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At least 19 records
All sourcesNASA NTRSDOE OSTI
NASA NTRS2000

Surgical Instrument Restraint in Weightlessness

Performing a surgical procedure during spaceflight will become more likely with longer duration missions in the near future. Minimal surgical capability has been present on previous missions as the definitive medical care time was short and the likelihood of surgical events too low to justify surgical hardware availability. Early demonstrations of surgical procedures in the weightlessness of parabolic flight indicated the need for careful logistical planning and restraint of surgical hardware. The consideration of human ergonomics also has more impact in weightlessness than in the conventionall-g environment. Three methods of surgical instrument restraint - a Minor Surgical Kit (MSK), a Surgical Restraint Scrub Suit (SRSS), and a Surgical Tray (ST) were evaluated in parabolic flight surgical procedures. The Minor Surgical Kit was easily stored, easily deployed, and demonstrated the best ability to facilitate a surgical procedure in weightlessness. Important factors in this surgical restraint system include excellent organization of supplies, ability to maintain sterility, accessibility while providing secure restraint, ability to dispose of sharp items and biological trash, and ergonomical efficiency.

Campbell, Mark R.↗
DOE OSTI2018

MR-Compatible Surgical Instruments Final Report CRADA No. TSB-0847-94

ITI is a California-based company formed in February 1994 to design, manufacture and market premium quality magnetic resonance imaging (MRI) medical devices and instruments. These products are for use in existing MR irnagers, as well as for emerging applications in reaI-tirne MRI-guided surgery and interventional radiology. Such application require products that are MR biocompatible and in many cases MR visible. In an era of managed health care, purchasing decisions by hospitals, medical centers and insurers emphasize cost-effectiveness. Since minimally invasive therapy reduces surgical costs, shortens hospital stay and post-operative rehabilitation, this segment of the health care industry is expected to grow rapidly. Many experts believe that high-speed MRI-guided therapy offers the best opportunity to maximize the benefits of minimally invasive procedures because MIH enables the clearest differentiation of normal from abnormal tissues. Manufacturers of conventional imagers, including General Electric, Siemens, and Philips, have aleady made substantial investments aid produced prototype high-speed MRI.imagers to permit continuous real-time visualization of tissues during surgical and endovascular procedures. According to forecasts published by the National Electrical Manufacturers Association (1993) and the Medical and Healthcare Marketplace Guide (1992), the average world~wide growth rate of MN installations is expected to be about 7% annually for the next three years, increasing 12-15% annually thereafter as developing countries buy increasing numbers of MM units. The same forecasters project 17,000- 20,000 MRI irnagers world-wide by the year 2000, with a throughput of 2,300-6,000 patients per machine per year, at an.average examination cost.of $560-780-per-patient.

60 APPLIED LIFE SCIENCES↗
NASA NTRS1999

Evaluation of a telerobotic system to assist surgeons in microsurgery

A tool was developed that assists surgeons in manipulating surgical instruments more precisely than is possible manually. The tool is a telemanipulator that scales down the surgeon's hand motion and filters tremor in the motion. The signals measured from the surgeon's hand are transformed and used to drive a six-degrees-of-freedom robot to position the surgical instrument mounted on its tip. A pilot study comparing the performance of the telemanipulator system against manual instrument positioning was conducted at the University of Southern California School of Medicine. The results show that a telerobotic tool can improve the performance of a microsurgeon by increasing the precision with which he can position surgical instruments, but this is achieved at the cost of increased time in performing the task. We believe that this technology will extend the capabilities of microsurgeons and allow more surgeons to perform highly skilled procedures currently performed only by the best surgeons. It will also enable performance of new surgical procedures that are beyond the capabilities of even the most skilled surgeons. Copyright 1999 Wiley-Liss, Inc.

Microsurgery/instrumentation/methods↗
NASA NTRS1994

Quantitative 3-D imaging topogrammetry for telemedicine applications

The technology to reliably transmit high-resolution visual imagery over short to medium distances in real time has led to the serious considerations of the use of telemedicine, telepresence, and telerobotics in the delivery of health care. These concepts may involve, and evolve toward: consultation from remote expert teaching centers; diagnosis; triage; real-time remote advice to the surgeon; and real-time remote surgical instrument manipulation (telerobotics with virtual reality). Further extrapolation leads to teledesign and telereplication of spare surgical parts through quantitative teleimaging of 3-D surfaces tied to CAD/CAM devices and an artificially intelligent archival data base of 'normal' shapes. The ability to generate 'topogrames' or 3-D surface numerical tables of coordinate values capable of creating computer-generated virtual holographic-like displays, machine part replication, and statistical diagnostic shape assessment is critical to the progression of telemedicine. Any virtual reality simulation will remain in 'video-game' realm until realistic dimensional and spatial relational inputs from real measurements in vivo during surgeries are added to an ever-growing statistical data archive. The challenges of managing and interpreting this 3-D data base, which would include radiographic and surface quantitative data, are considerable. As technology drives toward dynamic and continuous 3-D surface measurements, presenting millions of X, Y, Z data points per second of flexing, stretching, moving human organs, the knowledge base and interpretive capabilities of 'brilliant robots' to work as a surgeon's tireless assistants becomes imaginable. The brilliant robot would 'see' what the surgeon sees--and more, for the robot could quantify its 3-D sensing and would 'see' in a wider spectral range than humans, and could zoom its 'eyes' from the macro world to long-distance microscopy. Unerring robot hands could rapidly perform machine-aided suturing with precision micro-sewing machines, splice neural connections with laser welds, micro-bore through constricted vessels, and computer combine ultrasound, microradiography, and 3-D mini-borescopes to quickly assess and trace vascular problems in situ. The spatial relationships between organs, robotic arms, and end-effector diagnostic, manipulative, and surgical instruments would be constantly monitored by the robot 'brain' using inputs from its multiple 3-D quantitative 'eyes' remote sensing, as well as by contact and proximity force measuring devices. Methods to create accurate and quantitative 3-D topograms at continuous video data rates are described.

Altschuler, Bruce R.↗
NASA NTRS1997

Dexterity-Enhanced Telerobotic Microsurgery

The work reported in this paper is the result, of a collaboration between researchers at the Jet Propulsion Laboratory and Steve Charles, MD, a vitreo-retinal surgeon. The Robot Assisted MicroSurgery (RAMS) telerobotic workstation developed at JPL is a prototype of a system that will be completely under the manual control of a surgeon. The system has a slave robot that will hold surgical instruments. The slave robot motions replicate in six degrees of freedom those of tile. surgeon's hand measured using a master input device with a surgical instrument, shaped handle. The surgeon commands motions for the instrument by moving the handle in the desired trajectories. The trajectories are measured, filtered, and scaled down then used to drive the slave robot.

Charles, Steve↗
DOE OSTI2016

SU-F-P-42: “To Navigate, Or Not to Navigate: HDR BT in Recurrent Spine Lesions”

Purpose: We compare the accuracy of HDR catheter placement for paraspinal lesions using O-arm CBCT imaging combined with StealthStation navigation and traditional fluoroscopically guided catheter placement. Methods: CT and MRI scans were acquired pre-treatment to outline the lesions and design treatment plans (pre-plans) to meet dosimetric constrains. The pre-planned catheter trajectories were transferred into the StealthStation Navigation system prior to the surgery. The StealthStation is an infra red (IR) optical navigation system used for guidance of surgical instruments. An intraoperative CBCT scan (O-arm) was acquired with reference IR optical fiducials anchored onto the patient and registered with the preplan image study to guide surgical instruments in relation to the patients’ anatomy and to place the brachytherapy catheters along the pre-planned trajectories. The final treatment plan was generated based on a 2nd intraoperative CBCT scan reflecting achieved implant geometry. The 2nd CBCT was later registered with the initial CT scan to compare the preplanned dwell positions with actual dwell positions (catheter placements). Similar workflow was used in placement of 8 catheters (1 patient) without navigation, but under fluoroscopy guidance in an interventional radiology suite. Results: A total of 18 catheters (3 patients) were placed using navigation assisted surgery. Average displacement of 0.66 cm (STD=0.37cm) was observed between the pre-plan source positions and actual source positions in the 3 dimensional space. This translates into an average 0.38 cm positioning error in one direction including registration errors, digitization errors, and the surgeons ability to follow the planned trajectory. In comparison, average displacement of non-navigated catheters was 0.50 cm (STD=0.22cm). Conclusion: Spinal lesion HDR brachytherapy planning is a difficult task. Catheter placement has a direct impact on target coverage and dose to critical structures. While limited to a handful of patients, our experience shows navigation and fluoroscopy guided placement yield similar results.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

WE-AB-BRA-01: 3D-2D Image Registration for Target Localization in Spine Surgery: Comparison of Similarity Metrics Against Robustness to Content Mismatch

Purpose: In image-guided spine surgery, mapping 3D preoperative images to 2D intraoperative images via 3D-2D registration can provide valuable assistance in target localization. However, the presence of surgical instrumentation, hardware implants, and soft-tissue resection/displacement causes mismatches in image content, confounding existing registration methods. Manual/semi-automatic methods to mask such extraneous content is time consuming, user-dependent, error prone, and disruptive to clinical workflow. We developed and evaluated 2 novel similarity metrics within a robust registration framework to overcome such challenges in target localization. Methods: An IRB-approved retrospective study in 19 spine surgery patients included 19 preoperative 3D CT images and 50 intraoperative mobile radiographs in cervical, thoracic, and lumbar spine regions. A neuroradiologist provided truth definition of vertebral positions in CT and radiography. 3D-2D registration was performed using the CMA-ES optimizer with 4 gradient-based image similarity metrics: (1) gradient information (GI); (2) gradient correlation (GC); (3) a novel variant referred to as gradient orientation (GO); and (4) a second variant referred to as truncated gradient correlation (TGC). Registration accuracy was evaluated in terms of the projection distance error (PDE) of the vertebral levels. Results: Conventional similarity metrics were susceptible to gross registration error and failure modes associated with the presence of surgical instrumentation: for GI, the median PDE and interquartile range was 33.0±43.6 mm; similarly for GC, PDE = 23.0±92.6 mm respectively. The robust metrics GO and TGC, on the other hand, demonstrated major improvement in PDE (7.6 ±9.4 mm and 8.1± 18.1 mm, respectively) and elimination of gross failure modes. Conclusion: The proposed GO and TGC similarity measures improve registration accuracy and robustness to gross failure in the presence of strong image content mismatch. Such registration capability could offer valuable assistance in target localization without disruption of clinical workflow. G. Kleinszig and S. Vogt are employees of Siemens Healthcare.

60 APPLIED LIFE SCIENCES↗
NASA NTRS1966

Bibliography on Clean Rooms

Bibliography on contamination control, and air filtering for application to electronics and surgical instruments

ELECTRONIC EQUIPMENT↗
NASA NTRS1998

A Telerobot to Extend the Skill of Microsurgeons

The engineering details of the Robot Assisted MicroSurgery (RAMS) telerobotic system designed to assist microsurgeons improve the precision and dexterity with which they can position surgical instruments is described in this paper.

telerobotics microsurgery precise positioning of s↗
NASA NTRS1991

Minor surgery in microgravity

The purpose is to investigate and demonstrate equipment and techniques proposed for minor surgery on Space Station Freedom (SSF). The objectives are: (1) to test and evaluate methods of surgical instrument packaging and deployment; (2) to test and evaluate methods of surgical site preparation and draping; (3) to evaluate techniques of sterile procedure and maintaining sterile field; (4) to evaluate methods of trash management during medical/surgical procedures; and (4) to gain experience in techniques for performing surgery in microgravity. A KC-135 parabolic flight test was performed on March 30, 1990 with the goal of investigating and demonstrating surgical equipment and techniques under consideration for use on SSF. The flight followed the standard 40 parabola profile with 20 to 25 seconds of near-zero gravity in each parabola.

Billica, Roger↗
NASA NTRS2003

MEMS-Based Piezoelectric/Electrostatic Inchworm Actuator

A proposed inchworm actuator, to be designed and fabricated according to the principles of microelectromechanical systems (MEMS), would effect linear motion characterized by steps as small as nanometers and an overall range of travel of hundreds of microns. Potential applications for actuators like this one include precise positioning of optical components and active suppression of noise and vibration in scientific instruments, conveyance of wafers in the semiconductor industry, precise positioning for machine tools, and positioning and actuation of micro-surgical instruments. The inchworm motion would be generated by a combination of piezoelectric driving and electrostatic clamping. The actuator (see figure), would include a pair of holders (used for electrostatic clamping), a slider (the part that would engage in the desired linear motion), a driver, a piezoelectric stack under the driver, and a pair of polymer beams centrally clamped to the flexure beam via a T bar. The holders would be held stationary. One end of the piezoelectric stack would be held stationary; the other end would be connected to the bottom of the driver, which would be free to move up and down. All of these components except the piezoelectric stack and the polymer beams would be micromachined from a 500- m-thick silicon wafer by deep reactive-ion etching. The inchworm motion would be perpendicular to the broad faces of the wafer (perpendicular to the plane of the figure). The combination of the polymer beams and the centrally clamped flexure beam would spring-bias the slider into a position such that, in the absence of electrostatic clamping, the gap between the slider on the one hand and both the driver and the holder on the other hand would be no more than a few microns. This arrangement would make it possible to electrostatically pull the slider into contact with either the holders or the driver at a clamping force of the order of 1 N by applying a reasonably small voltage (of the order of 100 V).

Yang, Eui-Hyeok↗
NASA NTRS1999

Creation of Anatomically Accurate Computer-Aided Design (CAD) Solid Models from Medical Images

Most surgical instrumentation and implants used in the world today are designed with sophisticated Computer-Aided Design (CAD)/Computer-Aided Manufacturing (CAM) software. This software automates the mechanical development of a product from its conceptual design through manufacturing. CAD software also provides a means of manipulating solid models prior to Finite Element Modeling (FEM). Few surgical products are designed in conjunction with accurate CAD models of human anatomy because of the difficulty with which these models are created. We have developed a novel technique that creates anatomically accurate, patient specific CAD solids from medical images in a matter of minutes.

Stewart, John E.↗
DOE OSTI2018

Experimental Investigation of Mechanical Performance and Printability of Gamma-Irradiated Additively Manufactured ABS

The work presented in this paper investigates the effects of gamma radiation on ABS in forms of irradiated 3D-printed parts, and irradiated filament used to later 3D-printed parts, using a cobalt-60 gamma irradiator. Tensile and flexural test samples were fabricated using off-the-shelf FDM 3D printers and irradiated at different dosages. Mechanical properties including elastic and flexure moduli, ultimate and flexural strength, % elongation at break, and surface hardness were evaluated, and results were compared to a control group. Evidence of cross-linking and chain scission and signs of possible oxidation of polymer caused by irradiation were found in both test groups which led to changes in mechanical properties. Moreover, it was found that ABS filament retains its printability after absorbing 15 kGy of gamma radiation and that its mechanical performance is very similar to those of irradiated samples at the same dose. Obtained results show promise for using ABS to fabricate sterile surgical instruments.

75 CONDENSED MATTER PHYSICS, SUPERCONDUCTIVITY AND↗
DOE OSTI2015

Extremely durable biofouling-resistant metallic surfaces based on electrodeposited nanoporous tungstite films on steel

Formation of unwanted deposits on steels during their interaction with liquids is an inherent problem that often leads to corrosion, biofouling and results in reduction in durability and function. Here we report a new route to form anti-fouling steel surfaces by electrodeposition of nanoporous tungsten oxide (TO) films. TO-modified steels are as mechanically durable as bare steel and highly tolerant to compressive and tensile stresses due to chemical bonding to the substrate and island-like morphology. When inherently superhydrophilic TO coatings are converted to superhydrophobic, they remain non-wetting even after impingement with yttria-stabilized-zirconia particles, or exposure to ultraviolet light and extreme temperatures. Upon lubrication, these surfaces display omniphobicity against highly contaminating media retaining hitherto unseen mechanical durability. Furthermore, to illustrate the applicability of such a durable coating in biofouling conditions, we modified naval construction steels and surgical instruments and demonstrated significantly reduced marine algal film adhesion, Escherichia coli attachment and blood staining.

36 MATERIALS SCIENCE↗
DOE OSTI2021

DOE Plasma Science Center - Predictive Control of Plasma Kinetics: Multi-Phase and Bounded Systems (Final Report DE-SC0001939)

Low temperature plasmas (LTPs) are the plasmas of electron-volt (eV) physics and eV technologies. LTPs have characteristic electron temperatures of a few eV and fractional ionizations that are typically small. Since LTPs have electron temperatures commensurate with the threshold energies of excited states in neutral atoms and molecules, power transfer from electrons to these atoms and molecules efficiently produces activated species (e.g., radicals, excited states, photons). Acceleration of ions in the sheaths of LTPs to energies of tens to hundreds of eV enable activation of surface modifying processes – sputtering, etching, deposition. With such properties, LTPs are often and beneficially used in technological devices, ranging from etching and deposition in microelectronics and solar cell fabrication, to hardening of surgical instruments. LTPs harbor fundamental science issues that are intellectually challenging and rewarding. At the same time, there are enormous societal benefits that are enabled by LTPs. The entire present-day and future information technology infrastructure owes its very existence to LTPs. Renewable energy sources, such as solar cell arrays, could not be economically produced in the absence of deposition and etching by LTPs. In acknowledgment of the importance of LTPs, the DOE Office of Fusion Energy Sciences supported the Plasma Science Center for Predictive Control of Plasma Kinetics: Multi-Phase and Bounded Systems from August 2009 to July 2021, consisting of an initial 5-year grant, 3 funded extensions and 2 no-cost extensions. This is the final report of the Center in which the productivity of the Center is discussed in terms of publications, impact and personnel. High-lights of the research performed in the Center are provided.

36 MATERIALS SCIENCE↗
NASA NTRS1973

Observation of arterial blood pressure of the primate

The developments are reported in physiological instrumentation, surgical procedures, measurement and data analysis techniques, and the definition of flight experiments to determine the effects of prolonged weightlessness on the cardiovascular system of subhuman primates. The development of an implantable telemetric data acquisition system is discussed along with cardiovascular research applications in renal hemodynamics. It is concluded that the implant technique permits a valid interpretation, free of emotional response, for the manipulated variable on physiological functions. It also allows a better definition of normal physiological baseline conditions.

Meehan, J. P.↗
NASA NTRS1972

Coronary flow and left ventricular function during environmental stress.

A canine model was used to study the effects of different environmental stresses on the heart and coronary circulation. The heart was surgically instrumented to measure coronary blood flow, left ventricular pressure, and other cardiovascular variables. Coronary flow was recorded by telemetry. Physiologic data were processed and analyzed by analog and digital computers. By these methods the physiologic response to altitude hypoxia, carbon monoxide, hypercapnia, acceleration, exercise, and the interaction of altitude hypoxia and carbon monoxide were described. The effects of some of these stresses on the heart and coronary circulation are discussed.

Erickson, H. H.↗