Modern surgical departments are characterized by a high degree of automation supporting complex procedures. It recently became apparent that integrated operating rooms can improve the quality of care, simplify clinical workflows, and mitigate equipment-related incidents and human errors. Particularly using computer assistance based on data from integrated surgical devices is a promising opportunity. However, the lack of manufacturer-independent interoperability often prevents the deployment of collaborative assistive systems. The German flagship project OR.NET has therefore developed, implemented, validated, and standardized concepts for open medical device interoperability. This paper describes the universal OR.NET interoperability concept enabling a safe and dynamic manufacturer-independent interconnection of point-of-care (PoC) medical devices in the operating room and the whole clinic. It is based on a protocol specifically addressing the requirements of device-to-device communication, yet also provides solutions for connecting the clinical information technology (IT) infrastructure. We present the concept of a service-oriented medical device architecture (SOMDA) as well as an introduction to the technical specification implementing the SOMDA paradigm, currently being standardized within the IEEE 11073 service-oriented device connectivity (SDC) series. In addition, the Session concept is introduced as a key enabler for safe device interconnection in highly dynamic ensembles of networked medical devices; and finally, some security aspects of a SOMDA are discussed.
Abstract. In robotic radiosurgery, the compensation of motion of internal organs is vital. This is currently done in two phases: an external surrogate signal (usually active optical markers placed on the patient's chest) is recorded and subsequently correlated to an internal motion signal obtained using stereoscopic X-ray imaging. This internal signal is sampled very infrequently to minimise the patient's exposure to radiation. We have investigated the correlation of the external signal to the motion of the liver in a porcine study using ε-support vector regression. IR LEDs were placed on the swines' chest. Gold fiducials were placed in the swines' livers and were recorded using a two-plane X-ray system. The results show that a very good correlation model can be built using ε-SVR, in this test clearly outperforming traditional polynomial models by at least 45 and as much as 74 %. Using multiple markers simultaneously can increase the new model's accuracy.
Surgical procedures become more and more complex and the number of medical devices in an operating room (OR) increases continuously. Today's vendor-dependent solutions for integrated ORs are not able to handle this complexity. They can only form isolated solutions. Furthermore, high costs are a result of vendor-dependent approaches. Thus we present a service-oriented device communication for distributed medical systems that enables the integration and interconnection between medical devices among each other and to (medical) information systems, including plug-and-play functionality. This system will improve patient's safety by making technical complexity of a comprehensive integration manageable. It will be available as open standards that are part of the IEEE 11073 family of standards. The solution consists of a service-oriented communication technology, the so called Medical Devices Profile for Web Services (MDPWS), a Domain Information & Service Model, and a binding between the first two mechanisms. A proof of this concept has been done with demonstrators of real world OR devices.
Objective Recent surgical planning software provides valuable tools for evaluating different resection strategies preoperatively. With such virtual resections, predictions and quantitative analyses may be carried out to assess the resection feasibility with respect to tumors and risk structures. In oncologic liver surgery, additional tumors that were not seen in the preoperative images are often found during the intervention using intraoperative ultrasound (IOUS). Due to such findings, the resection strategy must be updated or completely revised. Materials and methods Therefore, we have developed methods for the intraoperative modification of resection plans. The probe of an ultrasound-based navigation system and alternatively the pointing device Wiimote are proposed as intraoperative interaction devices. Fast adaptation of planning information and the communication with both interaction devices is supported by our system, the Intraoperative Planning Assistant (IPA). The IPA has been evaluated in the operation room (OR) during laparoscopic liver interventions on pigs. Results Our preliminary results confirm that intraoperative modifications of resection plans are both feasible and beneficial for liver surgery. After the intraoperative modification task, updated remaining liver volume and resection volume were displayed and quantified within 10 s. Conclusion For the first time, surgeons are provided with a system for intraoperative modification of resection plans that offers a crucial decision support, is easy to use and integrates smoothly into the clinical workflow. The new system provides major support for decision making in the OR and thus improves the safety of surgical interventions.
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