Page 434 - Biomedical Engineering and Design Handbook Volume 2, Applications

412 SURGERY

System usability and maintainability are also important design considerations. Clearly, the
ergonomic design of the system from the surgeon’s perspective is important. 79,80 However, the inter-
faces provided for the operating room staff that must set up the equipment, help operate it, and pro-
vide routine maintenance are also crucial both for safety and economic reasons. Similarly, CIS
systems should include interfaces to help field engineers troubleshoot and service equipment. In this
regard, the ability of computer-based systems to log data during use can be especially useful in post-
failure analysis and in scheduling preventive maintenance, as well as in providing data for improve-
ment in surgical outcomes and techniques. Although most systems make some use of such facilities,
they are probably underused in present-day commercial systems.
System interoperability is currently a major challenge. Commonly accepted open standards per-
mitting different equipment to work together in a variety of settings are badly needed. Several com-
panies have proposed proprietary standards for use by alliances of vendors, and there has been some
academic and government-supported work to provide tool kits, especially in software. However,
these efforts are still very fragmented.

14.4 EXAMPLES OF CIS SYSTEMS

There are already a few dozen CIS systems available commercially or as prototypes in research lab-
oratories worldwide. Although it is not practical to present an exhaustive survey, this section
describes a few examples of integrated systems that use parts of the technology described above. For
the purposes of this overview, we distinguish between four types of systems:

1. Information enhancement systems
2. Robotic systems for precise preoperative plan execution
3. Robotic systems for human augmentation
4. Other robotic systems
Note that many real systems could logically fit in several of these categories.

14.4.1 Information Enhancement Systems
The purpose of information enhancement systems is to provide the surgeon and surgical team with
accurate, up-to-date, and useful data and images during the surgery so that they can best develop and
update their plan of action and perform surgical actions. To achieve this goal, information enhance-
ment systems usually combine information from different modalities, such as preoperative CT and
MRI data, real-time tracking data of tools and anatomy, intraoperative images such as ultrasound and
fluoroscopic x-ray images, video sequences from endoscopic cameras, and more. In some cases,
such as virtual diagnostic endoscopy, a simulated environment replaces the actual procedure.
Information enhancement systems are by far the most commonly used CIS systems. What distin-
guishes them from other CIS systems is that it is the surgeon who performs all surgical gestures with-
out any physical assistance from mechanical devices.
We classify information enhancement systems into three categories:
1. Navigation systems
2. Augmented reality navigation systems
3. Virtual reality systems
We describe them briefly next.