showed positive acceptance on behalf of the experts, residents and novices. For the technological stage the EVA Tracking System is introduced. EVA provides a solution for tracking laparoscopic instruments from the analysis of the monoscopic video image. Accuracy tests for the system are presented, which yielded an average RMSE of 16.33pp for 2D tracking of the instrument on the image and of 13mm for 3D spatial tracking. A validation experiment was conducted using one of the tasks and the most relevant MAPs. Construct validation showed significant differences for time, path length, depth, average speed, average acceleration, economy of area and economy of volume; especially between novices and residents/experts. More importantly, concurrent validation with the TrEndo® Tracking System presented high correlation values (>0.7) for 8 of the 9 MAPs proposed. Finally, the analytical stage allowed comparing the performance of three different supervised classification strategies in the determination of surgical competence based on motion-related information. The three classifiers were based on linear (linear discriminant analysis, LDA), non-linear (support vector machines, SVM) and fuzzy (adaptive neuro fuzzy inference systems, ANFIS) approaches. Results for SVM show slightly better performance than the other two classifiers: on average, accuracy for LDA, SVM and ANFIS was of 71.7%, 78.2% and 71% respectively. However, when confronted, no statistical significance was found between any of the three. Overall, this PhD corroborates the investigated research hypotheses regarding the definition of MIS assessment systems, the use of endoscopic video analysis as the main source of information and the relevance of motion analysis in the determination of surgical competence. New research fields in the training and assessment of MIS surgeons can be proposed based on these foundations, in order to contribute to the definition of structured and objective learning programmes that guarantee the accreditation of well-prepared professionals and the promotion of patient safety in the OR.

Optimal fits of diffusion constants from single-time data points of Brownian trajectories

Experimental methods based on single particle tracking (SPT) are being increasingly employed in the physical and biological sciences, where nanoscale objects are visualized with high temporal and spatial resolution. SPT can probe interactions between a particle and its environment but the price to be paid is the absence of ensemble averaging and a consequent lack of statistics. Here we address the benchmark question of how to accurately extract the diffusion constant of one single Brownian trajectory. We analyze a class of estimators based on weighted functionals of the square displacement. For a certain choice of the weight function these functionals provide the true ensemble averaged diffusion coefficient, with a precision that increases with the trajectory resolution.

Influence of the Second Flexural Mode on the Response of High-Speed Bridges

This paper deals with the assessment of the contribution of the second flexural mode to the dynamic behaviour of simply supported railway bridges. Alluding to the works of other authors, it is suggested in some references that the dynamic behaviour of simply supported bridges could be adequately represented taking into account only the contribution of the fundamental flexural mode. On the other hand, the European Rail Research Institute (ERRI) proposes that the second mode should also be included whenever the associated natural frequency is lower than 30 Hz]. This investigation endeavours to clarify the question as much as possible by establishing whether the maximum response of the bridge, in terms of displacements, accelerations and bending moments, can be computed accurately not taking account of the contribution of the second mode. To this end, a dimensionless formulation of the equations of motion of a simply supported beam traversed by a series of equally spaced moving loads is presented. This formulation brings to light the fundamental parameters governing the behaviour of the beam: damping ratio, dimensionless speed $ \alpha$=VT/L, and L/d ratio (L stands for the span of the beam, V for the speed of the train, T represents the fundamental period of the bridge and d symbolises the distance between consecutive loads). Assuming a damping ratio equal to 1%, which is a usual value for prestressed high-speed bridges, a parametric analysis is conducted over realistic ranges of values of $ \alpha$ and L/d. The results can be extended to any simply supported bridge subjected to a train of equally spaced loads in virtue of the so-called Similarity Formulae. The validity of these formulae can be derived from the dimensionless formulation mentioned above. In the parametric analysis the maximum response of the bridge is obtained for one thousand values of speed that cover the range from the fourth resonance of the first mode to the first resonance of the second mode. The response at twenty-one different locations along the span of the beam is compared in order to decide if the maximum can be accurately computed with the sole contribution of the fundamental mode.

Unattended motion detection system based on the mammalian retina

Sensing systems in living bodies offer a large variety of possible different configurations and philosophies able to be emulated in artificial sensing systems. Motion detection is one of the areas where different animals adopt different solutions and, in most of the cases, these solutions reflect a very sophisticated form. One of them, the mammalian visual system, presents several advantages with respect to the artificial ones. The main objective of this paper is to present a system, based on this biological structure, able to detect motion, its sense and its characteristics. The configuration adopted responds to the internal structure of the mammalian retina, where just five types of cells arranged in five layers are able to differentiate a large number of characteristics of the image impinging onto it. Its main advantage is that the detection of these properties is based purely on its hardware. A simple unit, based in a previous optical logic cell employed in optical computing, is the basis for emulating the different behaviors of the biological neurons. No software is present and, in this way, no possible interference from outside affects to the final behavior. This type of structure is able to work, once the internal configuration is implemented, without any further attention. Different possibilities are present in the architecture to be presented: detection of motion, of its direction and intensity. Moreover, some other characteristics, as symmetry may be obtained.

Assessment of interatomic potentials for atomistic analysis of static and dynamic properties of screw dislocations in W

Screw dislocations in bcc metals display non-planar cores at zero temperature which result in high lattice friction and thermally-activated strain rate behavior. In bcc W, electronic structure molecular statics calculations reveal a compact, non-degenerate core with an associated Peierls stress between 1.7 and 2.8 GPa. However, a full picture of the dynamic behavior of dislocations can only be gained by using more efficient atomistic simulations based on semiempirical interatomic potentials. In this paper we assess the suitability of five different potentials in terms of static properties relevant to screw dislocations in pure W. Moreover, we perform molecular dynamics simulations of stress-assisted glide using all five potentials to study the dynamic behavior of screw dislocations under shear stress. Dislocations are seen to display thermally-activated motion in most of the applied stress range, with a gradual transition to a viscous damping regime at high stresses. We find that one potential predicts a core transformation from compact to dissociated at finite temperature that affects the energetics of kink-pair production and impacts the mechanism of motion. We conclude that a modified embedded-atom potential achieves the best compromise in terms of static and dynamic screw dislocation properties, although at an expense of about ten-fold compared to central potentials.

EVA: Endoscopic Video Analysis of the surgical scene for the assessment of MIS psychomotor skills

The present work covers the first validation efforts of the EVA Tracking System for the assessment of minimally invasive surgery (MIS) psychomotor skills. Instrument movements were recorded for 42 surgeons (4 expert, 22 residents, 16 novice medical students) and analyzed for a box trainer peg transfer task. Construct validation was established for 7/9 motion analysis parameters (MAPs). Concurrent validation was determined for 8/9 MAPs against the TrEndo Tracking System. Finally, automatic determination of surgical proficiency based on the MAPs was sought by 3 different approaches to supervised classification (LDA, SVM, ANFIS), with accuracy results of 61.9%, 83.3% and 80.9% respectively. Results not only reflect on the validation of EVA for skills? assessment, but also on the relevance of motion analysis of instruments in the determination of surgical competence.

On-line MRI sequences for the evaluation of apple internal quality.

On-line dynamic MRI, which is oriented to industrial grading lines, requires high-speed sequences with motion correction artefacts. In this study two different types of motion correction sequences have been used and have been implemented in real-time (FLASH and UFLARE). They are based on T2* and T2 respectively and their selection depends on the expected contrast effect of the disorder: while watercore enhances bright areas due to higher fluid mobility, internal breakdown potentiates low signal due to texture degradation. For watercore study, five different apple cultivars were used (Normanda-18-, Fuji-35-, Helada-36-, Verde Doncella-54-, Esperiega-75-) along two seasons (2011 and 2012). In total 218 fruits were measured under both, static conditions (20 slices per fruit) and under dynamic conditions (3 repetitions without slice selection). For internal breakdown, Braeburn cultivar has been studied (in total 106 fruits) under both static (20 slices per fruit) and dynamic conditions (3 replicates with slice selection). Metrological aspects such as repeatability of dynamic images and subsequent histogram feature stability become of major interest for further industrial application. Segregation ability among varying degrees of disorder is also analyzed.