MEDICAL ROBOTICS

1. -Anvit Tawar -AlankarSaxena -Pierre Gennetay -GauravChoudhary MEDICAL ROBOTICS CAUTION: The images displayed may be disturbing

2. Contents • Introduction • Why AI in Medicine ? • History • Role of AI in Medicine • Surgical Robotics • Benefits of Robots • Design Challenges • Surgical Assistance • Clinical Application • ROBODOC • Da Vinci • Nanomedicine • Desired Properties • Design Issues • Today & Tomorrow • Future & Ethical Impact • Extraordinary Applications • Genetic Modification • Ethical Issues • Possible Risks • Further Reading & References

3. Introduction

4. Introduction – Why AI in Medicine ? • Medicine is a field in which such help is critically needed. • We see increase in expectations of the highest quality health care and the rapid growth of ever more detailed medical knowledge. • This leaves the physician with inadequate time to devote to each case and struggling to keep up with the newest developments in his field. • Continued training and recertification procedures encourage the physician to keep more of the relevant information constantly in mind.

5. Introduction – Why AI in Medicine ? • But fundamental limitations of human memory and recall coupled with the growth of knowledge assure that most of what is known cannot be known by most individuals. • This is the opportunity for new computer tools: to help organize, store, and retrieve appropriate medical knowledge needed by the practitioner in dealing with each difficult case. • To suggest appropriate diagnostic, prognostic and therapeutic decisions and decision making techniques.

6. History • With intelligent computers able to store and process vast stores of knowledge, the hope was that they would become perfect 'doctors in a box', assisting or surpassing clinicians with tasks like diagnosis. • With such motivations, a small but talented community of computer scientists and healthcare professionals set about shaping a research program for a new discipline called Artificial Intelligence in Medicine (AIM).

7. History • These researchers had a bold vision of the way AIM would revolutionize medicine, and push forward the frontiers of technology. • After the first euphoria surrounding the promise of artificially intelligent diagnostic programs, the last decade has seen increasing disillusion amongst many with the potential for such systems.  • Much of the difficulty has been the poor way in which they have fitted into clinical practice, either solving problems that were not perceived to be an issue, or imposing changes in the way clinicians worked. 

8. Role of AI in Medicine • Medical artificial intelligence is primarily concerned with the construction of AI programs that perform diagnosis and make therapy recommendations

9. Role of AI in Medicine • AI can support both the creation and the use of medical knowledge : • Proponents of so-called 'strong' AI are interested in creating computer systems whose behavior is at some level indistinguishable from humans • An AI system could be running within an electronic medical record system, for example, and alert a clinician when it detects a contraindication to a planned treatment.  • AI systems also have a very different role to play in the process of scientific research. In particular, AI systems have the capacity to learn, leading to the discovery of new phenomena and the creation of medical knowledge.

10. Role of AI in Medicine • Reasoning with medical knowledge: • Expert or knowledge-based systems contain medical knowledge, usually about a very specifically defined task, and are able to reason with data from individual patients to come up with reasoned conclusions.

11. Surgical Robotics

12. Benefits of Surgical Robots • Robots can perform tasks very accurately and precisely. Hence very effective for Minimally Invasive Surgery (MIS) – Less Cutting, Less Complications & Faster Recovery. • Can work in inaccessible or non-human-friendly zones, such as inside of the patient, or amidst X-rays. • Allow for Tele-Surgery or Remote Surgery, and even Unmanned surgery, where no human is directly involved.

13. Design Challenges • Surgical Robots present a unique set of challenges due to requirements of size, sterility, safety and dynamic nature of patient’s body. • MANIPULATION: Require ability to make highly dexterous movements in small spaces. • STERILITY: Mainly ensured by using disposable parts and sterile drape coverings. Leads to expensive maintenance.

14. Design Challenges (continued) • SENSING: Real-time Force and Vision/Imaging sensors are required for medical purposes. • INTERFERENCE: • MRI generates high magnetic field (1.5-3 Tesla) and RF pulses, in which traditional robotic components fail. • Non-metallic links and Piezo-Electric or Hydraulic motors are hence required. • REGISTRATION: • Transformation between coordinate systems of the body, images, robots and sensors. • Parts of the anatomy change shape, and thus Dynamic and Non-rigid transformations are required.

15. Surgical Assistance • Medical Interventions are highly interactive processes, and require many critical decisions to be made on the spot. No computational system, to date, possesses the judgment & intelligence required. • Goal of Surgical Assistance: Not to replace humans, but to provide with intelligent & versatile tools to augment the physician’s ability. • There are 2 Basic Augmentation Strategies: • Improve the physician’s existing ability, for example by providing X-ray vision to supplement direct vision • Increase the number of available sensors and actuators. These perform tasks such as endoscope handling or limb positioning

16. Surgical Assistance Paradigms • Control Methods: Steady-hand operation, Motion Scaling. Can be cooperative or teleoperative. • Haptic Feedback: Provides force/tactile feedback to the surgeon, thus eliminating the awkwardness due to lack of direct contact. • Information-enhanced Assistance: Software-generated force/position signals applied to the human, to guide his movement and improve accuracy & safety.

17. Clinical Application Examples • Percutaneous Needle-based Surgery • Minimally Invasive Surgery – Less cutting through the skin. • Exceedingly Complex, with translation and rotation along different axes in 3D, and bending and insertion forces of varying magnitude making it a delicate procedure. • Best served by robots that provide dexterous movements with high precision & accuracy. Image Courtesy: Johns Hopkins University

18. Clinical Application (continued…) • Neurosurgery • It is one of the first applications of surgical CAD/CAM (Computer-Aided Design/Manufacturing) systems. • Initially, robots were limited to passive tool positioning devices, but they are now used as active robots, carrying out various manipulations on the body. • The entry and target points are planned on CT/MR images. After coordinate transformations, the robot places a needle or drill guide, and executes the intervention. Image Courtesy:Integrated Surgical Systems

19. ROBODOC Image Courtesy: Robotics & Automation Magazine, IEEE • Developed for Total Hip Replacement & Total Knee Replacement. • It uses CT for 3D planning and modeling of the prosthesis with the body. A robot for automatic bone milling performs the surgery.

20. Da Vinci Tele-Surgery System Image Courtesy: boston.com • The system improves the surgeon’s skills by enabling him to remotely manipulate tissue through incisions which are too small for direct intervention. It also provides arms to handle endoscope, scissors, etc. at the patient-side slave robot.

21. Nanomedicine

23. Desired Properties • Small and Agile - to navigate through complex network of veins and arteries. • Capacity to carry medication or miniature tools. • Assuming the nanorobot isn't meant to stay in the patient forever, it should be able to make its way out of the host.

24. Design Issues Three main considerations that need focus: • Navigation • Power • Locomotion Most options can be divided into one of two categories: external systems and onboard systems.

25. External navigation systems • Using ultrasonic signals. • Using a MRI device • Doctors at EcolePolytechniquehave successfully maneuvered a small magnetic particle through a pig's arteries using MRI. Image Courtesy: Google • Injecting a radioactive dye • We use a fluoroscope to detect the radioactive dye as it moves through the circulatory system. • Complex 3-D images indicate where the nanorobot is located.

26. Onboard navigation systems • Chemical sensors • Detect the trail of specific chemicals to reach the right location. • A spectroscopic sensor would allow the nanorobot to take samples of surrounding tissue, analyze them and follow a path of the right combination of chemicals. • Miniature television camera • An operator at a console will be able to steer the device while watching a live video feed.

27. Powering the Nanorobot 3 kinds of powering systems: • Using the patient's own body as a way of generating power. • Power source on board the robot itself. • Using forces outside the patient's body to power the robot.

28. Internal Systems • Using patient’s body • Electrolytes found in blood : A nanorobot with mounted electrodes could form a battery using the electrolytes. • Chemical reactions with blood : The nanorobot would hold a small supply of chemicals that would become a fuel source. • Onboard Power systems • Batteries • Nuclear power

29. External Power Systems • Tethered systems • These need a strong wire between the nanorobot and the power source which should move effortlessly through the human body without causing damage. • A physical tether can supply power electrically or optically. • Use of ultrasonic signals • A nanorobot with a piezoelectric membrane could pick up ultrasonic signals and convert them into electricity.

30. Nanorobot Locomotion • Propulsion of the bot to the damaged cell is essential. • Because it may have to travel against the flow of blood, the propulsion system has to be relatively strong for its size. • Another important consideration is safety of the patient .The system must be able to move the nanorobot around without causing damage to the host.

31. Nanorobot Locomotion(Continued…) • Using Magnetic Fields • Scientists in Israel created a microrobot with small appendages to grip and crawl through blood vessels. • Magnetic fields outside the patient's body cause the robot's arms to vibrate, pushing it further through the blood vessels. • Capacitors • Use capacitors to generate magnetic fields that would pull conductive fluids through anelectromagnetic pump and shoot it out the back end. • Miniaturizedjet pumps could even use blood plasma to push the nanorobot forward.

32. Nanorobots: Today and Tomorrow • Teams around the world are working on creating the first practical medical nanorobot.  • Robots, a millimeter in diameter already exist, though they are all still in the testing phase of development. • Today's microrobots are just prototypes that lack the ability to perform medical tasks.

33. Nanorobots: Today and Tomorrow • In the future, nanorobots could revolutionize medicine.  • Doctors could treat everything from heart disease to cancer using tiny robots the size of bacteria. • Also nanorobot technology could be used to re-engineer our bodies to become resistant to disease, increase our strength or even improve our intelligence making us super-humans.

34. Nanorobots: Today and Tomorrow Will we one day have thousands of microscopic robots rushing around in our veins healing our cuts, bruises and illnesses? With the growing technology, it seems like anything is possible.

35. Future & Ethical Impact

36. Extraordinary possible applications • Nanobots in bloodstream displaying type of present bacteria could help quicken diagnosis. • Artificial red cells will provide a mean to perform blood substitution, treatment for anemia and lung disorders • Artificial phagocytes will help in destroying microbiological pathogens Image Courtesy: nanobotmodels.com • Artificial neurotransmitters will remedy to low level of neurotransmitters or deficient transport of neurotransmitters

37. Interest of genetic modification • Some human disease involve cellular malfunction, often caused by defective chromosomes or gene expression  Solution : replace genetic material in cell nucleus • Different techniques already used: • Viral, bacterial, chemical carriers • Electrical, UV or near IR pulses • DNA microinjection

38. Chromosome replacement therapy • Hypothetical cell repairing nanorobots : chromallocytes • They travel to a cell, enter its nucleus remove existing set of chromosomes, replace it by a new one and exit the body • Robert Freitas Jr. already made a very detailed description of the nano devices, their structure, energy supply mechanism, functioning , as well as the medical process and the emergency procedures in case of failure. Image Courtesy: nanobotmodels.com • The treatment of an entire large human organ would require 1 trillion devices and last 7 hours

39. Ethical issues • The most important consequence of the success of this chromosome replacement therapy would be the possibility to repair cell damage due to aging, which means very extended lives • It raises some ethical issues related to the transhumanist claim : it is possible and desirable to improve the human condition especially by developing technologies to eliminate aging and enhance human intellectual physical and psychological capacities • Transhumanists study potential benefits and dangers, and ethical matters related to the new technologies used • Even if technologies are new, issues have already been discussed during the genetic therapy debate

40. Possible risks • To produce the nanobots we need to be able to build complex structure atom by atom and this technology could be misused • In the scenario known as “grey-goo” nano-robots disassemble everything on earth to produce copies of themselves • Extended life span could cause an overpopulation problem with too many birth not being balanced by as many deaths.A simple solution could be to establish a control of the bitrh rate

41. Ethical decisions • Considering the possible risks, should we apply the precautionary principle and ban research? • In that case we would lose enormous potential benefits. • If research is banned, no protection will be there against misusage of nano technology  The best solution would be controlled research

42. Further Reading & References • A Practical NanoRobot for Treatment of Various Medical Problems, Leslie Rubinstein, Eighth Foresight Conference on Molecular Nanotechnology, November 2000, Foresight Institute • Medical Robotics, Giancarlo Ferrigno, Guido Baroni, Federico Casolo, Elena De Momi, Giuseppina Gini, Matteo Matteucci, and Alessandra Pedrocchi, IEEE Pulse, May/June 2011 • Surgical and Interventional Systems, Peter Kazanzides, Gabor Fichtinger, Gregory D. Hager, Allison M. Okamura, Louis L. Whitcomb, and Russell H. Taylor, Robotics and Automation Magazine 2008, IEEE • Medical Nanobots, Kirk L Kroeker, Communications of the ACM, September 2009 • Surgical Robots, Ron Alterovitz & Jaydev P Desai, Robotics and Automation Magazine June 2009, IEEE • Robotic Surgery, Riccardo Muradore, DavideBresolin, Luca Geretti, Paolo Fiorini, and TizianoVilla, Robotics and Automation Magazine September 2011, IEEE

43. Further Reading & References • http://io9.com/5066893/where-are-my-medical-nanobots • http://robotzeitgeist.com/tag/medical-robot • http://www.lasvegastribune.com/index.php?option=com_content&view=article&id=887:medical-nanobots-could-end-disease-aging-in-2-decades&catid=61:future-talk&Itemid=128 • http://www.informationweek.com/news/galleries/healthcare/patient/229100383?pgno=1 • http://blog.speculist.com/biotechnology/the-age-of-medi.html • http://www.cbc.ca/news/technology/story/2007/12/27/sperm-power.html • http://scienceray.com/technology/medical-nanobots-tiny-robots-performing-miracles/ • http://en.wikipedia.org/wiki/Nanomedicine • http://en.wikipedia.org/wiki/Molecular_nanotechnology • http://www.openclinical.org/aiinmedicine.html

44. Further Reading & References • http://edition.cnn.com/2007/TECH/science/02/08/ft.nanobots/index.html • http://www.dailytech.com/Scientists+Ready+New+Nanobots+to+Swim+in+Human+Blood+Stream/article14018.htm • http://findarticles.com/p/articles/mi_m1594/is_4_20/ai_n32144798/ • http://news.bbc.co.uk/2/hi/science/nature/7288426.stm • http://nanogloss.com/nanobots/how-nanobots-can-repair-damaged-tissue/#axzz1rDFKSinQ • http://www.nanobotmodels.com • http://jetpress.org/v16/freitas.pdf • http://www.foresight.org/Nanomedicine/Respirocytes.html • http://www.jetpress.org/volume14/freitas.html • http://www.transhumanism.org/resources/FAQv21.pdf • http://www.crnano.org/dangers.htm

45. The End