arXiv subjects

Mehran Armand

Publications and source records attributed to Mehran Armand.

At least 37 records · Page 2Linked to original sources

arXiv2024

A Roadmap Towards Automated and Regulated Robotic Systems

The rapid development of generative technology opens up possibility for higher level of automation, and artificial intelligence (AI) embodiment in robotic systems is imminent. However, due to the blackbox nature of the generative technology, the generation of the knowledge and workflow scheme is uncontrolled, especially in a dynamic environment and a complex scene. This poses challenges to regulations in safety-demanding applications such as medical scenes. We argue that the unregulated generative processes from AI is fitted for low level end tasks, but intervention in the form of manual or automated regulation should happen post-workflow-generation and pre-robotic-execution. To address this, we propose a roadmap that can lead to fully automated and regulated robotic systems. In this paradigm, the high level policies are generated as structured graph data, enabling regulatory oversight and reusability, while the code base for lower level tasks is generated by generative models. Our approach aims the transitioning from expert knowledge to regulated action, akin to the iterative processes of study, practice, scrutiny, and execution in human tasks. We identify the generative and deterministic processes in a design cycle, where generative processes serve as a text-based world simulator and the deterministic processes generate the executable system. We propose State Machine Seralization Language (SMSL) to be the conversion point between text simulator and executable workflow control. From there, we analyze the modules involved based on the current literature, and discuss human in the loop. As a roadmap, this work identifies the current possible implementation and future work. This work does not provide an implemented system but envisions to inspire the researchers working on the direction in the roadmap. We implement the SMSL and D-SFO paradigm that serve as the starting point of the roadmap.

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arXiv2024

Toward Process Controlled Medical Robotic System

Medical errors, defined as unintended acts either of omission or commission that cause the failure of medical actions, are the third leading cause of death in the United States. The application of autonomy and robotics can alleviate some causes of medical errors by improving accuracy and providing means to follow planned procedures. However, for the robotic applications to improve safety, they must maintain constant operating conditions in the presence of disturbances, and provide reliable measurements, evaluation, and control for each state of the procedure. This article addresses the need for process control in medical robotic systems, and proposes a standardized design cycle toward its automation. Monitoring and controlling the changing conditions in a medical or surgical environment necessitates a clear definition of workflows and their procedural dependencies. We propose integrating process control into medical robotic workflows to identify change in states of the system and environment, possible operations, and transitions to new states. Therefore, the system translates clinician experiences and procedure workflows into machine-interpretable languages. The design cycle using hFSM formulation can be a deterministic process, which opens up possibilities for higher-level automation in medical robotics. Shown in our work, with a standardized design cycle and software paradigm, we pave the way toward controlled workflows that can be automatically generated. Additionally, a modular design for a robotic system architecture that integrates hFSM can provide easy software and hardware integration. This article discusses the system design, software implementation, and example application to Robot-Assisted Transcranial Magnetic Stimulation and robot-assisted femoroplasty. We provide assessments using performance in terms of robotic tool placement and response to failure injections.

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arXiv2024

SAMM (Segment Any Medical Model): A 3D Slicer Integration to SAM

The Segment Anything Model (SAM) is a new image segmentation tool trained with the largest available segmentation dataset. The model has demonstrated that, with prompts, it can create high-quality masks for general images. However, the performance of the model on medical images requires further validation. To assist with the development, assessment, and application of SAM on medical images, we introduce Segment Any Medical Model (SAMM), an extension of SAM on 3D Slicer - an image processing and visualization software extensively used by the medical imaging community. This open-source extension to 3D Slicer and its demonstrations are posted on GitHub (https://github.com/bingogome/samm). SAMM achieves 0.6-second latency of a complete cycle and can infer image masks in nearly real-time.

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arXiv2023

Data-Driven Shape Sensing in Continuum Manipulators via Sliding Resistive Flex Sensors

We introduce a novel shape-sensing method using Resistive Flex Sensors (RFS) embedded in cable-driven Continuum Dexterous Manipulators (CDMs). The RFS is predominantly sensitive to deformation rather than direct forces, making it a distinctive tool for shape sensing. The RFS unit we designed is a considerably less expensive and robust alternative, offering comparable accuracy and real-time performance to existing shape sensing methods used for the CDMs proposed for minimally-invasive surgery. Our design allows the RFS to move along and inside the CDM conforming to its curvature, offering the ability to capture resistance metrics from various bending positions without the need for elaborate sensor setups. The RFS unit is calibrated using an overhead camera and a ResNet machine learning framework. Experiments using a 3D printed prototype of the CDM achieved an average shape estimation error of 0.968 mm with a standard error of 0.275 mm. The response time of the model was approximately 1.16 ms, making real-time shape sensing feasible. While this preliminary study successfully showed the feasibility of our approach for C-shape CDM deformations with non-constant curvatures, we are currently extending the results to show the feasibility for adapting to more complex CDM configurations such as S-shape created in obstructed environments or in presence of the external forces.

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arXiv2023

Skin Lesion Correspondence Localization in Total Body Photography

Longitudinal tracking of skin lesions - finding correspondence, changes in morphology, and texture - is beneficial to the early detection of melanoma. However, it has not been well investigated in the context of full-body imaging. We propose a novel framework combining geometric and texture information to localize skin lesion correspondence from a source scan to a target scan in total body photography (TBP). Body landmarks or sparse correspondence are first created on the source and target 3D textured meshes. Every vertex on each of the meshes is then mapped to a feature vector characterizing the geodesic distances to the landmarks on that mesh. Then, for each lesion of interest (LOI) on the source, its corresponding location on the target is first coarsely estimated using the geometric information encoded in the feature vectors and then refined using the texture information. We evaluated the framework quantitatively on both a public and a private dataset, for which our success rates (at 10 mm criterion) are comparable to the only reported longitudinal study. As full-body 3D capture becomes more prevalent and has higher quality, we expect the proposed method to constitute a valuable step in the longitudinal tracking of skin lesions.

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arXiv2023

Pelphix: Surgical Phase Recognition from X-ray Images in Percutaneous Pelvic Fixation

Surgical phase recognition (SPR) is a crucial element in the digital transformation of the modern operating theater. While SPR based on video sources is well-established, incorporation of interventional X-ray sequences has not yet been explored. This paper presents Pelphix, a first approach to SPR for X-ray-guided percutaneous pelvic fracture fixation, which models the procedure at four levels of granularity -- corridor, activity, view, and frame value -- simulating the pelvic fracture fixation workflow as a Markov process to provide fully annotated training data. Using added supervision from detection of bony corridors, tools, and anatomy, we learn image representations that are fed into a transformer model to regress surgical phases at the four granularity levels. Our approach demonstrates the feasibility of X-ray-based SPR, achieving an average accuracy of 93.8% on simulated sequences and 67.57% in cadaver across all granularity levels, with up to 88% accuracy for the target corridor in real data. This work constitutes the first step toward SPR for the X-ray domain, establishing an approach to categorizing phases in X-ray-guided surgery, simulating realistic image sequences to enable machine learning model development, and demonstrating that this approach is feasible for the analysis of real procedures. As X-ray-based SPR continues to mature, it will benefit procedures in orthopedic surgery, angiography, and interventional radiology by equipping intelligent surgical systems with situational awareness in the operating room.

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arXiv2023

Design and Fabrication of a Fiber Bragg Grating Shape Sensor for Shape Reconstruction of a Continuum Manipulator

Continuum dexterous manipulators (CDMs) are suitable for performing tasks in a constrained environment due to their high dexterity and maneuverability. Despite the inherent advantages of CDMs in minimally invasive surgery, real-time control of CDMs' shape during non-constant curvature bending is still challenging. This study presents a novel approach for the design and fabrication of a large deflection fiber Bragg grating (FBG) shape sensor embedded within the lumens inside the walls of a CDM with a large instrument channel. The shape sensor consisted of two fibers, each with three FBG nodes. A shape-sensing model was introduced to reconstruct the centerline of the CDM based on FBG wavelengths. Different experiments, including shape sensor tests and CDM shape reconstruction tests, were conducted to assess the overall accuracy of the shape sensing. The FBG sensor evaluation results revealed the linear curvature-wavelength relationship with the large curvature detection of 0.045 mm at a 90 degrees bending angle and a sensitivity of up to 5.50 nm/mm in each bending direction. The CDM's shape reconstruction experiments in a free environment demonstrated the shape tracking accuracy of 0.216+-0.126 mm for positive/negative deflections. Also, the CDM shape reconstruction error for three cases of bending with obstacles were observed to be 0.436+-0.370 mm for the proximal case, 0.485+-0.418 mm for the middle case, and 0.312+-0.261 mm for the distal case. This study indicates the adequate performance of the FBG sensor and the effectiveness of the model for tracking the shape of the large-deflection CDM with nonconstant-curvature bending for minimally-invasive orthopaedic applications.

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arXiv2022

STTAR: Surgical Tool Tracking using off-the-shelf Augmented Reality Head-Mounted Displays

The use of Augmented Reality (AR) for navigation purposes has shown beneficial in assisting physicians during the performance of surgical procedures. These applications commonly require knowing the pose of surgical tools and patients to provide visual information that surgeons can use during the task performance. Existing medical-grade tracking systems use infrared cameras placed inside the Operating Room (OR) to identify retro-reflective markers attached to objects of interest and compute their pose. Some commercially available AR Head-Mounted Displays (HMDs) use similar cameras for self-localization, hand tracking, and estimating the objects' depth. This work presents a framework that uses the built-in cameras of AR HMDs to enable accurate tracking of retro-reflective markers, such as those used in surgical procedures, without the need to integrate any additional components. This framework is also capable of simultaneously tracking multiple tools. Our results show that the tracking and detection of the markers can be achieved with an accuracy of 0.09 +- 0.06 mm on lateral translation, 0.42 +- 0.32 mm on longitudinal translation, and 0.80 +- 0.39 deg for rotations around the vertical axis. Furthermore, to showcase the relevance of the proposed framework, we evaluate the system's performance in the context of surgical procedures. This use case was designed to replicate the scenarios of k-wire insertions in orthopedic procedures. For evaluation, two surgeons and one biomedical researcher were provided with visual navigation, each performing 21 injections. Results from this use case provide comparable accuracy to those reported in the literature for AR-based navigation procedures.

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arXiv2022

SyntheX: Scaling Up Learning-based X-ray Image Analysis Through In Silico Experiments

Artificial intelligence (AI) now enables automated interpretation of medical images for clinical use. However, AI's potential use for interventional images (versus those involved in triage or diagnosis), such as for guidance during surgery, remains largely untapped. This is because surgical AI systems are currently trained using post hoc analysis of data collected during live surgeries, which has fundamental and practical limitations, including ethical considerations, expense, scalability, data integrity, and a lack of ground truth. Here, we demonstrate that creating realistic simulated images from human models is a viable alternative and complement to large-scale in situ data collection. We show that training AI image analysis models on realistically synthesized data, combined with contemporary domain generalization or adaptation techniques, results in models that on real data perform comparably to models trained on a precisely matched real data training set. Because synthetic generation of training data from human-based models scales easily, we find that our model transfer paradigm for X-ray image analysis, which we refer to as SyntheX, can even outperform real data-trained models due to the effectiveness of training on a larger dataset. We demonstrate the potential of SyntheX on three clinical tasks: Hip image analysis, surgical robotic tool detection, and COVID-19 lung lesion segmentation. SyntheX provides an opportunity to drastically accelerate the conception, design, and evaluation of intelligent systems for X-ray-based medicine. In addition, simulated image environments provide the opportunity to test novel instrumentation, design complementary surgical approaches, and envision novel techniques that improve outcomes, save time, or mitigate human error, freed from the ethical and practical considerations of live human data collection.

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arXiv2021

The Impact of Machine Learning on 2D/3D Registration for Image-guided Interventions: A Systematic Review and Perspective

Image-based navigation is widely considered the next frontier of minimally invasive surgery. It is believed that image-based navigation will increase the access to reproducible, safe, and high-precision surgery as it may then be performed at acceptable costs and effort. This is because image-based techniques avoid the need of specialized equipment and seamlessly integrate with contemporary workflows. Further, it is expected that image-based navigation will play a major role in enabling mixed reality environments and autonomous, robotic workflows. A critical component of image guidance is 2D/3D registration, a technique to estimate the spatial relationships between 3D structures, e.g., volumetric imagery or tool models, and 2D images thereof, such as fluoroscopy or endoscopy. While image-based 2D/3D registration is a mature technique, its transition from the bench to the bedside has been restrained by well-known challenges, including brittleness of the optimization objective, hyperparameter selection, and initialization, difficulties around inconsistencies or multiple objects, and limited single-view performance. One reason these challenges persist today is that analytical solutions are likely inadequate considering the complexity, variability, and high-dimensionality of generic 2D/3D registration problems. The recent advent of machine learning-based approaches to imaging problems that, rather than specifying the desired functional mapping, approximate it using highly expressive parametric models holds promise for solving some of the notorious challenges in 2D/3D registration. In this manuscript, we review the impact of machine learning on 2D/3D registration to systematically summarize the recent advances made by introduction of this novel technology. Grounded in these insights, we then offer our perspective on the most pressing needs, significant open problems, and possible next steps.

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arXiv2021

A Robotic System for Implant Modification in Single-stage Cranioplasty

Craniomaxillofacial reconstruction with patient-specific customized craniofacial implants (CCIs) is most commonly performed for large-sized skeletal defects. Because the exact size of skull resection may not be known prior to the surgery, in the single-stage cranioplasty, a large CCI is prefabricated and resized intraoperatively with a manual-cutting process provided by a surgeon. The manual resizing, however, may be inaccurate and significantly add to the operating time. This paper introduces a fast and non-contact approach for intraoperatively determining the exact contour of the skull resection and automatically resizing the implant to fit the resection area. Our approach includes four steps: First, a patient's defect information is acquired by a 3D scanner. Second, the scanned defect is aligned to the CCI by registering the scanned defect to the reconstructed CT model. Third, a cutting toolpath is generated from the contour of the scanned defect. Lastly, the large CCI is resized by a cutting robot to fit the resection area according to the given toolpath. To evaluate the resizing performance of our method, six different resection shapes were used in the cutting experiments. We compared the performance of our method to the performances of surgeon's manual resizing and an existing technique which collects the defect contour with an optical tracking system and projects the contour on the CCI to guide the manual modification. The results show that our proposed method improves the resizing accuracy by 56% compared to the surgeon's manual modification and 42% compared to the projection method.

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arXiv2020

Exploring Partial Intrinsic and Extrinsic Symmetry in 3D Medical Imaging

We present a novel methodology to detect imperfect bilateral symmetry in CT of human anatomy. In this paper, the structurally symmetric nature of the pelvic bone is explored and is used to provide interventional image augmentation for treatment of unilateral fractures in patients with traumatic injuries. The mathematical basis of our solution is on the incorporation of attributes and characteristics that satisfy the properties of intrinsic and extrinsic symmetry and are robust to outliers. In the first step, feature points that satisfy intrinsic symmetry are automatically detected in the Möbius space defined on the CT data. These features are then pruned via a two-stage RANSAC to attain correspondences that satisfy also the extrinsic symmetry. Then, a disparity function based on Tukey's biweight robust estimator is introduced and minimized to identify a symmetry plane parametrization that yields maximum contralateral similarity. Finally, a novel regularization term is introduced to enhance similarity between bone density histograms across the partial symmetry plane, relying on the important biological observation that, even if injured, the dislocated bone segments remain within the body. Our extensive evaluations on various cases of common fracture types demonstrate the validity of the novel concepts and the robustness and accuracy of the proposed method.

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arXiv2020

Fast and Automatic Periacetabular Osteotomy Fragment Pose Estimation Using Intraoperatively Implanted Fiducials and Single-View Fluoroscopy

Accurate and consistent mental interpretation of fluoroscopy to determine the position and orientation of acetabular bone fragments in 3D space is difficult. We propose a computer assisted approach that uses a single fluoroscopic view and quickly reports the pose of an acetabular fragment without any user input or initialization. Intraoperatively, but prior to any osteotomies, two constellations of metallic ball-bearings (BBs) are injected into the wing of a patient's ilium and lateral superior pubic ramus. One constellation is located on the expected acetabular fragment, and the other is located on the remaining, larger, pelvis fragment. The 3D locations of each BB are reconstructed using three fluoroscopic views and 2D/3D registrations to a preoperative CT scan of the pelvis. The relative pose of the fragment is established by estimating the movement of the two BB constellations using a single fluoroscopic view taken after osteotomy and fragment relocation. BB detection and inter-view correspondences are automatically computed throughout the processing pipeline. The proposed method was evaluated on a multitude of fluoroscopic images collected from six cadaveric surgeries performed bilaterally on three specimens. Mean fragment rotation error was 2.4 +/- 1.0 degrees, mean translation error was 2.1 +/- 0.6 mm, and mean 3D lateral center edge angle error was 1.0 +/- 0.5 degrees. The average runtime of the single-view pose estimation was 0.7 +/- 0.2 seconds. The proposed method demonstrates accuracy similar to other state of the art systems which require optical tracking systems or multiple-view 2D/3D registrations with manual input. The errors reported on fragment poses and lateral center edge angles are within the margins required for accurate intraoperative evaluation of femoral head coverage.

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arXiv2020

A Versatile Data-Driven Framework for Model-Independent Control of Continuum Manipulators Interacting With Obstructed Environments With Unknown Geometry and Stiffness

This paper addresses the problem of controlling a continuum manipulator (CM) in free or obstructed environments with no prior knowledge about the deformation behavior of the CM and the stiffness and geometry of the interacting obstructed environment. We propose a versatile data-driven priori-model-independent (PMI) control framework, in which various control paradigms (e.g. CM's position or shape control) can be defined based on the provided feedback. This optimal iterative algorithm learns the deformation behavior of the CM in interaction with an unknown environment, in real time, and then accomplishes the defined control objective. To evaluate the scalability of the proposed framework, we integrated two different CMs, designed for medical applications, with the da Vinci Research Kit (dVRK). The performance and learning capability of the framework was investigated in 11 sets of experiments including PMI position and shape control in free and unknown obstructed environments as well as during manipulation of an unknown deformable object. We also evaluated the performance of our algorithm in an ex-vivo experiment with a lamb heart.The theoretical and experimental results demonstrate the adaptivity, versatility, and accuracy of the proposed framework and, therefore, its suitability for a variety of applications involving continuum manipulators.

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arXiv2020

Generalizing Spatial Transformers to Projective Geometry with Applications to 2D/3D Registration

Differentiable rendering is a technique to connect 3D scenes with corresponding 2D images. Since it is differentiable, processes during image formation can be learned. Previous approaches to differentiable rendering focus on mesh-based representations of 3D scenes, which is inappropriate for medical applications where volumetric, voxelized models are used to represent anatomy. We propose a novel Projective Spatial Transformer module that generalizes spatial transformers to projective geometry, thus enabling differentiable volume rendering. We demonstrate the usefulness of this architecture on the example of 2D/3D registration between radiographs and CT scans. Specifically, we show that our transformer enables end-to-end learning of an image processing and projection model that approximates an image similarity function that is convex with respect to the pose parameters, and can thus be optimized effectively using conventional gradient descent. To the best of our knowledge, this is the first time that spatial transformers have been described for projective geometry. The source code will be made public upon publication of this manuscript and we hope that our developments will benefit related 3D research applications.

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arXiv2020

Automatic Annotation of Hip Anatomy in Fluoroscopy for Robust and Efficient 2D/3D Registration

Fluoroscopy is the standard imaging modality used to guide hip surgery and is therefore a natural sensor for computer-assisted navigation. In order to efficiently solve the complex registration problems presented during navigation, human-assisted annotations of the intraoperative image are typically required. This manual initialization interferes with the surgical workflow and diminishes any advantages gained from navigation. We propose a method for fully automatic registration using annotations produced by a neural network. Neural networks are trained to simultaneously segment anatomy and identify landmarks in fluoroscopy. Training data is obtained using an intraoperatively incompatible 2D/3D registration of hip anatomy. Ground truth 2D labels are established using projected 3D annotations. Intraoperative registration couples an intensity-based strategy with annotations inferred by the network and requires no human assistance. Ground truth labels were obtained in 366 fluoroscopic images across 6 cadaveric specimens. In a leave-one-subject-out experiment, networks obtained mean dice coefficients for left and right hemipelves, left and right femurs of 0.86, 0.87, 0.90, and 0.84. The mean 2D landmark error was 5.0 mm. The pelvis was registered within 1 degree for 86% of the images when using the proposed intraoperative approach with an average runtime of 7 seconds. In comparison, an intensity-only approach without manual initialization, registered the pelvis to 1 degree in 18% of images. We have created the first accurately annotated, non-synthetic, dataset of hip fluoroscopy. By using these annotations as training data for neural networks, state of the art performance in fluoroscopic segmentation and landmark localization was achieved. Integrating these annotations allows for a robust, fully automatic, and efficient intraoperative registration during fluoroscopic navigation of the hip.

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arXiv2020

From Perspective X-ray Imaging to Parallax-Robust Orthographic Stitching

Stitching images acquired under perspective projective geometry is a relevant topic in computer vision with multiple applications ranging from smartphone panoramas to the construction of digital maps. Image stitching is an equally prominent challenge in medical imaging, where the limited field-of-view captured by single images prohibits holistic analysis of patient anatomy. The barrier that prevents straight-forward mosaicing of 2D images is depth mismatch due to parallax. In this work, we leverage the Fourier slice theorem to aggregate information from multiple transmission images in parallax-free domains using fundamental principles of X-ray image formation. The semantics of the stitched image are restored using a novel deep learning strategy that exploits similarity measures designed around frequency, as well as dense and sparse spatial image content. Our pipeline, not only stitches images, but also provides orthographic reconstruction that enables metric measurements of clinically relevant quantities directly on the 2D image plane.

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arXiv2020

Reflective-AR Display: An Interaction Methodology for Virtual-Real Alignment in Medical Robotics

Robot-assisted minimally invasive surgery has shown to improve patient outcomes, as well as reduce complications and recovery time for several clinical applications. While increasingly configurable robotic arms can maximize reach and avoid collisions in cluttered environments, positioning them appropriately during surgery is complicated because safety regulations prevent automatic driving. We propose a head-mounted display (HMD) based augmented reality (AR) system designed to guide optimal surgical arm set up. The staff equipped with HMD aligns the robot with its planned virtual counterpart. In this user-centric setting, the main challenge is the perspective ambiguities hindering such collaborative robotic solution. To overcome this challenge, we introduce a novel registration concept for intuitive alignment of AR content to its physical counterpart by providing a multi-view AR experience via reflective-AR displays that simultaneously show the augmentations from multiple viewpoints. Using this system, users can visualize different perspectives while actively adjusting the pose to determine the registration transformation that most closely superimposes the virtual onto the real. The experimental results demonstrate improvement in the interactive alignment of a virtual and real robot when using a reflective-AR display. We also present measurements from configuring a robotic manipulator in a simulated trocar placement surgery using the AR guidance methodology.

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