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Marc Garbey Barbara Lee Bass Scott Berceli Christophe Collet Pietro Cerveri Editors Computational Surgery and Dual Training Computing, Robotics and Imaging Computational Surgery and Dual Training Marc Garbey • Barbara Lee Bass (cid:129) Scott Berceli Christophe Collet (cid:129) Pietro Cerveri Editors Computational Surgery and Dual Training Computing, Robotics and Imaging 123 Editors MarcGarbey BarbaraLeeBass DepartmentofComputerScience DepartmentSurgery UniversityofHouston TheMethodistHospitalResearchInstitut Houston,TX,USA Houston,TX,USA ScottBerceli ChristopheCollet DepartmentofSurgery Labo.Sciencesdel’Images,de UniversityofFloridaCollegeofMedicine UniversitéStrasbourgIENSPS Gainesville,FL,USA Illkirch,France PietroCerveri BiomedicalEngineeringDepartment PolitecnicodiMilano Milano,Italy ISBN978-1-4614-8647-3 ISBN978-1-4614-8648-0(eBook) DOI10.1007/978-1-4614-8648-0 SpringerNewYorkHeidelbergDordrechtLondon LibraryofCongressControlNumber:2013953712 ©SpringerScience+BusinessMediaNewYork2014 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpartof thematerialisconcerned,specificallytherightsoftranslation,reprinting,reuseofillustrations,recitation, broadcasting,reproductiononmicrofilmsorinanyotherphysicalway,andtransmissionorinformation storageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilarmethodology nowknownorhereafterdeveloped.Exemptedfromthislegalreservationarebriefexcerptsinconnection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’slocation,initscurrentversion,andpermissionforusemustalwaysbeobtainedfromSpringer. PermissionsforusemaybeobtainedthroughRightsLinkattheCopyrightClearanceCenter.Violations areliabletoprosecutionundertherespectiveCopyrightLaw. Theuseofgeneraldescriptivenames,registerednames,trademarks,servicemarks,etc.inthispublication doesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfromtherelevant protectivelawsandregulationsandthereforefreeforgeneraluse. While the advice and information in this book are believed to be true and accurate at the date of publication,neithertheauthorsnortheeditorsnorthepublishercanacceptanylegalresponsibilityfor anyerrorsoromissionsthatmaybemade.Thepublishermakesnowarranty,expressorimplied,with respecttothematerialcontainedherein. Printedonacid-freepaper SpringerispartofSpringerScience+BusinessMedia(www.springer.com) Preface While a concept in evolution, Computational Surgery is a new discipline that focuses on the application of medical imaging, robotics, biological modeling, simulation, and information technology in surgical treatment of patients. The COSINEconsortium(computationalsurgery.org)foundedin2008aimstoproduce anewbreedofengineersandscientistswhocanpartnerwithphysicianstoevolvethe nextgenerationofsurgicalcare.Thiseffort,fueledbytheurgentneedexpressedby thoughtleadersinthemedicaldeviceindustry,seekstofacilitatetherapidevolution toward computer-assisted surgical-based therapies. At a time where the medical budget of advanced countries is the fastest growing sector of the economy, the challengetoimproveefficiencywhilemaintainingthequalityofcarerequiresnew and innovativesolutions. As stated in the inaugural2010issue of this book,“The futureofsurgeryisintrinsicallylinkedtothefutureofcomputationalsciences:the medicalact will be computer assisted at every single step, from planningto post- surgeryrecoveryandthroughthesurgicalprocedureitself.”Theunderpinningofthe sentimentsis evenmoretruetoday,with this secondissue offeringa moremature pictureofafieldthatistakingrootina varietyofcoredisciplines.Asacollective groupfocus,researchinterestsencompassbutarenotlimitedtothefollowingareas: (cid:129) Modelingandsimulationtopredictsurgicaloutcomes (cid:129) Real-timesimulationtoaugmentoperatingroomprocedures (cid:129) Designofnewmedicaldevicestomeetproceduralneeds (cid:129) Integrationofpatient-specificdatatoproceduralplanningandoutcomes (cid:129) Multi-scalemodelingofsurgicaldisease In the currentissue, we presentrecentprogressesin fourcomplementaryfields ofcomputationalsurgery: 1. ModelingandSimulationofSurgicalProcedures 2. RoboticandImage-GuidedSurgicalIntervention 3. ImageAnalysisandVisualizationforSurgicalPlanning 4. InformationTechnologyasaFrameworkforSurgicalDecisionMaking v vi Preface AmongtheprimarygoalsofthisbookistopromotethedevelopmentofCyber- Infrastructurein the operatingroom, with a particular emphasis on computational methods to optimize the integration of procedural technologies, informatics, and human factors to maximize the delivery of surgical care. We are taking a holistic viewoftheoperatingroomtowardanintegratedplatformthatcombinessimulation, imaging,androboticsintoanewframeworkforsurgeonsandengineers,requiring new skills and promising interactions. This book provides a strategic view for developing a cross discipline curriculum in computational surgery aimed at two disciplines: (cid:129) Computationalscientistsandengineersmotivatedtocollaboratewithsurgeonsto improvethestateoftheart. (cid:129) Surgeons who are interested in the cutting-edge computational technology innovationsthatdrivemedicalimaging,robotics,andvirtualsurgerysimulation. Following the introduction, which offers a roadmap to achieve this goal, the book is organized into five parts that address successively the computer-assisted management of disease and surgery, the role of image processing in diagnostic and/or intervention, the image driven intervention and robotic, the contribution of modeling and simulation to surgery, and finally the training and performance analysis inherentto this new technology.We have made special efforts to include extended review chapters that define the landscape of the medical knowledge requiredtofacilitatethedialogbetweenspecialties.OurspecialthanksgotoBrian Butler,ShandaBlackmon,MarkDavies,MinPKim,AlanB.Lumsden,BinSTeh from the Methodist Hospital and William W. Lytton from the Downstate Medical Center,who have providedmuch of the informationprovidedin this contribution. Other chapters address various innovative computational methods and techniques for surgery improvement, some intended to rapidly open the path toward new practices,andothersdesignedtooutlinecriticalareasofactiveresearchthatrequire additionaldevelopmentpriortointegrationintoeverydaylifesurgicalpractice. Part II of this book discusses the computer-assisted management of disease throughmedicalimagingandimageanalysis.Detailedinthefirstchapterisastate- of-the-art virtual reality environment dedicated to the comprehensive planning of surgicalandinterventionaltherapies.Thefollowingchapterdescribesthe applica- tionofcomputer-aidedanalysisintheplanninganddeliveryofradiotherapythrough useofanintegratedsystemthatsimultaneouslyimagesthepatientandcontrolsthe localdeliveryofradiation.Thefinalchapterofthissectiondemonstratestheroleof modelingand simulationto predictthe cosmetic outcomefollowinglocalsurgical treatmentofbreastcarcinoma. Part III examines approaches aimed at improving the real-time connection between diagnostic imaging and the delivery of care. In this section, we engage thecomplexityofmultivariatedata,requiringbothefficientmodelingtoreconstruct compleximagesandadvancedinformaticstofacilitatetherapidcommunicationof complexdatasets.Drivingthisworkisthedevelopmentofabetterandfastertoolto guidesurgicalintervention. Preface vii PartIVbuildsuponautomaticimageprocessingandreal-timeimageguidanceto drivesophisticatedandcomplexinterventions.Thispartlooksatfourcomplemen- tary fields of application: cardiovascular intervention, orthopedic reconstructions, lungcancerresection,andabdominalendoscopy.Thecommonalitybetweenthese divergentdisciplinesistheextensiveuseofcomputersandalgorithmstoobtainthe most accurate and efficient minimally invasive procedures.It is a fascinating area ofresearchwheremedicalimaging,innovativeprocessingmethods,andadvanced robotic devicescome togetherwith simulation algorithmsto optimize controland maneuverability.The recentintroductionof arthroplastyusing personalizedresec- tionguidesisanexcellentexampleofthesechallenges,whereefficientandrobust methodsarerequiredtoextractclinicallandmarksfromdiagnosticimagestoreduce uncertainty and increase the reliability of the intervention. Similarly, innovative technologiesexploitingminiaturizedandsmartrobotsareofferingopportunitiesto gain access to the internal body, through access points that can be quite remote from the region of interest, reducing scars, and speeding up postoperative patient recovery. Part V returns to the fundamental understanding of disease. Through the mathematical modeling of tissue adaptation and repair, therapeutic opportunities to improve outcomes can be identified. Fundamental to this approach is a model thatissufficientlyaccuratetoprovidereliablepredictionyetrobustenoughtowork onavailableclinicaldata.Severalapplicationsfromcardiovascularinterventionto cancermanagement,fromneurologicdiseasetoboneassessment,arereviewed. Finally, Part VI discusses the fundamental aspect of training in surgery and the use of computational approaches to assess clinical competence. An improved understandingoftheintegrationandimplementationoftechnologyintheoperating roomiscriticaltooptimizingtheefficiencyprocedures. Our hope in detailing general concepts and reporting specific examples in computationalsurgeryistobothgrowfieldandbringtogethermodeling,computing, robotics,andimagingintooptimalsurgicalplatform.Sciencediscoveryinmodern surgery will benefit from this unique dialogue initiative between a community of surgeonsand computationalscientists. Finally we would like to thank the Partner UniversityFund(PUF),theAtlantisprogram,andtheJohnF.andCarolynBookout DistinguishedEndowedchairinsupportofthisteamproject. Houston,TX,USA MarcGarbey Houston,TX,USA BarbaraLeeBass Gainesville,FL,USA ScottBerceli Illkirch,France ChristopheCollet Milano,Italy PietroCerveri Contents PartI Introduction 1 A RoadMapforComputationalSurgery:Challenges andOpportunities.......................................................... 3 B.L.BassandM.Garbey PartII Computer Assisted Management of Disease andSurgery 2 Plato’sCAVE: A Multidimensional, Image-Guided RadiationTherapyCrossRealityPlatformwithAdvanced Surgical Planning, Simulation, and Visualization TechniquesUsing(Native)DICOMPatientImageStudies............ 27 E.BrianButler,PaulE.Sovelius,andNancyHuynh 3 StereotacticBodyRadiotherapy/StereotacticAblative BodyRadiotherapyforLungCancer .................................... 37 HuaRen,ShandaBlackmon,andBinS.Teh 4 Computer-AidedManagementinScoliosisSurgery.................... 57 TranNguyenHoangThiTho,TruongQuangDangKhoa, VoVanThanh,LawrenceH.Le,andVoVanToi 5 ComputationalModelingofBreastConservingSurgery (BCS)StartingfromMRIImaging....................................... 67 D.Thanoon,M.Garbey,andB.L.Bass PartIII ImageProcessingandDiagnostics 6 A Statistical Framework for Biomarker Analysis andHR-MAS2DMetaboliteIdentification.............................. 89 AkramBelghith,ChristopheCollet,andJean-PaulArmspach ix

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