Center for Computer-Integrated Surgical Systems and Technology

Structure of the Research Program
The “systems evolution” depicted in Figure B-2 has demanded a set of deliberate strategic changes in our entire center, most of which took place in Years 4 and 5. These changes involved the termination of an entire thrust (The original Thrust 3), the redefinition of our clinical focus and testbed milestones in Thrust 1, a strengthened focus on common CIS architectures in both thrusts, the creation of new research activities, and the termination of certain research activities because of completion or lack of relevance or productivity. To recognize the importance of underyling common CIS subsystems, last year we declared a new thrust (Thrust 0), Infrastructure, which is led by Dr. Peter Kazanzides, who was hired specifically to lead this thrust.
Our thrusts are not separate activities. Instead, as illustrated in Figure B-5, Thrust 0 is an R&D program that cuts across both Thrusts 1 and 2. Thrust 0 supports Thrust 1 and 2 in the implementation of specific systems, as well as being actively engaged in the definition of the next generation of CIS systems. Thrust 0 is an important arm in “hardening” our systems for both clinical adoption and commercial marketing.
Our research, although spanning the strategic plan from basic to applied research, is directed toward validation (proof-of-concept) within specific surgical scenarios, sometimes even for particular surgeries. In selecting specific surgical scenarios/testbeds, we apply several criteria:
Clinician involvement. This begins with the formation of a surgeon-researcher-engineer team. Fortunately, the CISST-ERC is associated with world-class medical institutions and our clinical collaborators have been strong and active supporters of our efforts.
Clinical importance of the proposed surgical application. We evaluate whether the procedure or condition to be treated is prevalent in the population, whether the “leverage” offered by the system’s capabilities over existing techniques is substantial, and whether there are potentially significant cost/quality impacts on clinical outcomes?
The project’s synergy with development of novel therapies. For example, there is widespread clinical research focused on development of localized therapy for cancer that requires the ability to integrate optimized dose planning and accurate delivery of patterns of localized treatments, such as radiation seeds, RF or laser ablation, or injected drugs.
Technical suitability. This is important for targeting of novel capabilities that are sufficiently difficult to require significant advances in basic knowledge and technology, but not impossible.
Availability of suitable infrastructure and “critical mass” to support the proposed application. In addition to clinician input, such factors include available imaging environments and databases, related research that can be leveraged, the potential for supplemental funding, and the interest of key researchers.
Industry interest. The center looks for projects that build upon ERC core strengths and are of interest to our industrial affiliates in order to promote collaborative work with them.
Overall research direction is then provided by the surgical scenarios on which we have chosen to concentrate. The research barriers to these scenarios must then be addressed, and projects funded according to priority. Researchers closest to the application have generally identified the technical barriers that must be addressed, and broad discussion during our planning cycle has led to detailed project planning in order to accomplish our overall goals. Funding priorities are ultimately set by the ERC Leadership and decisions to start new core-funded projects, continue funding, or de-fund projects are made every year. The allocation of our resources – including faculty, students, post-docs, and dollars – is set forth in table 2. It shows significant growth in funding, particularly in thrust 1 and the newly created tasks 1.4 and 0.1. We have been very successful in acquiring non-core funds to support projects within our strategy. This is a strong indication of the strength of our investigators and success of our strategic planning process.
Appendix II-A provides a list of all the research projects, by thrust, which fall within our research strategy and for which our faculty investigators have received funding. The list identifies, for each project, the investigators, the investigators’ departmental and institutional affiliations, and the sponsoring agency. Appendix II-B provides a comparable list of projects for which we are seeking additional funding as a means of enhancing our research and preparing for continuation after our core NSF funding expires.
Systems Vision
The mission of the Center for Computer Integrated Surgical Systems and Technology (CISST ERC) is to develop computer-integrated surgical (CIS) systems that will significantly change the way surgical procedures are carried out. Specifically, we will develop a family of systems that will combine innovative algorithms, robotic devices, imaging systems, sensors, and human-machine interfaces to work cooperatively with surgeons in the planning and execution of surgical procedures. Our goal is to produce systems that will greatly reduce costs, improve clinical outcomes, and increase the efficiency of health care delivery. By improving therapeutic precision and consistency, these systems will reduce therapeutic risks and enable the development of new treatment options.
We are addressing key knowledge, technology, and system design challenges that must be overcome in the development of CIS systems. By working closely with industry and clinicians, we will promote transfer of these results into clinical use and help educate a new generation of engineers, clinicians, and researchers needed to support this rapidly expanding field.
Systems Vision – Coupling Information Technology to Surgical Actions to Significantly Change Surgery
The growing demand for complex and minimally invasive surgical interventions is driving the search for ways to use computer-based information technology as a link between the preoperative plan and the tools utilized by the surgeon. Figure A-1 illustrates the architecture of CIS systems. At the core is a computer or network of computers performing modeling and analysis tasks such as image processing, surgical planning, monitoring and control of surgical processes. A variety of interface devices permit the computers to obtain images and other information about the patient, to assist physically in the surgical intervention, and to communicate with the surgeon and operating room personnel. The computers have access to anatomical atlases and statistical databases that can be used to assist in surgical planning, execution, and follow-up.
Data flow associated with these systems:
Images and other information about a patient are combined with statistical atlases of anatomy to create a patient-specific model for use in surgical planning. In the operating room, imaging and other sensing is used to register the preoperative model to current reality and to update the model and plan. Once this is done, the surgeon may supervise a robot that carries out a specific treatment step, such as inserting a needle or machining bone. In other cases, the CIS system will provide information to assist the surgeon’s manual execution of a task, for example through the use of computer graphic overlays on the surgeon’s field of view. In yet other cases, these modes will be combined. Post-operatively, the same imaging, modeling, and analysis capabilities can be used to facilitate patient follow-up and longer-term assessment of the effectiveness of treatment plans.
We refer to this paradigm of patient-specific modeling and planning, coupled with computer-assisted surgical execution and follow-up, as Surgical CAD/CAM, emphasizing the analogy with computer-integrated design and manufacturing systems. We refer to these CIS systems that work interactively with surgeons to extend human capabilities in carrying out surgical tasks as Surgical Assistants. These characterizations are complementary and not mutually exclusive. They draw upon common technologies, and real systems often have both CAD/CAM and Assistant traits. Nevertheless, the terms are useful as a means of structuring our vision of CISST.