1,720,972 research outputs found
Diffuse Reflectance Spectroscopy for Intraoperative Tumor Margin Assessment: Workflow Analysis and Effect of Coagulation on Tissue Sensing
No full textThe aim of this graduation project is to assess the feasibility of the photonic technology called diffuse reflectance spectroscopy (DRS) to aid in intraoperative margin assessment with the goal of obtaining clear margins for liver, breast and soft tissue tumors. The idea is to integrate optical fibers in the existing and widely used electrosurgical knife, which consists of a pencil holder and a blade electrode. The work consists of workflow analyses and experiments. Based on the former the role of DRS in clinical practice can be specified. The main object of the experiments is to find out if DRS is still usable when a layer of coagulated tissue due to electrosurgical activity is present. Lumpectomy workflows using four techniques are investigated. For palpable tumors intraoperative ultrasound (US) and palpation are used, while non-palpable tumors require iodine seeds or placement of a guidewire. The most important limitations of current methods include: no information about the actual margin for iodine seeds and guidewire procedures, complex patient preparation, expertise required to understand US images and lack of reinforced learning for palpation. One advantage of all techniques is that they provide extra information, allowing the surgeon to create a more detailed mental image of the tumor. Ultrasound provides continuous information on the margin, while palpation is very intuitive. DRS integrated into the electrosurgical instrument provides distinct benefits in the local assessment phase, including direct feedback on whether or not to make a cut without losing information. DRS sensing should be directed forward, parallel to the axis of the pencil. In the experimental phase the shape and size of the tissue area influenced by electrosurgical treatment is inves- tigated first. It is found that layers of coagulation up to 1.4 mm may occur in surgery. Next, experiments are performed to identify the effect of coagulation on DRS spectra. Protein denaturation and reduced water con- tent are clearly visible in the diffuse reflectance spectra, resulting in a decreased slope and increased intensities of peaks in the near-infrared (NIR) range. Spectral alterations are severe, requiring further investigation using Monte Carlo (MC) simulations. Two-layered MC models that consist of coagulated tissue on top of normal tissue are build for coagulation up to 1.5 mm. Using the slope and peaks described above a predictive model is created, based on a sigmoid fit of these so-called predictors. Coagulation depth is predicted with R2 values up to 0.99, indicating a valid model. Two-layered MC models of normal and tumor tissue show that breast tumors can be detected up to 4 mm, liver tumors are visible at 2 mm and lipoma in skeletal muscle can be seen at 5 mm when the fiber distance (FD) = 6 mm. Finally, three-layered MC models of coagulated, normal and tumor tissue yield predictors that strongly differ from tissue without tumor presence. No predictive model for tumor depth is created. The results from this project show that accurate depth determination of coagulation is possible as well as sensing the presence of a tumor within the sensing zone. The latter ensures that DRS may bring at least the same qual- ities as iodine seeds and the guidewire. An important benefit is that DRS provides information on the complete margin, rather than a discrete point. Quantitative depth prediction is required to compete with intraoperative US for invasive tumors. Overall, it was shown that if DRS is successfully developed it can bring important benefits to clinical practice. The effect of tissue coagulation on diffuse reflectance spectra is large, but can be accounted for with a mathemat- ical predictive model. The next crucial step is further investigation of tumor depth sensing and investigation of a complete predictive model. The depth sensing requirements are only completely met for breast tumors. For liver resection, tumors are only detected up to 2 mm. This means that the desired 1 cm margin cannot be safeguarded with DRS. Close margins however are often accepted in clinical practice and do improve patient outcome. DRS integration should not be considered as a replacement for current margin assessment techniques but rather as a complement. Overall, integration of DRS into electrosurgical instruments seems promising. More research is required to see if DRS can truly perform in the OR.Bio-Inspired DesignBioMechanical EngineeringMechanical, Maritime and Materials Engineerin
Evaluating the Translation of Diffuse Reflectance Spectroscopy into Hyperspectral Imaging: Bridging the gaps between the two technologies
No full textBreast cancer is the most prevalent cancer in women with about 1.7 million new cases reported worldwide in 2012. The two main types of surgical treatment for breast cancer are mastectomy and lumpectomy. In mastectomy, the entire affected breast is excised whereas in lumpectomy only the tumor along with a rim of healthy tissue is excised. This rim of healthy tissue surrounding the tumor is called a ‘surgical margin’ and to prevent recurrence of cancer, it is necessary that there are no cancer cells remaining after the surgery. Owing to this purpose, many techniques have been developed to discriminate between healthy tissue and tumor. Two noteworthy techniques are namely, diffuse reflectance spectroscopy (DRS) and Hyperspectral Imaging (HSI), which use spectral information to discriminate between healthy and cancerous tissues. Both techniques have the potential to be used for real time intraoperative characterization of breast tissue in vivo but each technique has its respective limitations. While HSI provides non-contact tissue imaging which DRS does not, DRS provides spatially resolved depth information that HSI does not.The goal of the thesis is to evaluate the translation of Diffuse Reflectance Spectroscopy into Hyperspectral imaging by bridging the gaps between the two technologies. For this purpose, three main research questions were answered. First, the changes in spectral shapes were observed when moving from contact DRS to HSI by acquiring data from two intermediate DRS set ups that emulated the non-contact and illumination settings of HSI. Second, the scope of a spatially resolved non-contact DRS tool was assessed. And third, the spatially resolved non-contact DRS in a clinical setting was put into perspective. A multitude of experiments were performed to answer these three research questions. All experiments were performed on commercial butter or ex vivo porcine adipose tissue samples. DRS measurements were obtained for a wavelength range spanning 400 nm to 1600 nm.Biomedical Engineerin
Breach detection using diffuse reflectance spectroscopy during spinal screw placement
No full textThe intraoperative guidance and placement of spinal screws is a complex procedure. High technical expertise is required fromthe surgeons in order to achieve adequate fixation and ensure patient safety by preventing vascular and neurological injuries. The conventional screw placement techniques face several challenges. Surgeons heavily rely on experience-based judgement, tactile feedback and X-ray guidance. The consequences of which are reflected in clinical literature via high risks associated with complications, screw placement accuracy variability and radiation exposure. Moreover, cost savings in terms of improved patient outcomes such as patient recovery times and fewer revision surgeries are major incentives towards development and clinical adoption of better intraoperative guidance technologies. The aim of this PhD work was to investigate the applicability of spectral sensing based technique namely Diffuse Reflectance Spectroscopy (DRS) for intraoperative instrument guidance and breach detection during pedicle screw placement procedures.Medical Instruments & Bio-Inspired Technolog
Developing a Breast Phantom to Test and Validate the Smart Electrosurgical Knife
No full textPrevious studies show that the smart electrosurgical knife, which adds diffuse reflectance spectroscopy to the traditional electrosurgical knife, is a promising technique for breast-conserving surgery, namely it enables real-time tissue characterization while cutting. More specifically, based on the fat/water-ratio, it enables intraoperative healthy from malignant tissue discrimination, therefore potentially reducing the re-excision rate with breast-conserving surgery procedures. However, the smart electrosurgical knife cannot be used on patients yet since it has not been validated yet. Several studies suggest phantoms are ideal for validation of systems including imaging systems like diffuse reflectance spectroscopy. Hence, for this master thesis, the objective was to develop a breast phantom that enables validation of the smart electrosurgical knife.Firstly, it was found that a study which enables validation of the smart electrosurgical knife, should mimic a breast-conserving surgery procedure including a breast phantom, so that the potential of the intraoperative margin assessment technique ‘’ diffuse reflectance spectroscopy ‘’, added to the traditional electrosurgical knife, could sufficiently be tested. For such a study to take place, it was found that the phantom should have a similar size and shape as human breasts containing a tumour. With regard to pre- and postoperative margin assessment, the phantom should have a contrast between the tumour and healthy phantom, which enables size, border, and location assessment of the phantom tumour upfront and residual tumour inspection after surgery. Intraoperatively, the phantom should have a significant difference in fat/water-ratio between the tumour and healthy phantom. This enables us to assess diffuse reflectance spectroscopy with its capability in discriminating healthy from malignant tissue. Furthermore, visually and mechanically, there should be a minimal difference between the tumour and healthy phantom, which eliminates the possibility of using the intraoperative margin assessment techniques, palpation and visual inspection. Finally, the phantom should have similar mechanical- electrically conductive and thermo tolerance properties as real breast tissue. This will result in realistic haptic feedback and tissue effects with electrosurgery.To develop such a phantom, various fat/water-ratios of water and lard, in combination with various additives such as guar gum, agar, gelatin and barium sulphate, were produced and tested. It turned out that agar in combination with water, lard, and the contrast agent barium sulphate, enables breast phantom production, that meets all the aforementioned phantom requirements. More specifically, the final phantom is a breast-shaped phantom with a realistic size and shape, consisting of healthy tissue with a tumour inclusion. The healthy tissue is composed of 50% lard, 50% water and then 5% agar by weight of water, whereas the tumour is composed of 20% lard, 80% water and then 3% agar- and 5% barium sulphate by weight of water. Since this phantom meets all requirements, it enables the design of a study that subsequently enables extensive testing and further validation of the smart electrosurgical knife.Biomedical Engineerin
The integration of diffuse reflectance spectroscopy into the electrosurgical knife used during breast-conserving surgery: Determining and overcoming the challenge of tissue debris adhering to the ‘smart’ electrosurgical knife
No full textAmong women, breast cancer has the highest incidence rate of all types of cancer worldwide. For 80% of these patients, a treatment option is the surgical procedure known as breast conserving surgery (BCS). Re-excision is required in 10-60% of these patients, as positive margins are encountered post-operatively, showing the need of an intra-operative margin assessment (IMA) technique. Diffuse Reflectance Spectroscopy (DRS) has proven to accurately discriminate real-time between malignant and non-malignant tissue. As electrosurgery (ES) is the main technique used for BCS, the incorporation of DRS into the electrosurgical knife (ESK) is desired. A ‘smart’ ESK has previously been developed, yet practical use was disturbed by tissue contamination of the integrated diffuse reflectance fibers during ES.This thesis, therefore, examines the characteristics of this contamination and the effects on the desired integration. Clinical and research analyses were done, obtaining requirements for a re-design of the ‘smart’ ESK. Instruments, settings and methods of cleaning the ESK in the operating room have been observed and the influence of clinical parameters on the amount of tissue debris has been investigated. Tissue contamination on ESK blades used for BCS was analyzed with the use of DRS and Fourier Transform – Infrared spectroscopy (FTIR). The impact of this contamination was additionally determined by power measurements of the ‘smart’ ESK after cutting on samples of subcutaneous porcine tissue for several time intervals.All measured spectra of the charring components adhering to the electrosurgical blades matched with proteins (best matching with hemoglobin and hydrolyzed proteins) and fatty acid esters adhering to the electrosurgical blades. Furthermore, significant decreased debris was found correlating with the date of surgery and the amount of times the ESK was cleaned. No significant influence was found of the amount of ES current used on the tissue debris, yet the intensity of the signal was expressively decreased with the increase of debris. During the power experiments, tissue debris on the ‘smart’ ES increased significantly over time while cutting. Polishing the fibers resulted in a fiber signal of only 43% of the maximal power.Disturbance occurred already early within the normal usage time of surgical procedures, with 1.9% of the maximal power left after 2 minutes of cutting. Prevention of fiber contamination seemed most effective by avoiding direct contact of the fibers with tissue during ES.Design challenges and requirements were obtained, resulting in three concepts aiming to overcome tissue adhering to the integrated fibers. Three prototypes were made and evaluated, which eventually led to a proposed re-design of the ‘smart’ ESK, containing integrated fibers which can be retracted into the casing when the knife is used to cut and is intermittently slided out for tissue contact to obtain DRS measurements. A working prototype was produced, which potentially overcomes the disrupted DRS measurements due to tissue contamination on the integrated fibers. Hence, a step is made towards the integration of DRS into the ESK. This will possibly have a positive impact on the margin assessment during surgery, which might reduce the number of re-excisions after BCS
A Wireless powered LED marker for Intraoperative Localization
No full textIntraoperative Localization plays an important role in achieving a safe and successful resection surgery. Conventionally, Intraoperative Localization techniques rely on intraoperative imaging guidance, radioactivity guidance, and fluorescence guidance together with local markers. These techniques can assist the surgeon by accurately finding the lesion in the operating room. In this article, an idea of using wireless powered LED marker as a more intuitive alternative is proposed, mainly inspired by the rapid developments in microelectronics and wireless power transfer techniques. This paper presents a complete system using a wireless powered LED marker that can be used for intraoperative localization. The operating frequency and source current density distribution were determined based on the Mid-field wireless power transfer theory. The results were simulated with muscle and multilayered breast tissue model in FEKO. During implementation, the transmitter is approximated by using a two-port antenna which operates at around 2Ghz. The size of the LED marker was minimized by using a double layer PCB design. The energy harvesting component is a 5-turn coil, which reduces the resonant frequency of the entire marker when it is wound around the PCB. The PCB is coated with biocompatible material. Finally, the system is tested and verified using media of air, tissue simulating liquid, butter, and swan lung tissue. It can be concluded that this system can potentially increase the convenience and accuracy of intraoperative localization
The Design and Development of an Anthropomorphic Coronary Artery Network Phantom: To Assist in the Development and Validation of Novel Imaging-Related Technologies
No full textPercutaneous coronary intervention (PCI) is one of the main medical procedures employed for the treatment of coronary artery disease. During this procedure, the coronary arteries are visualized using X-ray imaging. However, it only generates 2D images which can complicate several tasks, including assessing the lesion and correctly placing a stent. To overcome this limitation, researchers of Philips Research are developing technologies that allow the implementation of 3D imaging data derived from coronary CT angiography in the catheterization laboratory. Throughout the development, a coronary artery network phantom could serve as a beneficial tool. Such a phantom should be anthropomorphic and have realistic imaging and mechanical properties. Additionally, it should serve as a platform on which a basic PCI procedure can be performed. No commercially or academically developed phantom satisfies these criteria, thus the objective for this project was to design and develop an anthropomorphic coronary artery network phantom with realistic imaging and mechanical properties, which can be used to mimic both healthy and atherosclerotic human coronary arteries. A material study was initially conducted to find the most suitable materials for the development of the phantom. During the first stage, the radiodensity of several materials was measured. Based on those results, and other factors such as safety, usability and durability, it was concluded that PlatSil Gel 25 would be used for the development of the arterial wall. Additionally, the heart and non-calcified lesions were to be made from VytaFlex 20 in combination with BaSO4. The calcified lesions were to be made from PlatSil Gel 25 and also required the addition of BaSO4 to increase their radiodensity. After the imaging tests, uniaxial tensile tests were conducted to measure the stiffness of PlatSil Gel 25 samples with different concentrations of PlatSil hardener. These results demonstrated that PlatSil Gel 25 has a comparable stiffness to that of healthy human coronary arteries in the longitudinal direction. When combined with the hardener, it can also mimic the stiffness of atherosclerotic coronary arteries.After the material study, the coronary artery network phantom was designed and developed. The design comprises a simplified representation of the heart, and an arterial network that consists of the coronary artery network and a simplified representation of the arterial pathway distal to the aortic root. To manufacture the arterial network, a water-soluble 3D-printed mould was manually coated with PlatSil Gel 25 and subsequently dissolved in water. Due to the solubility of the mould, it was possible to manufacture a geometrically complex and hollow arterial network as a single part. Additionally, it was demonstrated that this manufacturing method can be used to include lesions within the arterial wall, and that its stiffness can be locally changed.During the evaluation of the final phantom, its geometrical, imaging and mechanical properties were assessed and compared with the formulated requirements. Based on the results it can be concluded that the phantom meets many of the requirements. Furthermore, it was demonstrated that a guidewire can be inserted into the arterial network and manipulated up to the end of the left circumflex artery. Nevertheless, the evaluation also revealed some areas of improvement. Most notable are the improvements related to the imaging properties of the phantom. For example, the radiodensity of the arterial wall was slightly too high. In addition, the attenuation was not uniform throughout the parts of the phantom that contained BaSO4, as was evident from X-ray and CT images.In conclusion, this project demonstrated that the utilized manufacturing method and materials can be used to develop a healthy and atherosclerotic coronary artery network phantom, that possesses realistic geometrical, imaging and mechanical properties. Additionally, it has the potential to serve as a platform on which a basic PCI procedure can be performed. Nevertheless, several areas of improvement related to both the manufacturing method and phantom remain, which might form the foundation for a future project.Biomedical Engineerin
Effect multi-electrode ablation catheter angle on electrode-tissue contact measurement
No full textIntroduction Sudden cardiac death is one of the major deaths worldwide. Several treatments are available to lower risks of sudden cardiac deaths. Atrial fibrillation is one of the leading causes for sudden cardiac deaths. Atrial fibrillation can be treated with drugs or with procedures or surgeries. Catheter ablation is one of these procedures. With the use of radiofrequency, the area in the heart causing the disrupting of the signal pathway and therefore causing the atrial fibrillation can be restored. When performing the ablation, the force on the heart tissue and insert angle of the catheter tip can influence the results of the catheter ablation. In this paper we investigate whether the impedance readout can be used to determine the force and the angle the multielectrode catheter tip is exerted on a phantom tissue. Methods To research the impedance readout with respect to the insert angle and force an experimental setup was designed. The electrodes of a catheter were connected to a HP impedance analyzer (HP 4192A). This catheter was guided through a 3D print with hollow tubes (90, 60, 45 and 30 degrees) to achieve the desired insert angle on a phantom. The 3D print is mounted to a linear stage to control the movement of the catheter with millimeter precision movement. The catheter was pressed onto a phantom. Cardiac phantoms were made with the base material Gellan Gum, Agar and PVA. The phantom was put in a container with a skinpatch counter electrode attached to it to be able to measure the impedance change. Below the container a scale is placed to readout the force that is being exerted on the phantom. Results Samples with base materials as Gellan Gum, Agar and PVA were made and the catheter was being exerted on it with various insert angles. Impedance change with increasing force and varying insert angles were recorded and graphs were taken out of the data that is being recorded with the use of Excel. The data has been taken from fresh made samples, 1 week old samples and 2 weeks old samples. From the graphs the relative impedance increase decreases when the insert angle is reduced from 90 to 30 degrees. Conclusion Impedance can be used to determine how much pressure is being exerted on a heart tissue. However, the catheter that approaches the heart tissue will have different insert angles. The impedance change is dependent on the various insert angles. Therefore it is not sure if this impedance change method can be used to determine the force that is being exerted on the heart tissue in a reliable way when the catheter tip angle is unknown.Biomedical Engineering | Medical Instruments and Medical Safety (MIMS
Formalization and Quantification of the workflow in the Catheterization Laboratory: First steps towards workflow optimization and efficiency enhancement in the Catheterization Laboratory
No full textCardiovascular disease is the number one cause of death in the USA and number two in the Netherlands(1, 2). In addition, it is expected that in 2030 40.5% of the population in America will be inflicted with a form of cardiovascular disease(2). The growing volumes and thereby health care costs will put a strain on hospitals and health care providers, as more individuals need to be treated with the same resources. Workflow and efficiency optimization are topics that are gaining momentum over the last years in the field of medicine (3-6). Health care providers see this as a viable solution to treat more patients and reduce the costs, i.e. increasing efficiency. This research group intend to automatically evaluate the workflow efficiency in the cath lab with use of two sensors: the X-ray imaging system and video cameras. In order to facilitate automatic workflow monitoring and optimization, prior research should be conducted, as “the initial step for improving the process is to acquire knowledge of how things are done”(7). To continue in this line of reasoning, in this research the current peri-operative workflow of the CAG procedure is formalized and quantified.METHODWe used the SPM (surgical process model) methodology to formalize the peri-operative workflow of the CAG. The role activity diagram (RAD) was chosen as the model representation. The model approach was top-down. The metrics were determined and designed based on a previous conducted literature study, the formalization of the workflow and the design criteria. The metrics were divided in two groups: 1) the high-level metrics and 2) the procedure and CAG specific metrics. To evaluate metrics two datasets were used: 1) the manually acquired dataset through observations and 2) the dataset retrieved from the X-ray imaging system. To validate the methodology, the outcomes of the metrics were compared with the experience of the cath lab team. The generalizability was tested by utilizing the phases and metrics in different endovascular procedures and in a different hospital.RESULTSIn total 19 metrics were created of which 11 evaluated the high-level workflow, three the procedure specific process and five the CAG specific steps. Prior the first procedure in the morning, the LA waiting time showed an average of 37 minutes and on average seven minutes are used for lab preparation. In the afternoon similar results are found: the LAs waiting time is longer than the actual lab preparation. The average percentage on-time start cases was 43%. A significant mean difference of 3.3 minutes (p=0.041) regarding the turn-over time was found between the two LA and three LA group. Delivery time showed a mean difference of 3.7 minutes (p=0.004), comparing inpatients (M = 8.1± 5.43 minutes) to outpatients (M = 4.4 ± 4.4 minutes). There was significant positive correlation between delivery times and turn-over times, r=0.66 (p<0.001). Longer delivery times resulted in longer turn-over times. The procedure time presented the highest mean and variance, M=38.0 ± 21.1 minutes. The patient preparation time and post-care duration presented low variances, respectively M=11.8 ± 3.8 minutes and M=4.6 ± 3.3 minutes. The variability in the procedural time could be attributed to the operative phase, M=22.4 ± 18.8 minutes. Within the operative phase, the duration of P1 and P2 accounted for 70% of the variability in the operative length. The X-ray imaging system was able to correctly measure consolidation of metrics describing P2, P3 and P4. The non-procedure specific metrics have the potential to be generalized to any type of procedure. Only P1 and P5 showed potential to be utilized in other endovascular procedures. The analysis in Haga hospital suggests that phases and the metrics could be generalized and therefore used in more cath labs throughout the Netherlands.DISCUSSIONThis research has paved the way for in-depth efficiency assessment and workflow optimization in the cath lab. The cost of delay in an OR is /day can be saved by optimizing the turn-over times. Moreover, the LAs wait in the morning for 20 minutes and in the afternoon for 15 minutes. In case the waiting time could be reduced with 50%, 18 minutes of wasted time would be utilized and 450 /day, which is approximately the scheduled time of one CAG procedure. As a result of optimization, an extra patient could be treated every day and money could be saved.Biomedical Engineerin
The usability of interventional X-ray data for intraoperative prediction of coronary angiography procedure duration
No full textMaximisation of treatment efficiency in hospitals can lead to significant growth in terms of patient satisfaction, staff productivity and hospital revenue. Scheduling for the operating department is currently done manually, using standard values for duration that vary with procedure type. This implies that no patient characteristics nor historical data are used to personalise predicted surgical duration. Furthermore, schedules are not updated when procedures are delayed. A relevant step towards dynamic scheduling is the realisation of real-time analysis of surgical workflow, based on intraoperatively acquired data. As of yet, the amount research performed into the use of automatically generated online data for duration prediction is limited. This research project involves an analysis of the usability and characteristics of interventional X-ray data, for predicting the total duration of coronary angiograms intraoperatively. A random forest classification algorithm is used to analyse each acquisition within the dataset and classify the total duration of the corresponding procedure as being below 10 minutes, 10 to 20 minutes, 20 to 30 minutes or 30 minutes and over. An additional 22 features were generated to add data from prior acquisitions of the same patient. Recursive feature elimination was used to determine the optimal feature set, to be used in the final model. Based on out-of-bag validation, the overall accuracy of the classification model was found to be 92.8\%. Considering an average procedure duration of 11 minutes, the interventional X-ray data shows exceptional capabilities of classifying both standard and delayed procedures. Further analysis with respect to procedure time shows that some Class 1 acquisitions are overestimated as Class 2 acquisitions, but that overestimation of procedure duration rarely occurs for the other three phases. This implies that a prediction made beyond 10 minutes into the procedure can be perceived as the absolute minimum duration class of the procedure. Additionally, Class 3 and Class 4 predictions are found to always correspond to the minimum procedure time, independent of procedural progress. Class 2 and Class 3 acquisitions are underestimated up until 10 minutes and 20 minutes into the procedure, respectively. Class 4 acquisitions are correctly classified at a relatively earlier point with respect to progress and are never incorrect beyond 20 minutes. Given the fact that overestimation does not occur beyond 10 minutes, nor when Class 3 or Class 4 is predicted, the first prediction of a new duration class is concluded to be a reliable reference point. Further investigation has shown that most Class 3 and Class 4 detection occur within the first five minutes of a procedure. Therefore, the model is successful at predicting a total duration of 20 minutes or more at an early stage of the procedure. This could significantly benefit the hospital in terms of procedure planning and knowing when to request the next patient. For a deeper understanding of the model's potential, individual procedures were analysed to gain insight into its additional value in terms of procedure scheduling. In terms of prediction features, the acquisition frequency, longitudinal position of the operating table, cumulative procedure duration, patient age and cumulative cine acquisition time were found to be the most important. The implementation of these features in further research on CAG phases is recommended. Movement of the operating table seems to be particularly informative for workflow analysis. In terms of clinical application, further optimisation is required in order to enable accurate prediction for the duration of shorter procedures. Nevertheless, the model provides an accurate tool for the real-time monitoring of procedural workflow and detecting significant delay, which proves that the usability of the data goes far beyond machine maintenance and service only.Biomedical Engineerin
- …
