Technologies for Therapy concern the design, prototyping, and application of technologies for assisted surgery and radiotherapy. Specific interests are methods and devices for: spatial localization, navigation in mini-invasive surgery, robotics and micro-robotics, target localization, surgical planning. Biomechanical, fluidynamic, and physical models are developed for the simulation and prediction of therapeutic outcomes. Strategies are developed for the characterization of soft tissues and their interaction with surgical instrumentation. Radiotherapy procedures are studied for robust and patient specific treatment planning, measurement and compensation of target and organ-at-risk motion , therapy personalization, estimation and control of local toxicity, computational tumor growth modelling. The integration and comparison of multimodal images acquired during the planning and intra-operative phases is applied for patient specific and image guided therapy, featuring adaptation to the current configuration of anatomo-pathological structures targeted by the surgical/radiosurgical approach. Patient specific modeling is based on multimodal images, image fusion, automatic detection of clinical landmarks, individual bio-mechanical and functional models, which are applied for surgical planning, the design of innovative surgical devices/techniques, the evaluation of stress in organs and endo-prostheses, the design of new therapeutic approaches (e.g., in cardio-vascular surgery and neurosurgery). Surgical navigation integrates several localization technologies with pre-surgical images through sensor fusion techniques. Cooperative robots and tele-manipulation augment reliability and appropriate management of adaptation to intra-surgical reality and appropriate management of geometrical and functional modifications with respect to surgical plan. Advances in the design of mechatronic devices for mini-invasive surgery (mainly abdominal) are pursued by means of miniaturization and integration of actuators and sensors. Computed Assisted radiotherapy leads to higher robustness in planning and stereotactic registration and enhances intra- and inter-fraction adaptation to displacement and deformation of target and organ-at-risk by means of the integration of in-room information and internal-to-external modeling. Development of innovative technologies and computational models for optimizing mechanical ventilation in intensive care unit (ICU) on ALI/ARDS adult patients and in neonatology by applying forced oscillation technique, suitable feedback methods and adaptive procedures for individualised treatment.
Cardiovascular research is reaching a maturation level which allows an actual consistent benefit to surgical decision and planning. To move further in this direction new and more powerful tools have to be designed. In particular tools for simulating fluid structure interaction phenomena using ALE techniques are developed and ultrafast cinematography is applied to validate this approach; projects are active on hybrid models for cardiac valve simulations combining Echographic images and MRI data with numerical modelling; mock simulators are designed and built, where porcine valves and vessels can be placed and operated by surgeons to test new procedures and endoscopic means. A further application deals with in vivo blood quantification by using 2D ultrasound and phase contrast MRI, in order to attain the complete 4D flow field directly from in vivo data. Concerning cardiovascular devices and prostheses, new models to predict long-term-effect blood damage and platelet activation are studied; mixed experimental/numerical modelling are used, in view of exploiting the potentialities of new treatment strategies (e.g., internal HDF) and technologies (new membranes); a multiscale computational approach is applied, when it is essential to catch the relevant phenomena (e.g., toxins sorption) from the molecular scale to the macroscale. In the more clinical-oriented procedures, major attention is paid to the development of methods and tools for the attainment of reliable patient specific models; in doing this, the focus remains the reliability of the methods that are developed for their real applicability.
The research in Medical Robotics and computer assisted surgery is aimed at developing innovative methods and devices for clinical and surgical applications. Current research topics in Medical Robotics at NearLab are: Automatic and intelligent planners for neurosurgical keyhole interventions (biopsy, DBS electrodes placements, drug delivery and stereo EEG) were developed, improving the human possibilities to handle the huge amount of three-dimensional information coming from preoperative imaging. Biomechanical models and robust functional hip joint center identification algorithms were studied, mainly for computer assisted assisted total knee arthroplasty interventions. Statistical bone shaping models for patient specific surgical planning are being studied. Methods for sensor information fusion in surgical navigation, for increasing the robustness and accuracy of the information provided to the surgeon or used by automatic tools assisting the surgery, were implemented. Sensors information fusion in surgical robotics and navigated surgery for increasing the intervention safety are studied. Robotic accurate autonomous target reaching and target motion compensation in awake tele-operated robotic neurosurgery were achieved. The force feedback was enhanced and coupled with haptics in robotic surgery. Enhanced human robot interaction and situation awareness in cooperative control modalities were implemented. Ontologies related to the patient description and to the surgical workflow provide help in the decision-making process for robotic surgical systems. Implantable micro-devices for surgery are being studied for minimally invasive access to brain regions, in particular modeling of micro-devices propulsion and control for soft tissue burrowing.
Computer Aided RadioTherapy and Surgery
Research in Computer Aided Radiotherapy is focused on 2D-3D-4D medical imaging, methods for automatic structures delineation (segmentation), rigid and elastic image registration for planning and on the integration between in-room imaging and motion tracking technologies for patient positioning, therapy set-up verification and tumor localization in image-guided adaptive radiotherapy.Specific issues under investigation are time-resolved robust treatment planning and radiation dose delivery for the treatment of moving organs (4D-therapy) in photon and particle therapy (protontherapy, carbon-ion therapy).Methods for in-vivo dosimetry in particle therapy based on PET-imaging are developed and tested. Design, development and clinical testing of robotic technologies for in-room patient imaging (multiple planar projections, volumetric reconstruction) and 2D-3D, 3D-3D image registration are part of the activities of the group in Computer Aided Radiotherapy. Research in Computer Aided Surgery is focused on modeling of anatomical structures from volumetric images (CT, MRI) finalized to surgical planning and navigation with adaptive features. Applications are in orthopedic surgery and plastic and reconstructive surgery with a particular focus on the autologous fat grafting technique for prosthetic-free breast reconstruction and deformities correction. Microrobots for minimal invasive surgery and NOTES (Natural Orifice Transluminal Surgery) are designed and developed in collaboration with abdominal surgical departments. Specific research in Computer Aided Surgery are: - development of range laser scanner for breast 3D surface modeling with respiratory motion compensation; - development of technologies and methods for geometry optimization of fat grafting and surgical navigation; - design and prototyping of snake-like microrobots for mini-invasive surgery; - 3D digital surface modeling for marker-free patient localization; - CT-based 3D modeling for surgical planning of total hip and knee replacement; - Novel implantable endo-articular devices