Mark Draelos

Contactless, autonomous robotic alignment of optical coherence tomography for in vivo evaluation of diseased retinas

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During the COVID-19 pandemic, an emphasis was placed on contactless, physical distancing and improved telehealth; contrariwise, standard-of-care ophthalmic imaging of patients required present, trained personnel. Here, we introduce contactless, autonomous robotic alignment of optical coherence tomography (RAOCT) for in vivo imaging of retinal disease and compare measured retinal thickness and diagnostic readability to technician operated clinical OCT. In a powered study, we found no statistically significant difference in retinal thickness in both healthy and diseased retinas (p > 0.7) or across a variety of demographics (gender, race, and age) between RAOCT and clinical OCT. In a secondary study, a retina specialist labeled a given volume as normal/abnormal. Compared to the clinical diagnostic label, sensitivity/specificity for RAOCT were equal or improved over clinical OCT. Contactless, autonomous RAOCT, that improves upon current clinical OCT, could play a role in both ophthal...

Robotic Optical Coherence Tomography Retinal Imaging for Emergency Department Patients: A Pilot Study for Emergency Physicians’ Diagnostic Performance

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Study objective To evaluate the diagnostic performance of emergency physicians’ interpretation of robotically acquired retinal optical coherence tomography images for detecting posterior eye abnormalities in patients seen in the emergency department. Methods Adult patients presenting to Duke University Hospital emergency department from November 2020 through October 2021 with acute visual changes, headache, or focal neurologic deficit(s) who received an ophthalmology consultation were enrolled in this pilot study. Emergency physicians provided standard clinical care, including direct ophthalmoscopy, at their discretion. Retinal optical coherence tomography images of these patients were obtained with a robotic, semi-autonomous optical coherence tomography system. We compared the detection of abnormalities in optical coherence tomography images by emergency physicians with a reference standard, a combination of ophthalmology consultation diagnosis and retina specialist optical cohe...

Optical coherence tomography refraction and optical path length correction for image-guided corneal surgery

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Optical coherence tomography (OCT) may be useful for guidance of ocular microsurgeries such as deep anterior lamellar keratoplasty (DALK), a form of corneal transplantation that requires delicate insertion of a needle into the stroma to approximately 90% of the corneal thickness. However, visualization of the true shape of the cornea and the surgical tool during surgery is impaired in raw OCT volumes due to both light refraction at the corneal boundaries, as well as geometrical optical path length distortion due to the group velocity of broadband OCT light in tissue. Therefore, uncorrected B-scans or volumes may not provide an accurate visualization suitable for reliable surgical guidance. In this article, we introduce a method to correct for both refraction and optical path length distortion in 3D in order to reconstruct corrected OCT B-scans in both natural corneas and corneas deformed by needle insertion. We delineate the separate roles of phase and group index in OCT image disto...

Robotically aligned optical coherence tomography with 5 degree of freedom eye tracking for subject motion and gaze compensation

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Optical coherence tomography (OCT) has revolutionized diagnostics in ophthalmology. However, OCT requires a trained operator and patient cooperation to carefully align a scanner with the subject’s eye and orient it in such a way that it images a desired region of interest at the retina. With the goal of automating this process of orienting and aligning the scanner, we developed a robot-mounted OCT scanner that automatically aligned with the pupil while matching its optical axis with the target region of interest at the retina. The system used two 3D cameras for face tracking and three high-resolution 2D cameras for pupil and gaze tracking. The tracking software identified 5 degrees of freedom for robot alignment and ray aiming through the ocular pupil: 3 degrees of translation (x, y, z) and 2 degrees of orientation ( yaw , pitch ). We evaluated the accuracy, precision, and range of our tracking system and demonstrated imaging performance on free-standing human subjects. Our re...

Contactless optical coherence tomography of the eyes of freestanding individuals with a robotic scanner

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Clinical systems for optical coherence tomography (OCT) are used routinely to diagnose and monitor patients with a range of ocular diseases. They are large tabletop instruments operated by trained staff, and require mechanical stabilization of the head of the patient for positioning and motion reduction. Here we report the development and performance of a robot-mounted OCT scanner for the autonomous contactless imaging, at safe distances, of the eyes of freestanding individuals without the need for operator intervention or head stabilization. The scanner uses robotic positioning to align itself with the eye to be imaged, as well as optical active scanning to locate the pupil and to attenuate physiological eye motion. We show that the scanner enables the acquisition of OCT volumetric datasets, comparable in quality to those of clinical tabletop systems, that resolve key anatomic structures relevant for the management of common eye conditions. Robotic OCT scanners may enable the diagn...

Systems and methods for arbitrary viewpoint robotic manipulation and robotic surgical assistance

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Systems and methods for arbitrary viewpoint robotic manipulation and robotic surgical assistance are disclosed. According to an aspect, a system includes one or more controllers configured to receive an image dataset of an actual environment within which the robotic tool is positioned. The controller(s) are also configured to generate a virtual environment of the actual environment based on the image dataset. Further, the controller(s) can control display of the virtual environment including a virtual tool controllable by a user for use to control the robotic tool within the actual environment. The controller(s) can receive user input for altering a perspective view of display of the virtual environment from a first perspective view to a second perspective view. Further, the controller(s) can maintain orientation of display of the virtual tool with respect to the user during display of the first perspective view and the second perspective view of the virtual environment. ( Read ...

Robotics and Virtual Reality for Optical Coherence Tomography-Guided Ophthalmic Surgery and Diagnostics (Thesis)

Ophthalmology is the only surgical specialty that routinely employs both microsurgical techniques and live intraoperative imaging, especially optical coherence tomography (OCT). Consequently, ophthalmic surgeons routinely face challenges in visualization and manipulation of small ocular tissues or in interpreting intraoperative imaging to guide their actions. This dissertation therefore seeks to advance the state-of-the-art in ophthalmic surgery with regards to manipulation, visualization, and interpretation. First, we address the interpretation challenge in ophthalmic surgery where live volumetric imaging from OCT systems recently incorporated into surgical microscopes has freed surgeons from the otherwise universal top-down viewpoint. These new viewpoints, however, disorient surgeons when directions of their hand motions and viewed tool motions do not align. Thus, we introduce a robotic surgery paradigm to decouple surgeons' hands from their tools and ensure that viewed tool motio...

Toward Autonomous Robotic Micro-Suturing using Optical Coherence Tomography Calibration and Path Planning

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Robotic automation has the potential to assist human surgeons in performing suturing tasks in microsurgery, and in order to do so a robot must be able to guide a needle with sub-millimeter precision through soft tissue. This paper presents a robotic suturing system that uses 3D optical coherence tomography (OCT) system for imaging feedback. Calibration of the robot-OCT and robot-needle transforms, wound detection, keypoint identification, and path planning are all performed automatically. The calibration method handles pose uncertainty when the needle is grasped using a variant of iterative closest points. The path planner uses the identified wound shape to calculate needle entry and exit points to yield an evenly-matched wound shape after closure. Experiments on tissue phantoms and animal tissue demonstrate that the system can pass a suture needle through wounds with 0.27 mm overall accuracy in achieving the planned entry and exit points. ( Read Full Article )

Optical Coherence Tomography Guided Robotic Needle Insertion for Deep Anterior Lamellar Keratoplasty

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Objective: Deep anterior lamellar keratoplasty (DALK) significantly reduces the post-transplantation morbidity in patients eligible for partial-thickness cornea grafts. The popular "big bubble" technique for DALK is so challenging, however, that a significant fraction of corneal pneumodissection attempts fail for surgeons without extensive DALK-specific experience, even with previous-generation cross-sectional optical coherence tomography (OCT) guidance. We seek to develop robotic, volumetric OCT-guided technology capable of facilitating or automating the difficult needle insertion step in DALK. Methods: Our system provides for real-time volumetric corneal imaging, segmentation, and tracking of the needle insertion to display feedback for surgeons and to generate needle insertion plans for robotic execution. We include a non-automatic mode for cooperative needle control for stabilization and tremor attenuation, and an automatic mode in which needle insertion plans are generated base...

Feature of the Week 06/24/2018: Duke University Researchers Show Exciting Advances in Live OCT Volumes in Immersive Virtual Reality

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Virtual reality (VR) head-mounted displays are an attractive technology for viewing intrasurgical optical coherence tomography (OCT) volumes because they liberate surgeons from microscope oculars. We demonstrate real-time, interactive viewing of OCT volumes in a commercial HTC Vive immersive VR system using previously reported ray casting techniques. Furthermore, we show interactive manipulation and sectioning of volumes using handheld controllers and guidance of mock surgical procedures in porcine eyes exclusively within VR. To the best of our knowledge, we report the first immersive VR-OCT viewer with stereo ray casting volumetric renders, arbitrary sectioning planes, and live acquisition support. We believe VR-OCT volume displays will advance ophthalmic surgery towards VR-integrated surgery.  

Real-time visualization and interaction with static and live optical coherence tomography volumes in immersive virtual reality

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Virtual reality (VR) head-mounted displays are an attractive technology for viewing intrasurgical optical coherence tomography (OCT) volumes because they liberate surgeons from microscope oculars. We demonstrate real-time, interactive viewing of OCT volumes in a commercial HTC Vive immersive VR system using previously reported ray casting techniques. Furthermore, we show interactive manipulation and sectioning of volumes using handheld controllers and guidance of mock surgical procedures in porcine eyes exclusively within VR. To the best of our knowledge, we report the first immersive VR-OCT viewer with stereo ray casting volumetric renders, arbitrary sectioning planes, and live acquisition support. We believe VR-OCT volume displays will advance ophthalmic surgery towards VR-integrated surgery. ( Read Full Article )

Review of intraoperative optical coherence tomography: technology and applications [Invited]

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During microsurgery, en face imaging of the surgical field through the operating microscope limits the surgeon’s depth perception and visualization of instruments and sub-surface anatomy. Surgical procedures outside microsurgery, such as breast tumor resections, may also benefit from visualization of the sub-surface tissue structures. The widespread clinical adoption of optical coherence tomography (OCT) in ophthalmology and its growing prominence in other fields, such as cancer imaging, has motivated the development of intraoperative OCT for real-time tomographic visualization of surgical interventions. This article reviews key technological developments in intraoperative OCT and their applications in human surgery. We focus on handheld OCT probes, microscope-integrated OCT systems, and OCT-guided laser treatment platforms designed for intraoperative use. Moreover, we discuss intraoperative OCT adjuncts and processing techniques currently under development to optimize the sur...

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