Collecting system percutaneous access using real-time tracking sensors: first pig model in vivo experience

Purpose: Precise needle puncture of the renal collecting system is an essential but challenging step for successful percutaneous nephrolithotomy. We evaluated the efficiency of a new real-time electromagnetic tracking system for in vivo kidney puncture. Materials and Methods: Six anesthetized female pigs underwent ureterorenoscopy to place a catheter with an electromagnetic tracking sensor into the desired puncture site and ascertain puncture success. A tracked needle with a similar electromagnetic tracking sensor was subsequently navigated into the sensor in the catheter. Four punctures were performed by each of 2 surgeons in each pig, including 1 each in the kidney, middle ureter, and right and left sides. Outcome measurements were the number of attempts and the time needed to evaluate the virtual trajectory and perform percutaneous puncture. Results: A total of 24 punctures were easily performed without complication. Surgeons required more time to evaluate the trajectory during ureteral than kidney puncture (median 15 seconds, range 14 to 18 vs 13, range 11 to 16, p ¼ 0.1). Median renal and ureteral puncture time was 19 (range 14 to 45) and 51 seconds (range 45 to 67), respectively (p ¼ 0.003). Two attempts were needed to achieve a successful ureteral puncture. The technique requires the presence of a renal stone for testing. Conclusions: The proposed electromagnetic tracking solution for renal collecting system puncture proved to be highly accurate, simple and quick. This method might represent a paradigm shift in percutaneous kidney access techniques

Collecting system percutaneous access using real-time tracking sensors: first pig model in vivo experience

Purpose: Precise needle puncture of the renal collecting system is an essential but challenging step for successful percutaneous nephrolithotomy. We evaluated the efficiency of a new real-time electromagnetic tracking system for in vivo kidney puncture. Materials and Methods: Six anesthetized female pigs underwent ureterorenoscopy to place a catheter with an electromagnetic tracking sensor into the desired puncture site and ascertain puncture success. A tracked needle with a similar electromagnetic tracking sensor was subsequently navigated into the sensor in the catheter. Four punctures were performed by each of 2 surgeons in each pig, including 1 each in the kidney, middle ureter, and right and left sides. Outcome measurements were the number of attempts and the time needed to evaluate the virtual trajectory and perform percutaneous puncture. Results: A total of 24 punctures were easily performed without complication. Surgeons required more time to evaluate the trajectory during ureteral than kidney puncture (median 15 seconds, range 14 to 18 vs 13, range 11 to 16, p ¼ 0.1). Median renal and ureteral puncture time was 19 (range 14 to 45) and 51 seconds (range 45 to 67), respectively (p ¼ 0.003). Two attempts were needed to achieve a successful ureteral puncture. The technique requires the presence of a renal stone for testing. Conclusions: The proposed electromagnetic tracking solution for renal collecting system puncture proved to be highly accurate, simple and quick. This method might represent a paradigm shift in percutaneous kidney access techniques.

Qualifound – a modular tool developed for quality improvement in foundries

Purpose – Castings defects are usually easy to characterize, but to eradicate them can be a difficult task. In many cases, defects are caused by the combined effect of different factors, whose identification is often difficult. Besides, the real non-quality costs are usually unknown, and even neglected. This paper aims to describe the development of a modular tool for quality improvement in foundries, and its main objective is to present the application potential and the foundry process areas that are covered and taken into account. Design/methodology/approach – The integrated model was conceived as an expert system, designated Qualifound, which performs both qualitative and quantitative analyses. For the qualitative analyses mode, the nomenclature and the description of defects are based on the classification suggested by the International Committee of the Foundry Technical Association. Thus, a database of defects was established, enabling one to associate the defects with the relevant process operations and the identification of their possible causes. The quantitative analysis mode deals with the number of produced and rejected castings and includes the calculation of the non-quality costs. Findings – The validation of Qualifound was carried out in a Portuguese foundry, whose quality system had been certified according to the ISO 9000 standards. Qualifound was used in every management area and it was concluded that the application had the required technological requisites to provide the necessary information for the foundry management to improve process quality. Originality/value – The paper presents a successful application of an informatics tool on quality improvement in foundries.

Real-time 3D interactive segmentation of echocardiographic data through user-based deformation of B-spline explicit active surfaces

Image segmentation is an ubiquitous task in medical image analysis, which is required to estimate morphological or functional properties of given anatomical targets. While automatic processing is highly desirable, image segmentation remains to date a supervised process in daily clinical practice. Indeed, challenging data often requires user interaction to capture the required level of anatomical detail. To optimize the analysis of 3D images, the user should be able to efficiently interact with the result of any segmentation algorithm to correct any possible disagreement. Building on a previously developed real-time 3D segmentation algorithm, we propose in the present work an extension towards an interactive application where user information can be used online to steer the segmentation result. This enables a synergistic collaboration between the operator and the underlying segmentation algorithm, thus contributing to higher segmentation accuracy, while keeping total analysis time competitive. To this end, we formalize the user interaction paradigm using a geometrical approach, where the user input is mapped to a non-cartesian space while this information is used to drive the boundary towards the position provided by the user. Additionally, we propose a shape regularization term which improves the interaction with the segmented surface, thereby making the interactive segmentation process less cumbersome. The resulting algorithm offers competitive performance both in terms of segmentation accuracy, as well as in terms of total analysis time. This contributes to a more efficient use of the existing segmentation tools in daily clinical practice. Furthermore, it compares favorably to state-of-the-art interactive segmentation software based on a 3D livewire-based algorithm.

A importância da personagem virtual no contexto da animação 3D em tempo real

O desenvolvimento de personagens digitais tridimensionais1 na área da animação, a constante procura por soluções tecnológicas convincentes, aliado a uma estética própria, tem contribuído para o sucesso e afirmação da animação tridimensional, na indústria do entretenimento. Contudo, toda a obra que procura ou explora a vertente digital/3D, torna-se ‘vitima’ das limitações do render2 aplicado a uma sequência de imagens, devido ao aumento dos custos financeiros e humanos, assim como da influência e dificuldade implicadas no cumprimento dos objectivos e prazos. O tempo real tem assumido, cada vez mais, um papel predominante na indústria da animação interactiva. Com a evolução da tecnologia surgiu a necessidade de procurar a metodologia apropriada que sirva de alavanca para o desenvolvimento de animações 3D em tempo real, através de softwares open-source ou de baixo orçamento, para a redução de custos, que possibilite simultaneamente descartar qualquer dependência do render na animação 3D. O desenvolvimento de personagens em tempo real, possibilita o surgimento de uma nova abordagem: a interactividade na arte de animar. Esta possibilita a introdução de um vasto leque de novas aplicações e consequentemente, contribui para o aumento do interesse e curiosidade por parte do espectador. No entanto, a inserção, implementação e (ab)uso da tecnologia na área da animação, levanta questões atuais sobre qual o papel do animador. Esta dissertação procura analisar estes aspectos, dando apoio ao projecto de animação 3D em tempo real, denominado ‘PALCO’.

A generic model for integration of Quality, Environment and Safety Management Systems

Purpose – The purpose of this paper is to propose a generic model of Integrated Management System of Quality, Environment and Safety (IMS-QES) that can be adapted and progressively to assimilate various Management Systems, of which highlights: ISO 9001 for Quality; ISO 14001 for Environment; OHSAS 18001 for Occupational Health and Safety. Design/methodology/approach – The model was designed in the real environment of a Portuguese Organization and 160 employees were surveyed. The rate response was equal to 86 percent. The conceived model was implemented in a first phase for the integration of Quality, Environment and Safety Management Systems. Findings – Among the main findings of the survey the paper highlights: the elimination of conflicts between individual systems with resources optimization; creation of added value to the business by eliminating several types of wastes; the integrated management of sustainability components in a global market; the improvement of partnerships with suppliers of goods and services; reducing the number of internal and external audits. Originality/value – This case study is one of the first Portuguese empirical researches about IMS-QES and the paper believes that it can be useful in the creation of a Portuguese guideline for integration, namely the Quality Management Systems; Environmental Management Systems and Occupational Health and Safety Management Systems among others.

Remote Patient Monitoring Based on ZigBee: Lessons from a Real-World Deployment

AIM: This work presents detailed experimental performance results from tests executed in the hospital environment for Health Monitoring for All (HM4All), a remote vital signs monitoring system based on a ZigBee® (ZigBee Alliance, San Ramon, CA) body sensor network (BSN). MATERIALS AND METHODS: Tests involved the use of six electrocardiogram (ECG) sensors operating in two different modes: the ECG mode involved the transmission of ECG waveform data and heart rate (HR) values to the ZigBee coordinator, whereas the HR mode included only the transmission of HR values. In the absence of hidden nodes, a non-beacon-enabled star network composed of sensing devices working on ECG mode kept the delivery ratio (DR) at 100%. RESULTS: When the network topology was changed to a 2-hop tree, the performance degraded slightly, resulting in an average DR of 98.56%. Although these performance outcomes may seem satisfactory, further investigation demonstrated that individual sensing devices went through transitory periods with low DR. Other tests have shown that ZigBee BSNs are highly susceptible to collisions owing to hidden nodes. Nevertheless, these tests have also shown that these networks can achieve high reliability if the amount of traffic is kept low. Contrary to what is typically shown in scientific articles and in manufacturers' documentation, the test outcomes presented in this article include temporal graphs of the DR achieved by each wireless sensor device. CONCLUSIONS: The test procedure and the approach used to represent its outcomes, which allow the identification of undesirable transitory periods of low reliability due to contention between devices, constitute the main contribution of this work.

Preliminary clinical trial in percutaneous nephrolithotomy using a real-time navigation system for percutaneous kidney access

Background: Precise needle puncture of renal calyces is a challenging and essential step for successful percutaneous nephrolithotomy. This work tests and evaluates, through a clinical trial, a real-time navigation system to plan and guide percutaneous kidney puncture. Methods: A novel system, entitled i3DPuncture, was developed to aid surgeons in establishing the desired puncture site and the best virtual puncture trajectory, by gathering and processing data from a tracked needle with optical passive markers. In order to navigate and superimpose the needle to a preoperative volume, the patient, 3D image data and tracker system were previously registered intraoperatively using seven points that were strategically chosen based on rigid bone structures and nearby kidney area. In addition, relevant anatomical structures for surgical navigation were automatically segmented using a multi-organ segmentation algorithm that clusters volumes based on statistical properties and minimum description length criterion. For each cluster, a rendering transfer function enhanced the visualization of different organs and surrounding tissues. Results: One puncture attempt was sufficient to achieve a successful kidney puncture. The puncture took 265 seconds, and 32 seconds were necessary to plan the puncture trajectory. The virtual puncture path was followed correctively until the needle tip reached the desired kidney calyceal. Conclusions: This new solution provided spatial information regarding the needle inside the body and the possibility to visualize surrounding organs. It may offer a promising and innovative solution for percutaneous punctures.

Real-time hand tracking for rehabilitation and character animation

Hand and finger tracking has a major importance in healthcare, for rehabilitation of hand function required due to a neurological disorder, and in virtual environment applications, like characters animation for on-line games or movies. Current solutions consist mostly of motion tracking gloves with embedded resistive bend sensors that most often suffer from signal drift, sensor saturation, sensor displacement and complex calibration procedures. More advanced solutions provide better tracking stability, but at the expense of a higher cost. The proposed solution aims to provide the required precision, stability and feasibility through the combination of eleven inertial measurements units (IMUs). Each unit captures the spatial orientation of the attached body. To fully capture the hand movement, each finger encompasses two units (at the proximal and distal phalanges), plus one unit at the back of the hand. The proposed glove was validated in two distinct steps: a) evaluation of the sensors’ accuracy and stability over time; b) evaluation of the bending trajectories during usual finger flexion tasks based on the intra-class correlation coefficient (ICC). Results revealed that the glove was sensitive mainly to magnetic field distortions and sensors tuning. The inclusion of a hard and soft iron correction algorithm and accelerometer and gyro drift and temperature compensation methods provided increased stability and precision. Finger trajectories evaluation yielded high ICC values with an overall reliability within application’s satisfying limits. The developed low cost system provides a straightforward calibration and usability, qualifying the device for hand and finger tracking in healthcare and animation industries.

Application of Gage R&R methodology for improving the training and evaluation of automatic optical inspection machine operators

The current level of demand by customers in the electronics industry requires the production of parts with an extremely high level of reliability and quality to ensure complete confidence on the end customer. Automatic Optical Inspection (AOI) machines have an important role in the monitoring and detection of errors during the manufacturing process for printed circuit boards. These machines present images of products with probable assembly mistakes to an operator and him decide whether the product has a real defect or if in turn this was an automated false detection. Operator training is an important aspect for obtaining a lower rate of evaluation failure by the operator and consequently a lower rate of actual defects that slip through to the following processes. The Gage R&R methodology for attributes is part of a Six Sigma strategy to examine the repeatability and reproducibility of an evaluation system, thus giving important feedback on the suitability of each operator in classifying defects. This methodology was already applied in several industry sectors and services at different processes, with excellent results in the evaluation of subjective parameters. An application for training operators of AOI machines was developed, in order to be able to check their fitness and improve future evaluation performance. This application will provide a better understanding of the specific training needs for each operator, and also to accompany the evolution of the training program for new components which in turn present additional new difficulties for the operator evaluation. The use of this application will contribute to reduce the number of defects misclassified by the operators that are passed on to the following steps in the productive process. This defect reduction will also contribute to the continuous improvement of the operator evaluation performance, which is seen as a quality management goal.

Voxel-based registration of simulated and real patient CBCT data for accurate dental implant pose estimation

The success of dental implant-supported prosthesis is directly linked to the accuracy obtained during implant’s pose estimation (position and orientation). Although traditional impression techniques and recent digital acquisition methods are acceptably accurate, a simultaneously fast, accurate and operator-independent methodology is still lacking. Hereto, an image-based framework is proposed to estimate the patient-specific implant’s pose using cone-beam computed tomography (CBCT) and prior knowledge of implanted model. The pose estimation is accomplished in a threestep approach: (1) a region-of-interest is extracted from the CBCT data using 2 operator-defined points at the implant’s main axis; (2) a simulated CBCT volume of the known implanted model is generated through Feldkamp-Davis-Kress reconstruction and coarsely aligned to the defined axis; and (3) a voxel-based rigid registration is performed to optimally align both patient and simulated CBCT data, extracting the implant’s pose from the optimal transformation. Three experiments were performed to evaluate the framework: (1) an in silico study using 48 implants distributed through 12 tridimensional synthetic mandibular models; (2) an in vitro study using an artificial mandible with 2 dental implants acquired with an i-CAT system; and (3) two clinical case studies. The results shown positional errors of 67±34μm and 108μm, and angular misfits of 0.15±0.08º and 1.4º, for experiment 1 and 2, respectively. Moreover, in experiment 3, visual assessment of clinical data results shown a coherent alignment of the reference implant. Overall, a novel image-based framework for implants’ pose estimation from CBCT data was proposed, showing accurate results in agreement with dental prosthesis modelling requirements.

A-scan ultrasound system for real-time puncture safety assessment during percutaneous nephrolithotomy

Background: Kidney stone is a major universal health problem, affecting 10% of the population worldwide. Percutaneous nephrolithotomy is a first-line and established procedure for disintegration and removal of renal stones. Its surgical success depends on the precise needle puncture of renal calyces, which remains the most challenging task for surgeons. This work describes and tests a new ultrasound based system to alert the surgeon when undesirable anatomical structures are in between the puncture path defined through a tracked needle. Methods: Two circular ultrasound transducers were built with a single 3.3-MHz piezoelectric ceramic PZT SN8, 25.4 mm of radius and resin-epoxy matching and backing layers. One matching layer was designed with a concave curvature to work as an acoustic lens with long focusing. The A-scan signals were filtered and processed to automatically detect reflected echoes. Results: The transducers were mapped in water tank and tested in a study involving 45 phantoms. Each phantom mimics different needle insertion trajectories with a percutaneous path length between 80 and 150 mm. Results showed that the beam cross-sectional area oscillates around the ceramics radius and it was possible to automatically detect echo signals in phantoms with length higher than 80 mm. Conclusions: This new solution may alert the surgeon about anatomical tissues changes during needle insertion, which may decrease the need of X-Ray radiation exposure and ultrasound image evaluation during percutaneous puncture.