Realitatea Augmentata: de la shopping-ul online la chirurgia coloanei vertebrale/ Augmented Reality: from online furniture shopping to spine surgeries

Realitatea Augmentata (RA), o tehnologie relativ noua, a fost folosita pana acum in diferite aplicatii: de la cumparaturile online de mobila, jocuri video, pana la aplicatii militare sau educationale. 

Este o tehnologie care integreaza in realitate imagini sau obiecte generate de calculator, corelate natural cu realitatea respectiva.    
In domeniul medical, ca si in celelalte domenii, tot mai multe centre de cercetare si companii private dezvolta aplicatii folosind aceasta tehnologie. 


Philips, lider mondial in solutii de sanatate, tocmai a anuntat dezvoltarea unui sistem de navigatie pentru chirurgia minim-invaziva care foloseste Realitatea Augmentata (RA).

Tehnologia dezvoltata de compania olandeza creste semnificativ acuratetea chirurgiei minim-invazive a coloanei vertebrale, fiind primul sistem din lume de acest tip.


Traditional, chirurgia coloanei vertebrale a fost realizata, pana acum cativa ani, printr-o incizie de dimensiuni mari care ii permitea chirurgului ata accesul la coloana cat si plasarea implanturilor (suruburi). Trebuie mentionat aici ca plantarea suruburilor in coloana trebuie facuta cu o acuratete ridicata: chiar si o eroare de un milimetru poate avea efecte catastrofale asupra pacientului. 
 


In ultmii ani, tehnicile tot mai avansate de imagistica medicala au inlocuit interventiile chirurgicale clasice, deschise, cu cele minim-invazive care se realizeaza printr-o incizie de dimensiuni mici.  

Aceste interventii sunt mai putin traumatizante pentru pacient, perioada de spitalizarea este redusa (uneori de la cateva zile pana la cateva ore!), iar riscul de a prelua bacterii nosocomiale este mult mai mic. 


Cu toate acestea, exista o problema importanta in cazul interventiilor minim-invazive: dificultatea de orientare a chirurgului din cauza lipsei vizibilitatii in campul operator (partea din interiorul corpului pe care se opereaza). 

In acest caz, orientarea chirurgului se face prin sisteme de navigatie in timp real care folosesc tehnici avansate de imagistica medicala.


Dezvoltarea rapida a tehnicilor de imagistica medicala a inlocuit salile clasice de operatie in asa numitele “sali de operatii hibride”: sali echipate complet cu sisteme de imagistica medicala 3D (ecograf, computer tomograf, scaner de imagistica nucleara) care permit monitorizarea pacientului in timpul operatiei si ghideaza chirurgul. Fara aceste sali, chirugia minim-invaziva nu ar putea fi realizata.  

Philips are peste 750 de sali de operatii hibride instalate la nivel global, fiind pionier in acest domeniu.


Compania adauga o noua facilitate acestei platforme: un sistem de navigatie bazat pe Realitate Augmentata, care va creste substantial acuratetea chirurgiei minim-invaziva a coloanei vertebrale. 


Conform declaratiei facute de reprezentatii Philips, sistemul de navigatie combina 1) imagini externe ale pacientului (care permit localizarea acestuia in sala de operatie), imagini care sunt achizitionate cu 4 camere optice de inalta rezolutie (5 megapixeli) precum si 2) imagini interne, din interiorul corpului, obtinute cu raze X cu doza mica. 

In acest fel, se obtine o reconstructie 3D a anatomiei pacientului, permitand  o mai mare acuratete in ghidarea instrumentelor chirurgicale si plasarea suruburilor. 


Sistemele de navigatie actuale sunt formate dintr-o camera cu infra-rosu corelate cu o imagine pre-operatorie obtinuta cu ajutrul Computer Tomografului si un sistem de referinta atasat pe coloana vertebrala, permitand astfel ghidarea chirurgului. 


Testele clinice efectuate pana acum au demonstrat o acuratete de 85% a interventiilor pe coloana realizate cu tehnologia care foloseste Realitatea Augmentata. Aceste rezultate sunt in contrast cu acuratetea de 64% obtinuta cu alte sisteme de navigatie.  




Augmented Reality: from online furniture shopping to spine surgeries

Augmented Reality, as a relatively new technology, has so far already been used for varying purposes: online furniture shopping, video games, or for educational and even military purposes. 

It is a technique which mixes reality with computer-generated images, in such a way that it seems naturally correlated to that reality. 

Also in the medical field, academics and private companies are finding more and more applications of this technology.


Philips, a world leader in health care products, has recently announced their development of a surgical navigation system based on Augmented Reality. 

The navigation technology proposed by the Dutch company significantly improves the accuracy of minimally-invasive spine surgery.


The traditional spine surgery was, for many years, an open procedure: the zone of interest was accessed through a large incision which allowed the surgeon to see the spine and to place the implants (screws). It should be mentioned here, that the placement of implants is a highly precarious activity: a variance of one milimeter could have catastrophic consequences for the patient.


In recent years, increasingly advanced imaging techniques replaced the use of traditional open surgery techniques towards minimally-invasive ones: reducing the large incisions to a small incision.

These interventions are less traumatic for the patient, significantly reduces  the period of hospitalization (sometimes from several days to only a few hours!), and lowering the risk of infection by nosocomial bacteria.  

There is, however, one important issue with small-incision surgeries.

This concerns the difficulty of orientation for the surgeon due to the lack of visibility in the operative field (the location within the body which needs to be operated on).    

For this reason, advanced imaging techniques are used to guide the surgeon during such small-incision surgeries. 


The rapid development in medical imaging techniques shifted the classic operating rooms into so-called “hybrid operating rooms”: rooms fully equipped with imaging systems (ultrasound, CT and MRI scanners) which make possible the real-time monitoring of the patient during the surgery and guides the surgeon. Without such rooms, small-incision surgeries would not be possible at all.

Philips is a pioneer in hybrid operating rooms, having more than 750 units around the world. 

The company is now about to add a new feature to that platform: a navigation system based on Augmented Reality, which should substantially improve the accuracy of minimally-invasive spine surgery. 

According to Philips, their new navigation system combines external views of the patient (which permits the space localization of the patient relative to the operating room) acquired by high-resolution optical cameras and internal images, acquired with low-dose X-rays.

This would make a 3D patient’s anatomy reconstruction possible, and makes the handling of surgical tools and the placement of implants less prone to mistakes. 


The pre-clinical tests which have been carried out, resulted in an accuracy rate of 85%  for the minimally-invasive spine surgeries performed with Augmented Reality technology. This is in contrast with the 64% accuracy rate obtained with other navigation technologies.