Minimally invasive medical technology

Minimally invasive medicine has the goal of providing health care with minimal trauma. When minimally invasive surgery is utilized, it reduces the length of hospital stays, lowers costs, lowers pain, and reduces blood loss. Other minimally invasive techniques minimize radiation exposure, tissue damage, and drug side effects.

Collecting contributions from workers in various fields within the sphere of minimally invasive medical technology, this book provides essential information for those involved with researching, designing, and using minimally invasive devices and systems. It emphasizes the technology required to accomplish minimally invasive medicine. The book will be of interest to biomedical engineers, medical physicists, and health care providers who want to know the technical workings of their devices and instruments.

Author Notes

John G Webster Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA

Hong CaoHong CaoHong CaoDean H SkuldtDean H SkuldtDean H SkuldtAlberto Rodriguez-RiveraAlberto Rodriguez-RiveraAlberto Rodriguez-RiveraXu LiXu LiOliver WiebenOliver WiebenGlenn WalkerSupan TungjitkusolmunJohn G WebsterG H Olivera and J M Kapatoes and K J Ruchala and P J Reckwerdt and E E Fitchard and H Keller and J P Balog and T R MackieJohn R Goomey

Preface	p. xvii
1 Chemical Sensors	p. 1
1.1 Objects of measurement	p. 1
1.1.1 Objects of chemical measurement	p. 1
1.1.2 Requirement of chemical-measurement sensor	p. 2
1.1.3 Placement of sensors	p. 2
1.2 Electrochemical sensors	p. 3
1.2.1 Electrode potential	p. 3
1.2.2 Potentiometric sensors	p. 5
1.2.3 Amperometric measurement	p. 7
1.2.4 Electrochemical gas sensors	p. 9
1.3 Fiber-optic chemical sensors	p. 10
1.3.1 Spectrophotometric analysis and Beer's Law	p. 10
1.3.2 Fiber-optic chemical sensors	p. 12
1.3.3 Optical oximetry	p. 14
1.4 Other transducers	p. 18
1.4.1 Acoustic bulk-wave device	p. 18
1.4.2 Acoustic surface-wave device	p. 19
1.4.3 Thermal measurement	p. 19
1.5 Biosensors	p. 19
1.5.1 Enzyme-based biosensors	p. 20
1.5.2 Immunosensors	p. 22
1.5.3 Microbial sensors	p. 23
Problems	p. 24
References	p. 24
2 Neuro-Electric Signal Recording	p. 26
2.1 Neuro-electric signal	p. 26
2.1.1 Resting potential	p. 26
2.1.2 Action potential	p. 27
2.2 Conventional electrodes	p. 28
2.2.1 Metal microelectrode	p. 29
2.2.2 Micropipette electrode	p. 29
2.3 Silicon-based microelectrodes	p. 30
Problems	p. 31
References	p. 32
3 Pressure Sensors	p. 33
3.1 Pressure measurement	p. 33
3.2 Indirect pressure measurement	p. 34
3.3 Direct measurement	p. 36
3.3.1 Diaphragm for pressure sensor	p. 36
3.3.2 Strain-gage pressure sensor	p. 37
3.3.3 Capacitive pressure sensor	p. 39
3.3.4 Fiber-optic pressure sensor	p. 40
3.4 Catheter-type pressure sensors	p. 42
3.4.1 Catheter-sensor pressure sensor	p. 42
3.4.2 Catheter-tip pressure sensor	p. 43
Problems	p. 44
References	p. 45
4 X-Ray-Based Imaging	p. 46
4.1 X-ray production	p. 47
4.1.1 The X-ray beam	p. 47
4.1.2 X-ray tubes	p. 47
4.1.3 Anode design	p. 48
4.2 Interaction of X-rays with matter	p. 49
4.2.1 Scattering	p. 49
4.2.2 Harmful effects of exposure	p. 49
4.3 X-ray detection	p. 50
4.3.1 Screen-film detectors	p. 51
4.3.2 Image intensifier	p. 51
4.3.3 Digital detectors	p. 52
4.4 Image quality	p. 53
4.5 X-ray applications	p. 54
4.5.1 X-ray mammography	p. 54
4.5.2 Fluoroscopy	p. 55
4.5.3 X-ray angiography	p. 55
4.6 Computed tomography	p. 55
4.6.1 Scanner technology	p. 56
4.6.2 Filtered back-projection	p. 56
4.6.3 Spiral CT	p. 57
Problems	p. 58
References	p. 58
5 Nuclear Medicine	p. 59
5.1 Radionuclides	p. 59
5.2 Gamma detection	p. 60
5.3 Single-photon emission computed tomography	p. 61
5.4 Positron emission tomography	p. 63
5.4.1 Event detection	p. 63
5.4.2 Uses of PET	p. 64
5.5 Image quality	p. 65
Problems	p. 66
References	p. 66
6 MRI	p. 67
6.1 MR physics	p. 67
6.1.1 Precession	p. 67
6.1.2 Excitation	p. 69
6.1.3 Relaxation	p. 70
6.2 Imaging principles	p. 71
6.2.1 Selective excitation	p. 71
6.2.2 Spatial encoding	p. 72
6.2.3 Pulse sequences	p. 72
6.3 Image quality	p. 74
6.4 MR angiography	p. 75
6.4.1 Noncontrast-enhanced methods	p. 75
6.4.2 Contrast-enhanced MR angiography	p. 76
6.5 Diffusion-weighted and functional MRI	p. 77
6.6 MR spectroscopic imaging	p. 78
Problems	p. 78
References	p. 79
7 Biomagnetic and Bioelectric Imaging	p. 80
7.1 Bioelectromagnetism	p. 80
7.1.1 Electroencephalography	p. 81
7.1.2 Magnetoencephalography	p. 81
7.1.3 Electrocardiography	p. 82
7.1.4 Magnetocardiography	p. 82
7.1.5 Biosuceptometry	p. 83
7.2 Image generation	p. 83
7.2.1 Heart bioelectrical or biomagnetic imaging	p. 84
7.2.2 Brain bioelectric or biomagnetic imaging	p. 85
7.2.3 The inverse problem	p. 85
7.2.4 Space and temporal resolution	p. 87
7.3 Bioeffects	p. 87
Problems	p. 87
References	p. 87
8 Ultrasound	p. 89
8.1 Physical principles of ultrasound	p. 89
8.1.1 Sound waves in sonography	p. 90
8.1.2 Speed, wavelength and frequency	p. 90
8.1.3 Sound intensity	p. 90
8.1.4 Sound behavior and its interaction with objects	p. 91
8.2 Transducers	p. 93
8.2.1 Transducer resonant frequency	p. 93
8.2.2 Transducer assembly head	p. 94
8.2.3 Types of transducer assembly head	p. 95
8.2.4 Sound beams	p. 95
8.2.5 Transducer beamforming	p. 97
8.3 Ultrasound image generation	p. 97
8.3.1 Ultrasound resolution	p. 99
8.3.2 Artifacts	p. 100
8.4 Doppler ultrasound	p. 102
8.4.1 Continuous wave Doppler ultrasound	p. 102
8.4.2 Pulsed Doppler ultrasound	p. 103
8.4.3 Duplex ultrasound	p. 103
8.4.4 Color flow Doppler ultrasound	p. 103
8.5 Three dimensional (3D) ultrasound	p. 104
8.6 Bioeffects	p. 104
Problems	p. 105
References	p. 106
9 Multimodal Imaging	p. 107
9.1 Multimodal imaging versus image fusion	p. 107
9.2 Multimodal imaging	p. 107
9.2.1 Anatomical data and the volume conductor model	p. 109
9.2.2 Source modelling	p. 111
9.2.3 Source localization	p. 112
9.2.4 Linearly constrained minimum variance (LMCV) spatial filters	p. 114
9.3 Image fusion	p. 117
9.3.1 Virtual colonoscopy	p. 117
9.3.2 Brain functionality with CT and SPECT	p. 118
9.3.3 Biomagnetic and bioelectric imaging	p. 120
9.4 Bioeffects	p. 120
Problems	p. 120
References	p. 121
10 General Techniques and Applications	p. 122
10.1 Minimally invasive cardiovascular surgery	p. 122
10.1.1 Minimally invasive direct coronary artery bypass	p. 123
10.1.2 PTMR	p. 124
10.1.3 Percutaneous transluminal coronary angioplasty	p. 126
10.2 Minimally invasive brain surgery	p. 127
10.2.1 Endoscopic neurosurgery and endoscope-assisted microneurosurgery	p. 127
10.2.2 Image-guided stereotaxic brain surgery	p. 128
10.3 Minimally invasive ophthalmalic surgery	p. 129
10.3.1 Laser glaucoma surgery	p. 129
10.3.2 Laser corneal reshaping surgery	p. 131
Problems	p. 133
References	p. 133
11 Endoscopic Surgery	p. 135
11.1 Endoscopes	p. 136
11.1.1 Rigid endoscope	p. 136
11.1.2 Flexible telescope	p. 137
11.1.3 New developments and perspectives of endoscopic technology	p. 139
11.2 Mechanical surgical tools for endoscopic surgery	p. 140
11.2.1 Endoscopic surgical tools for dissection, ligation and suturing	p. 141
11.2.2 Haptic feedback for endoscopic surgery	p. 141
11.3 Endoscopic electrosurgery, ultrasonic surgery and laser surgery	p. 142
11.3.1 Electrosurgical technologies in endoscopic surgery	p. 142
11.3.2 Ultrasonic surgery and harmonic scalpel	p. 144
11.3.3 Laser surgery	p. 144
11.4 The basic procedure and equipment set-up for laparoscopic surgery	p. 145
11.4.1 Basic procedures of laparoscopic surgery	p. 145
11.4.2 Equipment set-ups for laparoscopic surgery	p. 146
11.4.3 Descriptions of some laparoscopic equipment and surgical tools	p. 146
11.4.4 New trends and perspectives of laparoscopic technology	p. 147
11.5 Arthroscopy	p. 148
11.5.1 Instruments	p. 148
11.5.2 Arthroscopic knee surgery	p. 149
Problems	p. 150
References	p. 150
12 Image-Guided Surgery	p. 152
12.1 Image registration	p. 153
12.1.1 Rigid body transformation	p. 153
12.1.2 Nonrigid body transformation	p. 155
12.1.3 Extrinsic image registration	p. 155
12.1.4 Intrinsic image registration	p. 156
12.1.5 Image fusion	p. 157
12.2 Surgical planning	p. 158
12.2.1 Generic atlas models	p. 158
12.2.2 Visualization	p. 159
12.3 Stereotactic surgeries	p. 160
12.3.1 Frame-based stereotactic systems	p. 160
12.3.2 Frameless stereotactic systems	p. 162
12.4 Intraoperative endoscopy and microscopy	p. 165
12.4.1 Endoscopy	p. 166
12.4.2 Microscopy	p. 166
12.5 X-ray fluoroscopy	p. 167
12.6 Intraoperative computed tomography	p. 168
12.7 Intraoperative ultrasound	p. 169
12.8 Intraoperative magnetic resonance imaging	p. 169
12.8.1 Scanner design	p. 170
12.8.2 Instrumentation compatibility	p. 172
12.8.3 Instrument tracking	p. 172
12.8.4 Data acquisition and reconstruction	p. 173
Problems	p. 173
References	p. 173
13 Virtual and Augmented Reality in Medicine	p. 176
13.1 Virtual environment	p. 176
13.1.1 VR sensors	p. 177
13.1.2 VR actuators	p. 179
13.1.3 Augmented reality	p. 183
13.2 Teaching	p. 183
13.3 Diagnosis and surgical planning	p. 184
13.3.1 Diagnosis	p. 184
13.3.2 Surgical planning	p. 185
13.4 VR simulations	p. 187
13.4.1 Surgical simulation	p. 187
13.4.2 Simulating on patient-specific data	p. 189
13.4.3 Tissue modelling	p. 189
13.5 Image guidance	p. 190
13.6 Telesurgery	p. 191
Problems	p. 192
References	p. 192
14 Minimally Invasive Surgical Robotics	p. 195
14.1 Introduction to robotics	p. 195
14.1.1 Components of a robotic system	p. 196
14.1.2 Conceptual models of robots	p. 197
14.1.3 Robotic control	p. 197
14.1.4 Robotic actuators	p. 199
14.1.5 Robotic sensors	p. 199
14.2 Medical robotics	p. 200
14.2.1 Robotic endoscopes	p. 201
14.2.2 Gastrointestinal endoscopy	p. 202
14.2.3 Colonoscopy	p. 203
14.2.4 Laparoscopy	p. 204
14.2.5 Neurosurgery	p. 207
14.2.6 Eye surgery	p. 210
14.2.7 Orthopedic surgery	p. 211
14.2.8 Radiosurgery	p. 211
14.2.9 Ear surgery	p. 212
14.3 Robotics in telesurgery	p. 213
14.4 Safety	p. 216
Problems	p. 216
References	p. 217
15 Ablation	p. 219
15.1 Significance and present applications	p. 219
15.2 Radio-frequency ablation	p. 220
15.2.1 Background	p. 221
15.2.2 Mechanisms of RF energy-induced tissue injury	p. 221
15.2.3 Designs of RF ablation system	p. 223
15.2.4 Advantages and limitations	p. 226
15.2.5 Applications of radio-frequency ablation	p. 226
15.2.6 Research	p. 227
15.3 Laser ablation	p. 228
15.3.1 Background	p. 228
15.3.2 Laser-tissue interactions	p. 231
15.3.3 Advantages and limitations	p. 233
15.3.4 Applications	p. 234
15.3.5 Current research	p. 237
15.4 Ultrasound ablation	p. 237
15.4.1 High-intensity focused ultrasound: background	p. 238
15.4.2 Advantages and limitations	p. 239
15.4.3 Applications	p. 240
15.4.4 Research	p. 241
15.5 Cryoablation	p. 241
15.5.1 Background	p. 241
15.2.2 Mechanism of tissue damage	p. 242
15.5.3 Designs of cryoablation systems	p. 242
15.5.4 Advantages and limitations	p. 245
15.5.5 Applications of cryoablation	p. 246
15.5.6 Research	p. 247
15.6 Microwave ablation	p. 248
15.6.1 Background	p. 248
15.6.2 Designs	p. 249
15.6.3 Advantages and limitations	p. 250
15.6.4 Applications	p. 250
15.6.5 Research	p. 252
15.7 Chemical ablation	p. 252
15.7.1 Applications of chemical ablation	p. 253
Problems	p. 254
References	p. 254
16 Neuromuscular Stimulation	p. 257
16.1 Stimulating nerve	p. 257
16.1.1 Brain stimulation	p. 257
16.1.2 Diaphragm stimulation	p. 258
16.1.3 Bladder stimulation	p. 258
16.2 Cardiac pacemakers	p. 258
16.2.1 Lead	p. 258
16.2.2 Power source	p. 258
16.2.3 Sensing	p. 259
16.2.4 Control	p. 259
16.2.5 Pulse-generating unit	p. 259
16.2.6 Pacing synchrony	p. 259
16.3 Implantable cardioverter-defibrillators	p. 259
Problems	p. 260
References	p. 260
17 Helical Tomotherapy	p. 261
17.1 Introduction	p. 261
17.2 Processes	p. 263
17.2.1 Optimization	p. 265
17.2.2 Megavoltage computed tomography	p. 267
17.2.3 Registration in projection space	p. 269
17.2.4 Delivery modification	p. 270
17.2.5 Delivery verification	p. 272
17.2.6 Dose reconstruction	p. 273
17.3 Conclusions	p. 274
Problems	p. 274
References	p. 275
18 Drug Delivery	p. 278
18.1 Noninvasive drug delivery	p. 278
18.1.1 Respiratory delivery	p. 278
18.1.2 Transdermal delivery	p. 281
18.1.3 Oral controlled-release delivery	p. 291
18.1.4 Other noninvasive routes of administration	p. 294
18.2 Controlled-release drug delivery	p. 294
18.2.1 Controlled-release delivery	p. 295
18.2.2 Targeted-release delivery	p. 298
18.3 Controlled-dose delivery	p. 302
18.3.1 Implantable systems and micropumps	p. 302
18.3.2 Feedback systems	p. 303
Problems	p. 303
References	p. 304
Index	p. 306

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Table of Contents