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Papers by cinzia freschi

International Journal of Technology Assessment in Health Care, 2017

INTRODUCTION:The increasing complexity of decision-making in clinical practice and the financial ... more INTRODUCTION:The increasing complexity of decision-making in clinical practice and the financial pressure requires clinicians to develop some background about the economic consequences of their decisions and to become more and more managers of pre-defined budgets. The present work aims at describing a simple technology solution that could support prescription decisions and illustrates the results of a preliminary assessment of the tool in a sample of professionals. The solution has been developed to allow informed decision-making in the prescription of oral anti-diabetic drugs (OADs) in type II diabetes mellitus (T2DM) patients by supporting prescriptive appropriateness.METHODS:The tool developed is compatible with many kinds of hardware architectures and the most diffused web browsers. The system allows real-time reproduction of economic evaluation of the different therapeutic options for the management of T2DM patients. Assessment of “ease to use” and “usefulness” of the tool was ...

2004 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS) (IEEE Cat. No.04CH37566), 2000

In this paper a wearable biomechatronic system (named MEKA) for the analysis of knee movements in... more In this paper a wearable biomechatronic system (named MEKA) for the analysis of knee movements in two degrees of freedom is presented. The system has been designed in order to be used not only in laboratory environment (as many other commercial systems) but also in real-life conditions (e.g. for experiments on sport biomechanics). The performance of the MEKA device and of two commercial systems (an electrogoniometer and a camera-based motion analyzer) has been compared. The results showed that the MEKA system is able to obtain similar or even better performance during movements. After this preliminary assessment phase, the MEKA system has been used to analyse the modilications of motor performance of elderly and young people during gait using a *duai-task* approach. The results show that elderly people seems to be more affected by the increase cognitive efforts. l o conclusion, the MEKA system seems to be able to provide interesting information for experiments on biomechanics and motor COlltrOL

Electronics, 2016

In the context of surgical navigation systems based on augmented reality (AR), the key challenge ... more In the context of surgical navigation systems based on augmented reality (AR), the key challenge is to ensure the highest degree of realism in merging computer-generated elements with live views of the surgical scene. This paper presents an algorithm suited for wearable stereoscopic augmented reality video see-through systems for use in a clinical scenario. A video-based tracking solution is proposed that relies on stereo localization of three monochromatic markers rigidly constrained to the scene. A PnP-based optimization step is introduced to refine separately the pose of the two cameras. Video-based tracking methods using monochromatic markers are robust to non-controllable and/or inconsistent lighting conditions. The two-stage camera pose estimation algorithm provides sub-pixel registration accuracy. From a technological and an ergonomic standpoint, the proposed approach represents an effective solution to the implementation of wearable AR-based surgical navigation systems wherever rigid anatomies are involved.

Surgical Endoscopy, 2016

Background Despite many publications reporting on the increased hospital cost of robotic-assisted... more Background Despite many publications reporting on the increased hospital cost of robotic-assisted surgery (RAS) compared to direct manual laparoscopic surgery (DMLS) and open surgery (OS), the reported health economic studies lack details on clinical outcome, precluding valid health technology assessment (HTA). Methods The present prospective study reports total cost analysis on 699 patients undergoing general surgical, gynecological and thoracic operations between 2011 and 2014 in the Italian Public Health Service, during which period eight major teaching hospitals treated the patients. The study compared total healthcare costs of RAS, DMLS and OS based on prospectively collected data on patient outcome in addition to healthcare costs incurred by the three approaches. Results The cost of RAS operations was significantly higher than that of OS and DMLS for both gynecological and thoracic operations (p \ 0.001). The study showed no significant difference in total costs between OS and DMLS. Total costs of general surgery RAS were significantly higher than those of OS (p \ 0.001), but not against DMLS general surgery. Indirect costs were significantly lower in RAS compared to both DMLS general surgery and OS gynecological surgery due to the shorter length of hospital stay of RAS approach (p \ 0.001). Additionally, in all specialties compared to OS, patients treated by RAS experienced a quicker recovery and significantly less pain during the hospitalization and after discharge. Conclusions The present HTA while confirming higher total healthcare costs for RAS operations identified significant clinical benefits which may justify the increased expenditure incurred by this approach. Keywords Health technology assessment Á Robotic surgery Á da Vinci Á Economic evaluation in health care Á Economics of innovation Since 2000, the da Vinci surgical robot (Intuitive Surgical) has been the only system used clinically as an alternative to DMLS for the vast majority of laparoscopic operations. In 2013, surgeons performed approximately 523,000 robotic procedures worldwide, the commonest being hysterectomy and prostatectomy [1]. RAS has several advantages over DMLS, as the wristed end effectors permit seven degrees of freedom, thereby overcoming the kinematic constraints of DMLS, which together with motion scaling and HD stereoscopic imaging facilitates the execution of On behalf of the PRIN Research Group.

Lecture Notes in Computer Science, 2016

Computer Assisted Surgery, 2016

Background: Cardiovascular diseases are the first cause of death globally: an estimated 17.5 mill... more Background: Cardiovascular diseases are the first cause of death globally: an estimated 17.5 million people died in 2012. By combining the benefits of magnetic navigation and ultrasound (US) imaging, the authors proposed a robotic platform (i.e. the MicroVAST platform) for intravascular medical procedures. Methods: A 3D imaging US-based tracking algorithm is implemented for the navigation of a magnetic-dragged soft-tethered device. Tests were performed to evaluate the algorithm in terms of tracking error and precision of locomotion. Results: The 3D imaging US-based algorithm tracked the endovascular device with an error of 6.4 ± 2.8 pixels and a mean displacement between the endovascular device and the preoperative path of 13.6 ± 4.5 mm (computational time of 12.2 ± 1.5 ms and 30.7 ± 6.1 matched features). Conclusions: The MicroVAST platform includes innovative solutions for navigation allowing for an assisted magnetic locomotion of medical devices in the cardiovascular district by combining a 3D imaging US-based tracking algorithm with pre-operative data.

Biomedical Engineering, 2016

International journal of computer assisted radiology and surgery, Jan 12, 2014

Ultrasound (US) imaging offers advantages over other imaging modalities and has become the most w... more Ultrasound (US) imaging offers advantages over other imaging modalities and has become the most widespread modality for many diagnostic and interventional procedures. However, traditional 2D US requires a long training period, especially to learn how to manipulate the probe. A hybrid interactive system based on mixed reality was designed, implemented and tested for hand-eye coordination training in diagnostic and interventional US. A hybrid simulator was developed integrating a physical US phantom and a software application with a 3D virtual scene. In this scene, a 3D model of the probe with its relative scan plane is coherently displayed with a 3D representation of the phantom internal structures. An evaluation study of the diagnostic module was performed by recruiting thirty-six novices and four experts. The performances of the hybrid (HG) versus physical (PG) simulator were compared. After the training session, each novice was required to visualize a particular target structure. ...

Journal of Cranio-Maxillofacial Surgery, 2014

We present a newly designed, localiser-free, head-mounted system featuring augmented reality as a... more We present a newly designed, localiser-free, head-mounted system featuring augmented reality as an aid to maxillofacial bone surgery, and assess the potential utility of the device by conducting a feasibility study and validation. Our head-mounted wearable system facilitating augmented surgery was developed as a stand-alone, video-based, see-through device in which the visual features were adapted to facilitate maxillofacial bone surgery. We implement a strategy designed to present augmented reality information to the operating surgeon. LeFort1 osteotomy was chosen as the test procedure. The system is designed to exhibit virtual planning overlaying the details of a real patient. We implemented a method allowing performance of waferless, augmented-reality assisted bone repositioning. In vitro testing was conducted on a physical replica of a human skull, and the augmented reality system was used to perform LeFort1 maxillary repositioning. Surgical accuracy was measured with the aid of an optical navigation system that recorded the coordinates of three reference points (located in anterior, posterior right, and posterior left positions) on the repositioned maxilla. The outcomes were compared with those expected to be achievable in a three-dimensional environment. Data were derived using three levels of surgical planning, of increasing complexity, and for nine different operators with varying levels of surgical skill. The mean error was 1.70 ± 0.51 mm. The axial errors were 0.89 ± 0.54 mm on the sagittal axis, 0.60 ± 0.20 mm on the frontal axis, and 1.06 ± 0.40 mm on the craniocaudal axis. The simplest plan was associated with a slightly lower mean error (1.58 ± 0.37 mm) compared with the more complex plans (medium: 1.82 ± 0.71 mm; difficult: 1.70 ± 0.45 mm). The mean error for the anterior reference point was lower (1.33 ± 0.58 mm) than those for both the posterior right (1.72 ± 0.24 mm) and posterior left points (2.05 ± 0.47 mm). No significant difference in terms of error was noticed among operators, despite variations in surgical experience. Feedback from surgeons was acceptable; all tests were completed within 15 min and the tool was considered to be both comfortable and usable in practice. We used a new localiser-free, head-mounted, wearable, stereoscopic, video see-through display to develop a useful strategy affording surgeons access to augmented reality information. Our device appears to be accurate when used to assist in waferless maxillary repositioning. Our results suggest that the method can potentially be extended for use with many surgical procedures on the facial skeleton. Further, our positive results suggest that it would be appropriate to proceed to in vivo testing to assess surgical accuracy under real clinical conditions.

2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 2009

Ultrasound-guided biopsy is a proficient mininvasive approach for tumors staging but requires ver... more Ultrasound-guided biopsy is a proficient mininvasive approach for tumors staging but requires very long training and particular manual and 3D space perception abilities of the physician, for the planning of the needle trajectory and the execution of the procedure. In order to simplify this difficult task, we have developed an integrated system that provides the clinician two types of assistance: an augmented reality visualization allows accurate and easy planning of needle trajectory and target reaching verification; a robot arm with a six-degree-of-freedom force sensor allows the precise positioning of the needle holder and allows the clinician to adjust the planned trajectory (cooperative control) to overcome needle deflection and target motion. Preliminary tests have been executed on an ultrasound phantom showing high precision of the system in static conditions and the utility and usability of the cooperative control in simulated no-rigid conditions.

Lecture Notes in Computer Science, 2014

International Journal of Computer Assisted Radiology and Surgery, 2014

An anatomically realistic ultrasound liver phantom with tissue-specific distinct signal propertie... more An anatomically realistic ultrasound liver phantom with tissue-specific distinct signal properties is needed for training of novices in diagnostic and interventional procedures. The main objective of this work was development and testing of a new durable liver ultrasound training phantom for use with a hybrid simulator. A liver ultrasound phantom was fabricated in four main phases: materials selection, segmentation of CT images and realization of 3D models, vessel and lesion realization, and final assembly with silicone casting. Silicone was used as basic material due to its durability and stability over time. Several additives were analyzed and mixed with the polymer to reproduce the echogenicity of three simulated soft tissue types: parenchyma, lesions, and veins. Cysts and vessel trees appear anechoic in the B mode ultrasound images when realized with pure silicone. The liver parenchyma, hypoechoic, and hyperechoic lesions were realized with different concentrations of graphite and Vaseline oil to increase their relative echogenicity. These materials were successful for creation of an ultrasound liver phantom containing simulated blood vessels and lesions. The phantom reproduces the human liver morphology and provides vessels and lesions ultrasound images with recognizable differences in echogenicity. The speed of sound in the simulated materials is inaccurate, but the problem can be overcome via software adjustment in a hybrid simulator.

Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference, 2014

Magnetic guide of endovascular devices or magnetized therapeutic microparticles to the specific t... more Magnetic guide of endovascular devices or magnetized therapeutic microparticles to the specific target in the arterial tree is increasingly studied, since it could improve treatment efficacy and reduce side effects. Most proposed systems use external permanent magnets attached to robotic manipulators or magnetic resonance imaging (MRI) systems to guide internal carriers to the region of treatment. We aim to simplify this type of procedures, avoiding or reducing the need of robotic arms and MRI systems in the surgical scenario. On account of this we investigated the use of a wearable stereoscopic video see-through augmented reality system to show the hidden vessel to the surgeon; in this way, the surgeon is able to freely move the external magnet, following the showed path, to lead the endovascular magnetic device towards the desired position. In this preliminary study, we investigated the feasibility of such an approach trying to guide a magnetic capsule inside a vascular mannequin....

The International Journal of Medical Robotics and Computer Assisted Surgery, 2012

Background Endovascular procedures are nowadays limited by difficulties arising from the use of 2... more Background Endovascular procedures are nowadays limited by difficulties arising from the use of 2D images and are associated with dangerous X-ray exposure and the injection of nephrotoxic contrast medium. Methods An electromagnetic navigator is proposed to guide endovascular procedures with reduced radiation dose and contrast medium injection. Five DOF electromagnetic sensors are calibrated and used to track in real time the positions and orientation of endovascular catheters and guidewires, while intraoperative 3D rotational angiography is used to acquire 3D models of patient anatomy. A preliminary prototype is developed to prove the feasibility of the system using an anthropomorphic phantom. Results The spatial accuracy of the system was evaluated during 70 targeting trials obtaining an overall accuracy of 1.2 AE 0.3 mm; system usability was positively evaluated by three surgeons. Conclusions The strategy proposed to sensorize endovascular instruments paves the way for the development of surgical strategies with reduced radiation dose and contrast medium injection. Further in vitro, animal and clinical experiments are necessary for complete surgical validation.

The International Journal of Medical Robotics and Computer Assisted Surgery, 2013

The da Vinci robotic surgical telemanipulator has been utilized in several surgical specialties f... more The da Vinci robotic surgical telemanipulator has been utilized in several surgical specialties for varied procedures, and the users&amp;amp;amp;amp;amp;#39; experiences have been widely published. To date, no detailed system technical analyses have been performed. A detailed review was performed of all publications and patents about the technical aspects of the da Vinci robotic system. Published technical literature on the da Vinci system highlight strengths and weaknesses of the robot design. While the system facilitates complex surgical operations and has a low malfunction rate, the lack of haptic (especially tactile) feedback and collisions between the robotic arms remain the major limitations of the system. Accurate, preplanned positioning of access ports is essential. Knowledge of the technical aspects of the da Vinci robot is important for optimal use. We confirmed the excellent system functionality and ease of use for surgeons without an engineering background. Research and development of the surgical robot has been predominant in the literature. Future trends address robot miniaturization and intelligent control design.