機械式巡航系統於手術訓練之應用研究

Research on Application of Robotic Navigation System to Surgical Training

10.6342/NTU201600213

陳鼎元

機械式手術巡航系統 ； 手術臨床規劃 ； 腦室穿刺引流術 ； 水腦症 ； 圖形化人機介面 ； 座標疊合 ； 3D Slicer ； Matlab ； Robotic Surgical System ； Surgical Planning ； VP Shunt ； Hydrocephalus ； Graphical User Interface ； Registration ； 3D Slicer ； Matlab

國立臺灣大學機械工程學系學位論文

2016年

碩士

楊宏智

繁體中文

現今的臨床手術中，許多手術仍僅憑著醫師經驗動刀，伴隨著高風險與不確定性，本研究擬開發出一套機械式巡航系統輔助手術，為醫師規劃出準確的位置開刀，提升手術的安全性與便捷性。 談到提升精準度與安全性，醫學影像導航手術 (Image-Guided Surgery) 的普及帶來了許多貢獻，臨床上對於避免術後併發症、縮短病患術後復原時間的需求也逐漸增加。 因此，一套精準、靈巧、好用的醫學影像導航系統在這全新世代中，已成為醫師不可或缺的得力助手，縱觀機械式、光學式、電磁式三種醫學影像導航系統，機械式手術導航系統擁有構造簡單、架設方便、行動限制小、應用靈活等優點，使用前不需費時進行繁瑣的設定，也不會產生醫師進行手術時遮蔽光線而失去追蹤的問題，諸多面向，機械式導航系統相較於其它兩者，有著明顯的優勢。 而本研究先針對治療水腦症病患的腦室穿刺引流手術進行規劃，透過機械手臂搭配CT斷層掃描的資訊，準確地指出最適合穿刺的位置，協助醫師迅速且準確地完成手術，同時擬將這套系統搭配上自製頭形假體，提供新進實習醫師一個精準方便的穿刺練習系統。 利用工業級機械手臂搭配雷射測距儀組合成定位器，輔以3D Slicer三維影像重建軟體、Matlab GUI圖形化人機介面進行數學演算、座標疊合與訊息傳遞，為醫師做好整組手術的臨床規劃，並經過多次實驗交叉驗證其精準度，以期將此系統盡快推上臨床使用，為腦室疾病病患謀福祉。

In order to achieve the greater safety during surgeries, The Image-Guided Surgery becomes more and more popular, also the needs of avoiding complications and shortening the recovery time after the surgery gradually expands. Therefore, an accurate, clever, and useful Image-Guided System in the new generation becomes indispensable. Seeing between the three types of Image-Guided System among Robotic, Optical, and Electro-Magnetical ones, the Robotic Image-Guided System has the advantages of: simpler structure, conveniently equipped, movable, clever applications, and there’s no need for complicated time-cost setup, it also avoids the light-shielding problem in the Optical ones. By multiple points-of-view, the Robotic Image-Guided System has an obvious superiority compared with the others. The research’s main idea is to create a Robotic Surgical Navigation System, so far we have focused on clinical planning for the VP Shunt surgery which cures the patients suffering from Hydrocephalus. We use a robot arm and a laser pointer, combined with the CT images’ information, pointing at the most suitable point to insert, helping the doctors to finish the surgery rapidly and accurately. In addition, we want to add the system with a self-made head-like phantom, providing the new surgeons a convenient and accurate Insertion-Practice System. We combine an Industrial Robot Arm with a Laser Pointer to construct a localizer, taking the advantages of some softwares: 3D Slicer for 3D Visualization, Matlab Graphical User Interface for the numerical inputs / outputs and calculations, registrations and communications, planning a complete clinical surgery process for the doctor. Through many experiments and cross-validations to make sure the accuracy, we expect to put the system to real clinical uses as soon as possible, playing goods for the patients suffering from brain diseases.

1. [1] Hancke S, Holm HH, Koch F, “Ultrasonically Guided Percutaneous Fine Needle Biopsy of the Pancreas,” The International Journal of Surg Gynecol Obstet, Vol.140, No.3, pp. 361-364, 1975.
   連結：
2. [3] Lindgren PG, “Percutaneous Needle Biopsy: A New Technique,” The International Journal of Acta Radiol, Vol. 23, pp. 653-656, 1982.
   連結：
3. [5] Matthew A. Wright, Dennis Balance, Ian D. Robertson, and Brain Poteet, “Introduction to DICOM for the Practicing Veterinarian,” The International Journal of Veterinary Radiology & Ultrasound, Vol. 49, No. 1, Supp. 1, pp. S14-S18, 2008.
   連結：
4. [6] D. A. Rajon, W. E. Bolch, “Marching Cube Algorithm: Review and Trilinear Interpolation Adaptation for Image-Based Dosimetric Models,” The International Journal of Computerized Medical Imaging and Graphics, Vol. 27, pp. 411-435, 2003.
   連結：
5. [8] Patricia S. P. Thong, Stephanus S. Tandjung, Muhammad Mobeen Movania, Wei-Ming Chiew, Malini Olivo, Ramaswamy Bhuvaneswari, Hock-Soon Seah, Feng Lin, Kemao Qian, and Khee-Chee Soo, “Toward Real-Time Virtual Biopsy of Oral Lesions using Confocal Laser Endomicroscopy Interfaced with Embedded Computing,” The International Journal of Biomedical Optics, Vol. 17, No. 5, pp. 1-10, May 2012.
   連結：
6. [11] 林浩瑋，“精密定位與自動進給手術用骨骼鑽孔平台之研究，” 元智大學機械工程研究所碩士論文，2000年。
   連結：
7. [14] Yukio Kosugi, EIJU Watanabe, Junichi Goto, Takashi Watanabe, Satonobu Yoshimoto, Kintomo Takakura, and Jun Ikebe, “An Articulated Neurosurgical Navigation System using MRI and CT Images," IEEE Transactions on Biomedical Engineering, Vol. 35, No. 2, pp.147-152, February 1988.
   連結：
8. [17] K. S. Arun, T. S. Huang, and S. D. Blostein, “Least-Squares Fitting of Two 3-D Point Sets,” IEEE Transactions on Pattern Analysis and Machine Intelligence, Vol. 9, No. 5, pp. 698-700, September 1987.
   連結：
9. [18] E. De Castro, and C. Morandi, “Registration of Translated and Rotated Images using Finite Fourier Transforms,” IEEE Transactions on Pattern Analysis and Machine Intelligence, Vol. 9, No. 5, pp. 700-703, May 1987.
   連結：
10. [19] Paul J. Besl, and Neil D. Mckay, “A Method for Registration of 3-D Shapes,” IEEE Transactions on Pattern Analysis and Machine Intelligence, Vol. 14, No.2,
    連結：
11. pp. 239-256, February 1992.
    連結：
12. [20] Calvin R. Maurer, Robert J. Maciunas, and J. Michael Fitzpatrick, “Registration of Head CT Images to Physical Space using a Weighted Combination of Points and Surfaces,” IEEE Transactions on Medical Imaging, Vol. 17, No. 5, pp. 753-761, October 1998.
    連結：
13. [24] 林書玄，“適用於穿刺手術之醫療機械手臂設計與臨床適用性分析，” 國立臺灣大學工學院機械工程學系碩士論文，2011年。
    連結：
14. [25] 歐峻杰，“適用於穿刺手術之機械式醫療導航系統人機介面設計與臨床誤差分析，” 國立臺灣大學工學院機械工程學系碩士論文，2013年。
    連結：
15. [26] 陳昭揚，“適用於手術訓練之機械式導航系統，” 國立臺灣大學工學院機械工程學系碩士論文，2015年。
    連結：
16. [2] Reinisch H, “A New Biopsy Device (Author’s Transl),” The International Journal of Arc Gschwulstforsch, Vol. 47, No. 7, pp. 611-615, 1977.
17. [4] Lee W. Goldman, “Principles of CT and CT Technology,” The International Journal of Nuclear Medicine Technology, Vol. 35, No. 3, pp. 115-128, September 2007.
18. [7] Benjamin Mora, Jean-Pierre Jessel, and Rene Caubet, “A New Object-Order Ray-Casting Algorithm,” Proceeding of The Conference on Visualization ’02, Washington, DC, USA, Vol. 1, pp. 203-210, October 2002.
19. [9] 王小平，肖越勇，“CT導航技術及其臨床應用研究進展，” 國際醫學放射學雜誌，第35期，第一卷，第66-69頁，2012年1月。
20. [10] Surgical Robot Assistant, Intelligent Systems Laboratory, July 2016, http://cecs.wright.edu.tw.
21. [12] 顱內立體定位導航系統，日隆儀器股份有限公司，2016年6月14日， http://www.upwards.com.tw/ 。
22. [13] Medtronic Fusion ENT Navigation，Medtronic，April 2016, www.youtube.com/watch?v=6RhnyTR9B1U/.
23. [15] Tian Xia, Clint Baird, George Jallo, Kathryn Hayes, Nobuyuki Nakajima, Nobuhiko Hata, and Peter Kazanzides, “An Integrated System for Planning, Navigation and Robotic Assistance for Skull Base Surgery,” The International Journal of Medical Robotics and Computer Assisted Surgery, Vol. 4, pp. 321-330, September 2008.
24. [16] Saul Tovar-Arriaga, Ralf Tita, Jesus Carlos Pedraza-Ortega, Efren Gorrostieta, and Willi A. Kalender, “Development of A Robotic FD-CT-Guided Navigation System for Needle Placement – Preliminary Accuracy Tests,” The International Journal of Medical Robotics and Computer Assisted Surgery, Vol. 7, pp. 225-236, April 2011.
25. [21] Biqiang Du, Ning Xi, and Erick Nieves, “Industrial Robot Calibration using A Virtual Linear Constraint,” The International Journal on Smart Sensing and Intelligent Systems, Vol. 5, No. 4, pp. 987-1001, December 2012.
26. [22] 王聖達，“結合擴增實境技術之手術導引系統，” 長庚大學電機工程研究所碩士論文，2008年。
27. [23] 林建宏， “適用於水腦症腦室引流管放置之影像巡航系統，” 國立臺灣大學工學院醫學工程研究所碩士論文，2012年。