Kidney targeting and puncturing during percutaneous nephrolithotomy: recent advances and future perspectives

Background and Purpose: Precise needle puncture of the kidney is a challenging and essential step for successful percutaneous nephrolithotomy (PCNL). Many devices and surgical techniques have been developed to easily achieve suitable renal access. This article presents a critical review to address the methodologies and techniques for conducting kidney targeting and the puncture step during PCNL. Based on this study, research paths are also provided for PCNL procedure improvement. Methods: Most relevant works concerning PCNL puncture were identified by a search of Medline/PubMed, ISI Web of Science, and Scopus databases from 2007 to December 2012. Two authors independently reviewed the studies. Results: A total of 911 abstracts and 346 full-text articles were assessed and discussed; 52 were included in this review as a summary of the main contributions to kidney targeting and puncturing. Conclusions: Multiple paths and technologic advances have been proposed in the field of urology and minimally invasive surgery to improve PCNL puncture. The most relevant contributions, however, have been provided by the applicationofmedical imaging guidance, newsurgical tools,motion tracking systems, robotics, andimage processing and computer graphics. Despite the multiple research paths for PCNL puncture guidance, no widely acceptable solution has yet been reached, and it remains an active and challenging research field. Future developments should focus on real-time methods, robust and accurate algorithms, and radiation free imaging techniques

Palco: a multisensor realtime 3D cartoon production system

This paper presents Palco, a prototype system specifically designed for the production of 3D cartoon animations. The system addresses the specific problems of producing cartoon animations, where the main obj ective is not to reproduce realistic movements, but rather animate cartoon characters with predefined and characteristic body movements and facial expressions. The techniques employed in Palco are simple and easy to use, not requiring any invasive or complicated motion capture system, as both body motion and facial expression of actors are captured simultaneously, using an infrared motion detection sensor, a regular camera and a pair of electronically instrumented gloves. The animation process is completely actor-driven, with the actor controlling the character movements, gestures, facial expression and voice, all in realtime. The actor controlled cartoonification of the captured facial and body motion is a key functionality of Palco, and one that makes it specifically suited for the production of cartoon animations.

An Electromagnetic Tracker System for the design of a dental superstructure

Nowadays, different techniques are available for manufacturing full-arch implant-supported prosthesis, many of them based on an impression procedure. Nevertheless, the long-term success of the prosthesis is highly influenced by the accuracy during such process, being affected by factors such as the impression material, implant position, angulation and depth. This paper investigates the feasibility of a 3D electromagnetic motion tracking system as an acquisition method for modeling such prosthesis. To this extent, we propose an implant acquisition method at the patient mouth, using a specific prototyped tool coupled with a tracker sensor, and a set of calibration procedures (for distortion correction and tool calibration), that ultimately obtains combined measurements of the implant’s position and angulation, and eliminating the use of any impression material. However, in the particular case of the evaluated tracking system, the order of magnitude of the obtained errors invalidates its use for this specific application.

Electromagnetic tracker feasibility in the design of a dental superstructure for edentulous patients

The success of the osseointegration concept and the Brånemark protocol is highly associated to the accuracy in the production of an implant-supported prosthesis. One of most critical steps for long-term success of these prosthesis is the accuracy obtained during the impression procedure, which is affected by factors such as the impression material, implant position, angulation and depth. This paper investigates the feasibility of 3D electromagnetic motion tracking systems as an acquisition method for modeling full-arch implant-supported prosthesis. To this extent, we propose an implant acquisition method at the patient mouth and a calibration procedure, based on a 3D electromagnetic tracker that obtains combined measurements of implant’s position and angulation, eliminating the use of any impression material. Three calibration algorithms (namely linear interpolation, higher-order polynomial and Hardy multiquadric) were tested to compensate for the electromagnetic tracker distortions introduced by the presence of nearby metals. Moreover, implants from different suppliers were also tested to study its impact on tracking accuracy. The calibration methodology and the algorithms employed proved to implement a suitable strategy for the evaluation of novel dental impression techniques. However, in the particular case of the evaluated electromagnetic tracking system, the order of magnitude of the obtained errors invalidates its use for the full-arch modeling of implant-supported prosthesis.

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.

Dense motion field estimation from myocardial boundary displacements

Minimally invasive cardiovascular interventions guided by multiple imaging modalities are rapidly gaining clinical acceptance for the treatment of several cardiovascular diseases. These images are typically fused with richly detailed pre-operative scans through registration techniques, enhancing the intra-operative clinical data and easing the image-guided procedures. Nonetheless, rigid models have been used to align the different modalities, not taking into account the anatomical variations of the cardiac muscle throughout the cardiac cycle. In the current study, we present a novel strategy to compensate the beat-to-beat physiological adaptation of the myocardium. Hereto, we intend to prove that a complete myocardial motion field can be quickly recovered from the displacement field at the myocardial boundaries, therefore being an efficient strategy to locally deform the cardiac muscle. We address this hypothesis by comparing three different strategies to recover a dense myocardial motion field from a sparse one, namely, a diffusion-based approach, thin-plate splines, and multiquadric radial basis functions. Two experimental setups were used to validate the proposed strategy. First, an in silico validation was carried out on synthetic motion fields obtained from two realistic simulated ultrasound sequences. Then, 45 mid-ventricular 2D sequences of cine magnetic resonance imaging were processed to further evaluate the different approaches. The results showed that accurate boundary tracking combined with dense myocardial recovery via interpolation/ diffusion is a potentially viable solution to speed up dense myocardial motion field estimation and, consequently, to deform/compensate the myocardial wall throughout the cardiac cycle. Copyright © 2015 John Wiley & Sons, Ltd.

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.

Validation of percutaneous puncture trajectory during renal access using 4D ultrasound reconstruction

Background: An accurate percutaneous puncture is essential for disintegration and removal of renal stones. Although this procedure has proven to be safe, some organs surrounding the renal target might be accidentally perforated. This work describes a new intraoperative framework where tracked surgical tools are superimposed within 4D ultrasound imaging for security assessment of the percutaneous puncture trajectory (PPT). Methods: A PPT is first generated from the skin puncture site towards an anatomical target, using the information retrieved by electromagnetic motion tracking sensors coupled to surgical tools. Then, 2D ultrasound images acquired with a tracked probe are used to reconstruct a 4D ultrasound around the PPT under GPU processing. Volume hole-filling was performed in different processing time intervals by a tri-linear interpolation method. At spaced time intervals, the volume of the anatomical structures was segmented to ascertain if any vital structure is in between PPT and might compromise the surgical success. To enhance the volume visualization of the reconstructed structures, different render transfer functions were used. Results: Real-time US volume reconstruction and rendering with more than 25 frames/s was only possible when rendering only three orthogonal slice views. When using the whole reconstructed volume one achieved 8-15 frames/s. 3 frames/s were reached when one introduce the segmentation and detection if some structure intersected the PPT. Conclusions: The proposed framework creates a virtual and intuitive platform that can be used to identify and validate a PPT to safely and accurately perform the puncture in percutaneous nephrolithotomy.

Sistema eletromecânico para controlo intuitivo dos movimentos de uma sonda transesofágica

O ser humano realiza uma alimentação pouco variada, com grandes teores de açúcar e gorduras saturadas, ao mesmo tempo, está sujeito a profissões cada vez mais competitivas aonde passa longos períodos sentados sem qualquer esforço físico. Estes aspetos levam à acumulação de gorduras em redor de todos os órgãos, que promovem o aparecimento de problemas cardiovascular, que são atualmente, a principal causa de morte no mundo. O tratamento das doenças cardiovasculares é em muitas situações realizado por procedimentos minimamente-invasivos, que são guiados através de imagem médica. Contudo, a utilização de radiação durante a navegação é normalmente requerida o que tem consequências para o paciente e para a equipa médica. Nesta dissertação, focamo-nos nos recentes sistemas de aquisição de imagem sem radiação e no desenvolvimento de sistemas mais inteligentes para facilitar o controlo destes equipamentos durante o procedimento. Assim, pretendemos desenvolver um robô que apoie na aquisição de imagens de ultrassons através de uma sonda transesofágica. O robô desenvolvido possui um conjunto de engrenagens que fazem a transferência de movimento para as rodas dos manípulos da sonda e um encoder magnético que proporciona uma leitura rápida e de alta precisão dos movimentos da sonda. De forma a automaticamente adaptar a posição da sonda na direção do alvo anatómico, um sistema de motion tracking foi acoplado ao robô e ao instrumento cirúrgico utilizado durante o procedimento. Assim, todos os movimentos realizados pelo intervencionista são repetidos pela sonda, permitindo assim adquirir uma imagem de ultrassom sempre centrada no instrumento cirúrgico. Para avaliar a performance do robô foram realizados testes em laboratório. mais concretamente: 1) controlo do robô sem sonda acoplada e 2) controlo do robô com sonda acoplada. Os testes foram realizados com diferentes posições angulares, em todas as gamas de funcionamento do robô, avaliando o erro da posição final em relação posição desejada e o tempo de resposta. Os resultados demonstraram que um erro médio de 2º foi observado para as diferentes situações com um tempo médio de resposta de 300 ms. Os resultados alcançados demonstraram uma boa resposta do sistema, pelo que se espera que sistema desenvolvido venha ser capaz de reduzir o tempo de intervenção, aumentando a qualidade da intervenção e minimizando possíveis erros.

Análise de métodos de replicação: o caso IBOVESPA

Este artigo apresenta e implementa os principais métodos quantitativos para replicar o Índice Bovespa. Os modelos utilizados são: replicação plena, carteira de mínima variância global, Black e minimização quadrática sem venda a descoberto, cujos critérios de análise incluem os parâmetros de tracking error, beta, R-quadrado e semelhança de série em relação à média e à variância. Concluiu-se que não existe o melhor modelo na aplicação ao Ibovespa, porque todos mostraram seus méritos e suas limitações nas diversas condições simuladas, além do fato de cada administrador poder ter necessidades diferentes, mutáveis no espaço e no tempo.

Direct Power Control of Matrix Converter Based Unified Power Flow Controllers

This paper presents the Direct Power Control of Three-Phase Matrix Converters (DPC-MC) operating as Unified Power Flow Controllers (UPFC). Since matrix converters allow direct AC/AC power conversion without intermediate energy storage link, the resulting UPFC has reduced volume and cost, together with higher reliability. Theoretical principles of DPC-MC method are established based on an UPFC model, together with a new direct power control approach based on sliding mode control techniques. As a result, active and reactive power can be directly controlled by selection of an appropriate switching state of matrix converter. This new direct power control approach associated to matrix converters technology guarantees decoupled active and reactive power control, zero error tracking, fast response times and timely control actions. Simulation results show good performance of the proposed system.

Detecção automática de bagagem abandonada

Por razões de segurança, tem vindo a aumentar a utilização de sistemas de videovigilância em espaços públicos. Face a acontecimentos recentes, designadamente a ocorrência de explosões, é importante detectar bagagem abandonada porque poderá ser perigosa. Surge neste contexto a motivação para este trabalho, cujo objectivo é a detecção automática de objectos abandonados num lugar de embarque e desembarque de passageiros. O sistema desenvolvido processa as imagens obtidas pelas câmaras de videovigilância. Para cada câmara, cada imagem é comparada com a respectiva imagem de fundo, determinada inicialmente, para detectar alterações no local. Após processamento para remover efeitos de sombra e pontos espúrios, a representação binária das alterações é projectada no plano do chão e fundida com as outras projecções. Através da análise da fusão das projecções, identificam-se as blobs, designação da representação de passageiros e bagagem neste domínio. A detecção de bagagem abandonada baseia-se na ideia de que isso corresponde à divisão de uma blob em duas, permanecendo uma no local onde ocorreu a bifurcação e tendo havido afastamento da outra. Usando os dados de referência do encontro Performance Evaluation of Tracking and Surveillance, realizado em 2006, discute-se o desempenho do protótipo implementado e a sua parametrização e apresentam-se aspectos de refinamento e implementação da heurística de detecção. Analisada a utilização de imagens de um sistema de videovigilância instalado com outra finalidade, constata-se a forte dependência em relação ao número e disposição das câmaras, que neste caso, se revela desadequada.

Impacto da infecção do Vírus da Imunodeficiência Humana na deformação miocárdica: projecto de investigação

Mestrado em Tecnologia de Diagnóstico e Intervenção Cardiovascular. Área de especialização: Ultrassonografia Cardiovascular.

Estudo da função sistólica do ventrículo direito por ecocardiografia transtorácica: relatório de projecto

Mestrado em Tecnologia de Diagnóstico e Intervenção Cardiovascular. Área de especialização - Ultrassonografia Cardiovascular

Dissecting the role of CLASP1 in the mammalian development

A mitose é o evento celular, através do qual uma células transmite uma cópias do seu DNA às células filhas. Este processo é mediado pelo fuso mitótico, o qual consiste numa rede bipolar microtubulos. A dinâmica dos microtubulos é regulada por proteínas associadas a estes (MAPs – Microtubule-Associated Proteins), tais como as proteínas associadas às extremidades positivas dos microtubulos (+TIPs – Plus-ends Tracking proteins). As proteínas associadas às CLIPs (CLASPs – CLIP-associated proteins) pertencem a esta família e estão altamente conservadas nos eucariotas. Estas interagem com os microtubulos regulando o fuso mitótico, a segregação dos cromossomas e o comportamento dos microtubulos ao nível do cinetocoro. Assim, as CLASPs têm sido descritas como essenciais à manutenção da integridade genética durante a divisão celular. Um modelo animal knockout para o gene Clasp1 é uma ferramenta indispensável à descoberta do papel da CLASP1 a nível fisiológico. Nos animais knockout foi observado um fenótipo letal, no qual 100% dos recém-nascidos morreram poucos minutos após o nascimento, no decurso de falência respiratória. Após análise histopatológica, observamos que os pulmões dos animais knockout apresentam um atraso no desenvolvimento. Porém, a análise da expressão de marcadores de diferenciação celular, mostrou que os pneumócitos tipo I e II estão presente e diferenciados nos animais knockout aquando do seu nascimento. No entanto, um defeito primário a nível pulmonar ainda não pode ser excluído. Níveis elevados de glicogénio no parênquima alveolar dos animais knockout sugerem imaturidade pulmonar ou deficiente produção do líquido surfactante. Adicionalmente, ainda não está esclarecido de que forma pode este atraso explicar a letalidade observada nos recémnascidos knockout. Verificamos também que expressão de CLASP1 é transiente ao longo do desenvolvimento, sendo particularmente elevada no cérebro, o que pode explicar o seu papel já descrito na biologia dos neurónios. A CLASP1 é ubiquamente expressa em mamíferos adultos, o que sugere que esta proteína é também importante em tecidos diferenciados. Nesta fase, o significado biológico da CLASP1 em mamíferos ainda não foi descortinado. No entanto, nenhum animal knockout para Clasp1 foi capaz de sobreviver ex uterus, o que sugere um papel fundamental desta proteína na fase final do desenvolvimento dos mamíferos.