IERAPSI: An Integrated Environment for Rehearsal And Planning of Surgical Interventions

Details
Funded by: EU Fifth Framework Program	Reference: IST-1999-12175
Start: 2000-01-01	Duration: 36 months
Partners
Coordinator: The Victoria University of Manchester	United Kingdom
Contractor: CRS4	Italy
Contractor: Dresden University of Technology	Germany
Contractor: Institute of Laryngology and Otology, University College London	United Kingdom
Contractor: Virtual Presence Ltd.	United Kingdom
Contractor: Genias Benelux	The Netherlands
Contractor: CS SI	France

Abstract

IERAPSI provides a novel approach to computerised image-guided surgical planning. The project aims at providing an environment for visualising and interacting with the anatomy and pathology demonstrated by advanced imaging methods and VR techniques. At the same time IERAPSI will allow rehearsal of procedures on an individual patient and the development of training systems based on individual patient's variations in anatomy and pathology.

Objectives

Today, planning of surgical procedures makes poor use of imaging data. In most cases surgeons simply study medical images from MRI, CT, etc. prior to surgery and construct an internal 3D model of anatomy in each individual case. Previous knowledge of normal anatomy is essential. Further the ability to rehearse the surgical procedure using patient specific data is extremely rare. IERAPSI will provide an interactive computerised environment for the planning and rehearsal of surgical procedures in individual patients. The most important goal is to contribute to the European Community's social objectives by improving the provision of health and life through the introduction of modern science technology into healthcare. Specifically, IERAPSI will provide: Image review and analysis tools to allow the surgical review of CT, MRI and angiographic examinations in an interactive 2D and 3D manner; an integrated suite of image segmentation and visualisation tools intended to allow rapid and accurate identification of individual structure based on their imaging characteristics; a physics based surgical simulation system with visual and haptic feedback for training surgeons to perform operations on individual patient data. To meet the project objectives IERAPSI will address surgery of the petrous bone - a common surgical site with complex anatomy. It requires a range of surgical procedures with escalating levels of complexity. CRS4 is the partner responsible for the study and development of the surgical simulation platform.

Achievements

The project has produced the following tangible results: a physically motivated burr-bone interaction model, loosely based on Hertz contact theory, that includes haptic forces evaluation, the bone erosion process and the resulting debris; adaptive techniques for real-time haptic and visual simulation of bone dissection, that exploit a multiresolution representation of the bone characteristic function to adaptively trade simulation quality with speed; a dynamic direct volume rendering technique based on OpenGL register combiners that is able to render shaded representations of dynamically changing rectilinear scalar volume in parallel to simulation threads; a running prototype of the bone dissection simulator. The system is based on patient-specific volumetric object models derived from 3D CT and MR imaging data. Real-time feedback is provided to the trainees via direct volume rendering and haptic feedback. The performance constraints dictated by the human perceptual system are met by exploiting parallelism via a decoupled simulation approach on a multi-processor PC platform. The end-user evaluation of the simulator was based on three groups of users characterized as: experts (Senior ENT Surgeons); with theoretical knowledge (residents); no previous experience. Complete session traces were acquired during the training sessions and have been later analyzed and compared. The system demonstrated realistic haptic and visual rendering, and the ability of simulating complete mastoidectomy procedures.

Related information

Biomedical Applications Group

Publications

	[1] Marco Agus, Andrea Giachetti, Enrico Gobbetti, Gianluigi Zanetti, and Antonio Zorcolo. Tracking the movement of surgical tools in a virtual temporal bone dissection simulator. In Surgery Simulation and Soft Tissue Modeling. Pages 102-109, Springer Verlag, New York, NY, USA, June 2003.
	[2] Marco Agus, Andrea Giachetti, Enrico Gobbetti, Bruno Picasso, Stefano Sellari Franceschini, Gianluigi Zanetti, and Antonio Zorcolo. A haptic model of a bone-cutting burr. In J. D. Westwood, editor, Medicine Meets Virtual Reality 2003. Pages 4-10, IOS, Amsterdam, The Netherlands, January 2003.
	[3] Marco Agus, Andrea Giachetti, Enrico Gobbetti, Gianluigi Zanetti, and Antonio Zorcolo. Real-time Haptic and Visual Simulation of Bone Dissection. Presence: Teleoperators and Virtual Environments, 12(1): 110-122, February 2003.
	[4] Marco Agus, Andrea Giachetti, Enrico Gobbetti, Gianluigi Zanetti, and Antonio Zorcolo. Adaptive techniques for real-time haptic and visual simulation of bone dissection. In IEEE Virtual Reality Conference. Pages 102-109. IEEE Computer Society Press, March 2003.
	[5] Marco Agus, Andrea Giachetti, Enrico Gobbetti, Gianluigi Zanetti, and Antonio Zorcolo. Un sistema multiprocessore per la simulazione della chirurgia sull'osso temporale. In Proceedings of the Second MIMOS Conference, October 2002.
	[6] Andrea Giachetti, Marco Agus, Enrico Gobbetti, and Gianluigi Zanetti. Blood, dust and mud for a temporal bone surgical simulator. In Proceedings of the 5th Conference of the European Society of Mathematical and Theoretical Biology, Poster sessions, July 2002.
	[7] Marco Agus, Andrea Giachetti, Enrico Gobbetti, Gianluigi Zanetti, and Antonio Zorcolo. Haptic Simulation of Bone Dissection. In Abstract - SIMAI 2002 Symposium on Methods and Applications in Advanced Computational Mechanics, May 2002.
	[8] Marco Agus, Andrea Giachetti, Enrico Gobbetti, Gianluigi Zanetti, and Antonio Zorcolo. A multiprocessor decoupled system for the simulation of temporal bone surgery. Computing and Visualization in Science, 5(1): 35-43, 2002.
	[9] Marco Agus, Andrea Giachetti, Enrico Gobbetti, Gianluigi Zanetti, and Antonio Zorcolo. Real-time Haptic and Visual Simulation of Bone Dissection. In IEEE Virtual Reality Conference. Pages 209-216. IEEE Computer Society Press, February 2002.
	[10] Marco Agus, Andrea Giachetti, Enrico Gobbetti, Gianluigi Zanetti, Nigel W. John, and Robert J. Stone. Mastoidectomy Simulation with Combined Visual and Haptic Feedback. In J. D. Westwood, H. M. Hoffmann, G. T. Mogel, and D. Stredney, editors, Medicine Meets Virtual Reality 2002. Pages 17-23, IOS, Amsterdam, The Netherlands, January 2002.
	[11] Alan Jackson, Nigel W. John, Neil A. Thacker, John E. Gillespie, Enrico Gobbetti, Gianluigi Zanetti, Robert Stone, Alf D. Linney, Ghassan H. Alusi, Stefano Sellari Franceschini, Armin Schwerdtner, and Ad Emmen. Developing a virtual reality environment for petrous bone surgery: a state-of-the-art review. Journal of Otology & Neurotology, 23(2): 111-121, March 2002.
	[12] Nigel W. John, Neil Thacker, Maja Pokric, Alan Jackson, Gianluigi Zanetti, Enrico Gobbetti, Andrea Giachetti, Robert Stone, Joao Campos, Ad Emmen, Armin Schwerdtner, Emanuele Neri, Stefano Sellari Franceschini, and Frederic Rubio. An Integrated Simulator for Surgery of the Petrous Bone. In J. D. Westwood, editor, Medicine Meets Virtual Reality 2001. IOS, January 2001.

Technical Reports

	[1] Marco Agus, Andrea Giachetti, Enrico Gobbetti, Gianluigi Zanetti, and Antonio Zorcolo. IERAPSI Petrous bone surgical simulation platform. Deliverable D4.2. EU Project IERAPSI (IST-1999-12175), January 2003.
	[2] Marco Agus, Andrea Giachetti, Enrico Gobbetti, and Gianluigi Zanetti. IERAPSI Surgical Simulator Software Kernel. Deliverable D4.1. EU Project IERAPSI (IST-1999-12175), February 2002.
	[3] Nigel W. John, Neil A. Thacker, Maja Pokric, Marco Agus, Andrea Giachetti, Enrico Gobbetti, Gianluigi Zanetti, Robert J. Stone, Manfred Kummer, and Frederic Rubio. IERAPSI Surgical Procedures and Implementation Specification. Deliverable D2. EU Project IERAPSI (IST-1999-12175), July 2000.

	Marco Agus, Fabio Bettio, Andrea Giachetti, Enrico Gobbetti, Gianluigi Zanetti, Antonio Zorcolo, Michele D'Anteo, Stefano Sellari Franceschini, and Simone Valori Real and Virtual Surgical Procedures on the Temporal Bone CRS4 Video n. 104 - Date: 10/2002 - Duration: 00:08:30 Presented at: IEEE Virtual Reality Conference, Conference held in Los Angeles, CA, USA, March 22-26, 2003.
	Marco Agus, Fabio Bettio, Andrea Giachetti, Enrico Gobbetti, Gianluigi Zanetti, Antonio Zorcolo, and Stefano Sellari Franceschini Extradural Bone Removal Simulation CRS4 Video n. 103 - Date: 10/2002 - Duration: 00:07:03
	Marco Agus, Fabio Bettio, Andrea Giachetti, Enrico Gobbetti, Gianluigi Zanetti, and Aantonio Zorcolo Real-time haptic and visual simulation of bone dissection CRS4 Video n. 97 - Date: 09/2001 - Duration: 00:04:25 Presented at: IEEE Virtual Reality Conference, Conference held in Orlando, FL, USA, March 24-28, 2002.