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Biomedical subjects

S Hassfeld

Publications and source records attributed to S Hassfeld.

At least 55 records · Page 3Linked to original sources
PubMed2000

3D norm data: the first step towards semiautomatic virtual craniofacial surgery.

When planning craniofacial surgical interventions, the ideal appearance of the patient is very important. The final appearance should be as close as possible to that which the patient would have if he/she were without defects. Our first step towards achieving this is to build a database containing sets of three-dimensional CT images that allows for comparison of the shape of a patient with defects to the typical shape of an age- and sex-matched "average" person without defects. We started to collect CT data from patients without pathologies and, in co-operation with two radiology institutes (in Mannheim and Heidelberg), over 100 CT data sets have now been collected and classified according to age and sex. It is necessary to choose an appropriate statistical method to calculate the norm data from the different data sets. Based on the statistical method, an age- and sex-matched "average" model of the anatomy will be created.

Adolescent↗
PubMed2000

[Computer-assisted oral, maxillary and facial surgery].

BACKGROUND: Methods from the area of virtual reality are used in oral and maxillofacial surgery for the planning and three-dimensional individual simulation of surgeries. SIMULATION: In order to simulate complex surgeries with the aid of a computer, the diagnostic image data and especially various imaging modalities (CT, MRT, US) must be arranged in relation to each other, thus enabling rapid switching between the various modalities as well as the viewing of mixed images. Segmenting techniques for the reconstruction of three-dimensional representations of soft-tissue and osseous areas are required. We must develop ergonomic and intuitively useable interaction methods for the surgeon, thus allowing for precise and fast entry of the planned surgical intervention in the planning and simulation phase. SURGERY: During the surgical phase, instrument navigation tools offer the surgeon interactive support through operation guidance and control of potential dangers. This feature is already available today. Future intraoperative assistance will take the form of such passive tools for the support of intraoperative orientation as well as so-called tracking systems (semi-active systems) which accompany and support the surgeons' work. The final form are robots which execute specific steps completely autonomously. DISCUSSION: The techniques of virtual reality keep gaining in importance for medical applications. Many applications are still being developed or are still in the form of a prototype. However, it is already clear that developments in this area will have a considerable effect on the surgeon's routine work.

Computer Simulation↗
PubMed2000

[Bipolar irrigation forceps. Initial experiences with a new device in high frequency surgery].

PROBLEM: During most surgeries, tissues are coagulated by a high-frequency current in order to stop the bleeding. Usually, bipolar forceps are used for this procedure. Until now it could not be avoided, however, that the biotissue would adhere to the forceps ends making hemostasis more difficult to achieve. Can this negative effect possibly be avoided? MATERIAL AND METHOD: A newly developed bipolar irrigation forceps spilling out a 0.9% sodium chloride solution during the coagulation process has been designed to avoid this disadvantage. The irrigation forceps has been tested and evaluated experimentally in surgery as well as clinically. RESULTS: The irrigation liquid selected is a 0.9% sodium chloride solution. Thermal imaging during biotissue coagulation has shown that the tissue heats up more and faster with flushed coagulation, and that the tip of the forceps heats up less than with unirrigated coagulation. In both experimental-surgical as well as in clinical tests it was possible to stop the biotissue sticking to the ends of the forceps. This effect was also confirmed histologically. CONCLUSION: Since other methods of avoiding the sticking effect during tissue coagulation by a high-frequency current have not been successful until now, the bipolar irrigation electrode is a promising new development. It helps the surgeon to work more efficiently and safely without having to adapt to big changes, and, at the same time, it reduces the risk of complications.

Animals↗
PubMed2000

Intuitive operation planning based on force feedback.

In the craniofacial surgery image-slices obtained from tomographies are used for planning and simulation of surgical interventions. Using these image-slices three-dimensional geometric models can be reconstructed, representing bones and soft tissue. However, for planning complex surgical interventions simulation methods are needed additionally to the pure visualisation. Exemplary, planning a Frontal Orbital Advancement (FOA) operation the cutting trajectories, their depth and orientation in each point, the drill hole, the position, orientation and deformation of bones, etc. are the point of interest. Especially for intraoperative execution supported by navigation systems or robots. In order to be able to plan such complex interventions with the help of computers, geometrical and haptical models must be generated from the image-slices. On the one hand these models represent the anatomical structures exactly, on the other hand they are needed for the simulation of the different activities, which have to be performed during the surgical intervention like drilling, milling, deforming, positioning, etc. Beside the geometrical and haptical models methods for interactions must be supplied to the physician for an accurate and intuitive planning of the surgical intervention. We developed such an operation planning system which is already used in clinical practise in Heidelberg.

Artificial Intelligence↗
PubMed2000

A pattern catalogue of surgical interventions for computer-supported operation planning.

In this paper we present a new operation planning system which was evaluated in the clinic for Cranio-Maxillo-Facial-Surgery at the University of Heidelberg. In opposite to commercial systems our goal was, that the system considers the complete surgical intervention and not only a single procedure of it. A second goal was, that the system enables managing of complex operations, independent of which way the intervention will be intraoperatively performed (without technical support, with passive navigation support or active support by robots). Our system supports the surgeon during the preoperative planning as well as during the intraoperative execution phase. Therefore we developed a course model by which the managing of surgical interventions is possible. The focus of this paper is on this course model. At first we introduce instruction graphs and describe the structure of each activity observing its attributes and their context. Additionally, various surgical scopes will be presented which enable the surgeon to select one view among different ones of the individual operation procedures in accordance to medical and technical knowledge as well as in accordance to different degrees of abstraction. At last we demonstrate operation patterns, used as expert knowledge.

Computer Simulation↗
PubMed2000

Clinical evaluation of a highly accurate algorithm for CT bone contour segmentation.

Planning, visualisation and intraoperative navigation in a robot assisted environment for craniofacial surgery require highly accurate methods for the segmentation of bone structures in CT data. Clinical systems are still based on time consuming interactive methods like the seed-point segmentation. Faster methods with no need for interactivity lacks in precision. In the following we will present an automatic and highly accurate algorithm for the segmentation of bone contours in CT data. It is based on an algorithm for the automatic calculation of a grey-value tissue relation model for CT and MRI data.

Algorithms↗
PubMed2000

A real-time CORBA based system architecture for robot assisted craniofacial surgery.

We present the concept of a system architecture for the computer aided craniofacial surgery. The architecture is based on CORBA, an industrial standard specification for the development of distributed applications. Our concept includes a fundamental behaviour oriented communication model and some fundamental software safety considerations. We've developed a standard library for the integration of new services and devices into our system architecture. It decreases development time noticeably. We tested the performance and usability of our concept on an evaluation set up consisting of a surgery robot system, an infrared navigation system, a force-torque sensor and a visualisation software, obtaining excellent results. Future work will consist in the integration of further devices and the extension of our safety concept. An accurate clinical evaluation will take place continuously.

Computer Graphics↗
PubMed2000

Texture mapping based visualisation methods for the manipulation of CT data: interaction and ergonomics.

The manipulation of large CT datasets needs fast visualisation methods for a comfortable user interaction. Modern visualisation techniques make use texture hardware in graphics workstations extensively. In the following we will present an interactive tool for the positioning of anatomical landmarks in CT datasets of non-pathological children. The tool includes a fast visualisation of CT cross sections based on a texture mapping technique and an interactive three-dimensional view of the segmented CT dataset.

Cephalometry↗
PubMed2000

Computer aided planning device for preoperative bending of osteosynthesis plates.

In craniofacial surgery bone fractures and repositioned bone segments often have to be fixed by titanium miniplates. In clinical routines the surgeon has to fit each miniplate t be used to the individual bone structure of the patient: bending and fitting of a miniplate must frequently be repeated several times. Often up to twenty minutes are required to achieve the best fit of a single osteosynthesis plate. As a patient usually receive several miniplates for bone fixture, he will be exposed to long anaesthesia. In co-operation with the surgeons of the Clinic of Maxillofacial surgery at the University of Heidelberg we have conceived a planning system for the preoperative positioning of miniplates on a model of the patient's skull. The appropriate bending is computed and the bending data are stored for later use by a bending device and an intraoperative positioning aid. The principles of our computer-aided tool are presented in this paper.

Bone Plates↗
PubMed2000

Synthesis of CAD/CAM, robotics and biomaterial implant fabrication: single-step reconstruction in computer-aided frontotemporal bone resection.

The preoperative manufacturing of individual skull implants, developed by an interdisciplinary research group at Ruhr-University Bochum, is based on the use of titanium as the most common material for implants at present. Using the existing technology for materials that can be milled or moulded, customized implants may be manufactured as well. The goal of the study was to examine biodegradable materials and to evaluate the practicability of intraoperative instrument navigation and robotics. Data acquisition of an adult sheep's head was performed with helical computer tomography (CT). The data were transferred onto a computer aided design/computer aided manufacturing system (CAD/CAM system), and two complex defects in the frontotemporal skull were designed. Standard individual titanium implants were milled for both of the defects. Additionally, for one of the defects a resection template, as well as a mould for the biodegradable poly(D,L-lactide) (PDLLA) implant, were fabricated by the CAD/CAM system. A surgeon carried out the first bone resection (#1) for the prefabricated titanium implant using the resection template and an oscillating saw. The robot system Stäubli RX90CR, modified for clinical use, carried out the other resection (#2). Both titanium implants and the PDLLA implant were inserted in their respective defects to compare the precision of their fit. A critical comparison of both implant materials and both resection types shows that fabrication of a PDLLA implant and robot resection are already possible. At present, the titanium implant and resection using a template are more convincing due to the higher precision and practicability.

Absorbable Implants↗
PubMed2000

Comparative examination of the accuracy of a mechanical and an optical system in CT and MRT based instrument navigation.

The aim of an intraoperative instrument navigation system is to support the surgeon in the localization of anatomical regions and to guide the use of surgical instruments. An overview of technical principles and literature reports on various navigation systems is provided here. The navigation accuracy (tested on a plastic phantom under simulated operating room conditions) of the mechanical Viewing Wand system and the optical SPOCS system amounts to 1 to 3 mm for computerized tomography (CT) data, with a significant inverse dependence on the layer thickness. The values for magnetic resonance tomography (MRT) data are significantly higher. In regard to the choice of registration points, a statistically inverse dependence exists between the number of points and the distance between the points. During the time period between autumn 1993 and mid-1999, more than 120 clinical applications were performed. The intraoperative accuracy was in the range of < or = 3 mm. Registering the patient position with preoperatively inserted screw markers achieved accuracy values of < or = 2 mm. The instrument navigation technique has proved to be very advantageous for the spatial orientation of the surgeons. The possibility of checking resection borders has opened up new perspectives in tumor surgery. A quality improvement and a reduction of the operational risks as well as a considerable decline in the stress placed on the patient can be expected in the near future due the techniques of computer-assisted surgery.

Humans↗
PubMed1999

Digital radiography of interproximal bone loss; validity of different filters.

The aim of the present study was to compare linear measurements of interproximal bone loss on digitized radiographic images after application of different filters to the gold standard of intrasurgical measurements. Immediately before surgery, 50 radiographs of 50 periodontally-diseased teeth exhibiting interproximal bone loss, were obtained by a standardized technique in 33 patients. Intrasurgically, the distances from the cementoenamel junction (CEJ) to the alveolar crest (AC) and from the CEJ to the deepest extension of the bony defect (BD) were assessed. All radiographs were digitized with a flatbed scanner (resolution: 600x1200 dpi). Using the FRIACOM-soft-ware, the linear distances CEJ to AC and CEJ to BD were measured at 50 interproximal lesions from the digitized but unchanged radiographic images and also after use of 7 different basic image-processing modes (enhancement of contrast [dynamics], inversion, high-pass, enhancement of gray-level differences, mean value, histogram correction, spreading of grey values) with 11-fold magnification. Neither the measurement of the distance CEJ to AC on the unchanged images nor assessments with any of the filters revealed significant differences from the gold standard. Multivariate analysis of variance showed the respective filter (p=0.009), intrasurgical and radiographic assessments (p<0.0001), to statistically significantly, influence the difference between intrasurgical and radiographic measurements of the distance CEJ to BD. The underestimation of the intra-surgically assessed distance CEJ to BD by radiographic measurements ranged from 0.3+/-2.0 to 0.8+/-1.9 mm. The filter "mean value" underestimated interproximal bone loss statistically significantly more than the digitized but unchanged radiograph (p=0.05). In this study, basic digital manipulations (filters) of radiographic images failed to result in statistically significantly more valid measurements of interproximal bone loss when compared to the unchanged but digitized images. All radiographic assessments on the digitized images except for use of one filter (mean value) came close to the intrasurgical gold standard.

Adult↗
PubMed1999

Virtual surgery in a (tele-)radiology framework.

This paper presents telemedicine as an extension of a teleradiology framework through tools for virtual surgery. To classify the described methods and applications, the research field of virtual reality (VR) is broadly reviewed. Differences with respect to technical equipment, methodological requirements and areas of application are pointed out. Desktop VR, augmented reality, and virtual reality are differentiated and discussed in some typical contexts of diagnostic support, surgical planning, therapeutic procedures, simulation and training. Visualization techniques are compared as a prerequisite for virtual reality and assigned to distinct levels of immersion. The advantage of a hybrid visualization kernel is emphasized with respect to the desktop VR applications that are subsequently shown. Moreover, software design aspects are considered by outlining functional openness in the architecture of the host system. Here, a teleradiology workstation was extended by dedicated tools for surgical planning through a plug-in mechanism. Examples of recent areas of application are introduced such as liver tumor resection planning, diagnostic support in heart surgery, and craniofacial surgery planning. In the future, surgical planning systems will become more important. They will benefit from improvements in image acquisition and communication, new image processing approaches, and techniques for data presentation. This will facilitate preoperative planning and intraoperative applications.

Surgical Procedures, Operative↗
PubMed1999

Development of an interactive multimedia-CBT-program for dental implantology and using tests of a program prototype.

The aim of the study was the development of a teaching program for dental implantology designed to improve student education as well as further training in this area. Initially, the computer equipment of German dentists was evaluated. Then, the contents of a teaching program "implantology interactive" were defined. A fully functional program prototype was developed in co-operation with a medical publishing house. Subsequently, the program was tested and statistically evaluated by 70 dental students and 40 dentists for the purpose of quality assurance. The program received extremely positive ratings with regard to design and functionality. Furthermore it was found to be clearly arranged and easy to comprehend. Even computer illiterate test persons had no problem working with the program. The biggest problem discovered during the test run was that 21% of the test persons lost their orientation while working with the program. The results of the study were used to optimize the program. For example, a graphic orientation tree was integrated, thereby improving the orientation within the program. The extremely positive reactions of the test persons leads us to expect that the introduced CBT-project will be successful. The use of the program in the student education in the dental clinic in Heidelberg and a publication in a medical publishing house are to be expected in the near future.

Attitude of Health Personnel↗
PubMed1999

Factors influencing changes in maxillary arch dimensions in unilateral cleft lip and palate patients until six months of age.

OBJECTIVE: The objectives of the present study were (1) to investigate whether growth increments until 6 months of age are influenced by particular factors, (2) to analyze whether anterior cleft reduction is dependent on the extent of the cleft width at birth, and (3) to examine the correlation between maxillary measurements at birth and the anterior cleft width at 6 months of age. DESIGN: The study design was prospective and longitudinal. SETTING: Heidelberg University Hospital Interdisciplinary Cleft/Craniofacial Center. PATIENTS AND METHOD: The longitudinal records of 34 patients (24 male and 10 female) with complete unilateral cleft lip, alveolar ridge, and hard and soft palate were included in this study. All patients were treated with the same protocol. All participants were assessed at 0 and 6 months of age. Maxillary plaster casts of the patients were analyzed using a computer-controlled three-dimensional digitizing system. MAIN OUTCOME MEASURE: Maxillary models were measured and compared to putative factors influencing growth. RESULTS: No statistically significant differences were found between maxillary growth changes and increases in weight and length. Similarly, there was no significant interaction between the extent of the alveolar cleft width at birth and its reduction prior to lip closure. In contrast, significant differences of maxillary growth increments could be found between male and female patients. Stepwise regression analysis demonstrated a correlation between maxillary measurements at birth and growth increments. CONCLUSION: The results of the study indicate that gender plays a certain role in growth changes within the first 6 months of age.

Aging↗
PubMed1998

Cloning and characterization of the 5'-flanking region of the human cardiotrophin-1 gene.

To enable the analysis of the regulation of the human cardiotrophin-1 gene expression, the 5'-flanking region of the human cardiotrophin-1 gene was cloned and sequenced. Data bank search revealed several cis- active DNA elements (SP1, CREB, C/EBP, AP1 and AP-2 like and GATA) in the proximal 1.1 kb region. Six nested 5-'terminal deletion mutants from -1091/+39 to -218/+39 were fused to a luciferase reportergene and proved to be functionally active after transfection into COS-7 cells.

Animals↗