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Interfaces for Modular Surgical Planning and Assistance Systems
Gessat, Michael
Modern surgery of the 21st century relies in many aspects on computers or, in a wider sense, digital data processing. Department administration, OR scheduling, billing, and - with increasing pervasion - patient data management are performed with the aid of so called Surgical Information Systems (SIS) or, more general, Hospital Information Systems (HIS). Computer Assisted Surgery (CAS) summarizes techniques which assist a surgeon in the preparation and conduction of surgical interventions...
Orthognathic positioning system: intraoperative system to transfer virtual surgical plan to operating field during orthognathic surgery.
Polley, John W; Figueroa, Alvaro A
To introduce the concept and use of an occlusal-based "orthognathic positioning system" (OPS) to be used during orthognathic surgery. The OPS consists of intraoperative occlusal-based devices that transfer virtual surgical planning to the operating field for repositioning of the osteotomized dentoskeletal segments. The system uses detachable guides connected to an occlusal splint. An initial drilling guide is used to establish stable references or landmarks. These are drilled on the bone that will not be repositioned adjacent to the osteotomy line. After mobilization of the skeletal segment, a final positioning guide, referenced to the drilled landmarks, is used to transfer the skeletal segment according to the virtual surgical planning. The OPS is digitally designed using 3-dimensional computer-aided design/computer-aided manufacturing technology and manufactured with stereolithographic techniques. Virtual surgical planning has improved the preoperative assessment and, in conjunction with the OPS, the execution of orthognathic surgery. The OPS has the possibility to eliminate the inaccuracies commonly associated with traditional orthognathic surgery planning and to simplify the execution by eliminating surgical steps such as intraoperative measuring, determining the condylar position, the use of bulky intermediate splints, and the use of intermaxillary wire fixation. The OPS attempts precise translation of the virtual plan to the operating field, bridging the gap between virtual and actual surgery. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
Role of RENAL nephrometry scoring system in planning surgical intervention in patients with localized renal mas
Mohamed Samir Shaaban; Tamer Mohammed Abou Youssif; Ahmed Mostafa; Hossam Eldin Hegazy; Mohammed Adel Atta
Purpose: The study was designed to validate the value of preoperative planning using RENAL nephrometry scoring system in patients having organ confined renal tumors and undergoing surgical intervention and to assess its correlation with the surgical technique. Patient and methods: Forty patients with organ-confined renal masses underwent RENAL nephrometry scoring which was correlated with the surgical technique either radical or nephron-sparing surgery. Result: RENAL nephrometry scoring...
Watanabe, Gou; Ishikawa, Norihiro
The da Vinci surgical system was developed by Intuitive Surgical Inc. in the United States as an endoscopic surgical device to assist remote control surgeries. In 1998, the Da Vinci system was first used for cardiothoracic procedures. Currently a combination of robot-assisted internal thoracic artery harvest together with coronary artery bypass grafting (CABG) through a mini-incision (ThoraCAB) or totally endoscopic procedures including anastomoses under robotic assistance (TECAB) are being conducted for the treatment of coronary artery diseases. With the recent advances in catheter interventions, hybrid procedures combining catheter intervention with ThoraCAB or TECAB are anticipated in the future.On the other hand, with the decrease in number of coronary artery bypass surgeries, the share of valvular surgeries is expected to increase in the future. Among them, mitral valvuloplasty for mitral regurgitation is anticipated to be conducted mainly by low-invasive procedures, represented by minimally invasive cardiac surgery( MICS) and robot-assisted surgery. Apart from the intrinsic good surgical view, robotic-assisted systems offer additional advantages of the availability of an amplified view and the easy to observe the mitral valve in the physiological position. Thus, robotic surgical surgeries that make complicated procedures easier are expected to accomplish further developments in the future. Furthermore, while the number of surgeries for atrial septal defects has decreased dramatically following the widespread use of Amplatzer septal occluder, robotic surgery may become a good indication for cases in which the Amplatzer device is not indicated. In Japan, clinical trial of the da Vinci robotic system for heart surgeries has been completed. Statutory approval of the da Vinci system for mitral regurgitation and atrial septal defects is anticipated in the next few years.
DEFF Research Database (Denmark)
Leleur, Steen
This book presents principles and methodology for planning in a complex world. It sets out a so-called systemic approach to planning, among other things, by applying "hard" and "soft" methodologies and methods in combination. The book is written for Ph.D and graduate students in engineering...
Fontan Surgical Planning: Previous Accomplishments, Current Challenges, and Future Directions.
Trusty, Phillip M; Slesnick, Timothy C; Wei, Zhenglun Alan; Rossignac, Jarek; Kanter, Kirk R; Fogel, Mark A; Yoganathan, Ajit P
The ultimate goal of Fontan surgical planning is to provide additional insights into the clinical decision-making process. In its current state, surgical planning offers an accurate hemodynamic assessment of the pre-operative condition, provides anatomical constraints for potential surgical options, and produces decent post-operative predictions if boundary conditions are similar enough between the pre-operative and post-operative states. Moving forward, validation with post-operative data is a necessary step in order to assess the accuracy of surgical planning and determine which methodological improvements are needed. Future efforts to automate the surgical planning process will reduce the individual expertise needed and encourage use in the clinic by clinicians. As post-operative physiologic predictions improve, Fontan surgical planning will become an more effective tool to accurately model patient-specific hemodynamics.
The Virtual Surgical Pelvis : Anatomy Visualization for Education and Surgical Planning
Smit, N.N.
This thesis deals with visualizing anatomical data for medical education and surgical planning purposes. To this end, we have developed a detailed virtual atlas, the Virtual Surgical Pelvis (VSP),which unifies surgically relevant knowledge on pelvic anatomy. We provide methods to share the knowledge
Towards Safe Robotic Surgical Systems
DEFF Research Database (Denmark)
Sloth, Christoffer; Wisniewski, Rafael
a controller for motion compensation in beating-heart surgery, and prove that it is safe, i.e., the surgical tool is kept within an allowable distance and orientation of the heart. We solve the problem by simultaneously finding a control law and a barrier function. The motion compensation system is simulated...... from several initial conditions to demonstrate that the designed control system is safe for every admissible initial condition....
3D printed abdominal aortic aneurysm phantom for image guided surgical planning with a patient specific fenestrated endovascular graft system
Meess, Karen M.; Izzo, Richard L.; Dryjski, Maciej L.; Curl, Richard E.; Harris, Linda M.; Springer, Michael; Siddiqui, Adnan H.; Rudin, Stephen; Ionita, Ciprian N.
Following new trends in precision medicine, Juxatarenal Abdominal Aortic Aneurysm (JAAA) treatment has been enabled by using patient-specific fenestrated endovascular grafts. The X-ray guided procedure requires precise orientation of multiple modular endografts within the arteries confirmed via radiopaque markers. Patient-specific 3D printed phantoms could familiarize physicians with complex procedures and new devices in a risk-free simulation environment to avoid periprocedural complications and improve training. Using the Vascular Modeling Toolkit (VMTK), 3D Data from a CTA imaging of a patient scheduled for Fenestrated EndoVascular Aortic Repair (FEVAR) was segmented to isolate the aortic lumen, thrombus, and calcifications. A stereolithographic mesh (STL) was generated and then modified in Autodesk MeshMixer for fabrication via a Stratasys Eden 260 printer in a flexible photopolymer to simulate arterial compliance. Fluoroscopic guided simulation of the patient-specific FEVAR procedure was performed by interventionists using all demonstration endografts and accessory devices. Analysis compared treatment strategy between the planned procedure, the simulation procedure, and the patient procedure using a derived scoring scheme. Results: With training on the patient-specific 3D printed AAA phantom, the clinical team optimized their procedural strategy. Anatomical landmarks and all devices were visible under x-ray during the simulation mimicking the clinical environment. The actual patient procedure went without complications. Conclusions: With advances in 3D printing, fabrication of patient specific AAA phantoms is possible. Simulation with 3D printed phantoms shows potential to inform clinical interventional procedures in addition to CTA diagnostic imaging.
Surgical accuracy of three-dimensional virtual planning
DEFF Research Database (Denmark)
Stokbro, Kasper; Aagaard, Esben; Torkov, Peter
This retrospective study evaluated the precision and positional accuracy of different orthognathic procedures following virtual surgical planning in 30 patients. To date, no studies of three-dimensional virtual surgical planning have evaluated the influence of segmentation on positional accuracy...... and transverse expansion. Furthermore, only a few have evaluated the precision and accuracy of genioplasty in placement of the chin segment. The virtual surgical plan was compared with the postsurgical outcome by using three linear and three rotational measurements. The influence of maxillary segmentation...
Additive Manufacturing for Surgical Planning of Mandibular Fracture
Directory of Open Access Journals (Sweden)
Nadja Maria da Silva Oliveira Brito
Full Text Available Currently, imaging techniques such as Computed Tomography with three-dimensional reconstruction (3D and Magnetic Resonances are being routinely used in pre-surgical planning in all fields of medicine. Nowadays, virtual three-dimensional images, commonly displayed on two-dimensional surfaces, such as the computer screen, can be used to produce rapidly prototyped models, with excellent dimensional accuracy and fine reproduction of anatomical structures, providing professionals with the ability to use the biomodel in planning and simulating medical and dental procedures (oral and maxillofacial surgery, making individualized facial implants and prostheses, measurements and previous adaptations of prefabricated fixation plates, thus contributing to considerable reductions in surgical time and consequently the duration of anesthesia, minimizing infection risks and reducing hospital costs. In this report, we describe a case of surgical planning and treatment of bilateral atrophic mandibular fracture, in which, for surgical planning, authors used Rapid Prototyping as an adjunct tool, considering the advantages already outlined.
Output control of da Vinci surgical system's surgical graspers.
Johnson, Paul J; Schmidt, David E; Duvvuri, Umamaheswar
The number of robot-assisted surgeries performed with the da Vinci surgical system has increased significantly over the past decade. The articulating movements of the robotic surgical grasper are controlled by grip controls at the master console. The user interface has been implicated as one contributing factor in surgical grasping errors. The goal of our study was to characterize and evaluate the user interface of the da Vinci surgical system in controlling surgical graspers. An angular manipulator with force sensors was used to increment the grip control angle as grasper output angles were measured. Input force at the grip control was simultaneously measured throughout the range of motion. Pressure film was used to assess the maximum grasping force achievable with the endoscopic grasping tool. The da Vinci robot's grip control angular input has a nonproportional relationship with the grasper instrument output. The grip control mechanism presents an intrinsic resistant force to the surgeon's fingertips and provides no haptic feedback. The da Vinci Maryland graspers are capable of applying up to 5.1 MPa of local pressure. The angular and force input at the grip control of the da Vinci robot's surgical graspers is nonproportional to the grasper instrument's output. Understanding the true relationship of the grip control input to grasper instrument output may help surgeons understand how to better control the surgical graspers and promote fewer grasping errors. Copyright © 2014 Elsevier Inc. All rights reserved.
Software components for medical image visualization and surgical planning
Starreveld, Yves P.; Gobbi, David G.; Finnis, Kirk; Peters, Terence M.
Purpose: The development of new applications in medical image visualization and surgical planning requires the completion of many common tasks such as image reading and re-sampling, segmentation, volume rendering, and surface display. Intra-operative use requires an interface to a tracking system and image registration, and the application requires basic, easy to understand user interface components. Rapid changes in computer and end-application hardware, as well as in operating systems and network environments make it desirable to have a hardware and operating system as an independent collection of reusable software components that can be assembled rapidly to prototype new applications. Methods: Using the OpenGL based Visualization Toolkit as a base, we have developed a set of components that implement the above mentioned tasks. The components are written in both C++ and Python, but all are accessible from Python, a byte compiled scripting language. The components have been used on the Red Hat Linux, Silicon Graphics Iris, Microsoft Windows, and Apple OS X platforms. Rigorous object-oriented software design methods have been applied to ensure hardware independence and a standard application programming interface (API). There are components to acquire, display, and register images from MRI, MRA, CT, Computed Rotational Angiography (CRA), Digital Subtraction Angiography (DSA), 2D and 3D ultrasound, video and physiological recordings. Interfaces to various tracking systems for intra-operative use have also been implemented. Results: The described components have been implemented and tested. To date they have been used to create image manipulation and viewing tools, a deep brain functional atlas, a 3D ultrasound acquisition and display platform, a prototype minimally invasive robotic coronary artery bypass graft planning system, a tracked neuro-endoscope guidance system and a frame-based stereotaxy neurosurgery planning tool. The frame-based stereotaxy module has been
Applying Mathematical Models to Surgical Patient Planning
J.M. van Oostrum (Jeroen)
textabstractOn a daily basis surgeons, nurses, and managers face cancellation of surgery, peak demands on wards, and overtime in operating rooms. Moreover, the lack of an integral planning approach for operating rooms, wards, and intensive care units causes low resource utilization and makes patient
Surgical planning for microsurgical excision of cerebral arterio-venous malformations using virtual reality technology.
Ng, Ivan; Hwang, Peter Y K; Kumar, Dinesh; Lee, Cheng Kiang; Kockro, Ralf A; Sitoh, Y Y
To evaluate the feasibility of surgical planning using a virtual reality platform workstation in the treatment of cerebral arterio-venous malformations (AVMs) Patient-specific data of multiple imaging modalities were co-registered, fused and displayed as a 3D stereoscopic object on the Dextroscope, a virtual reality surgical planning platform. This system allows for manipulation of 3D data and for the user to evaluate and appreciate the angio-architecture of the nidus with regards to position and spatial relationships of critical feeders and draining veins. We evaluated the ability of the Dextroscope to influence surgical planning by providing a better understanding of the angio-architecture as well as its impact on the surgeon's pre- and intra-operative confidence and ability to tackle these lesions. Twenty four patients were studied. The mean age was 29.65 years. Following pre-surgical planning on the Dextroscope, 23 patients underwent microsurgical resection after pre-surgical virtual reality planning, during which all had documented complete resection of the AVM. Planning on the virtual reality platform allowed for identification of critical feeders and draining vessels in all patients. The appreciation of the complex patient specific angio-architecture to establish a surgical plan was found to be invaluable in the conduct of the procedure and was found to enhance the surgeon's confidence significantly. Surgical planning of resection of an AVM with a virtual reality system allowed detailed and comprehensive analysis of 3D multi-modality imaging data and, in our experience, proved very helpful in establishing a good surgical strategy, enhancing intra-operative spatial orientation and increasing surgeon's confidence.
Pre-surgical planning and MR-tractography utility in brain tumour resection
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Romano, A.; Fantozzi, L.M.; Bozzao, A. [University Sapienza, Department of Neuroradiology, S. Andrea Hospital, Rome (Italy); D' Andrea, G.; Mastronardi, L.; Ferrante, L. [University Sapienza, Department of Neurosurgery, S. Andrea Hospital, Rome (Italy); Minniti, G. [University Sapienza, Department of Radiotherapy, S. Andrea Hospital, Rome (Italy)
The purposes of this study were (1) to evaluate the possible identification of trajectories of fibre tracts, (2) to examine the useful of a neuronavigation system for pre-surgical planning, (3) to assess pre- and post-surgery patients' clinical condition and (4) to evaluate the impact of this information on surgical planning and procedure. Twenty-eight right-handed patients were prospectively and consecutively studied. All the patients were clinically assessed by a neurologist in both pre- and post-surgical phases. Separately the pyramidal tract, optic radiation and arcuate fasciculus were reconstructed. The trajectories were considered suitable for surgical planning if there were no interruptions of any of the layers at the level of the lesion. Dedicated software 'merged' the acquired images with the tractographic processing, and the whole dataset was sent to the neuronavigation system. The assessment of the 37 visualised trajectories close to the tumour resulted in a modification of the surgical approach to corticotomy in six patients (21%); the impact on the definition of the resection margins during surgery was 64% (18 cases). The overall impact percentage on the surgical procedure was 82%. In 27 cases, the symptoms had not changed. MR-tractography provides the neurosurgeon with a new anatomical view that has an impact on the surgical resection planning for brain neoplasms. (orig.)
Pre-surgical planning and MR-tractography utility in brain tumour resection
International Nuclear Information System (INIS)
Romano, A.; Fantozzi, L.M.; Bozzao, A.; D'Andrea, G.; Mastronardi, L.; Ferrante, L.; Minniti, G.
The purposes of this study were (1) to evaluate the possible identification of trajectories of fibre tracts, (2) to examine the useful of a neuronavigation system for pre-surgical planning, (3) to assess pre- and post-surgery patients' clinical condition and (4) to evaluate the impact of this information on surgical planning and procedure. Twenty-eight right-handed patients were prospectively and consecutively studied. All the patients were clinically assessed by a neurologist in both pre- and post-surgical phases. Separately the pyramidal tract, optic radiation and arcuate fasciculus were reconstructed. The trajectories were considered suitable for surgical planning if there were no interruptions of any of the layers at the level of the lesion. Dedicated software 'merged' the acquired images with the tractographic processing, and the whole dataset was sent to the neuronavigation system. The assessment of the 37 visualised trajectories close to the tumour resulted in a modification of the surgical approach to corticotomy in six patients (21%); the impact on the definition of the resection margins during surgery was 64% (18 cases). The overall impact percentage on the surgical procedure was 82%. In 27 cases, the symptoms had not changed. MR-tractography provides the neurosurgeon with a new anatomical view that has an impact on the surgical resection planning for brain neoplasms. (orig.)
Xia, Shengli; Wang, Xiuhui; Fu, Beigang; Lu, Yaogang; Wang, Minghui
To explore the clinical value of computer-assisted surgical planning in the treatment of ankle fractures. Between January 2012 and January 2014, open reduction and internal fixation were performed on 42 patients with ankle fractures. There were 22 males and 20 females with an average age of 52 years (range, 19-72 years). The causes were spraining injury (20 cases), traffic accident injury (14 cases), and falling from height injury (8 cases). The time from injury to operation was 5 hours to 12 days (mean, 2.5 days). All fractures were closed trimalleolar fractures. According to Lauge-Hansen classification, 25 cases were rated as supination extorsion type IV, 13 as pronation extorsion type IV, and 4 as pronation abduction type III. The preoperative planning was made by virtual reduction and internal fixation using Superimage software. The mean operation time was 93.7 minutes (range, 76-120 minutes). Delayed wound healing occurred in 1 case, and secondary healing was obtained after treatment; primary healing of incision was achieved in the other patients. Postoperative X-ray films and CT images showed anatomic reduction of fracture and good position of internal fixation. All patients were followed up 14.6 months on average (range, 9-27 months). The range of motion of the affected ankle was close to the normal side at 6-8 weeks. The mean fracture healing time was 13.1 weeks (range, 11-17 weeks). Degenerative change of the ankle joint was observed in 3 cases (7.1%) with manifestation of mild narrowing of joint space on the X-ray films at last follow-up. According to Baird-Jackson score system, the results were excellent in 24 cases, good in 13 cases, and fair in 5 cases, with an excellent and good rate of 88%. Computer-assisted surgical planning for ankle fractures can help surgeons identify type of ankle fractures and improve surgical scheme for guiding fracture reduction and selecting and placing implants, so good effectiveness can be obtained.
Virtual surgical planning in endoscopic skull base surgery.
Haerle, Stephan K; Daly, Michael J; Chan, Harley H L; Vescan, Allan; Kucharczyk, Walter; Irish, Jonathan C
Skull base surgery (SBS) involves operative tasks in close proximity to critical structures in a complex three-dimensional (3D) anatomy. The aim was to investigate the value of virtual planning (VP) based on preoperative magnetic resonance imaging (MRI) for surgical planning in SBS and to compare the effects of virtual planning with 3D contours between the expert and the surgeon in training. Retrospective analysis. Twelve patients with manually segmented anatomical structures based on preoperative MRI were evaluated by eight surgeons in a randomized order using a validated National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire. Multivariate analysis revealed significant reduction of workload when using VP (PNASA-TLX differences (P.05). Preoperative anatomical segmentation with virtual surgical planning using contours in endoscopic SBS significantly reduces the workload for the expert and the surgeon in training. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.
Development of a Cognitive Robotic System for Simple Surgical Tasks
Directory of Open Access Journals (Sweden)
Riccardo Muradore
Full Text Available The introduction of robotic surgery within the operating rooms has significantly improved the quality of many surgical procedures. Recently, the research on medical robotic systems focused on increasing the level of autonomy in order to give them the possibility to carry out simple surgical actions autonomously. This paper reports on the development of technologies for introducing automation within the surgical workflow. The results have been obtained during the ongoing FP7 European funded project Intelligent Surgical Robotics (I-SUR. The main goal of the project is to demonstrate that autonomous robotic surgical systems can carry out simple surgical tasks effectively and without major intervention by surgeons. To fulfil this goal, we have developed innovative solutions (both in terms of technologies and algorithms for the following aspects: fabrication of soft organ models starting from CT images, surgical planning and execution of movement of robot arms in contact with a deformable environment, designing a surgical interface minimizing the cognitive load of the surgeon supervising the actions, intra-operative sensing and reasoning to detect normal transitions and unexpected events. All these technologies have been integrated using a component-based software architecture to control a novel robot designed to perform the surgical actions under study. In this work we provide an overview of our system and report on preliminary results of the automatic execution of needle insertion for the cryoablation of kidney tumours.
Preoperative surgical planning and simulation of complex cranial base tumors in virtual reality
Institute of Scientific and Technical Information of China (English)
YI Zhi-qiang; LI Liang; MO Da-peng; ZHANG Jia-yong; ZHANG Yang; BAO Sheng-de
@@ The extremely complex anatomic relationships among bone,tumor,blood vessels and cranial nerves remains a big challenge for cranial base tumor surgery.Therefore.a good understanding of the patient specific anatomy and a preoperative planning are helpful and crocial for the neurosurgeons.Three dimensional (3-D) visualization of various imaging techniques have been widely explored to enhance the comprehension of volumetric data for surgical planning.1 We used the Destroscope Virtual Reality (VR) System (Singapore,Volume Interaction Pte Ltd,software:RadioDexterTM 1.0) to optimize preoperative plan in the complex cranial base tumors.This system uses patient-specific,coregistered,fused radiology data sets that may be viewed stereoscopically and can be manipulated in a virtual reality environment.This article describes our experience with the Destroscope VR system in preoperative surgical planning and simulation for 5 patients with complex cranial base tumors and evaluates the clinical usefulness of this system.
Current Status of Surgical Planning for Orthognathic Surgery: Traditional Methods versus 3D Surgical Planning
Directory of Open Access Journals (Sweden)
Jeffrey A. Hammoudeh, MD, DDS
Conclusions: It is our opinion that virtual model surgery will displace and replace traditional model surgery as it will become cost and time effective in both the private and academic setting for practitioners providing orthognathic surgical care in cleft and noncleft patients.
Systems Engineering Management Plan
International Nuclear Information System (INIS)
The purpose of this Monitored Retrievable Storage (MRS) Project Systems Engineering Management Plan (SEMP) is to define and establish the MRS Project Systems Engineering process that implements the approved policy and requirements of the Office of Civilian Radioactive Waste Management (OCRWM) for the US Department of Energy (DOE). This plan is Volume 5 of the MRS Project Management Plan (PMP). This plan provides the framework for implementation of systems engineering on the MRS Project consistent with DOE Order 4700.1, the OCRWM Program Management System Manual (PMSM), and the OCRWM Systems Engineering Management Plan (SEMP)
A projective surgical navigation system for cancer resection
Gan, Qi; Shao, Pengfei; Wang, Dong; Ye, Jian; Zhang, Zeshu; Wang, Xinrui; Xu, Ronald
Near infrared (NIR) fluorescence imaging technique can provide precise and real-time information about tumor location during a cancer resection surgery. However, many intraoperative fluorescence imaging systems are based on wearable devices or stand-alone displays, leading to distraction of the surgeons and suboptimal outcome. To overcome these limitations, we design a projective fluorescence imaging system for surgical navigation. The system consists of a LED excitation light source, a monochromatic CCD camera, a host computer, a mini projector and a CMOS camera. A software program is written by C++ to call OpenCV functions for calibrating and correcting fluorescence images captured by the CCD camera upon excitation illumination of the LED source. The images are projected back to the surgical field by the mini projector. Imaging performance of this projective navigation system is characterized in a tumor simulating phantom. Image-guided surgical resection is demonstrated in an ex-vivo chicken tissue model. In all the experiments, the projected images by the projector match well with the locations of fluorescence emission. Our experimental results indicate that the proposed projective navigation system can be a powerful tool for pre-operative surgical planning, intraoperative surgical guidance, and postoperative assessment of surgical outcome. We have integrated the optoelectronic elements into a compact and miniaturized system in preparation for further clinical validation.
Planning for information systems
King, William R
Edited by one of the best-known and most widely respected figures in the field, ""Planning for Information Systems"" is a comprehensive, single source overview of the myriad ideas and processes that are identified with IS planning. While many chapters deal with high level strategic planning, the book gives equal attention to on-the-ground planning issues.Part I, 'Key Concepts of IS Planning', focuses on how IS planning has evolved over the years; business-IS strategic alignment; and the role of dynamic organizational capabilities in leveraging IS competencies. Part II, 'The Organizational IS P
Immediate postoperative outcome of orthognathic surgical planning, and prediction of positional changes in hard and soft tissue, independently of the extent and direction of the surgical corrections required
DEFF Research Database (Denmark)
Donatsky, Ole; Bjørn-Jørgensen, Jens; Hermund, Niels Ulrich
orthognathic correction using the computerised, cephalometric, orthognathic, surgical planning system (TIOPS). Preoperative cephalograms were analysed and treatment plans and prediction tracings produced by computerised interactive simulation. The planned changes were transferred to models and finally...... with the presently included soft tissue algorithms, the current study shows relatively high mean predictability of the immediately postoperative hard and soft tissue outcome, independent of the extent and direction of required orthognathic correction. Because of the relatively high individual variability, caution...
Abdominal tumours in children: 3-D visualisation and surgical planning.
Günther, P; Schenk, J P; Wunsch, R; Tröger, J; Waag, K L
Solid abdominal tumours are of special importance in the field of paediatric surgery. Because of the dangers of cumulative irradiation and improved delineation of soft parts MRI is usually employed in children for diagnostic assessment. Compiling the radiologic information for surgical planning is often difficult by conventional methods. Newly improved and efficient 3-D volume rendering software is now available for visual reconstruction of tumour anatomy utilising segmentation and other special techniques. Because the intraoperative complication rate is close to 20 % as described in the literature, optimal preoperative visualisation and planning would seem imperative. All children with solid abdominal tumours at Heidelberg University in the year 2002 were included in this study. MR examinations were performed with a 0.5 Tesla magnet using a standard protocol. All MR data were processed with VG Studio Max 1.1, converting the two-dimensional data into three-dimensional data. This report presents 15 cases using this special technique: 7 with abdominal neuroblastoma, 6 with nephroblastoma, 1 ganglioneuroma, and 1 ovarian teratoma. Our experience shows that a better understanding of the surgical anatomy, particularly regarding the surrounding organs and vasculature, can be helpful in decreasing the incidence of inadvertent intraoperative injuries to these structures.
3D Boolean operations in virtual surgical planning.
Charton, Jerome; Laurentjoye, Mathieu; Kim, Youngjun
Boolean operations in computer-aided design or computer graphics are a set of operations (e.g. intersection, union, subtraction) between two objects (e.g. a patient model and an implant model) that are important in performing accurate and reproducible virtual surgical planning. This requires accurate and robust techniques that can handle various types of data, such as a surface extracted from volumetric data, synthetic models, and 3D scan data. This article compares the performance of the proposed method (Boolean operations by a robust, exact, and simple method between two colliding shells (BORES)) and an existing method based on the Visualization Toolkit (VTK). In all tests presented in this article, BORES could handle complex configurations as well as report impossible configurations of the input. In contrast, the VTK implementations were unstable, do not deal with singular edges and coplanar collisions, and have created several defects. The proposed method of Boolean operations, BORES, is efficient and appropriate for virtual surgical planning. Moreover, it is simple and easy to implement. In future work, we will extend the proposed method to handle non-colliding components.
Three-dimensional photogrammetry for surgical planning of tissue expansion in hemifacial microsomia.
Jayaratne, Yasas S N; Lo, John; Zwahlen, Roger A; Cheung, Lim K
We aim to illustrate the applications of 3-dimensional (3-D) photogrammetry for surgical planning and longitudinal assessment of the volumetric changes in hemifacial microsomia. A 3-D photogrammetric system was employed for planning soft tissue expansion and transplantation of a vascularized scapular flap for a patient with hemifacial microsomia. The facial deficiency was calculated by superimposing a mirror of the normal side on the preoperative image. Postsurgical volumetric changes were monitored by serial superimposition of 3-D images. A total of 31 cm(3) of tissue expansion was achieved within a period of 4 weeks. A scapular free flap measuring 8 cm × 5 cm was transplanted to augment the facial deficiency. Postsurgical shrinkage of the flap was observed mainly in the first 3 months and it was minimal thereafter. 3-D photogrammetry can be used as a noninvasive objective tool for assessing facial deformity, planning, and postoperative follow-up of surgical correction of facial asymmetry.
Utilization of a multimedia PACS workstation for surgical planning of epilepsy
Soo Hoo, Kent; Wong, Stephen T.; Hawkins, Randall A.; Knowlton, Robert C.; Laxer, Kenneth D.; Rowley, Howard A.
Surgical treatment of temporal lobe epilepsy requires the localization of the epileptogenic zone for surgical resection. Currently, clinicians utilize electroencephalography, various neuroimaging modalities, and psychological tests together to determine the location of this zone. We investigate how a multimedia neuroimaging workstation built on top of the UCSF Picture Archiving and Communication System can be used to aid surgical planning of epilepsy and related brain diseases. This usage demonstrates the ability of the workstation to retrieve image and textural data from PACS and other image sources, register multimodality images, visualize and render 3D data sets, analyze images, generate new image and text data from the analysis, and organize all data in a relational database management system.
Systems for tracking minimally invasive surgical instruments.
Chmarra, M K; Grimbergen, C A; Dankelman, J
Minimally invasive surgery (e.g. laparoscopy) requires special surgical skills, which should be objectively assessed. Several studies have shown that motion analysis is a valuable assessment tool of basic surgical skills in laparoscopy. However, to use motion analysis as the assessment tool, it is necessary to track and record the motions of laparoscopic instruments. This article describes the state of the art in research on tracking systems for laparoscopy. It gives an overview on existing systems, on how these systems work, their advantages, and their shortcomings. Although various approaches have been used, none of the tracking systems to date comes out as clearly superior. A great number of systems can be used in training environment only, most systems do not allow the use of real laparoscopic instruments, and only a small number of systems provide force feedback.
Simulation based planning of surgical interventions in pediatric cardiology
Marsden, Alison L.
Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. However, while medical imaging provides increasingly detailed anatomical information, clinicians often have limited access to hemodynamic data that may be crucial to patient risk assessment and treatment planning. Computational simulations can now provide detailed hemodynamic data to augment clinical knowledge in both adult and pediatric applications. There is a particular need for simulation tools in pediatric cardiology, due to the wide variation in anatomy and physiology in congenital heart disease patients, necessitating individualized treatment plans. Despite great strides in medical imaging, enabling extraction of flow information from magnetic resonance and ultrasound imaging, simulations offer predictive capabilities that imaging alone cannot provide. Patient specific simulations can be used for in silico testing of new surgical designs, treatment planning, device testing, and patient risk stratification. Furthermore, simulations can be performed at no direct risk to the patient. In this paper, we outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We then step through pressing challenges in the field, including multiscale modeling, boundary condition selection, optimization, and uncertainty quantification. Finally, we summarize simulation results of two representative examples from pediatric cardiology: single ventricle physiology, and coronary aneurysms caused by Kawasaki disease. These examples illustrate the potential impact of computational modeling tools in the clinical setting.
Application of virtual surgical planning with computer assisted design and manufacturing technology to cranio-maxillofacial surgery.
Zhao, Linping; Patel, Pravin K; Cohen, Mimis
Computer aided design and manufacturing (CAD/CAM) technology today is the standard in manufacturing industry. The application of the CAD/CAM technology, together with the emerging 3D medical images based virtual surgical planning (VSP) technology, to craniomaxillofacial reconstruction has been gaining increasing attention to reconstructive surgeons. This article illustrates the components, system and clinical management of the VSP and CAD/CAM technology including: data acquisition, virtual surgical and treatment planning, individual implant design and fabrication, and outcome assessment. It focuses primarily on the technical aspects of the VSP and CAD/CAM system to improve the predictability of the planning and outcome.
Investing in a Surgical Outcomes Auditing System
Bermudez, Luis; Trost, Kristen; Ayala, Ruben
Background. Humanitarian surgical organizations consider both quantity of patients receiving care and quality of the care provided as a measure of success. However, organizational efficacy is often judged by the percent of resources spent towards direct intervention/surgery, which may discourage investment in an outcomes monitoring system. Operation Smile's established Global Standards of Care mandate minimum patient followup and quality of care. Purpose. To determine whether investment of resources in an outcomes monitoring system is necessary and effectively measures success. Methods. This paper analyzes the quantity and completeness of data collected over the past four years and compares it against changes in personnel and resources assigned to the program. Operation Smile began investing in multiple resources to obtain the missing data necessary to potentially implement a global Surgical Outcomes Auditing System. Existing personnel resources were restructured to focus on postoperative program implementation, data acquisition and compilation, and training materials used to educate local foundation and international employees. Results. An increase in the number of postoperative forms and amount of data being submitted to headquarters occurred. Conclusions. Humanitarian surgical organizations would benefit from investment in a surgical outcomes monitoring system in order to demonstrate success and to ameliorate quality of care. PMID:23401763
Development of haptic system for surgical robot
Gang, Han Gyeol; Park, Jiong Min; Choi, Seung-Bok; Sohn, Jung Woo
In this paper, a new type of haptic system for surgical robot application is proposed and its performances are evaluated experimentally. The proposed haptic system consists of an effective master device and a precision slave robot. The master device has 3-DOF rotational motion as same as human wrist motion. It has lightweight structure with a gyro sensor and three small-sized MR brakes for position measurement and repulsive torque generation, respectively. The slave robot has 3-DOF rotational motion using servomotors, five bar linkage and a torque sensor is used to measure resistive torque. It has been experimentally demonstrated that the proposed haptic system has good performances on tracking control of desired position and repulsive torque. It can be concluded that the proposed haptic system can be effectively applied to the surgical robot system in real field.
Energy Technology Data Exchange (ETDEWEB)
Holland, Robert C. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)
A Sewer System Management Plan (SSMP) is required by the State Water Resources Control Board (SWRCB) Order No. 2006-0003-DWQ Statewide General Waste Discharge Requirements (WDR) for Sanitary Sewer Systems (General Permit). DOE, National Nuclear Security Administration (NNSA), Sandia Field Office has filed a Notice of Intent to be covered under this General Permit. The General Permit requires a proactive approach to reduce the number and frequency of sanitary sewer overflows (SSOs) within the State. SSMPs must include provisions to provide proper and efficient management, operation, and maintenance of sanitary sewer systems and must contain a spill response plan.
An Evaluation of Preparedness, Delivery and Impact of Surgical and Anesthesia Care in Madagascar: A Framework for a National Surgical Plan.
Bruno, Emily; White, Michelle C; Baxter, Linden S; Ravelojaona, Vaonandianina Agnès; Rakotoarison, Hasiniaina Narindria; Andriamanjato, Hery Harimanitra; Close, Kristin L; Herbert, Alison; Raykar, Nakul; Saluja, Saurabh; Shrime, Mark G
The Lancet Commission on Global Surgery (LCoGS) described the lack of access to safe, affordable, timely surgical, and anesthesia care. It proposed a series of 6 indicators to measure surgery, accompanied by time-bound targets and a template for national surgical planning. To date, no sub-Saharan African country has completed and published a nationwide evaluation of its surgical system within this framework. Mercy Ships, in partnership with Harvard Medical School and the Madagascar Ministry of Health, collected data on the 6 indicators from 22 referral hospitals in 16 out of 22 regions of Madagascar. Data collection was by semi-structured interviews with ministerial, medical, laboratory, pharmacy, and administrative representatives in each region. Microsimulation modeling was used to calculate values for financial indicators. In Madagascar, 29% of the population can access a surgical facility within 2 h. Surgical workforce density is 0.78 providers per 100,000 and annual surgical volume is 135-191 procedures per 100,000 with a perioperative mortality rate of 2.5-3.3%. Patients requiring surgery have a 77.4-86.3 and 78.8-95.1% risk of incurring impoverishing and catastrophic expenditure, respectively. Of the six LCoGS indicator targets, Madagascar meets one, the reporting of perioperative mortality rate. Compared to the LCoGS targets, Madagascar has deficits in surgical access, workforce, volume, and the ability to offer financial risk protection to surgical patients. Its perioperative mortality rate, however, appears better than in comparable countries. The government is committed to improvement, and key stakeholder meetings to create a national surgical plan have begun.
Patient-specific surgical simulator for the pre-operative planning of single-incision laparoscopic surgery with bimanual robots.
Turini, Giuseppe; Moglia, Andrea; Ferrari, Vincenzo; Ferrari, Mauro; Mosca, Franco
The trend of surgical robotics is to follow the evolution of laparoscopy, which is now moving towards single-incision laparoscopic surgery. The main drawback of this approach is the limited maneuverability of the surgical tools. Promising solutions to improve the surgeon's dexterity are based on bimanual robots. However, since both robot arms are completely inserted into the patient's body, issues related to possible unwanted collisions with structures adjacent to the target organ may arise. This paper presents a simulator based on patient-specific data for the positioning and workspace evaluation of bimanual surgical robots in the pre-operative planning of single-incision laparoscopic surgery. The simulator, designed for the pre-operative planning of robotic laparoscopic interventions, was tested by five expert surgeons who evaluated its main functionalities and provided an overall rating for the system. The proposed system demonstrated good performance and usability, and was designed to integrate both present and future bimanual surgical robots.
Planning Systems for Distributed Operations
Maxwell, Theresa G.
This viewgraph representation presents an overview of the mission planning process involving distributed operations (such as the International Space Station (ISS)) and the computer hardware and software systems needed to support such an effort. Topics considered include: evolution of distributed planning systems, ISS distributed planning, the Payload Planning System (PPS), future developments in distributed planning systems, Request Oriented Scheduling Engine (ROSE) and Next Generation distributed planning systems.
International Nuclear Information System (INIS)
Gaylord, J.
The purpose of this study is to specify the design for an initial optics supply planning system for NIF, and to present quality assurance and test plans for the construction of the system as specified. The National Ignition Facility (NIF) is a large laser facility that is just starting operations. Thousands of specialized optics are required to operate the laser, and must be exchanged over time based on the laser shot plan and predictions of damage. Careful planning and tracking of optic exchanges is necessary because of the tight inventory of spare optics, and the long lead times for optics procurements and production changes. Automated inventory forecasting and production planning tools are required to replace existing manual processes. The optics groups members who are expected to use the supply planning system are the stakeholders for this project, and are divided into three groups. Each of these groups participated in a requirements specification that was used to develop this design. (1) Optics Management--These are the top level stakeholdersk, and the final decision makers. This group is the interface to shot operations, is ultimately responsible for optics supply, and decides which exchanges will be made. (2) Work Center Managers--This group manages the on site optics processing work centers. They schedule the daily work center operations, and are responsible for developing long term processing, equipment, and staffing plans. (3) Component Engineers--This group manages the vendor contracts for the manufacture of new optics and the off site rework of existing optics. They are responsible for sourcing vendors, negotiating contracts, and managing vendor processes. The scope of this analysis is to describe the structure and design details of a system that will meet all requirements that were described by stakeholders and documented in the analysis model for this project. The design specifies the architecture, components, interfaces, and data stores of the system
Oncentra brachytherapy planning system.
Yang, Jack
In modern cancer management, treatment planning has progressed as a contemporary tool with all the advances in computing power in recent years. One of the advanced planning tools uses 3-dimensional (3D) data sets for accurate dose distributions in patient prescription. Among these planning processes, brachytherapy has been a very important part of a successful cancer management program, offering clinical benefits with specific or combined treatments with external beam therapy. In this chapter, we mainly discussed the Elekta Oncentra planning system, which is the main treatment planning tool for high-dose rate (HDR) modality in our facility and in many other facilities in the United States. HDR is a technically advanced form of brachytherapy; a high-intensity radiation source (3.6 mm in length) is delivered with step motor in submillimeter precision under computer guidance directly into the tumor areas while minimizing injury to surrounding normal healthy tissue. Oncentra planning is the key component to generate a deliverable brachytherapy procedure, which is executed on the microSelectron V3 remote afterloader treatment system. Creating a highly conformal plan can be a time-consuming task. The development of Oncentra software (version 4.5.3) offers a variety of useful tools that facilitate many of the clinical challenging tasks for planning, such as contouring and image reconstruction, as well as rapid planning calculations with dose and dose volume histogram analysis. Oncentra Brachy module creates workflow and optimizes the planning accuracy for wide varieties of clinical HDR treatments, such as skin, gynecologic (GYN), breast, prostate, and many other applications. The treatment file can also be transferred to the afterloader control station for speedy delivery. The design concept, calculation algorithms, and optimization modules presented some key characteristics to plan and treat the patients effectively and accurately. The dose distribution and accuracy of
SAGES TAVAC safety and effectiveness analysis: da Vinci ® Surgical System (Intuitive Surgical, Sunnyvale, CA).
Tsuda, Shawn; Oleynikov, Dmitry; Gould, Jon; Azagury, Dan; Sandler, Bryan; Hutter, Matthew; Ross, Sharona; Haas, Eric; Brody, Fred; Satava, Richard
The da Vinci(®) Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) is a computer-assisted (robotic) surgical system designed to enable and enhance minimally invasive surgery. The Food and Drug Administration (FDA) has cleared computer-assisted surgical systems for use by trained physicians in an operating room environment for laparoscopic surgical procedures in general, cardiac, colorectal, gynecologic, head and neck, thoracic and urologic surgical procedures. There are substantial numbers of peer-reviewed papers regarding the da Vinci(®) Surgical System, and a thoughtful assessment of evidence framed by clinical opinion is warranted. The SAGES da Vinci(®) TAVAC sub-committee performed a literature review of the da Vinci(®) Surgical System regarding gastrointestinal surgery. Conclusions by the sub-committee were vetted by the SAGES TAVAC Committee and SAGES Executive Board. Following revisions, the document was evaluated by the TAVAC Committee and Executive Board again for final approval. Several conclusions were drawn based on expert opinion organized by safety, efficacy, and cost for robotic foregut, bariatric, hepatobiliary/pancreatic, colorectal surgery, and single-incision cholecystectomy. Gastrointestinal surgery with the da Vinci(®) Surgical System is safe and comparable, but not superior to standard laparoscopic approaches. Although clinically acceptable, its use may be costly for select gastrointestinal procedures. Current data are limited to the da Vinci(®) Surgical System; further analyses are needed.
Systems engineering management plan
International Nuclear Information System (INIS)
Conner, C.W.
The purpose of this Systems Engineering Management Plan (SEMP) is to prescribe the systems engineering procedures to be implemented at the Program level and the minimum requirements for systems engineering at the Program-element level. The Program level corresponds to the Director, OCRWM, or to the organizations within OCRWM to which the Director delegates responsibility for the development of the System and for coordinating and integrating the activities at the Program-element level. The Office of Policy and Outreach (OPO) and the Office of Resource Management (ORM) support the Director at the Program level. The Program-element level corresponds to the organizations within OCRWM (i.e., the Office of Geologic Repositories (OGR) and the Office of Storage and Transportation Systems (OSTS)) with overall responsibility for developing the System elements - that is, the mined geologic disposal system (MGDS), monitored retrievable storage (MRS) (if approved by Congress), and the transportation system
Mobile systems capability plan
International Nuclear Information System (INIS)
This plan was prepared to initiate contracting for and deployment of these mobile system services. 102,000 cubic meters of retrievable, contact-handled TRU waste are stored at many sites around the country. Also, an estimated 38,000 cubic meters of TRU waste will be generated in the course of waste inventory workoff and continuing DOE operations. All the defense TRU waste is destined for disposal in WIPP near Carlsbad NM. To ship TRU waste there, sites must first certify that the waste meets WIPP waste acceptance criteria. The waste must be characterized, and if not acceptable, subjected to additional processing, including repackaging. Most sites plan to use existing fixed facilities or open new ones between FY1997-2006 to perform these functions; small-quantity sites lack this capability. An alternative to fixed facilities is the use of mobile systems mounted in trailers or skids, and transported to sites. Mobile systems will be used for all characterization and certification at small sites; large sites can also use them. The Carlsbad Area Office plans to pursue a strategy of privatization of mobile system services, since this offers a number of advantages. To indicate the possible magnitude of the costs of deploying mobile systems, preliminary estimates of equipment, maintenance, and operating costs over a 10-year period were prepared and options for purchase, lease, and privatization through fixed-price contracts considered
Treatment of Brodie's Syndrome using parasymphyseal distraction through virtual surgical planning and RP assisted customized surgical osteotomy guide-A mock surgery report
Dahake, Sandeep; Kuthe, Abhaykumar; Mawale, Mahesh
This paper aims to describe virtual surgical planning (VSP), computer aided design (CAD) and rapid prototyping (RP) systems for the preoperative planning of accurate treatment of the Brodie's Syndrome. 3D models of the patient's maxilla and mandible were separately generated based on computed tomography (CT) image data and fabricated using RP. During the customized surgical osteotmy guide (CSOG) design process, the correct position was identified and the geometry of the CSOG was generated based on affected mandible of the patient and fabricated by a RP technique. Surgical approach such as preoperative planning and simulation of surgical procedures was performed using advanced software. The VSP and RP assisted CSOG was used to avoid the damage of the adjacent teeth and neighboring healthy tissues. Finally the mock surgery was performed on the biomodel (i.e. diseased RP model) of mandible with reference to the normal maxilla using osteotomy bur with the help of CSOG. Using this CSOG the exact osteotomy of the mandible and the accurate placement of the distractor were obtained. It ultimately improved the accuracy of the surgery in context of the osteotomy and distraction. The time required in cutting the mandible and placement of the distractor was found comparatively less than the regular free hand surgery.
[The rational application of Da Vinci surgical system in thyroidectomy].
He, Q Q
Da Vinci surgical system is the most advanced minimally invasive surgical platform in the world, and this system has been widely used in cardiac surgery, urology surgery, gynecologic surgery and general surgery. Although the application of this system was relatively late in thyroid surgery, the number of thyroidectomy with Da Vinci surgical system is increasing quickly. Having reviewed recent studies and summarized clinical experience, compared with traditional open operation, the robotic thyroidectomy has the same surgical safety and effectiveness in selective patients with thyroid cancer. In this paper, several aspects on this novel operation were demonstrated, including surgical indications and contraindications, the approaches, surgical procedures and postoperative complications, in order to promote the rational application of Da Vinci surgical system in thyroidectomy.
Design, implementation and testing of master slave robotic surgical system
International Nuclear Information System (INIS)
Ali, S.A.
The autonomous manipulation of the medical robotics is needed to draw up a complete surgical plan in development. The autonomy of the robot comes from the fact that once the plan is drawn up off-line, it is the servo loops, and only these, that control the actions of the robot online, based on instantaneous control signals and measurements provided by the vision or force sensors. Using only these autonomous techniques in medical and surgical robotics remain relatively limited for two main reasons: Predicting complexity of the gestures, and human Safety. Therefore, Modern research in haptic force feedback in medical robotics is aimed to develop medical robots capable of performing remotely, what a surgeon does by himself. These medical robots are supposed to work exactly in the manner that a surgeon does in daily routine. In this paper the master slave tele-robotic system is designed and implemented with accuracy and stability by using 6DOF (Six Degree of Freedom) haptic force feedback devices. The master slave control strategy, haptic devices integration, application software designing using Visual C++ and experimental setup are considered. Finally, results are presented the stability, accuracy and repeatability of the system. (author)
Design, Implementation and Testing of Master Slave Robotic Surgical System
Directory of Open Access Journals (Sweden)
Syed Amjad Ali
Full Text Available The autonomous manipulation of the medical robotics is needed to draw up a complete surgical plan in development. The autonomy of the robot comes from the fact that once the plan is drawn up off-line, it is the servo loops, and only these, that control the actions of the robot online, based on instantaneous control signals and measurements provided by the vision or force sensors. Using only these autonomous techniques in medical and surgical robotics remain relatively limited for two main reasons: Predicting complexity of the gestures, and human Safety. Therefore, Modern research in haptic force feedback in medical robotics is aimed to develop medical robots capable of performing remotely, what a surgeon does by himself. These medical robots are supposed to work exactly in the manner that a surgeon does in daily routine. In this paper the master slave tele-robotic system is designed and implemented with accuracy and stability by using 6DOF (Six Degree of Freedom haptic force feedback devices. The master slave control strategy, haptic devices integration, application software designing using Visual C++ and experimental setup are considered. Finally, results are presented the stability, accuracy and repeatability of the system
Application of virtual reality techniques in preoperative surgical planning for intracranial anterior circulation aneurysms
Directory of Open Access Journals (Sweden)
Shou-sen WANG
Full Text Available Objective To investigate the value of virtual reality (VR technique in the surgical planning for anterior circulation aneurysms of Willis circle. Methods A total of 50 patients with 57 aneurysms confirmed by CT angiography in the anterior circle of Willis were enrolled in this study. In preoperative Hunt-Hess scale, grade Ⅰ was designated in 7 patients, grade Ⅱ in 22, grade Ⅲ in 17, grade Ⅳ in 3, grade Ⅴ in 1 patient. Among the aneurysms, 16 were small (≤5mm in diameter, 28 medium (5-15mm, 10 large (15-25mm and 3 giant (≥25mm in size. The thin-slice head scanning data were achieved by 64-slice spiral CT machine. These data was then transferred into Dextroscope image workstation. The virtual imaging system generated clear and vivid virtual images. We compared the findings between simulation surgical operation and actual operation. Results VR system make the operator felt "personally on the scene" and was able to communicate with the imaging. It could not only visually display the anatomical structures in three dimensions, but also could simulate some surgical procedures, which basically simulated the same outcome of actual operation. All the 50 patients were successfully treated by microsurgical clipping of main aneurysmal or contributory aneurysmal necks. Conclusions The surgeons is able to be more confident, and the identification for the complex vascular abnormality is improved by planning operative procedure in virtual-reality environment. The virtual-reality system makes the actual operative procedure more concise, thus it is of positive value in surgery for intracranial aneurysm.
An automatic virtual patient reconstruction from CT-scans for hepatic surgical planning.
Soler, L; Delingette, H; Malandain, G; Ayache, N; Koehl, C; Clément, J M; Dourthe, O; Marescaux, J
PROBLEM/BACKGROUND: In order to help hepatic surgical planning we perfected automatic 3D reconstruction of patients from conventional CT-scan, and interactive visualization and virtual resection tools. From a conventional abdominal CT-scan, we have developed several methods allowing the automatic 3D reconstruction of skin, bones, kidneys, lung, liver, hepatic lesions, and vessels. These methods are based on deformable modeling or thresholding algorithms followed by the application of mathematical morphological operators. From these anatomical and pathological models, we have developed a new framework for translating anatomical knowledge into geometrical and topological constraints. More precisely, our approach allows to automatically delineate the hepatic and portal veins but also to label the portal vein and finally to build an anatomical segmentation of the liver based on Couinaud definition which is currently used by surgeons all over the world. Finally, we have developed a user friendly interface for the 3D visualization of anatomical and pathological structures, the accurate evaluation of volumes and distances and for the virtual hepatic resection along a user-defined cutting plane. A validation study on a 30 patients database gives 2 mm of precision for liver delineation and less than 1 mm for all other anatomical and pathological structures delineation. An in vivo validation performed during surgery also showed that anatomical segmentation is more precise than the delineation performed by a surgeon based on external landmarks. This surgery planning system has been routinely used by our medical partner, and this has resulted in an improvement of the planning and performance of hepatic surgery procedures. We have developed new tools for hepatic surgical planning allowing a better surgery through an automatic delineation and visualization of anatomical and pathological structures. These tools represent a first step towards the development of an augmented
Application of da Vinci surgical robotic system in hepatobiliary surgery
Directory of Open Access Journals (Sweden)
Chen Jiahai
Full Text Available The development of minimally invasive surgery has brought a revolutionary change to surgery techniques, and endoscopic surgical robots, especially Da Vinci robotic surgical system, has further broaden the scope of minimally invasive surgery, which has been applied in a variety of surgical fields including hepatobiliary surgery. Today, the application of Da Vinci surgical robot can cover most of the operations in hepatobiliary surgery which has proved to be safe and practical. What's more, many clinical studies in recent years have showed that Da Vinci surgical system is superior to traditional laparoscopy. This paper summarize the advantage and disadvantage of Da Vinci surgical system, and outlines the current status of and future perspectives on the robot-assisted hepatobiliary surgery based on the cases reports in recent years of the application of Da Vinci surgical robot.
Planning of surgical treatment of upper extremity in patients with cerebral palsy
Directory of Open Access Journals (Sweden)
V. V. Umnov
Full Text Available The purpose - to devise the algorithm of patient examination with spastic hand to determine what the variant of surgical treatment is indicated. The variant of surgical treatment and it's results are depend on the cause of upper extremity deformation. Materials and methods. This study is based on a survey of children with cerebral palsy with lesions of the upper extremity. The main criterion for the selection of patients was the presence of the combined lesion of the upper extremity, where the cause of dysfunction hands are not only fixed contractures, but primary tonic. Was to survey 47 patients with spastic forms of cerebral palsy with the defeat of the upper limb, but the study group included only 26 of them in the ages of 7 to 18 years (average 12,1, as having the clinical picture both types of contractures. We have developed and applied a system of examinations, modeling expected outcome of selective neurotomy motor nerves of the upper limb, which allows to estimate the possible result of such treatment, and clearly differentiate tonic and fixed contracture. Results and conclusions. Based on the results of study we supposed that, using diagnostic blockade motor nerve at the period of planning surgical treatment help us to create temporary reversible model of selective neurotomy motor nerve branches and identify the type of contracture, degree of manifestation and functional perspective.
Systems for tracking minimally invasive surgical instruments
Chmarra, M. K.; Grimbergen, C. A.; Dankelman, J.
Minimally invasive surgery (e.g. laparoscopy) requires special surgical skills, which should be objectively assessed. Several studies have shown that motion analysis is a valuable assessment tool of basic surgical skills in laparoscopy. However, to use motion analysis as the assessment tool, it is
Virtual surgical modification for planning tetralogy of Fallot repair
Plasencia, Jonathan; Babiker, Haithem; Richardson, Randy; Rhee, Edward; Willis, Brigham; Nigro, John; Cleveland, David; Frakes, David H.
Goals for treating congenital heart defects are becoming increasingly focused on the long-term, targeting solutions that last into adulthood. Although this shift has motivated the modification of many current surgical procedures, there remains a great deal of room for improvement. We present a new methodological component for tetralogy of Fallot (TOF) repair that aims to improve long-term outcomes. The current gold standard for TOF repair involves the use of echocardiography (ECHO) for measuring the pulmonary valve (PV) diameter. This is then used, along with other factors, to formulate a Z-score that drives surgical preparation. Unfortunately this process can be inaccurate and requires a mid-operative confirmation that the pressure gradient across the PV is not excessive. Ideally, surgeons prefer not to manipulate the PV as this can lead to valve insufficiency. However, an excessive pressure gradient across the valve necessitates surgical action. We propose the use of computational fluid dynamics (CFD) to improve preparation for TOF repair. In our study, pre-operative CT data were segmented and reconstructed, and a virtual surgical operation was then performed to simulate post-operative conditions. The modified anatomy was used to drive CFD simulation. The pressure gradient across the pulmonary valve was calculated to be 9.24mmHg, which is within the normal range. This finding indicates that CFD may be a viable tool for predicting post-operative pressure gradients for TOF repair. Our proposed methodology would remove the need for mid-operative measurements that can be both unreliable and detrimental to the patient.
[Clinical application of Da Vinci surgical system in China].
Jin, Zhenyu
Da Vinci robotic surgical system leads the development of minimally invasive surgical techniques. By using Da Vinci surgical robot for minimally invasive surgery, it brings a lot of advantages to the surgeons. Since 2008, Da Vinci surgeries have been performed in 14 hospitals in domestic cities such as Beijing and Shanghai. Until the end of 2012, 3 551 cases of Da Vinci robotic surgery have been performed, covering various procedures of various surgical departments including the department of general surgery, urology, cardiovascular surgery, thoracic surgery, gynecology, and etc. Robotic surgical technique has made remarkable achievements.
Reliability of implant placement after virtual planning of implant positions using cone beam CT data and surgical (guide) templates.
Nickenig, Hans-Joachim; Eitner, Stephan
We assessed the reliability of implant placement after virtual planning of implant positions using cone-beam CT data and surgical guide templates. A total of 102 patients (250 implants, 55.4% mandibular; mean patient age, 40.4 years) who had undergone implant treatment therapy in an armed forces dental clinic (Cologne, Germany) between July 1, 2005 and December 1, 2005. They were treated with a system that allows transfer of virtual planning to surgical guide templates. Only in eight cases the surgical guides were not used because a delayed implant placement was necessary. In four posterior mandibular cases, handling was limited because of reduced interocclusal distance, requiring 50% shortening of the drill guides. The predictability of implant size was high: only one implant was changed to a smaller diameter (because of insufficient bone). In all cases, critical anatomical structures were protected and no complications were detected in postoperative panoramic radiographs. In 58.1% (147) of the 250 implants, a flapless surgery plan was realized. Implant placement after virtual planning of implant positions using cone beam CT data and surgical templates can be reliable for preoperative assessment of implant size, position, and anatomical complications. It is also indicative of cases amenable to flapless surgery.
Automatic Multiple-Needle Surgical Planning of Robotic-Assisted Microwave Coagulation in Large Liver Tumor Therapy.
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Shaoli Liu
Full Text Available The "robotic-assisted liver tumor coagulation therapy" (RALTCT system is a promising candidate for large liver tumor treatment in terms of accuracy and speed. A prerequisite for effective therapy is accurate surgical planning. However, it is difficult for the surgeon to perform surgical planning manually due to the difficulties associated with robot-assisted large liver tumor therapy. These main difficulties include the following aspects: (1 multiple needles are needed to destroy the entire tumor, (2 the insertion trajectories of the needles should avoid the ribs, blood vessels, and other tissues and organs in the abdominal cavity, (3 the placement of multiple needles should avoid interference with each other, (4 an inserted needle will cause some deformation of liver, which will result in changes in subsequently inserted needles' operating environment, and (5 the multiple needle-insertion trajectories should be consistent with the needle-driven robot's movement characteristics. Thus, an effective multiple-needle surgical planning procedure is needed. To overcome these problems, we present an automatic multiple-needle surgical planning of optimal insertion trajectories to the targets, based on a mathematical description of all relevant structure surfaces. The method determines the analytical expression of boundaries of every needle "collision-free reachable workspace" (CFRW, which are the feasible insertion zones based on several constraints. Then, the optimal needle insertion trajectory within the optimization criteria will be chosen in the needle CFRW automatically. Also, the results can be visualized with our navigation system. In the simulation experiment, three needle-insertion trajectories were obtained successfully. In the in vitro experiment, the robot successfully achieved insertion of multiple needles. The proposed automatic multiple-needle surgical planning can improve the efficiency and safety of robot-assisted large liver tumor
Automatic Multiple-Needle Surgical Planning of Robotic-Assisted Microwave Coagulation in Large Liver Tumor Therapy.
Liu, Shaoli; Xia, Zeyang; Liu, Jianhua; Xu, Jing; Ren, He; Lu, Tong; Yang, Xiangdong
The "robotic-assisted liver tumor coagulation therapy" (RALTCT) system is a promising candidate for large liver tumor treatment in terms of accuracy and speed. A prerequisite for effective therapy is accurate surgical planning. However, it is difficult for the surgeon to perform surgical planning manually due to the difficulties associated with robot-assisted large liver tumor therapy. These main difficulties include the following aspects: (1) multiple needles are needed to destroy the entire tumor, (2) the insertion trajectories of the needles should avoid the ribs, blood vessels, and other tissues and organs in the abdominal cavity, (3) the placement of multiple needles should avoid interference with each other, (4) an inserted needle will cause some deformation of liver, which will result in changes in subsequently inserted needles' operating environment, and (5) the multiple needle-insertion trajectories should be consistent with the needle-driven robot's movement characteristics. Thus, an effective multiple-needle surgical planning procedure is needed. To overcome these problems, we present an automatic multiple-needle surgical planning of optimal insertion trajectories to the targets, based on a mathematical description of all relevant structure surfaces. The method determines the analytical expression of boundaries of every needle "collision-free reachable workspace" (CFRW), which are the feasible insertion zones based on several constraints. Then, the optimal needle insertion trajectory within the optimization criteria will be chosen in the needle CFRW automatically. Also, the results can be visualized with our navigation system. In the simulation experiment, three needle-insertion trajectories were obtained successfully. In the in vitro experiment, the robot successfully achieved insertion of multiple needles. The proposed automatic multiple-needle surgical planning can improve the efficiency and safety of robot-assisted large liver tumor therapy
A patient group based business planning model for a surgical specialty
Adan, I.J.B.F.; Vissers, J.M.H.; van den Heuvel, M.N.; Wiersema, K.; Vissers, J.M.H.; Beech, R.
In this contribution we present an approach for a business planning model for a surgical specialty, based on modelling of all patient processes as well as of the dynamics involved in planning and managing resources. An important basis of the model is the description of the processes of all patient
3D treatment planning systems.
Saw, Cheng B; Li, Sicong
Three-dimensional (3D) treatment planning systems have evolved and become crucial components of modern radiation therapy. The systems are computer-aided designing or planning softwares that speed up the treatment planning processes to arrive at the best dose plans for the patients undergoing radiation therapy. Furthermore, the systems provide new technology to solve problems that would not have been considered without the use of computers such as conformal radiation therapy (CRT), intensity-modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT). The 3D treatment planning systems vary amongst the vendors and also the dose delivery systems they are designed to support. As such these systems have different planning tools to generate the treatment plans and convert the treatment plans into executable instructions that can be implemented by the dose delivery systems. The rapid advancements in computer technology and accelerators have facilitated constant upgrades and the introduction of different and unique dose delivery systems than the traditional C-arm type medical linear accelerators. The focus of this special issue is to gather relevant 3D treatment planning systems for the radiation oncology community to keep abreast of technology advancement by assess the planning tools available as well as those unique "tricks or tips" used to support the different dose delivery systems. Copyright © 2018 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
3D-visualization by MRI for surgical planning of Wilms tumors
International Nuclear Information System (INIS)
Schenk, J.P.; Wunsch, R.; Jourdan, C.; Troeger, J.; Waag, K.-L.; Guenther, P.; Graf, N.; Behnisch, W.
Purpose: To improve surgical planning of kidney tumors in childhood (Wilms tumor, mesoblastic nephroma) after radiologic verification of the presumptive diagnosis with interactive colored 3D-animation in MRI. Materials and Methods: In 7 children (1 boy, 6 girls) with a mean age of 3 years (1 month to 11 years), the MRI database (DICOM) was processed with a raycasting-based 3D-volume-rendering software (VG Studio Max 1.1/Volume Graphics). The abdominal MRI-sequences (coronal STIR, coronal T1 TSE, transverse T1/T2 TSE, sagittal T2 TSE, transverse and coronal T1 TSE post contrast) were obtained with a 0.5T unit in 4-6 mm slices. Additionally, phase-contrast-MR-angiography was applied to delineate the large abdominal and retroperitoneal vessels. A notebook was used to demonstrate the 3D-visualization for surgical planning before surgery and during the surgical procedure. Results: In all 7 cases, the surgical approach was influenced by interactive 3D-animation and the information found useful for surgical planning. Above all, the 3D-visualization demonstrates the mass effect of the Wilms tumor and its anatomical relationship to the renal hilum and to the rest of the kidney as well as the topographic relationship of the tumor to the critical vessels. One rupture of the tumor capsule occurred as a surgical complication. For the surgeon, the transformation of the anatomical situation from MRI to the surgical situs has become much easier. Conclusion: For surgical planning of Wilms tumors, the 3D-visualization with 3D-animation of the situs helps to transfer important information from the pediatric radiologist to the pediatric surgeon and optimizes the surgical preparation. A reduction of complications is to be expected. (orig.)
[3D-visualization by MRI for surgical planning of Wilms tumors].
Schenk, J P; Waag, K-L; Graf, N; Wunsch, R; Jourdan, C; Behnisch, W; Tröger, J; Günther, P
To improve surgical planning of kidney tumors in childhood (Wilms tumor, mesoblastic nephroma) after radiologic verification of the presumptive diagnosis with interactive colored 3D-animation in MRI. In 7 children (1 boy, 6 girls) with a mean age of 3 years (1 month to 11 years), the MRI database (DICOM) was processed with a raycasting-based 3D-volume-rendering software (VG Studio Max 1.1/Volume Graphics). The abdominal MRI-sequences (coronal STIR, coronal T1 TSE, transverse T1/T2 TSE, sagittal T2 TSE, transverse and coronal T1 TSE post contrast) were obtained with a 0.5T unit in 4 - 6 mm slices. Additionally, a phase-contrast-MR-angiography was applied to delineate the large abdominal and retroperitoneal vessels. A notebook was used to demonstrate the 3D-visualization for surgical planning before surgery and during the surgical procedure. In all 7 cases, the surgical approach was influenced by interactive 3D-animation and the information found useful for surgical planning. Above all, the 3D-visualization demonstrates the mass effect of the Wilms tumor and its anatomical relationship to the renal hilum and to the rest of the kidney as well as the topographic relationship of the tumor to the critical vessels. One rupture of the tumor capsule occurred as a surgical complication. For the surgeon, the transformation of the anatomical situation from MRI to the surgical situs has become much easier. For surgical planning of Wilms tumors, the 3D-visualization with 3D-animation of the situs helps to transfer important information from the pediatric radiologist to the pediatric surgeon and optimizes the surgical preparation. A reduction of complications is to be expected.
The role of multi-detector CT angiography in surgical planning for congenital cervicothoracic kyphoscoliosis: a case report
Energy Technology Data Exchange (ETDEWEB)
Lee, Hyun; Choi, Won Gyu; Shin, Ho Dong; Hwang, Byeong Wook; Lee, Sang Jin; Lee, Sang Ho [Busan Wooridul Spine Hospital, Busan (Korea, Republic of)
Surgical correction of a cervicothoracic deformity is difficult with a potential risk of vascular injury. Comprehensive preoperative vascular evaluation is important for safe and successful surgery. The use of multi-detector computed tomography angiography (MDCTA) allows a combined display of vascular and osseous structures of the musculoskeletal system. However, no clinical reports have described the use of MDCTA for surgical planning of anterior cervicothoracic surgery in patients with vascular malformation. The case of a 7-year-old girl with congenital cervicothoracic kyphoscoliosis who underwent preoperative MDCTA evaluation and successful correction is presented in this report.
Multimodal image registration of the scoliotic torso for surgical planning
International Nuclear Information System (INIS)
Harmouche, Rola; Cheriet, Farida; Labelle, Hubert; Dansereau, Jean
This paper presents a method that registers MRIs acquired in prone position, with surface topography (TP) and X-ray reconstructions acquired in standing position, in order to obtain a 3D representation of a human torso incorporating the external surface, bone structures, and soft tissues. TP and X-ray data are registered using landmarks. Bone structures are used to register each MRI slice using an articulated model, and the soft tissue is confined to the volume delimited by the trunk and bone surfaces using a constrained thin-plate spline. The method is tested on 3 pre-surgical patients with scoliosis and shows a significant improvement, qualitatively and using the Dice similarity coefficient, in fitting the MRI into the standing patient model when compared to rigid and articulated model registration. The determinant of the Jacobian of the registration deformation shows higher variations in the deformation in areas closer to the surface of the torso. The novel, resulting 3D full torso model can provide a more complete representation of patient geometry to be incorporated in surgical simulators under development that aim at predicting the effect of scoliosis surgery on the external appearance of the patient's torso
Multimodal image registration of the scoliotic torso for surgical planning
Background This paper presents a method that registers MRIs acquired in prone position, with surface topography (TP) and X-ray reconstructions acquired in standing position, in order to obtain a 3D representation of a human torso incorporating the external surface, bone structures, and soft tissues. Methods TP and X-ray data are registered using landmarks. Bone structures are used to register each MRI slice using an articulated model, and the soft tissue is confined to the volume delimited by the trunk and bone surfaces using a constrained thin-plate spline. Results The method is tested on 3 pre-surgical patients with scoliosis and shows a significant improvement, qualitatively and using the Dice similarity coefficient, in fitting the MRI into the standing patient model when compared to rigid and articulated model registration. The determinant of the Jacobian of the registration deformation shows higher variations in the deformation in areas closer to the surface of the torso. Conclusions The novel, resulting 3D full torso model can provide a more complete representation of patient geometry to be incorporated in surgical simulators under development that aim at predicting the effect of scoliosis surgery on the external appearance of the patient's torso. PMID:23289431
Comparing Pre- and Post-Operative Fontan Hemodynamic Simulations: Implications for the Reliability of Surgical Planning
Haggerty, Christopher M.; de Zélicourt, Diane A.; Restrepo, Maria; Rossignac, Jarek; Spray, Thomas L.; Kanter, Kirk R.; Fogel, Mark A.; Yoganathan, Ajit P.
Background Virtual modeling of cardiothoracic surgery is a new paradigm that allows for systematic exploration of various operative strategies and uses engineering principles to predict the optimal patient-specific plan. This study investigates the predictive accuracy of such methods for the surgical palliation of single ventricle heart defects. Methods Computational fluid dynamics (CFD)-based surgical planning was used to model the Fontan procedure for four patients prior to surgery. The objective for each was to identify the operative strategy that best distributed hepatic blood flow to the pulmonary arteries. Post-operative magnetic resonance data were acquired to compare (via CFD) the post-operative hemodynamics with predictions. Results Despite variations in physiologic boundary conditions (e.g., cardiac output, venous flows) and the exact geometry of the surgical baffle, sufficient agreement was observed with respect to hepatic flow distribution (90% confidence interval-14 ± 4.3% difference). There was also good agreement of flow-normalized energetic efficiency predictions (19 ± 4.8% error). Conclusions The hemodynamic outcomes of prospective patient-specific surgical planning of the Fontan procedure are described for the first time with good quantitative comparisons between preoperatively predicted and postoperative simulations. These results demonstrate that surgical planning can be a useful tool for single ventricle cardiothoracic surgery with the ability to deliver significant clinical impact. PMID:22777126
Virtual surgical planning and 3D printing in prosthetic orbital reconstruction with percutaneous implants: a technical case report
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Huang Y
Full Text Available Yu-Hui Huang,1,2 Rosemary Seelaus,1,2 Linping Zhao,1,2 Pravin K Patel,1,2 Mimis Cohen1,2 1The Craniofacial Center, Department of Surgery, Division of Plastic & Reconstructive Surgery, University of Illinois Hospital & Health Sciences System, 2University of Illinois College of Medicine at Chicago, Chicago, IL, USA Abstract: Osseointegrated titanium implants to the cranial skeleton for retention of facial prostheses have proven to be a reliable replacement for adhesive systems. However, improper placement of the implants can jeopardize prosthetic outcomes, and long-term success of an implant-retained prosthesis. Three-dimensional (3D computer imaging, virtual planning, and 3D printing have become accepted components of the preoperative planning and design phase of treatment. Computer-aided design and computer-assisted manufacture that employ cone-beam computed tomography data offer benefits to patient treatment by contributing to greater predictability and improved treatment efficiencies with more reliable outcomes in surgical and prosthetic reconstruction. 3D printing enables transfer of the virtual surgical plan to the operating room by fabrication of surgical guides. Previous studies have shown that accuracy improves considerably with guided implantation when compared to conventional template or freehand implant placement. This clinical case report demonstrates the use of a 3D technological pathway for preoperative virtual planning through prosthesis fabrication, utilizing 3D printing, for a patient with an acquired orbital defect that was restored with an implant-retained silicone orbital prosthesis. Keywords: computer-assisted surgery, virtual surgical planning (VSP, 3D printing, orbital prosthetic reconstruction, craniofacial implants
Simulation-based planning of surgical interventions in pediatric cardiology
Marsden, Alison
Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. This is particularly true in pediatric cardiology, due to the wide variation in anatomy observed in congenital heart disease patients. While medical imaging provides increasingly detailed anatomical information, clinicians currently have limited knowledge of important fluid mechanical parameters. Treatment decisions are therefore often made using anatomical information alone, despite the known links between fluid mechanics and disease progression. Patient-specific simulations now offer the means to provide this missing information, and, more importantly, to perform in-silico testing of new surgical designs at no risk to the patient. In this talk, we will outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We will then present new methodology for coupling optimization with simulation and uncertainty quantification to customize treatments for individual patients. Finally, we will present examples in pediatric cardiology that illustrate the potential impact of these tools in the clinical setting.
Manager's assistant systems for space system planning
Bewley, William L.; Burnard, Robert; Edwards, Gary E.; Shoop, James
This paper describes a class of knowledge-based 'assistant' systems for space system planning. Derived from technology produced for the DARPA/USAF Pilot's Associate program, these assistant systems help the human planner by doing the bookkeeping to maintain plan data and executing the procedures and heuristics currently used by the human planner to define, assess, diagnose, and revise plans. Intelligent systems for Space Station Freedom assembly sequence planning and Advanced Launch System modeling will be presented as examples. Ongoing NASA-funded work on a framework supporting the development of such tools will also be described.
Virtual surgical planning and 3D printing in prosthetic orbital reconstruction with percutaneous implants: a technical case report.
Huang, Yu-Hui; Seelaus, Rosemary; Zhao, Linping; Patel, Pravin K; Cohen, Mimis
Osseointegrated titanium implants to the cranial skeleton for retention of facial prostheses have proven to be a reliable replacement for adhesive systems. However, improper placement of the implants can jeopardize prosthetic outcomes, and long-term success of an implant-retained prosthesis. Three-dimensional (3D) computer imaging, virtual planning, and 3D printing have become accepted components of the preoperative planning and design phase of treatment. Computer-aided design and computer-assisted manufacture that employ cone-beam computed tomography data offer benefits to patient treatment by contributing to greater predictability and improved treatment efficiencies with more reliable outcomes in surgical and prosthetic reconstruction. 3D printing enables transfer of the virtual surgical plan to the operating room by fabrication of surgical guides. Previous studies have shown that accuracy improves considerably with guided implantation when compared to conventional template or freehand implant placement. This clinical case report demonstrates the use of a 3D technological pathway for preoperative virtual planning through prosthesis fabrication, utilizing 3D printing, for a patient with an acquired orbital defect that was restored with an implant-retained silicone orbital prosthesis.
Complex systems, evolutionary planning?
Bertolini, L.; de Roo, G.; Silva, E.A.
Coping with uncertainty is a defining challenge for spatial planners. Accordingly, most spatial planning theories and methods are aimed at reducing uncertainty. However, the question is what should be done when this seems impossible? This chapter proposes an evolutionary interpretation of spatial
The use of virtual surgical planning and navigation in the treatment of orbital trauma
Directory of Open Access Journals (Sweden)
Alan Scott Herford
Full Text Available Virtual surgical planning (VSP has recently been introduced in craniomaxillofacial surgery with the goal of improving efficiency and precision for complex surgical operations. Among many indications, VSP can also be applied for the treatment of congenital and acquired craniofacial defects, including orbital fractures. VSP permits the surgeon to visualize the complex anatomy of craniofacial region, showing the relationship between bone and neurovascular structures. It can be used to design and print using three-dimensional (3D printing technology and customized surgical models. Additionally, intraoperative navigation may be useful as an aid in performing the surgery. Navigation is useful for both the surgical dissection as well as to confirm the placement of the implant. Navigation has been found to be especially useful for orbit and sinus surgery. The present paper reports a case describing the use of VSP and computerized navigation for the reconstruction of a large orbital floor defect with a custom implant.
International Nuclear Information System (INIS)
Fontenla, D.P.
All aspects of treatment planning in radiotherapy are discussed in detail. Included are, among others, machine data and their acquisition, photon dose calculations and tests thereof, criteria of acceptability, sources of uncertainties, from 2D to 3D and from 3D to IMRT, dosimetric measurements for RTP validation, frequency of QA tests and suggested tolerances for TPS, time and staff requirements, model based segmentation, multi-dimensional radiotherapy (MD C RT), and biological IMRT process. (P.A.)
Three-dimensional printing in surgical planning: A case of aortopulmonary window with interrupted aortic arch
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Ryan A Moore
Full Text Available Better anatomical understanding and conceptualization of complex congenital heart defects using three-dimensional (3D printing may improve surgical planning, especially in rare defects. In this report, we utilized 3D printing to delineate the exact cardiac anatomy of a neonate with an aortopulmonary window associated with interrupted aortic arch to devise a novel approach to the repair.
Algorithm for planning a double-jaw orthognathic surgery using a computer-aided surgical simulation (CASS) protocol. Part 1: planning sequence
Xia, J. J.; Gateno, J.; Teichgraeber, J. F.; Yuan, P.; Chen, K.-C.; Li, J.; Zhang, X.; Tang, Z.; Alfi, D. M.
The success of craniomaxillofacial (CMF) surgery depends not only on the surgical techniques, but also on an accurate surgical plan. The adoption of computer-aided surgical simulation (CASS) has created a paradigm shift in surgical planning. However, planning an orthognathic operation using CASS differs fundamentally from planning using traditional methods. With this in mind, the Surgical Planning Laboratory of Houston Methodist Research Institute has developed a CASS protocol designed specifically for orthognathic surgery. The purpose of this article is to present an algorithm using virtual tools for planning a double-jaw orthognathic operation. This paper will serve as an operation manual for surgeons wanting to incorporate CASS into their clinical practice. PMID:26573562
Resting-state functional magnetic resonance imaging for surgical planning in pediatric patients: a preliminary experience.
Roland, Jarod L; Griffin, Natalie; Hacker, Carl D; Vellimana, Ananth K; Akbari, S Hassan; Shimony, Joshua S; Smyth, Matthew D; Leuthardt, Eric C; Limbrick, David D
OBJECTIVE Cerebral mapping for surgical planning and operative guidance is a challenging task in neurosurgery. Pediatric patients are often poor candidates for many modern mapping techniques because of inability to cooperate due to their immature age, cognitive deficits, or other factors. Resting-state functional MRI (rs-fMRI) is uniquely suited to benefit pediatric patients because it is inherently noninvasive and does not require task performance or significant cooperation. Recent advances in the field have made mapping cerebral networks possible on an individual basis for use in clinical decision making. The authors present their initial experience translating rs-fMRI into clinical practice for surgical planning in pediatric patients. METHODS The authors retrospectively reviewed cases in which the rs-fMRI analysis technique was used prior to craniotomy in pediatric patients undergoing surgery in their institution. Resting-state analysis was performed using a previously trained machine-learning algorithm for identification of resting-state networks on an individual basis. Network maps were uploaded to the clinical imaging and surgical navigation systems. Patient demographic and clinical characteristics, including need for sedation during imaging and use of task-based fMRI, were also recorded. RESULTS Twenty patients underwent rs-fMRI prior to craniotomy between December 2013 and June 2016. Their ages ranged from 1.9 to 18.4 years, and 12 were male. Five of the 20 patients also underwent task-based fMRI and one underwent awake craniotomy. Six patients required sedation to tolerate MRI acquisition, including resting-state sequences. Exemplar cases are presented including anatomical and resting-state functional imaging. CONCLUSIONS Resting-state fMRI is a rapidly advancing field of study allowing for whole brain analysis by a noninvasive modality. It is applicable to a wide range of patients and effective even under general anesthesia. The nature of resting
Surgical data processing for smart intraoperative assistance systems
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Stauder Ralf
Full Text Available Different components of the newly defined field of surgical data science have been under research at our groups for more than a decade now. In this paper, we describe our sensor-driven approaches to workflow recognition without the need for explicit models, and our current aim is to apply this knowledge to enable context-aware surgical assistance systems, such as a unified surgical display and robotic assistance systems. The methods we evaluated over time include dynamic time warping, hidden Markov models, random forests, and recently deep neural networks, specifically convolutional neural networks.
Surgical drill system and surgical drill bit to be used therein
Margallo Balbas, E.; Wieringa, P.A.; French, P.J.; Lee, R.A.; Breedveld, P.
Surgical drill system comprising a mechanical drill bit and means for imaging the vicinity of the drill bit tip, said means comprising: at least one optical fiber having a distal end and a proximal end, said distal end being located adjacent said drill bit tip, an optical processing unit, said
Cone Beam CT in Diagnosis and Surgical Planning of Dentigerous Cyst
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Naira Figueiredo Deana
Full Text Available Diagnosis and preoperative planning are critical in the execution of any surgical procedure. Panoramic radiography is a routine method used in dentistry to assist clinical diagnosis; however, with this technique 3D anatomical structures are compressed into 2D images, resulting in overlapping of structures which are of interest in the diagnosis. In this study we report the case of a patient who presented with a dentigerous cyst of expressive dimensions in the body of the mandible region. The surgery was planned and executed after observing the margins of the lesion by Cone Beam Computed Tomography (CBCT. We conclude that CBCT is a precise method to help diagnosis; it provides greater accuracy in surgical treatment planning through 3D image display, allowing more effective results.
Virtual reality based surgical assistance and training system for long duration space missions.
Montgomery, K; Thonier, G; Stephanides, M; Schendel, S
Access to medical care during long duration space missions is extremely important. Numerous unanticipated medical problems will need to be addressed promptly and efficiently. Although telemedicine provides a convenient tool for remote diagnosis and treatment, it is impractical due to the long delay between data transmission and reception to Earth. While a well-trained surgeon-internist-astronaut would be an essential addition to the crew, the vast number of potential medical problems necessitate instant access to computerized, skill-enhancing and diagnostic tools. A functional prototype of a virtual reality based surgical training and assistance tool was created at our center, using low-power, small, lightweight components that would be easy to transport on a space mission. The system consists of a tracked, head-mounted display, a computer system, and a number of tracked surgical instruments. The software provides a real-time surgical simulation system with integrated monitoring and information retrieval and a voice input/output subsystem. Initial medical content for the system has been created, comprising craniofacial, hand, inner ear, and general anatomy, as well as information on a number of surgical procedures and techniques. One surgical specialty in particular, microsurgery, was provided as a full simulation due to its long training requirements, significant impact on result due to experience, and likelihood for need. However, the system is easily adapted to realistically simulate a large number of other surgical procedures. By providing a general system for surgical simulation and assistance, the astronaut-surgeon can maintain their skills, acquire new specialty skills, and use tools for computer-based surgical planning and assistance to minimize overall crew and mission risk.
Independent Navigation System for a Surgical Colonoscope
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Lilia A. Ochoa-Luna
Full Text Available This paper provides a novel algorithm to attain the independent navigation of a colonoscopy surgical endoscope. First, it introduces a brief description of this issue through the scientist advance for medical robotics. It then makes a quickly count of the existent methods and at the end it provides the basis in order to propose a new alternative solution with help from vision-guidance. That means that images will be processed and interpreted with the purpose of maintaining the endoscope always at the intestine center. All this considered will help us to reduce colonoscopy surgeries consequences and the most important advantage of this new method proposed is that surgeons will accomplish their work easier and more efficiently.
Information Systems for University Planning.
Robinson, Robert J.
This paper proposes construction of a separate data base environment for university planning information, distinct from data bases and systems supporting operational functioning and management. The data base would receive some of its input from the management information systems (MIS)/transactional data bases and systems through a process of…
Planning-Programming-Budgeting Systems.
Tudor, Dean
Planning Programming and Budgeting Systems (PPBS) have been considered as either synonymous with abstract, advanced, mathematical systems analysis or as an advanced accounting and control system. If PPBS is to perform a useful function, both viewpoints must be combined such that a number of standardized procedures and reports are required and…
Feasibility of Electronic Nicotine Delivery Systems in Surgical Patients.
Nolan, Margaret; Leischow, Scott; Croghan, Ivana; Kadimpati, Sandeep; Hanson, Andrew; Schroeder, Darrell; Warner, David O
Cigarette smoking is a known risk factor for postoperative complications. Quitting or cutting down on cigarettes around the time of surgery may reduce these risks. This study aimed to determine the feasibility of using electronic nicotine delivery systems (ENDS) to help patients achieve this goal, regardless of their intent to attempt long-term abstinence. An open-label observational study was performed of cigarette smoking adults scheduled for elective surgery at Mayo Clinic Rochester and seen in the pre-operative evaluation clinic between December 2014 and June 2015. Subjects were given a supply of ENDS to use prior to and 2 weeks after surgery. They were encouraged to use them whenever they craved a cigarette. Daily use of ENDS was recorded, and patients were asked about smoking behavior and ENDS use at baseline, 14 days and 30 days. Of the 105 patients approached, 80 (76%) agreed to participate; five of these were later excluded. Among the 75, 67 (87%) tried ENDS during the study period. At 30-day follow-up, 34 (51%) who had used ENDS planned to continue using them. Average cigarette consumption decreased from 15.6 per person/d to 7.6 over the study period (P < .001). At 30 days, 11/67 (17%) reported abstinence from cigarettes. ENDS use is feasible in adult smokers scheduled for elective surgery and is associated with a reduction in perioperative cigarette consumption. These results support further exploration of ENDS as a means to help surgical patients reduce or eliminate their cigarette consumption around the time of surgery. Smoking in the perioperative period increases patients' risk for surgical complications and healing difficulties, but new strategies are needed to help patients quit or cut down during this stressful time. These pilot data suggest that ENDS use is feasible and well-accepted in surgical patients, and worthy of exploration as a harm reduction strategy in these patients. © The Author 2016. Published by Oxford University Press on behalf of
Planning ATES systems under uncertainty
Jaxa-Rozen, Marc; Kwakkel, Jan; Bloemendal, Martin
Aquifer Thermal Energy Storage (ATES) can contribute to significant reductions in energy use within the built environment, by providing seasonal energy storage in aquifers for the heating and cooling of buildings. ATES systems have experienced a rapid uptake over the last two decades; however, despite successful experiments at the individual level, the overall performance of ATES systems remains below expectations - largely due to suboptimal practices for the planning and operation of systems in urban areas. The interaction between ATES systems and underground aquifers can be interpreted as a common-pool resource problem, in which thermal imbalances or interference could eventually degrade the storage potential of the subsurface. Current planning approaches for ATES systems thus typically follow the precautionary principle. For instance, the permitting process in the Netherlands is intended to minimize thermal interference between ATES systems. However, as shown in recent studies (Sommer et al., 2015; Bakr et al., 2013), a controlled amount of interference may benefit the collective performance of ATES systems. An overly restrictive approach to permitting is instead likely to create an artificial scarcity of available space, limiting the potential of the technology in urban areas. In response, master plans - which take into account the collective arrangement of multiple systems - have emerged as an increasingly popular alternative. However, permits and master plans both take a static, ex ante view of ATES governance, making it difficult to predict the effect of evolving ATES use or climactic conditions on overall performance. In particular, the adoption of new systems by building operators is likely to be driven by the available subsurface space and by the performance of existing systems; these outcomes are themselves a function of planning parameters. From this perspective, the interactions between planning authorities, ATES operators, and subsurface conditions
TWRS Systems Engineering Working Plan
International Nuclear Information System (INIS)
Eiholzer, C.R.
The purpose of this Systems Engineering (SE) Working Plan (SEWP) is to describe how the Westinghouse Hanford Company (WHC) Tank Waste Remediation System (TWRS) will implement the SE polity and guidance provided in the Tank Waste Remediation System (TWRS) Systems Engineering Management Plan (SEMP). Sections 2.0 through 4.0 cover how the SE process and management will be performed to develop a technical baseline within TWRS. Section 5.0 covers the plans and schedules to implement the SE process and management within TWRS. Detailed information contained in the TWRS Program SEMP is not repeated in this document. This SEWP and the SE discipline defined within apply to the TWRS Program and new and ongoing TWRS projects or activities, including new facilities and safety. The SE process will be applied to the existing Tank Farm operations where the Richland TWRS Program Office management determines the process appropriate and where value will be added to existing Tank Farm system and operations
Processing system of jaws tomograms for pathology identification and surgical guide modeling
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Putrik, M. B., E-mail: email@example.com; Ivanov, V. Yu. [Ural Federal University named after the first President of Russia B.N. Yeltsin, Yekaterinburg (Russian Federation); Lavrentyeva, Yu. E. [Private dental clinic «Uraldent», Yekaterinburg (Russian Federation)
The aim of the study is to create an image processing system, which allows dentists to find pathological resorption and to build surgical guide surface automatically. X-rays images of jaws from cone beam tomography or spiral computed tomography are the initial data for processing. One patient's examination always includes up to 600 images (or tomograms), that's why the development of processing system for fast automation search of pathologies is necessary. X-rays images can be useful not for only illness diagnostic but for treatment planning too. We have studied the case of dental implantation – for successful surgical manipulations surgical guides are used. We have created a processing system that automatically builds jaw and teeth boundaries on the x-ray image. After this step, obtained teeth boundaries used for surgical guide surface modeling and jaw boundaries limit the area for further pathologies search. Criterion for the presence of pathological resorption zones inside the limited area is based on statistical investigation. After described actions, it is possible to manufacture surgical guide using 3D printer and apply it in surgical operation.
Processing system of jaws tomograms for pathology identification and surgical guide modeling
International Nuclear Information System (INIS)
Putrik, M. B.; Ivanov, V. Yu.; Lavrentyeva, Yu. E.
The aim of the study is to create an image processing system, which allows dentists to find pathological resorption and to build surgical guide surface automatically. X-rays images of jaws from cone beam tomography or spiral computed tomography are the initial data for processing. One patient's examination always includes up to 600 images (or tomograms), that's why the development of processing system for fast automation search of pathologies is necessary. X-rays images can be useful not for only illness diagnostic but for treatment planning too. We have studied the case of dental implantation – for successful surgical manipulations surgical guides are used. We have created a processing system that automatically builds jaw and teeth boundaries on the x-ray image. After this step, obtained teeth boundaries used for surgical guide surface modeling and jaw boundaries limit the area for further pathologies search. Criterion for the presence of pathological resorption zones inside the limited area is based on statistical investigation. After described actions, it is possible to manufacture surgical guide using 3D printer and apply it in surgical operation
Modelling and Experiment Based on a Navigation System for a Cranio-Maxillofacial Surgical Robot
Duan, Xingguang; Gao, Liang; Li, Jianxi; Li, Haoyuan; Guo, Yanjun
In view of the characteristics of high risk and high accuracy in cranio-maxillofacial surgery, we present a novel surgical robot system that can be used in a variety of surgeries. The surgical robot system can assist surgeons in completing biopsy of skull base lesions, radiofrequency thermocoagulation of the trigeminal ganglion, and radioactive particle implantation of skull base malignant tumors. This paper focuses on modelling and experimental analyses of the robot system based on navigation technology. Firstly, the transformation relationship between the subsystems is realized based on the quaternion and the iterative closest point registration algorithm. The hand-eye coordination model based on optical navigation is established to control the end effector of the robot moving to the target position along the planning path. The closed-loop control method, "kinematics + optics" hybrid motion control method, is presented to improve the positioning accuracy of the system. Secondly, the accuracy of the system model was tested by model experiments. And the feasibility of the closed-loop control method was verified by comparing the positioning accuracy before and after the application of the method. Finally, the skull model experiments were performed to evaluate the function of the surgical robot system. The results validate its feasibility and are consistent with the preoperative surgical planning. PMID:29599948
Modelling and Experiment Based on a Navigation System for a Cranio-Maxillofacial Surgical Robot
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Xingguang Duan
Full Text Available In view of the characteristics of high risk and high accuracy in cranio-maxillofacial surgery, we present a novel surgical robot system that can be used in a variety of surgeries. The surgical robot system can assist surgeons in completing biopsy of skull base lesions, radiofrequency thermocoagulation of the trigeminal ganglion, and radioactive particle implantation of skull base malignant tumors. This paper focuses on modelling and experimental analyses of the robot system based on navigation technology. Firstly, the transformation relationship between the subsystems is realized based on the quaternion and the iterative closest point registration algorithm. The hand-eye coordination model based on optical navigation is established to control the end effector of the robot moving to the target position along the planning path. The closed-loop control method, "kinematics + optics" hybrid motion control method, is presented to improve the positioning accuracy of the system. Secondly, the accuracy of the system model was tested by model experiments. And the feasibility of the closed-loop control method was verified by comparing the positioning accuracy before and after the application of the method. Finally, the skull model experiments were performed to evaluate the function of the surgical robot system. The results validate its feasibility and are consistent with the preoperative surgical planning.
Optical surgical navigation system causes pulse oximeter malfunction.
Satoh, Masaaki; Hara, Tetsuhito; Tamai, Kenji; Shiba, Juntaro; Hotta, Kunihisa; Takeuchi, Mamoru; Watanabe, Eiju
An optical surgical navigation system is used as a navigator to facilitate surgical approaches, and pulse oximeters provide valuable information for anesthetic management. However, saw-tooth waves on the monitor of a pulse oximeter and the inability of the pulse oximeter to accurately record the saturation of a percutaneous artery were observed when a surgeon started an optical navigation system. The current case is thought to be the first report of this navigation system interfering with pulse oximetry. The causes of pulse jamming and how to manage an optical navigation system are discussed.
Surgical bedside master console for neurosurgical robotic system.
Arata, Jumpei; Kenmotsu, Hajime; Takagi, Motoki; Hori, Tatsuya; Miyagi, Takahiro; Fujimoto, Hideo; Kajita, Yasukazu; Hayashi, Yuichiro; Chinzei, Kiyoyuki; Hashizume, Makoto
We are currently developing a neurosurgical robotic system that facilitates access to residual tumors and improves brain tumor removal surgical outcomes. The system combines conventional and robotic surgery allowing for a quick conversion between the procedures. This concept requires a new master console that can be positioned at the surgical bedside and be sterilized. The master console was developed using new technologies, such as a parallel mechanism and pneumatic sensors. The parallel mechanism is a purely passive 5-DOF (degrees of freedom) joystick based on the author's haptic research. The parallel mechanism enables motion input of conventional brain tumor removal surgery with a compact, intuitive interface that can be used in a conventional surgical environment. In addition, the pneumatic sensors implemented on the mechanism provide an intuitive interface and electrically isolate the tool parts from the mechanism so they can be easily sterilized. The 5-DOF parallel mechanism is compact (17 cm width, 19cm depth, and 15cm height), provides a 505,050 mm and 90° workspace and is highly backdrivable (0.27N of resistance force representing the surgical motion). The evaluation tests revealed that the pneumatic sensors can properly measure the suction strength, grasping force, and hand contact. In addition, an installability test showed that the master console can be used in a conventional surgical environment. The proposed master console design was shown to be feasible for operative neurosurgery based on comprehensive testing. This master console is currently being tested for master-slave control with a surgical robotic system.
Radionuclide bone imaging in the surgical treatment planning of odontogenic keratocysts
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Lurie, A.G.; Puri, S.; James, R.B.; Warnich, J.T.
Locally aggressive benign lesions of the jaws, such as odontogenic keratocysts and ameloblastomas, require complete excision in view of the high incidence of recurrence after incomplete surgical removal. Because of the limitations of conventional radiology as the sole technique for determining the extent of these lesions, the use of 99m-technetium-labeled bone-imaging agents is suggested. This method of defining the location of surgical margins is based on the agent's sensitivity as an indicator of subtle changes in bone metabolism. A case of an unusually large recurrent odontogenic keratocyst is presented in which the planning of the surgical procedure was predicated on the results of a bone scan of the jaws in addition to conventional radiology. This diagnostic procedure, especially when used in conjunction with conventional radiology, appears to be of considerable value in defining the extent of a variety of oral-maxillofacial bony lesions.
Radionuclide bone imaging in the surgical treatment planning of odontogenic keratocysts
International Nuclear Information System (INIS)
Lurie, A.G.; Puri, S.; James, R.B.; Warnich, J.T.
Locally aggressive benign lesions of the jaws, such as odontogenic keratocysts and ameloblastomas, require complete excision in view of the high incidence of recurrence after incomplete surgical removal. Because of the limitations of conventional radiology as the sole technique for determining the extent of these lesions, the use of 99m-technetium-labeled bone-imaging agents is suggested. This method of defining the location of surgical margins is based on the agent's sensitivity as an indicator of subtle changes in bone metabolism. A case of an unusually large recurrent odontogenic keratocyst is presented in which the planning of the surgical procedure was predicated on the results of a bone scan of the jaws in addition to conventional radiology. This diagnostic procedure, especially when used in conjunction with conventional radiology, appears to be of considerable value in defining the extent of a variety of oral-maxillofacial bony lesions
Full Scale 3D Preoperative Planning System of the Ankle Joint Replacement Surgery with Multimedia System
Directory of Open Access Journals (Sweden)
Shuh-Ping Sun
Full Text Available This study is intended to develop a computer-aided pre-surgical planning and simulating system in a multimedia environment for ankle joint replacement surgery. This system uses full-scale 3D reverse engineering techniques in design and development of the pre-surgical planning modules for ankle joint replacement surgery. This planning system not only develops the real-scale 3D image of the artificial ankle joint but also provides a detailed interior measurement of the ankle joint from various cutting planes. In this study, we apply the multimedia user interface to integrate different software functions into a surgical planning system with integrated functions. The functions include 3D model image acquisition, cutting, horizontal shifting and rotation of related bones (tibia and talus of the ankle joint in the predetermined time. For related bones of the ankle joint, it can also be used to design artificial ankle joints for adults in Taiwan. Those planning procedures can be recorded in this system for further research and investigation. Furthermore, since this system is a multimedia user interface, surgeons can use this system to plan and find a better and more efficient surgical approach before surgery. A database is available for this system to update and expand, which can provide different users with clinical cases as per their experience and learning.
Virtual Reality Simulator Systems in Robotic Surgical Training.
Mangano, Alberto; Gheza, Federico; Giulianotti, Pier Cristoforo
The number of robotic surgical procedures has been increasing worldwide. It is important to maximize the cost-effectiveness of robotic surgical training and safely reduce the time needed for trainees to reach proficiency. The use of preliminary lab training in robotic skills is a good strategy for the rapid acquisition of further, standardized robotic skills. Such training can be done either by using a simulator or by exercises in a dry or wet lab. While the use of an actual robotic surgical system for training may be problematic (high cost, lack of availability), virtual reality (VR) simulators can overcome many of these obstacles. However, there is still a lack of standardization. Although VR training systems have improved, they cannot yet replace experience in a wet lab. In particular, simulated scenarios are not yet close enough to a real operative experience. Indeed, there is a difference between technical skills (i.e., mechanical ability to perform a simulated task) and surgical competence (i.e., ability to perform a real surgical operation). Thus, while a VR simulator can replace a dry lab, it cannot yet replace training in a wet lab or operative training in actual patients. However, in the near future, it is expected that VR surgical simulators will be able to provide total reality simulation and replace training in a wet lab. More research is needed to produce more wide-ranging, trans-specialty robotic curricula.
Knowing the operative game plan: a novel tool for the assessment of surgical procedural knowledge.
Balayla, Jacques; Bergman, Simon; Ghitulescu, Gabriela; Feldman, Liane S; Fraser, Shannon A
What is the source of inadequate performance in the operating room? Is it a lack of technical skills, poor judgment or a lack of procedural knowledge? We created a surgical procedural knowledge (SPK) assessment tool and evaluated its use. We interviewed medical students, residents and training program staff on SPK assessment tools developed for 3 different common general surgery procedures: inguinal hernia repair with mesh in men, laparoscopic cholecystectomy and right hemicolectomy. The tools were developed as a step-wise assessment of specific surgical procedures based on techniques described in a current surgical text. We compared novice (medical student to postgraduate year [PGY]-2) and expert group (PGY-3 to program staff) scores using the Mann-Whitney U test. We calculated the total SPK score and defined a cut-off score using receiver operating characteristic analysis. In all, 5 participants in 7 different training groups (n = 35) underwent an interview. Median scores for each procedure and overall SPK scores increased with experience. The median SPK for novices was 54.9 (95% confidence interval [CI] 21.6-58.8) compared with 98.05 (95% CP 94.1-100.0) for experts (p = 0.012). The SPK cut-off score of 93.1 discriminates between novice and expert surgeons. Surgical procedural knowledge can reliably be assessed using our SPK assessment tool. It can discriminate between novice and expert surgeons for common general surgical procedures. Future studies are planned to evaluate its use for more complex procedures.
Virtual Surgical Planning for Correction of Delayed Presentation Scaphocephaly Using a Modified Melbourne Technique.
Macmillan, Alexandra; Lopez, Joseph; Mundinger, Gerhard S; Major, Melanie; Medina, Miguel A; Dorafshar, Amir H
Late treatment of scaphocephaly presents challenges including need for more complex surgery to achieve desired head shape. Virtual surgical planning for total vault reconstruction may mitigate some of these challenges, but has not been studied in this unique and complex clinical setting. A retrospective chart review was conducted for patients with scaphocephaly who presented to our institution between 2000 and 2014. Patients presenting aged 12 months or older who underwent virtual surgical planning-assisted cranial vault reconstruction were included. Patient demographic, intraoperative data, and postoperative outcomes were recorded. Pre- and postoperative anthropometric measurements were obtained to document the fronto-occipital (FO) and biparietal (BP) distance and calculate cephalic index (CI). Virtual surgical planning predicted, and actual postoperative anthropometric measurements were compared. Five patients were identified who fulfilled inclusion criteria. The mean age was 50.6 months. One patient demonstrated signs of elevated intracranial pressure preoperatively. Postoperatively, all but one needed no revisional surgery (Whitaker score of 1). No patient demonstrated postoperative evidence of bony defects, bossing, or suture restenosis. The mean preoperative, simulated, and actual postoperative FO length was 190.3, 182, and 184.3 mm, respectively. The mean preoperative, simulated, and actual postoperative BP length was 129, 130.7, and 131 mm, respectively. The mean preoperative, simulated, and actual postoperative CI was 66, 72, and 71.3, respectively. Based on our early experience, virtual surgical planning using a modified Melbourne technique for total vault remodeling achieves good results in the management of late presenting scaphocephaly.
Do Robotic Surgical Systems Improve Profit Margins? A Cross-Sectional Analysis of California Hospitals.
Shih, Ya-Chen Tina; Shen, Chan; Hu, Jim C
The aim of this study was to examine the association between ownership of robotic surgical systems and hospital profit margins. This study used hospital annual utilization data, annual financial data, and discharge data for year 2011 from the California Office of Statewide Health Planning and Development. We first performed bivariate analysis to compare mean profit margin by hospital and market characteristics and to examine whether these characteristics differed between hospitals that had one or more robotic surgical systems in 2011 and those that did not. We applied the t test and the F test to compare mean profit margin between two groups and among three or more groups, respectively. We then conducted multilevel logistic regression to determine the association between ownership of robotic surgical systems and having a positive profit margin after controlling for other hospital and market characteristics and accounting for possible correlation among hospitals located within the same market. The study sample included 167 California hospitals with valid financial information. Hospitals with robotic surgical systems tended to report more favorable profit margins. However, multilevel logistic regression showed that this relationship (an association, not causality) became only marginally significant (odds ratio [OR] = 6.2; P = 0.053) after controlling for other hospital characteristics, such as ownership type, teaching status, bed size, and surgical volumes, and market characteristics, such as total number of robotic surgical systems owned by other hospitals in the same market area. As robotic surgical systems become widely disseminated, hospital decision makers should carefully evaluate the financial and clinical implications before making a capital investment in this technology. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
A virtual reality interface for pre-planning of surgical operations based on a customized model of the patient
Witkowski, Marcin; Lenar, Janusz; Sitnik, Robert; Verdonschot, Nico
We present a human-computer interface that enables the operator to plan a surgical procedure on the musculoskeletal (MS) model of the patient's lower limbs, send the modified model to the bio-mechanical analysis module, and export the scenario parameters to the surgical navigation system. The interface provides the operator with tools for: importing customized MS model of the patient, cutting bones and manipulating/removal of bony fragments, repositioning muscle insertion points, muscle removal and placing implants. After planning the operator exports the modified MS model for bio-mechanical analysis of the functional outcome. If the simulation result is satisfactory the exported scenario data may be directly used during the actual surgery. The advantages of the developed interface are the possibility of installing it in various hardware configurations and coherent operation regardless of the devices used. The hardware configurations proposed to be used with the interface are: (a) a standard computer keyboard and mouse, and a 2-D display, (b) a touch screen as a single device for both input and output, or (c) a 3-D display and a haptic device for natural manipulation of 3-D objects. The interface may be utilized in two main fields. Experienced surgeons may use it to simulate their intervention plans and prepare input data for a surgical navigation system while student or novice surgeons can use it for simulating results of their hypothetical procedure. The interface has been developed in the TLEMsafe project (www.tlemsafe.eu) funded by the European Commission FP7 program.
How to Plan Ventilation Systems.
Clarke, John H.
Ventilation systems for factory safety demand careful planning. The increased heat loads and new processes of industry have introduced complex ventilation problems in--(1) ventilation supply, (2) duct work design, (3) space requirements, (4) hood face velocities, (5) discharge stacks, and (6) building eddies. This article describes and diagrams…
Transmission system planning in Ontario
Energy Technology Data Exchange (ETDEWEB)
Barrie, D; Macedo, F X; Mcconnach, J S [Ontario Hydro, Toronto, ON (Canada)
In recent years, new and modified approaches to planning the large transmission system that serves the province of Ontario, Canada, have been necessary to accommodate the rapidly changing planning environment including slower uncertain growth, ageing of facilities, integration of demand side management and non utility generation options, increased competitiveness, increased financial stresses and affordable constraints. This paper describes some of the new and modified approaches and tools that have been adopted or are being developed by Ontario Hydro to cope with this changing environment. (author) 9 refs., 4 figs.
Use of three-dimensional, CAD/CAM-assisted, virtual surgical simulation and planning in the pediatric craniofacial population.
Gray, Rachel; Gougoutas, Alexander; Nguyen, Vinh; Taylor, Jesse; Bastidas, Nicholas
Virtual Surgical Planning (VSP) and computer-aided design/computer-aided manufacturing (CAD/CAM) have recently helped improve efficiency and accuracy in many different craniofacial surgeries. Research has mainly focused on the use in the adult population with the exception of the use for mandibular distractions and cranial vault remodeling in the pediatric population. This study aims to elucidate the role of VSP and CAD/CAM in complex pediatric craniofacial cases by exploring its use in the correction of midface hypoplasia, orbital dystopia, mandibular reconstruction, and posterior cranial vault expansion. A retrospective analysis of thirteen patients who underwent 3d, CAD/CAM- assisted preoperative surgical planning between 2012 and 2016 was performed. All CAD/CAM assisted surgical planning was done in conjunction with a third party vendor (either 3D Systems or Materialise). Cutting and positioning guides as well as models were produced based on the virtual plan. Surgeries included free fibula mandible reconstruction (n = 4), lefort I osteotomy and distraction (n = 2), lefort II osteotomy with monobloc distraction (n = 1), expansion of the posterior vault for correction of chiari malformation (n = 3), and secondary orbital and midface reconstruction for facial trauma (n = 3). The patient's age, diagnosis, previous surgeries, length of operating time, complications, and post-surgery satisfaction were determined. In all cases we found presurgical planning was helpful to improve accuracy and significantly decrease intra-operative time. In cases where distraction was used, the planned and actual vectors were found to be accurate with excellent clinical outcomes. There were no complications except for one patient who experienced a wound infection post-operatively which did not alter the ultimate reconstruction. All patients experienced high satisfaction with their outcomes and excellent subjective aesthetic results were achieved. Preoperative planning using
Development of a High Resolution 3D Infant Stomach Model for Surgical Planning
Chaudry, Qaiser; Raza, S. Hussain; Lee, Jeonggyu; Xu, Yan; Wulkan, Mark; Wang, May D.
Medical surgical procedures have not changed much during the past century due to the lack of accurate low-cost workbench for testing any new improvement. The increasingly cheaper and powerful computer technologies have made computer-based surgery planning and training feasible. In our work, we have developed an accurate 3D stomach model, which aims to improve the surgical procedure that treats the infant pediatric and neonatal gastro-esophageal reflux disease (GERD). We generate the 3-D infant stomach model based on in vivo computer tomography (CT) scans of an infant. CT is a widely used clinical imaging modality that is cheap, but with low spatial resolution. To improve the model accuracy, we use the high resolution Visible Human Project (VHP) in model building. Next, we add soft muscle material properties to make the 3D model deformable. Then we use virtual reality techniques such as haptic devices to make the 3D stomach model deform upon touching force. This accurate 3D stomach model provides a workbench for testing new GERD treatment surgical procedures. It has the potential to reduce or eliminate the extensive cost associated with animal testing when improving any surgical procedure, and ultimately, to reduce the risk associated with infant GERD surgery.
CMS Planning and Scheduling System
Kotamaki, M
The paper describes the procedures and the system to build and maintain the schedules needed to manage time, resources, and progress of the CMS project. The system is based on the decomposition of the project into work packages, which can be each considered as a complete project with its own structure. The system promotes the distribution of the decision making and responsibilities to lower levels in the organisation by providing a state-of-the-art system to formalise the external commitments of the work packages without limiting their ability to modify their internal schedules to best meet their commitments. The system lets the project management focus on the interfaces between the work packages and alerts the management immediately if a conflict arises. The proposed system simplifies the planning and management process and eliminates the need for a large, centralised project management system.
Patient-specific surgical planning and hemodynamic computational fluid dynamics optimization through free-form haptic anatomy editing tool (SURGEM).
Pekkan, Kerem; Whited, Brian; Kanter, Kirk; Sharma, Shiva; de Zelicourt, Diane; Sundareswaran, Kartik; Frakes, David; Rossignac, Jarek; Yoganathan, Ajit P
The first version of an anatomy editing/surgical planning tool (SURGEM) targeting anatomical complexity and patient-specific computational fluid dynamics (CFD) analysis is presented. Novel three-dimensional (3D) shape editing concepts and human-shape interaction technologies have been integrated to facilitate interactive surgical morphology alterations, grid generation and CFD analysis. In order to implement "manual hemodynamic optimization" at the surgery planning phase for patients with congenital heart defects, these tools are applied to design and evaluate possible modifications of patient-specific anatomies. In this context, anatomies involve complex geometric topologies and tortuous 3D blood flow pathways with multiple inlets and outlets. These tools make it possible to freely deform the lumen surface and to bend and position baffles through real-time, direct manipulation of the 3D models with both hands, thus eliminating the tedious and time-consuming phase of entering the desired geometry using traditional computer-aided design (CAD) systems. The 3D models of the modified anatomies are seamlessly exported and meshed for patient-specific CFD analysis. Free-formed anatomical modifications are quantified using an in-house skeletization based cross-sectional geometry analysis tool. Hemodynamic performance of the systematically modified anatomies is compared with the original anatomy using CFD. CFD results showed the relative importance of the various surgically created features such as pouch size, vena cave to pulmonary artery (PA) flare and PA stenosis. An interactive surgical-patch size estimator is also introduced. The combined design/analysis cycle time is used for comparing and optimizing surgical plans and improvements are tabulated. The reduced cost of patient-specific shape design and analysis process, made it possible to envision large clinical studies to assess the validity of predictive patient-specific CFD simulations. In this paper, model
Is There a Difference in Cost Between Standard and Virtual Surgical Planning for Orthognathic Surgery?
Resnick, Cory M; Inverso, Gino; Wrzosek, Mariusz; Padwa, Bonnie L; Kaban, Leonard B; Peacock, Zachary S
Virtual surgical planning (VSP) and 3-dimensional printing of surgical splints are becoming the standard of care for orthognathic surgery, but costs have not been thoroughly evaluated. The purpose of this study was to compare the cost of VSP and 3-dimensional printing of splints ("VSP") versus that of 2-dimensional cephalometric evaluation, model surgery, and manual splint fabrication ("standard planning"). This is a retrospective cohort study including patients planned for bimaxillary surgery from January 2014 to January 2015 at Massachusetts General Hospital. Patients were divided into 3 groups by case type: symmetric, nonsegmental (group 1); asymmetric (group 2); and segmental (group 3). All cases underwent both VSP and standard planning with times for all activities recorded. The primary and secondary predictor variables were method of treatment planning and case type, respectively. Time-driven activity-based micro-costing analysis was used to quantify the differences in cost. Results were analyzed using a paired t test and analysis of variance. The sample included 43 patients (19 in group 1, 17 in group 2, and 7 in group 3). The average times and costs were 194 ± 14.1 minutes and $2,765.94, respectively, for VSP and 540.9 ± 99.5 minutes and $3,519.18, respectively, for standard planning. For the symmetric, nonsegmental group, the average times and costs were 188 ± 17.8 minutes and $2,700.52, respectively, for VSP and 524.4 ± 86.1 minutes and $3,380.17, respectively, for standard planning. For the asymmetric group, the average times and costs were 187.4 ± 10.9 minutes and $2,713.69, respectively, for VSP and 556.1 ± 94.1 minutes and $3,640.00, respectively, for standard planning. For the segmental group, the average times and costs were 208.8 ± 13.5 minutes and $2,883.62, respectively, for VSP and 542.3 ± 118.4 minutes and $3,537.37, respectively, for standard planning. All time and cost differences were statistically significant (P
Patient-specific cardiac phantom for clinical training and preprocedure surgical planning.
Laing, Justin; Moore, John; Vassallo, Reid; Bainbridge, Daniel; Drangova, Maria; Peters, Terry
Minimally invasive mitral valve repair procedures including MitraClip ® are becoming increasingly common. For cases of complex or diseased anatomy, clinicians may benefit from using a patient-specific cardiac phantom for training, surgical planning, and the validation of devices or techniques. An imaging compatible cardiac phantom was developed to simulate a MitraClip ® procedure. The phantom contained a patient-specific cardiac model manufactured using tissue mimicking materials. To evaluate accuracy, the patient-specific model was imaged using computed tomography (CT), segmented, and the resulting point cloud dataset was compared using absolute distance to the original patient data. The result, when comparing the molded model point cloud to the original dataset, resulted in a maximum Euclidean distance error of 7.7 mm, an average error of 0.98 mm, and a standard deviation of 0.91 mm. The phantom was validated using a MitraClip ® device to ensure anatomical features and tools are identifiable under image guidance. Patient-specific cardiac phantoms may allow for surgical complications to be accounted for preoperative planning. The information gained by clinicians involved in planning and performing the procedure should lead to shorter procedural times and better outcomes for patients.
A GPU Accelerated Spring Mass System for Surgical Simulation
DEFF Research Database (Denmark)
Mosegaard, Jesper; Sørensen, Thomas Sangild
There is a growing demand for surgical simulators to dofast and precise calculations of tissue deformation to simulateincreasingly complex morphology in real-time. Unfortunately, evenfast spring-mass based systems have slow convergence rates for largemodels. This paper presents a method to accele...... to accelerate computation of aspring-mass system in order to simulate a complex organ such as theheart. This acceleration is achieved by taking advantage of moderngraphics processing units (GPU)....
SDDOT transportation systems management & operations program plan.
The objective of this project is the development of a comprehensive Transportation Systems Management and : Operations (TSM&O) Program Plan for the South Dakota Department of Transportation. This plan guides : business planning and strategic decision...
New real-time MR image-guided surgical robotic system for minimally invasive precision surgery
Energy Technology Data Exchange (ETDEWEB)
Hashizume, M.; Yasunaga, T.; Konishi, K. [Kyushu University, Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Fukuoka (Japan); Tanoue, K.; Ieiri, S. [Kyushu University Hospital, Department of Advanced Medicine and Innovative Technology, Fukuoka (Japan); Kishi, K. [Hitachi Ltd, Mechanical Engineering Research Laboratory, Hitachinaka-Shi, Ibaraki (Japan); Nakamoto, H. [Hitachi Medical Corporation, Application Development Office, Kashiwa-Shi, Chiba (Japan); Ikeda, D. [Mizuho Ikakogyo Co. Ltd, Tokyo (Japan); Sakuma, I. [The University of Tokyo, Graduate School of Engineering, Bunkyo-Ku, Tokyo (Japan); Fujie, M. [Waseda University, Graduate School of Science and Engineering, Shinjuku-Ku, Tokyo (Japan); Dohi, T. [The University of Tokyo, Graduate School of Information Science and Technology, Bunkyo-Ku, Tokyo (Japan)
To investigate the usefulness of a newly developed magnetic resonance (MR) image-guided surgical robotic system for minimally invasive laparoscopic surgery. The system consists of MR image guidance [interactive scan control (ISC) imaging, three-dimensional (3-D) navigation, and preoperative planning], an MR-compatible operating table, and an MR-compatible master-slave surgical manipulator that can enter the MR gantry. Using this system, we performed in vivo experiments with MR image-guided laparoscopic puncture on three pigs. We used a mimic tumor made of agarose gel and with a diameter of approximately 2 cm. All procedures were successfully performed. The operator only advanced the probe along the guidance device of the manipulator, which was adjusted on the basis of the preoperative plan, and punctured the target while maintaining the operative field using robotic forceps. The position of the probe was monitored continuously with 3-D navigation and 2-D ISC images, as well as the MR-compatible laparoscope. The ISC image was updated every 4 s; no artifact was detected. A newly developed MR image-guided surgical robotic system is feasible for an operator to perform safe and precise minimally invasive procedures. (orig.)
New real-time MR image-guided surgical robotic system for minimally invasive precision surgery
International Nuclear Information System (INIS)
Hashizume, M.; Yasunaga, T.; Konishi, K.; Tanoue, K.; Ieiri, S.; Kishi, K.; Nakamoto, H.; Ikeda, D.; Sakuma, I.; Fujie, M.; Dohi, T.
To investigate the usefulness of a newly developed magnetic resonance (MR) image-guided surgical robotic system for minimally invasive laparoscopic surgery. The system consists of MR image guidance [interactive scan control (ISC) imaging, three-dimensional (3-D) navigation, and preoperative planning], an MR-compatible operating table, and an MR-compatible master-slave surgical manipulator that can enter the MR gantry. Using this system, we performed in vivo experiments with MR image-guided laparoscopic puncture on three pigs. We used a mimic tumor made of agarose gel and with a diameter of approximately 2 cm. All procedures were successfully performed. The operator only advanced the probe along the guidance device of the manipulator, which was adjusted on the basis of the preoperative plan, and punctured the target while maintaining the operative field using robotic forceps. The position of the probe was monitored continuously with 3-D navigation and 2-D ISC images, as well as the MR-compatible laparoscope. The ISC image was updated every 4 s; no artifact was detected. A newly developed MR image-guided surgical robotic system is feasible for an operator to perform safe and precise minimally invasive procedures. (orig.)
Right attitude, right decision and timely planning in surgical pedodontics -scoop out or expose it.
Kethineni, Balaji; Peddi, Ravigna; Puppala, Ravindar; Banavath, Sunitha; Chowdary, Uday Kumar; Raj, Deepak
Radicular cysts are the most common odontogenic cystic lesions of inflammatory origin and are usually asymptomatic and are left unnoticed, until detected by routine radiography. It is managed either by surgical enucleation or marsupialization. Conventional nonsurgical endodontic treatment has a high degree of clinical success, but in certain cases surgical intervention becomes necessary. This is the case report of a patient presenting with unilateral radicular cyst. The lesion is managed by marsupialization using a novel and safe method of separating the soft tissue mass of the periapical lesion which was in proximity to vital and vulnerable anatomical tissue, emphasizing the need of application of treatment in the best interest of patients. The treatment of choice is dependent on the size and localization of the lesion, the bone integrity of the lesions wall and its proximity to vital structure. This case report of radicular cysts emphasis on the advantages and disadvantages of the leading criteria that should be taken into consideration when assessing the treatment modalities for radicular cyst. Odontogenic cysts, Radicular cyst, Marsupialization, Enucleation. How to cite this article: Kethineni B, Peddi R, Puppala R, Sunitha B, Chowdary U K, Raj D. Right Attitude, Right Decision and Timely Planning in Surgical Pedodontics -Scoop Out or Expose It. J Int Oral Health 2013; 5(2):50-54.
Planned posterior assisted levitation in severe subluxated cataract: Surgical technique and clinical results
Directory of Open Access Journals (Sweden)
Tova Lifshitz
Full Text Available We report the surgical technique and outcome of planned posterior assisted levitation (P-PAL in four cases of subluxated cataract. P-PAL was planned as the preferred approach in all cases. A spatula was inserted via the pars plana, the whole lens was lifted to the anterior chamber and then removed through a scleral tunnel incision. Anterior chamber intraocular lenses were implanted in all cases. All four eyes had severe subluxation of the crystalline lenses with marked phacodonesis. Two eyes had history of blunt trauma, and the other two eyes had severe pseudoexfoliation with spontaneous lens subluxation. Follow-up ranged from 1 to 2 years in three cases. The postoperative visual acuity was 20/80 or better. No intraoperative complications were observed. In conclusion, the P-PAL technique was successfully performed during cataract surgery in four eyes with severe subluxated cataracts. There were no complications over the long-term follow-up.
Pilot chargeback system program plan
International Nuclear Information System (INIS)
Smith, P.
This planning document outlines the steps necessary to develop, test, evaluate, and potentially implement a pilot chargeback system at the Idaho National Engineering and Environmental Laboratory for the treatment, storage, and disposal of current waste. This pilot program will demonstrate one system that can be used to charge onsite generators for the treatment and disposal of low-level radioactive waste. In FY 1997, mock billings will begin by July 15, 1997. Assuming approvals are received to do so, FY 1998 activities will include modifying the associated automated systems, testing and evaluating system performance, and estimating the amount generators will spend for waste storage, treatment, and disposal in FY 1999. If the program is fully implemented in FY 1999, generators will pay actual, automated bills for waste management services from funds transferred to their budgets from Environmental Management
Site systems engineering: Systems engineering management plan
Energy Technology Data Exchange (ETDEWEB)
Grygiel, M.L. [Westinghouse Hanford Co., Richland, WA (United States)
The Site Systems Engineering Management Plan (SEMP) is the Westinghouse Hanford Company (WHC) implementation document for the Hanford Site Systems Engineering Policy, (RLPD 430.1) and Systems Engineering Criteria Document and Implementing Directive, (RLID 430.1). These documents define the US Department of Energy (DOE), Richland Operations Office (RL) processes and products to be used at Hanford to implement the systems engineering process at the site level. This SEMP describes the products being provided by the site systems engineering activity in fiscal year (FY) 1996 and the associated schedule. It also includes the procedural approach being taken by the site level systems engineering activity in the development of these products and the intended uses for the products in the integrated planning process in response to the DOE policy and implementing directives. The scope of the systems engineering process is to define a set of activities and products to be used at the site level during FY 1996 or until the successful Project Hanford Management Contractor (PHMC) is onsite as a result of contract award from Request For Proposal DE-RP06-96RL13200. Following installation of the new contractor, a long-term set of systems engineering procedures and products will be defined for management of the Hanford Project. The extent to which each project applies the systems engineering process and the specific tools used are determined by the project`s management.
Business System Planning Project, Preliminary System Design
International Nuclear Information System (INIS)
CH2M HILL Hanford Group, Inc. (CHG) is currently performing many core business functions including, but not limited to, work control, planning, scheduling, cost estimating, procurement, training, and human resources. Other core business functions are managed by or dependent on Project Hanford Management Contractors including, but not limited to, payroll, benefits and pension administration, inventory control, accounts payable, and records management. In addition, CHG has business relationships with its parent company CH2M HILL, U.S. Department of Energy, Office of River Protection and other River Protection Project contractors, government agencies, and vendors. The Business Systems Planning (BSP) Project, under the sponsorship of the CH2M HILL Hanford Group, Inc. Chief Information Officer (CIO), have recommended information system solutions that will support CHG business areas. The Preliminary System Design was developed using the recommendations from the Alternatives Analysis, RPP-6499, Rev 0 and will become the design base for any follow-on implementation projects. The Preliminary System Design will present a high-level system design, providing a high-level overview of the Commercial-Off-The-Shelf (COTS) modules and identify internal and external relationships. This document will not define data structures, user interface components (screens, reports, menus, etc.), business rules or processes. These in-depth activities will be accomplished at implementation planning time
Fusion of magnetic resonance angiography and magnetic resonance imaging for surgical planning for meningioma. Technical note
International Nuclear Information System (INIS)
Kashimura, Hiroshi; Ogasawara, Kuniaki; Arai, Hiroshi
A fusion technique for magnetic resonance (MR) angiography and MR imaging was developed to help assess the peritumoral angioarchitecture during surgical planning for meningioma. Three-dimensional time-of-flight (3D-TOF) and 3D-spoiled gradient recalled (SPGR) datasets were obtained from 10 patients with intracranial meningioma, and fused using newly developed volume registration and visualization software. Maximum intensity projection (MIP) images from 3D-TOF MR angiography and axial SPGR MR imaging were displayed at the same time on the monitor. Selecting a vessel on the real-time MIP image indicated the corresponding points on the axial image automatically. Fusion images showed displacement of the anterior cerebral or middle cerebral artery in 7 patients and encasement of the anterior cerebral arteries in I patient, with no relationship between the main arterial trunk and tumor in 2 patients. Fusion of MR angiography and MR imaging can clarify relationships between the intracranial vasculature and meningioma, and may be helpful for surgical planning for meningioma. (author)
A revised 3-column classification approach for the surgical planning of extended lateral tibial plateau fractures.
Hoekstra, H; Kempenaers, K; Nijs, S
Variable angle locking compression plates allow for lateral buttress and support of the posterolateral joint surface of tibial plateau fractures. This gives room for improvement of the surgical 3-column classification approach. Our aim was to revise and validate the 3-column classification approach to better guide the surgical planning of tibial plateau fractures extending into the posterolateral corner. In contrast to the 3-column classification approach, in the revised approach the posterior border of the lateral column in the revised approach lies posterior instead of anterior of the fibula. According to the revised 3-column classification approach, extended lateral column fractures are defined as single lateral column fractures extending posteriorly into the posterolateral corner. CT-images of 36 patients were reviewed and classified twice online according to Schatzker and revised 3-column classification approach by five observers. The intraobserver reliability was calculated using the Cohen's kappa and the interobserver reliability was calculated using the Fleiss' kappa. The intraobserver reliability showed substantial agreement according to Landis and Koch for both Schatzker and the revised 3-column classification approach (0.746 vs. 0.782 p = 0.37, Schatzker vs. revised 3-column, respectively). However, the interobserver reliability of the revised 3-column classification approach was significantly higher as compared to the Schatzker classification (0.531 vs. 0.669 p column, respectively). With the introduction of variable angle locking compression plates, the revised 3-column classification approach is a very helpful tool in the preoperative surgical planning of tibial plateau fractures, in particular, lateral column fractures that extend into the posterolateral corner. The revised 3-column classification approach is rather a practical supplement to the Schatzker classification. It has a significantly higher interobserver reliability as compared to the
Patient-specific three-dimensional printing for pre-surgical planning in hepatocellular carcinoma treatment.
Perica, Elizabeth; Sun, Zhonghua
Recently, three-dimensional (3D) printing has shown great interest in medicine, and 3D printed models may be rendered as part of the pre-surgical planning process in order to better understand the complexities of an individual's anatomy. The aim of this study is to investigate the feasibility of utilising 3D printed liver models as clinical tools in pre-operative planning for resectable hepatocellular carcinoma (HCC) lesions. High-resolution contrast-enhanced computed tomography (CT) images were acquired and utilized to generate a patient-specific 3D printed liver model. Hepatic structures were segmented and edited to produce a printable model delineating intrahepatic anatomy and a resectable HCC lesion. Quantitative assessment of 3D model accuracy compared measurements of critical anatomical landmarks acquired from the original CT images, standard tessellation language (STL) files, and the 3D printed liver model. Comparative analysis of surveys completed by two radiologists investigated the clinical value of 3D printed liver models in radiology. The application of utilizing 3D printed liver models as tools in surgical planning for resectable HCC lesions was evaluated through kappa analysis of questionnaires completed by two abdominal surgeons. A scaled down multi-material 3D liver model delineating patient-specific hepatic anatomy and pathology was produced, requiring a total production time of 25.25 hours and costing a total of AUD $1,250. A discrepancy was found in the total mean of measurements at each stage of production, with a total mean of 18.28±9.31 mm for measurements acquired from the original CT data, 15.63±8.06 mm for the STL files, and 14.47±7.71 mm for the 3D printed liver model. The 3D liver model did not enhance the radiologists' perception of patient-specific anatomy or pathology. Kappa analysis of the surgeon's responses to survey questions yielded a percentage agreement of 80%, and a κ value of 0.38 (P=0.24) indicating fair agreement. Study
Estimation of carrying angle based on CT images in preoperative surgical planning for cubitus deformities
International Nuclear Information System (INIS)
Park, Shinsuk; Kim, Eugene
Conventionally, the carrying angle of the elbow is measured using simple two-dimensional radiography or goniometry, which has questionable reliability. This study proposes a novel method for estimating carrying angles using computed tomography that can enhance the reliability of the angle measurement. Data of CT scans from 25 elbow joints were processed to build segmented three-dimensional models. The cross-sectional centerlines of the ulna and the humerus were traced from the 3D models, and the angle between 2 vectors formed from the centerlines of the humerus and the ulna was defined as the 'three-dimensional carrying angle.' These angles were compared with those measured by simple radiograph. Two cases of angular deformity were underwent surgery based on this preoperative surgical planning, and the postoperative 3D carrying angles were evaluated using the proposed method. The mean value of the calculated three-dimensional carrying angle was 20.7deg±3.61, while it was 16.3deg±3.21 based on simple radiography without statistical difference. Based on the 3D carrying angle estimations, 2 surgical cases of cubitus deformities were planned by comparison with the normal contra-lateral elbow. Postoperative angle estimations confirmed that the corrected angles were nearly identical to the planned angles for both cases. The results of this study showed that the carrying angle can be accurately estimated using three-dimensional CT and that the proposed method is useful in evaluating deformities of the elbow with high reliability. (author)
A software system that uses artificial intelligence techniques to help with complex Space Shuttle scheduling at Kennedy Space Center is commercially available. Stottler Henke Associates, Inc.(SHAI), is marketing its automatic scheduling system, the Automated Manifest Planner (AMP), to industries that must plan and project changes many different times before the tasks are executed. The system creates optimal schedules while reducing manpower costs. Using information entered into the system by expert planners, the system automatically makes scheduling decisions based upon resource limitations and other constraints. It provides a constraint authoring system for adding other constraints to the scheduling process as needed. AMP is adaptable to assist with a variety of complex scheduling problems in manufacturing, transportation, business, architecture, and construction. AMP can benefit vehicle assembly plants, batch processing plants, semiconductor manufacturing, printing and textiles, surface and underground mining operations, and maintenance shops. For most of SHAI's commercial sales, the company obtains a service contract to customize AMP to a specific domain and then issues the customer a user license.
Critical roles of orthopaedic surgeon leadership in healthcare systems to improve orthopaedic surgical patient safety.
Kuo, Calvin C; Robb, William J
The prevention of medical and surgical harm remains an important public health problem despite increased awareness and implementation of safety programs. Successful introduction and maintenance of surgical safety programs require both surgeon leadership and collaborative surgeon-hospital alignment. Documentation of success of such surgical safety programs in orthopaedic practice is limited. We describe the scope of orthopaedic surgical patient safety issues, define critical elements of orthopaedic surgical safety, and outline leadership roles for orthopaedic surgeons needed to establish and sustain a culture of safety in contemporary healthcare systems. We identified the most common causes of preventable surgical harm based on adverse and sentinel surgical events reported to The Joint Commission. A comprehensive literature review through a MEDLINE(®) database search (January 1982 through April 2012) to identify pertinent orthopaedic surgical safety articles found 14 articles. Where gaps in orthopaedic literature were identified, the review was supplemented by 22 nonorthopaedic surgical references. Our final review included 36 articles. Six important surgical safety program elements needed to eliminate preventable surgical harm were identified: (1) effective surgical team communication, (2) proper informed consent, (3) implementation and regular use of surgical checklists, (4) proper surgical site/procedure identification, (5) reduction of surgical team distractions, and (6) routine surgical data collection and analysis to improve the safety and quality of surgical patient care. Successful surgical safety programs require a culture of safety supported by all six key surgical safety program elements, active surgeon champions, and collaborative hospital and/or administrative support designed to enhance surgical safety and improve surgical patient outcomes. Further research measuring improvements from such surgical safety systems in orthopaedic care is needed.
Individualized Surgical Approach Planning for Petroclival Tumors Using a 3D Printer.
Muelleman, Thomas John; Peterson, Jeremy; Chowdhury, Naweed Iffat; Gorup, Jason; Camarata, Paul; Lin, James
Objectives To determine the utility of three-dimensional (3D) printed models in individualized petroclival tumor resection planning by measuring the fidelity of printed anatomical structures and comparing tumor exposure afforded by different approaches. Design Case series and review of the literature. Setting Tertiary care center. Participants Three patients with petroclival lesions. Main Outcome Measures Subjective opinion of access by neuro-otologists and neurosurgeons as well as surface area of tumor exposure. Results Surgeons found the 3D models of each patient's skull and tumor useful for preoperative planning. Limitations of individual surgical approaches not identified through preoperative imaging were apparent after 3D models were evaluated. Significant variability in exposure was noted between models for similar or identical approaches. A notable drawback is that our printing process did not replicate mastoid air cells. Conclusions We found that 3D modeling is useful for individualized preoperative planning for approaching petroclival tumors. Our printing techniques did produce authentic replicas of the tumors in relation to bony structures.
Definition of postlumpectomy tumor bed for radiotherapy boost field planning: CT versus surgical clips
International Nuclear Information System (INIS)
Goldberg, Hadassah; Prosnitz, Robert G.; Olson, John A.; Marks, Lawrence B.
Purpose: To compare the location and extent of the tumor bed as defined by surgical clips and computed tomography (CT) scans, after lumpectomy, for electron boost planning as part of breast radiotherapy. Methods and Materials: Planning CT images of 31 operated breasts in 30 patients who underwent lumpectomy were reviewed. One or more clips were placed in the lumpectomy cavity. Serial CT images were used to measure the depth and transverse and longitudinal dimensions. The area and geometric center of the tumor bed were defined by the clips and CT. Results: The CT and clip measurements were identical for the maximal tumor depth in 27 of 30 patients. The CT bed extended beyond the clips by 0-7 mm medially in the transverse/longitudinal extent (multiclip patients). The median distance between the geometric centers in the coronal plane for the tumor bed center was larger for patients with single clips than for those with multiple clips (p 2 . The CT bed was more readily visible in patients with a shorter interval between surgery and radiotherapy. Conclusion: The maximal depth of the tumor bed was similar using the two methods. The extent and centers of the clip-and CT-determined beds differed significantly. This may indicate an underestimation of the tumor bed as defined by clips only and justifies integration of CT information in boost field planning
Directory of Open Access Journals (Sweden)
Lola Yorita Astri
Full Text Available An integrated information system is needed in an enterprise to support businessprocesses run by an enterprise. Therefore, to develop information system can use enterprisearchitecture approach which can define strategic planning of enterprise information system. SMPNegeri 1 Jambi can be viewed as an enterprise because there are entities that should be managedthrough an integrated information system. Since there has been no unification of different elementsin a unity yet, enterprise architecture model using Enterprise Architecture Planning (EAP isneeded which will obtain strategic planning of enterprise information system in SMP Negeri 1Jambi. The goal of strategic planning of information system with Enterprise Architecture Planning(EAP is to define primary activities run by SMP Negeri 1 Jambi and support activities supportingprimary activities. They can be used as a basis for making data architecture which is the entities ofapplication architecture. At last, technology architecture is designed to describe technology neededto provide environment for data application. The plan of implementation is the activity plan madeto implemented architectures by enterprise.
Postoperative Surgical Site Infections: Understanding the Discordance Between Surveillance Systems.
Ali-Mucheru, Mariam N; Seville, Maria T; Miller, Vickie; Sampathkumar, Priya; Etzioni, David A
To characterize agreement in the ascertainment of surgical site infections (SSIs) between the National Surgical Quality Improvement Program (NSQIP), National Healthcare Safety Network (NHSN), and administrative data. The NSQIP, NHSN, and administrative data are the primary systems used to monitor and report SSIs for the purpose of quality control and benchmarking of hospitals and surgeons. These systems have different methods for identifying SSIs. We queried the NHSN, NSQIP, and administrative data systems for patients who had an operation at 1 of 4 hospitals within a single health system between January 2013 and September 2015. The detection of an SSI during a postoperative hospitalization was the outcome of analysis. Any SSI detected by one (or more) of these systems was analyzed by 2 reviewers to determine the presence of discrete elements of documentation constituting evidence of SSI. Concordance between the 3 systems (NHSN, NSQIP, and administrative data) was analyzed using Cohen's kappa. After application of appropriate exclusion criteria, a cohort of 9447 inpatient operations was analyzed. In total, 130 SSIs were detected by 1 or more of the 3 systems, with reported SSI rates of 0.5% (NHSN), 0.7% (administrative data), and 1.0% (NSQIP). Of these 130 SSIs, only 17 SSIs were reported by all 3 systems. The concordance between these 3 systems was moderate (kappa values NSQIP-NHSN = 0.50 [0.40-0.60], administrative-NHSN = 0.36 [0.24-0.47], and administrative-NSQIP = 0.47 [0.38-0.57]). Chart review found that reasons for discordance were related to issues of different criteria as well as inaccuracies. There is significant discordance in the determination of SSIs reported by the NHSN, NSQIP, and administrative data. The differences and limitations of each of these systems have to be recognized, especially when using these data for quality reports and pay for performance.
A Quantitative Exposure Planning Tool for Surgical Approaches to the Sacroiliac Joint.
Phelps, Kevin D; Ming, Bryan W; Fox, Wade E; Bellamy, Nelly; Sims, Stephen H; Karunakar, Madhav A; Hsu, Joseph R
To aid in surgical planning by quantifying and comparing the osseous exposure between the anterior and posterior approaches to the sacroiliac joint. Anterior and posterior approaches were performed on 12 sacroiliac joints in 6 fresh-frozen torsos. Visual and palpable access to relevant surgical landmarks was recorded. Calibrated digital photographs were taken of each approach and analyzed using Image J. The average surface areas of exposed bone were 44 and 33 cm for the anterior and posterior approaches, respectively. The anterior iliolumbar ligament footprint could be visualized in all anterior approaches, whereas the posterior aspect could be visualized in all but one posterior approach. The anterior approach provided visual and palpable access to the anterior superior edge of the sacroiliac joint in all specimens, the posterior superior edge in 75% of specimens, and the inferior margin in 25% and 50% of specimens, respectively. The inferior sacroiliac joint was easily visualized and palpated in all posterior approaches, although access to the anterior and posterior superior edges was more limited. The anterior S1 neuroforamen was not visualized with either approach and was more consistently palpated when going posterior (33% vs. 92%). Both anterior and posterior approaches can be used for open reduction of pure sacroiliac dislocations, each with specific areas for assessing reduction. In light of current plate dimensions, fractures more than 2.5 cm lateral to the anterior iliolumbar ligament footprint are amenable to anterior plate fixation, whereas those more medial may be better addressed through a posterior approach.
Planning surgical reconstruction in Treacher-Collins syndrome using virtual simulation.
Nikkhah, Dariush; Ponniah, Allan; Ruff, Cliff; Dunaway, David
Treacher-Collins syndrome is a rare autosomal dominant condition of varying phenotypic expression. The surgical correction in this syndrome is difficult, and the approach varies between craniofacial departments worldwide. The authors aimed to design standardized tools for planning orbitozygomatic and mandibular reconstruction in Treacher-Collins syndrome using geometric morphometrics. The Great Ormond Street Hospital database was retrospectively identified for patients with Treacher-Collins syndrome. Thirteen children (aged 2 to 15 years) who had suitable preoperative three-dimensional computed tomographic head scans were included. Six Treacher-Collins syndrome three-dimensional computed tomographic head scans were quantitatively compared using a template of 96 anatomically defined landmarks to 26 age-matched normal dry skulls. Thin-plate spline videos illustrated the characteristic deformities of retromicrognathia and maxillary and orbitozygomatic hypoplasia in the Treacher-Collins syndrome population. Geometric morphometrics was used in the virtual reconstruction of the orbitozygomatic and mandibular region in Treacher-Collins syndrome patients. Intrarater and interrater reliability of the landmarks was acceptable and within a standard deviation of less than 1 mm on 97 percent and 100 percent of 10 repeated scans, respectively. Virtual normalization of the Treacher-Collins syndrome skull effectively describes characteristic skeletal deformities and provides a useful guide to surgical reconstruction. Size-matched stereolithographic templates derived from thin-plate spline warps can provide effective intraoperative templates for zygomatic and mandibular reconstruction in the Treacher-Collins syndrome patient. Diagnostic, V.
The combined use of senometry and ultrasonography for breast cancer surgical planning
Directory of Open Access Journals (Sweden)
Ștefan Voiculescu
Full Text Available Ultrasound exerts an important role in breast cancer diagnosis protocol, but the use of eco-senometry can also improve therapeutic options, surgical planning and technique. We describe various measurement formulas and techniques that are applied in order to acquire important information regarding the breast and its lesions. Senometry and ultrasonography have been proven to be very effective, reaching up to reliability levels as high as 0.997 and accuracy levels as high as 99.6%. Senometry and ultrasonography have clearly demonstrated their value in breast cancer diagnosis and treatment. These methods are reliable, inexpensive and can be easily performed by the surgeon. More advances in the domain are expected in the future.
A multicenter prospective study of surgical audit systems.
Haga, Yoshio; Ikejiri, Koji; Wada, Yasuo; Takahashi, Tadateru; Ikenaga, Masakazu; Akiyama, Noriyoshi; Koike, Shoichiro; Koseki, Masato; Saitoh, Toshihiro
This study was undertaken to evaluate a modified form of Estimation of Physiologic Ability and Surgical Stress (E-PASS) for surgical audit comparing with other existing models. Although several scoring systems have been devised for surgical audit, no nation-wide survey has been performed yet. We modified our previous E-PASS surgical audit system by computing the weights of 41 procedures, using data from 4925 patients who underwent elective digestive surgery, designated it as mE-PASS. Subsequently, a prospective cohort study was conducted in 43 national hospitals in Japan from April 1, 2005, to April 8, 2007. Variables for the E-PASS and American Society of Anesthesiologists (ASA) status-based model were collected for 5272 surgically treated patients. Of the 5272 patients, we also collected data for the Portsmouth modification of Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) in 3128 patients. The area under the receiver operative characteristic curve (AUC) was used to evaluate discrimination performance to detect in-hospital mortality. The ratio of observed to estimated in-hospital mortality rates (OE ratio) was defined as a measure of quality. The numbers of variables required were 10 for E-PASS, 7 for mE-PASS, 20 for P-POSSUM, and 4 for the ASA status-based model. The AUC (95% confidence interval) values were 0.86 (0.79-0.93) for E-PASS, 0.86 (0.79-0.92) for mE-PASS, 0.81 (0.75-0.88) for P-POSSUM, and 0.73 (0.63-0.83) for the ASA status-based model. The OE ratios for mE-PASS among large-volume hospitals significantly correlated with those for E-PASS (R = 0.93, N = 9, P = 0.00026), P-POSSUM (R = 0.96, N = 6, P = 0.0021), and ASA status-based model (R = 0.83, N = 9, P = 0.0051). Because of its features of easy use, accuracy, and generalizability, mE-PASS is a candidate for a nation-wide survey.
49 CFR 659.25 - Annual review of system safety program plan and system security plan.
... system security plan. 659.25 Section 659.25 Transportation Other Regulations Relating to Transportation... and system security plan. (a) The oversight agency shall require the rail transit agency to conduct an annual review of its system safety program plan and system security plan. (b) In the event the rail...
Geographic information system planning and monitoring best ...
African Journals Online (AJOL)
Poor urbanization policies, inefficient planning and monitoring technologies are evident. The consequences include some of the worst types of environmental hazards. Best urbanization practices require integrated planning approaches that result in environmental conservation. Geographic Information systems (GIS) provide ...
SCANPLAN planning system for medical accelerators
International Nuclear Information System (INIS)
Ovsyannikov, D.A.; Sergeev, S.L.; Stuchenkov, A.B.; Vorogushin, M.F.; Tikhomirov, A.S.; Shishov, V.A.
The SCANPLAN automatic system for planning and documentation of every treatment of the photon radiotherapy is described. The system is oriented at the operating systems Windows 98, 2000 and is developed with using the Visual Studio 6.0 technology. This system consists of the following components: planning unit, module for preparation of anatomical information, data base and patient catalogs [ru
Functional MRI in pre-surgical planning: Case study and cautionary notes
Directory of Open Access Journals (Sweden)
Bruce S Spottiswoode
Full Text Available Background. Since its inception almost 20 years ago, functional magnetic resonance imaging (fMRI has greatly advanced our knowledge of human brain function. Although the clinical applications of fMRI are still limited, there have recently been encouraging advances for its use in pre-operative functional cortical mapping to identify potentially eloquent areas prior to neurosurgery. Objectives. We explore the potential use of this emerging technique by presenting a neurosurgical case study, as performed at the Cape Universities Brain Imaging Centre (CUBIC, Tygerberg, Cape Town. We conclude with a brief summary of the potential pitfalls of this technique, as well as cautionary guidelines based on our experience. Methods and results. A 22-year-old male patient from Tygerberg Hospital underwent the successful resection of an anaplastic astrocytoma after fMRI presurgical planning at our facility. The subject was able to leave the ward unassisted. Conclusion. If consideration is given to the many limitations of this emerging technique, fMRI can be useful in aiding the neurosurgeon in pre-operative planning of his surgical approach.
Breast MRI in Invasive Lobular Carcinoma: A Useful Investigation in Surgical Planning?
Parvaiz, Muhammad Asad; Yang, Peiming; Razia, Eisha; Mascarenhas, Margaret; Deacon, Caroline; Matey, Pilar; Isgar, Brian; Sircar, Tapan
Magnetic resonance imaging (MRI) is highly sensitive in detecting invasive lobular carcinoma (ILC) of the breast. In our institution, patients who are deemed to be suitable for breast conserving surgery (BCS) with unifocal small ILC on standard imaging are offered breast MRI to exclude multifocal and larger ILC. Our study investigates the usefulness of breast MRI in ILC. A prospective cohort study over a 58-month period, including all consecutive patients with ILC having breast MRI. Primary objective was to find out the proportion of ILC patients where preoperative MRI caused a change in the surgical treatment. Secondary objectives included finding mastectomy rate (initial & final), re-operation rate, cancer size correlation with different imaging modalities and final histopathology, loco-regional recurrence and disease-free survival. A total of 334 bilateral breast MRI were performed including 72 (21.5%) MRI for ILC patients. All these MRI were carried out within 2 week of patients given the diagnosis (median 5.5 days). Age range was 24-83 (median 56.5) years. Nineteen of 72 ILC patients (26.4%) had a change in their planned operation from BCS to a different operation owing to MRI findings (seven patients with multifocal cancers, 10 with significantly larger size of the cancer and two with contralateral malignancy). Initial mastectomy rate was 31.9%, final mastectomy rate was 36.1% and re-operation rate in BCS group was 18.3%. MRI correlated better with ILC histopathology cancer size than mammogram and ultrasound scans. There was no statistically significant difference (p = 0.999) between the cancer size on histology (median 23 mm) and MRI (median 25 mm). However, mammogram (median 17 mm) and ultrasound (median 14.5 mm) scans showed cancer sizes significantly different to final histology cancer size (p = 0.0008 and p = 0.0021 respectively). Over a 44 months median follow-up (range 27-85), 95.8% disease-free survival and 98.6% overall survival have been observed
Construction of a remote radiotherapy planning system
International Nuclear Information System (INIS)
Ogawa, Yoshihiro; Nemoto, Kenji; Takahashi, Chiaki; Takai, Yoshihiro; Yamada, Shogo; Seiji, Hiromasa; Sasaki, Kazuya
We constructed a remote radiotherapy planning system, and we examined the usefulness of and faults in our system in this study. Two identical radiotherapy planning systems, one installed at our institution and the other installed at an affiliated hospital, were used for radiotherapy planning. The two systems were connected by a wide area network (WAN), using a leased line. Beam data for the linear accelerator at the affiliated hospital were installed in the two systems. During the period from December 2001 to December 2002, 43 remote radiotherapy plans were made using this system. Data were transmitted using a file transfer protocol (FTP) software program. The 43 radiotherapy plans examined in this study consisted of 13 ordinary radiotherapy plans, 28 radiotherapy plans sent to provide assistance for medical residents, and 2 radiotherapy plans for emergency cases. There were ten minor planning changes made in radiotherapy plans sent to provide assistance for medical residents. Our remote radiotherapy planning system based on WAN using a leased line is useful for remote radiotherapy, with advantages for both radiation oncologists and medical residents. (author)
A highly articulated robotic surgical system for minimally invasive surgery.
Ota, Takeyoshi; Degani, Amir; Schwartzman, David; Zubiate, Brett; McGarvey, Jeremy; Choset, Howie; Zenati, Marco A
We developed a novel, highly articulated robotic surgical system (CardioARM) to enable minimally invasive intrapericardial therapeutic delivery through a subxiphoid approach. We performed preliminary proof of concept studies in a porcine preparation by performing epicardial ablation. CardioARM is a robotic surgical system having an articulated design to provide unlimited but controllable flexibility. The CardioARM consists of serially connected, rigid cyclindrical links housing flexible working ports through which catheter-based tools for therapy and imaging can be advanced. The CardioARM is controlled by a computer-driven, user interface, which is operated outside the operative field. In six experimental subjects, the CardioARM was introduced percutaneously through a subxiphoid access. A commercial 5-French radiofrequency ablation catheter was introduced through the working port, which was then used to guide deployment. In all subjects, regional ("linear") left atrial ablation was successfully achieved without complications. Based on these preliminary studies, we believe that the CardioARM promises to enable deployment of a number of epicardium-based therapies. Improvements in imaging techniques will likely facilitate increasingly complex procedures.
International Nuclear Information System (INIS)
Certa, P.J.; Kirkbride, R.A.; Hohl, T.M.; Empey, P.A.; Wells, M.N.
The U.S. Department of Energy (DOE), Office of River Protection (ORP) manages the River Protection Project (RPP). The RPP mission is to retrieve and treat Hanford's tank waste and close the tank farms to protect the Columbia River. As a result, ORP is responsible for the retrieval, treatment, and disposal of approximately 57 million gallons 1 of radioactive waste contained in the Hanford Site waste tanks and closure2 of all the tanks and associated facilities. The previous revision of the System Plan was issued in May 2008. ORP has made a number of changes to the tank waste treatment strategy and plans since the last revision of this document, and additional changes are under consideration. ORP has contracts in place to implement the strategy for completion of the mission and establish the capability to complete the overall mission. The current strategl involves a number of interrelated activities. ORP will reduce risk to the environment posed by tank wastes by the following: (1) Retrieving the waste from the single-shell tanks (SST) to double-shell tanks (DST) and delivering the waste to the Waste Treatment and Immobilization Plant (WTP). (2) Constructing and operating the WTP, which will safely treat all of the high-level waste (HLW) fraction contained in the tank farms. About one-third of the low-activity waste (LAW) fraction separated from the HLW fraction in the WTP will be immobilized in the WTP LAW Vitrification Facility. (3) Developing and deploying supplemental treatment capability assumed to be a second LAW vitrification facility that can safely treat about two-thirds of the LAW contained in the tank farms. (4) Developing and deploying supplemental pretreatment capability currently assumed to be an Aluminum Removal Facility (ARF) using a lithium hydrotalcite process to mitigate sodium management issues. (5) Developing and deploying treatment and packaging capability for contact-handled transuranic (CH-TRU) tank waste for possible shipment to and disposal
Energy Technology Data Exchange (ETDEWEB)
The U.S. Department of Energy (DOE), Office of River Protection (ORP) manages the River Protection Project (RPP). The RPP mission is to retrieve and treat Hanford's tank waste and close the tank farms to protect the Columbia River. As a result, ORP is responsible for the retrieval, treatment, and disposal of approximately 57 million gallons 1 of radioactive waste contained in the Hanford Site waste tanks and closure2 of all the tanks and associated facilities. The previous revision of the System Plan was issued in May 2008. ORP has made a number of changes to the tank waste treatment strategy and plans since the last revision of this document, and additional changes are under consideration. ORP has contracts in place to implement the strategy for completion of the mission and establish the capability to complete the overall mission. The current strategl involves a number of interrelated activities. ORP will reduce risk to the environment posed by tank wastes by the following: (1) Retrieving the waste from the single-shell tanks (SST) to double-shell tanks (DST) and delivering the waste to the Waste Treatment and Immobilization Plant (WTP). (2) Constructing and operating the WTP, which will safely treat all of the high-level waste (HLW) fraction contained in the tank farms. About one-third of the low-activity waste (LAW) fraction separated from the HLW fraction in the WTP will be immobilized in the WTP LAW Vitrification Facility. (3) Developing and deploying supplemental treatment capability assumed to be a second LAW vitrification facility that can safely treat about two-thirds of the LAW contained in the tank farms. (4) Developing and deploying supplemental pretreatment capability currently assumed to be an Aluminum Removal Facility (ARF) using a lithium hydrotalcite process to mitigate sodium management issues. (5) Developing and deploying treatment and packaging capability for contact-handled transuranic (CH-TRU) tank waste for possible shipment to and
Expansion planning for electrical generating systems
International Nuclear Information System (INIS)
The guidebook outlines the general principles of electric power system planning in the context of energy and economic planning in general. It describes the complexities of electric system expansion planning that are due to the time dependence of the problem and the interrelation between the main components of the electric system (generation, transmission and distribution). Load forecasting methods are discussed and the principal models currently used for electric system expansion planning presented. Technical and economic information on power plants is given. Constraints imposed on power system planning by plant characteristics (particularly nuclear power plants) are discussed, as well as factors such as transmission system development, environmental considerations, availability of manpower and financial resources that may affect the proposed plan. A bibliography supplements the references that appear in each chapter, and a comprehensive glossary defines terms used in the guidebook
Energy Technology Data Exchange (ETDEWEB)
The U.S. Department of Energy (DOE), Office of River Protection (ORP) manages the River Protection Project (RPP). The RPP mission is to retrieve and treat Hanford's tank waste and close the tank farms to protect the Columbia River. As a result, the ORP is responsible for the retrieval, treatment, and disposal of the approximately 57 million gallons of radioactive waste contained in the Hanford Site waste tanks and closure of all the tanks and associated facilities. The previous revision of the System Plan was issued in September 2003. ORP has approved a number of changes to the tank waste treatment strategy and plans since the last revision of this document, and additional changes are under consideration. The ORP has established contracts to implement this strategy to establish a basic capability to complete the overall mission. The current strategy for completion of the mission uses a number of interrelated activities. The ORP will reduce risk to the environment posed by tank wastes by: (1) Retrieving the waste from the single-shell tanks (SST) to double-shell tanks (DST) for treatment and disposal; (2) Constructing and operating the WTP, which will safely treat all of the high-level waste (HLW) and about half of the low-activity waste (LAW) contained in the tank farms, and maximizing its capability and capacity; (3) Developing and deploying supplemental treatment capability or a second WTP LAW Facility that can safely treat about half of the LAW contained in the tank farms; (4) Developing and deploying treatment and packaging capability for transuranic (TRU) tank waste for shipment to and disposal at the Waste Isolation Pilot Plant (WIPP); (5) Deploying interim storage capacity for the immobilized HLW and shipping that waste to Yucca Mountain for disposal; (6) Operating the Integrated Disposal Facility for the disposal of immobilized LAW, along with the associated secondary waste, (7) Closing the SST and DST tank farms, ancillary facilities, and al1 waste
International Nuclear Information System (INIS)
The U.S. Department of Energy (DOE), Office of River Protection (ORP) manages the River Protection Project (RPP). The RPP mission is to retrieve and treat Hanford's tank waste and close the tank farms to protect the Columbia River. As a result, the ORP is responsible for the retrieval, treatment, and disposal of the approximately 57 million gallons of radioactive waste contained in the Hanford Site waste tanks and closure of all the tanks and associated facilities. The previous revision of the System Plan was issued in September 2003. ORP has approved a number of changes to the tank waste treatment strategy and plans since the last revision of this document, and additional changes are under consideration. The ORP has established contracts to implement this strategy to establish a basic capability to complete the overall mission. The current strategy for completion of the mission uses a number of interrelated activities. The ORP will reduce risk to the environment posed by tank wastes by: (1) Retrieving the waste from the single-shell tanks (SST) to double-shell tanks (DST) for treatment and disposal; (2) Constructing and operating the WTP, which will safely treat all of the high-level waste (HLW) and about half of the low-activity waste (LAW) contained in the tank farms, and maximizing its capability and capacity; (3) Developing and deploying supplemental treatment capability or a second WTP LAW Facility that can safely treat about half of the LAW contained in the tank farms; (4) Developing and deploying treatment and packaging capability for transuranic (TRU) tank waste for shipment to and disposal at the Waste Isolation Pilot Plant (WIPP); (5) Deploying interim storage capacity for the immobilized HLW and shipping that waste to Yucca Mountain for disposal; (6) Operating the Integrated Disposal Facility for the disposal of immobilized LAW, along with the associated secondary waste, (7) Closing the SST and DST tank farms, ancillary facilities, and al1 waste
Patient-specific model of a scoliotic torso for surgical planning
Harmouche, Rola; Cheriet, Farida; Labelle, Hubert; Dansereau, Jean
A method for the construction of a patient-specific model of a scoliotic torso for surgical planning via inter-patient registration is presented. Magnetic Resonance Images (MRI) of a generic model are registered to surface topography (TP) and X-ray data of a test patient. A partial model is first obtained via thin-plate spline registration between TP and X-ray data of the test patient. The MRIs from the generic model are then fit into the test patient using articulated model registration between the vertebrae of the generic model's MRIs in prone position and the test patient's X-rays in standing position. A non-rigid deformation of the soft tissues is performed using a modified thin-plate spline constrained to maintain bone rigidity and to fit in the space between the vertebrae and the surface of the torso. Results show average Dice values of 0:975 +/- 0:012 between the MRIs following inter-patient registration and the surface topography of the test patient, which is comparable to the average value of 0:976 +/- 0:009 previously obtained following intra-patient registration. The results also show a significant improvement compared to rigid inter-patient registration. Future work includes validating the method on a larger cohort of patients and incorporating soft tissue stiffness constraints. The method developed can be used to obtain a geometric model of a patient including bone structures, soft tissues and the surface of the torso which can be incorporated in a surgical simulator in order to better predict the outcome of scoliosis surgery, even if MRI data cannot be acquired for the patient.
Rapid Automated Mission Planning System, Phase II
National Aeronautics and Space Administration — The proposed innovation is an automated UAS mission planning system that will rapidly identify emergency (contingency) landing sites, manage contingency routing, and...
System i Disaster Recovery Planning
Dolewski, Richard
Mapping out all the preparations necessary for an effective disaster recovery plan and its safeguard-a continuous maintenance program-this guide is aimed at IT managers of small and medium businesses. The opening section covers the initial steps of auditing vulnerability, ranking essential IT functions, and reviewing the storage of tape backups, with the following discussion focused on the elements of the plan itself. The plan includes a mission statement, a definition of disaster, the assignment of staff to teams, methods of compensating for human error, and standards for documenting the step
Radwaste treatment complex. DRAWMACS planned maintenance system
International Nuclear Information System (INIS)
Keel, A.J.
This document describes the operation of the Planned Maintenance System for the Radwaste Treatment Complex. The Planned Maintenance System forms part of the Decommissioning and Radwaste Management Computer System (DRAWMACS). Further detailed information about the data structure of the system is contained in Database Design for the DRAWMACS Planned Maintenance System (AEA-D and R-0285, 2nd issue, 25th February 1992). Information for other components of DRAWMACS is contained in Basic User Guide for the Radwaste Treatment Plant Computer System (AEA-D and R-0019, July 1990). (author)
Planning and design of information systems
Blokdijk, André
Planning and Design of Information Systems provides a theoretical base and a practical method of executing the planning of computerized information systems, and the planning and design of individual applications. The book is organized into five parts, covering the non-technical and nonimplementational part of information systems planning, design, and development. Part I gives the theoretical base for the subsequent parts of the book. It discusses modeling, techniques, notations, boundaries, quality issues and aspects, and decomposition techniques and problems. Part II discusses the needs, prob
Impact of 3D virtual planning on reconstruction of mandibular and maxillary surgical defects in head and neck oncology.
Witjes, Max J H; Schepers, Rutger H; Kraeima, Joep
This review describes the advances in 3D virtual planning for mandibular and maxillary reconstruction surgical defects with full prosthetic rehabilitation. The primary purpose is to provide an overview of various techniques that apply 3D technology safely in primary and secondary reconstructive cases of patients suffering from head and neck cancer. Methods have been developed to overcome the problem of control over the margin during surgery while the crucial decision with regard to resection margin and planning of osteotomies were predetermined by virtual planning. The unlimited possibilities of designing patient-specific implants can result in creative uniquely applied solutions for single cases but should be applied wisely with knowledge of biomechanical engineering principles. The high surgical accuracy of an executed 3D virtual plan provides tumor margin control during ablative surgery and the possibility of planned combined use of osseus free flaps and dental implants in the reconstruction in one surgical procedure. A thorough understanding of the effects of radiotherapy on the reconstruction, soft tissue management, and prosthetic rehabilitation is imperative in individual cases when deciding to use dental implants in patients who received radiotherapy.
Complex Osteotomies of Tibial Plateau Malunions Using Computer-Assisted Planning and Patient-Specific Surgical Guides.
Fürnstahl, Philipp; Vlachopoulos, Lazaros; Schweizer, Andreas; Fucentese, Sandro F; Koch, Peter P
The accurate reduction of tibial plateau malunions can be challenging without guidance. In this work, we report on a novel technique that combines 3-dimensional computer-assisted planning with patient-specific surgical guides for improving reliability and accuracy of complex intraarticular corrective osteotomies. Preoperative planning based on 3-dimensional bone models was performed to simulate fragment mobilization and reduction in 3 cases. Surgical implementation of the preoperative plan using patient-specific cutting and reduction guides was evaluated; benefits and limitations of the approach were identified and discussed. The preliminary results are encouraging and show that complex, intraarticular corrective osteotomies can be accurately performed with this technique. For selective patients with complex malunions around the tibia plateau, this method might be an attractive option, with the potential to facilitate achieving the most accurate correction possible.
Transperineal Ultrasound as a Tool to Plan Surgical Strategies in Pediatric Urology: Back to the Future?
de Jesus, Lisieux Eyer; Fazecas, Tatiana; Ribeiro, Bianca G; Dekermacher, Samuel
To demonstrate the usefulness and advantages of transperineal ultrasound (TPUS) on planning the surgical tactics to treat childhood pelviperineal disease (CPPD). A cohort of CPPD is reviewed to provide a pictorial review of TPUS as imaging method variety of CPPD. Other imaging methods are compared with TPUS. TPUS studies of patients showing different conditions on the spectrum of pelviperineal malformation are shown in detail (pictorial review, graphically shown-see figures in the article and as supplementary material), highlighting the advantages of the method and comparing TPUS findings with other imaging techniques. Magnetic resonance imaging, contrast genitograms, voiding cystourethrography, and genital or urologic endoscopy have some important disadvantages, especially radiation exposure, high cost, not easily available equipment, and the need of general anesthesia or deep sedation in children. TPUS is easily available, including in impoverished environments, portable, painless, reproducible, inexpensive, and capable of providing detailed and specific information about pelviperineal malformation with accuracy. Data provided by TPUS are comparable with other imaging techniques (Table 1). Its main disadvantage is the dependency on the expertise of the operator to obtain high-quality, well-interpreted images. Copyright © 2017 Elsevier Inc. All rights reserved.
Tank waste remediation system environmental program plan
Energy Technology Data Exchange (ETDEWEB)
Borneman, L.E.
This Environmental Program Plan has been developed in support of the Integrated Environmental, Safety and Health Management System and consistent with the goals of DOE/RL-96-50, Hanford Strategic Plan (RL 1996a), and the specifications and guidance for ANSI/ISO 14001-1996, Environmental Management Systems Specification with guidance for use (ANSI/ISO 1996).
Tank waste remediation system environmental program plan
International Nuclear Information System (INIS)
Borneman, L.E.
This Environmental Program Plan has been developed in support of the Integrated Environmental, Safety and Health Management System and consistent with the goals of DOE/RL-96-50, Hanford Strategic Plan (RL 1996a), and the specifications and guidance for ANSI/ISO 14001-1996, Environmental Management Systems Specification with guidance for use (ANSI/ISO 1996)
A SWOT analysis of Planning Support Systems
Vonk, G.; Geertman, S.; Schot, P.P.
Insight into the strengths, weaknesses, opportunities, and threats (SWOT) of planning support systems (PSS) is fragmented between users and system developers. The lack of combined insights blocks development in the right direction and makes potential users hesitant to apply PSS in planning. This
Utility of 3D printed temporal bones in pre-surgical planning for complex BoneBridge cases.
Mukherjee, Payal; Cheng, Kai; Flanagan, Sean; Greenberg, Simon
With the advent of single-sided hearing loss increasingly being treated with cochlear implantation, bone conduction implants are reserved for cases of conductive and mixed hearing loss with greater complexity. The BoneBridge (BB, MED-EL, Innsbruck, Austria) is an active fully implantable device with no attenuation of sound energy through soft tissue. However, the floating mass transducer (FMT) part of the device is very bulky, which limits insertion in complicated ears. In this study, 3D printed temporal bones of patients were used to study its utility in preoperative planning on complicated cases. Computed tomography (CT) scans of 16 ears were used to 3D print their temporal bones. Three otologists graded the use of routine preoperative planning provided by MED-EL and that of operating on the 3D printed bone of the patient. Data were collated to assess the advantage and disadvantage of the technology. There was a statistically significant benefit in using 3D printed temporal bones to plan surgery for difficult cases of BoneBridge surgery compared to the current standard. Surgeons preferred to have the printed bones in theatre to plan their drill sites and make the transition of the planning to the patient's operation more precise. 3D printing is an innovative use of technology in the use of preoperative planning for complex ear surgery. Surgical planning can be done on the patient's own anatomy which may help to decrease operating time, reduce cost, increase surgical precision and thus reduce complications.
Cevidanes, Lucia; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael
This paper discusses the development of methods for computer-aided jaw surgery. Computer-aided jaw surgery allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery (CAS) system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3D surface models from Cone-beam CT (CBCT), dynamic cephalometry, semi-automatic mirroring, interactive cutting of bone and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intra-operative guidance. The system provides further intra-operative assistance with the help of a computer display showing jaw positions and 3D positioning guides updated in real-time during the surgical procedure. The CAS system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training and assessing the difficulties of the surgical procedures prior to the surgery. CAS has the potential to make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. Supported by NIDCR DE017727, and DE018962 PMID:20816308
Three-dimensional Cross-Platform Planning for Complex Spinal Procedures: A New Method Adaptive to Different Navigation Systems.
Kosterhon, Michael; Gutenberg, Angelika; Kantelhardt, Sven R; Conrad, Jens; Nimer Amr, Amr; Gawehn, Joachim; Giese, Alf
A feasibility study. To develop a method based on the DICOM standard which transfers complex 3-dimensional (3D) trajectories and objects from external planning software to any navigation system for planning and intraoperative guidance of complex spinal procedures. There have been many reports about navigation systems with embedded planning solutions but only few on how to transfer planning data generated in external software. Patients computerized tomography and/or magnetic resonance volume data sets of the affected spinal segments were imported to Amira software, reconstructed to 3D images and fused with magnetic resonance data for soft-tissue visualization, resulting in a virtual patient model. Objects needed for surgical plans or surgical procedures such as trajectories, implants or surgical instruments were either digitally constructed or computerized tomography scanned and virtually positioned within the 3D model as required. As crucial step of this method these objects were fused with the patient's original diagnostic image data, resulting in a single DICOM sequence, containing all preplanned information necessary for the operation. By this step it was possible to import complex surgical plans into any navigation system. We applied this method not only to intraoperatively adjustable implants and objects under experimental settings, but also planned and successfully performed surgical procedures, such as the percutaneous lateral approach to the lumbar spine following preplanned trajectories and a thoracic tumor resection including intervertebral body replacement using an optical navigation system. To demonstrate the versatility and compatibility of the method with an entirely different navigation system, virtually preplanned lumbar transpedicular screw placement was performed with a robotic guidance system. The presented method not only allows virtual planning of complex surgical procedures, but to export objects and surgical plans to any navigation or
Postimplementation Planning and Organizational Structure of Enterprise Resource Planning Systems
Wilson, Charmaine V.
Globalization, rapid technological changes, and competitive pressures have resulted in company leaders' worldwide adopting of enterprise resource planning (ERP) systems to improve productivity and business operations and reduce costs in the post-implementation phase. The research addressed organizational leaders' inability to optimize…
Usefulness of Computed Tomography in pre-surgical evaluation of maxillo-facial pathology with rapid prototyping and surgical pre-planning by virtual reality
International Nuclear Information System (INIS)
Toso, Francesco; Zuiani, Chiara; Vergendo, Maurizio; Bazzocchi, Massimo; Salvo, Iolanda; Robiony, Massimo; Politi, Massimo
Purpose. To validate a protocol for creating virtual models to be used in the construction of solid prototypes useful for the planning-simulation of maxillo-facial surgery, in particular for very complex anatomical and pathologic problems. To optimize communications between the radiology, engineering and surgical laboratories. Methods and materials. We studied 16 patients with different clinical problems of the maxillo-facial district. Exams were performed with multidetector computed tomography (MDCT) and single slice computed tomography (SDCT) with axial scans and collimation of 0.5-2 mm, and reconstruction interval of 1 mm. Subsequently we performed 2D multiplanar reconstructions and 3D volume-rendering reconstructions. We exported the DICOM images to the engineering laboratory, to recognize and isolate the bony structures by software. With these data the solid prototypes were generated using stereolitography. To date, surgery has been preformed on 12 patients after simulation of the procedure on the stereolitography model. Results. The solid prototypes constructed in the difficult cases were sufficiently detailed despite problems related to the artefacts generated by dental fillings and prostheses. In the remaining cases the MPR/3D images were sufficiently detailed for surgical planning. The surgical results were excellent in all patients who underwent surgery, and the surgeons were satisfied with the improvement in quality and the reduction in time required for the procedure. Conclusions. MDCT enables rapid prototyping using solid replication, which was very helpful in maxillofacial surgery, despite problems related to artifacts due to dental fillings and prosthesis within the acquisition field; solutions for this problem are work in progress. The protocol used for communication between the different laboratories was valid and reproducible [it
Steam Generator Inspection Planning Expert System
International Nuclear Information System (INIS)
Rzasa, P.
Applying Artificial Intelligence technology to steam generator non-destructive examination (NDE) can help identify high risk locations in steam generators and can aid in preparing technical specification compliant eddy current test (ECT) programs. A steam Generator Inspection Planning Expert System has been developed which can assist NDE or utility personnel in planning ECT programs. This system represents and processes its information using an object oriented declarative knowledge base, heuristic rules, and symbolic information processing, three artificial intelligence based techniques incorporated in the design. The output of the system is an automated generation of ECT programs. Used in an outage inspection, this system significantly reduced planning time
Vertebral column decancellation in Pott's deformity: use of Surgimap Spine for preoperative surgical planning, retrospective review of 18 patients.
Hu, Wenhao; Zhang, Xuesong; Yu, Jiayi; Hu, Fanqi; Zhang, Hao; Wang, Yan
In the late stage of Spinal tuberculosis, the bony destruction and vertebral collapse often leads to significant kyphosis, presenting clinically as a painful gibbus deformity, with increased instability, vertebral body translations and increased risk of neurologic involvement. Vertebral column decancellation is thought to be suitable for most patients with severe rigid kyphosis. Surgimap Spine, could offer a pragmatic graphical method for the surgical planning of osteotomies. The aim of this study was to evaluate the efficacy of Vertebral column decancellation planned preoperatively with the computer software-assistance in the patients with Pott's kyphosis. Between May 2012 and May 2015, 18 patients with Pott's kyphosis underwent the Vertebral column decancellation using Surgimap Spine for preoperative surgical planning. Preoperative and postoperative Konstam's angle, sagittal vertical angle, lumbar lordosis, thoracic kyphosis, pelvic tilt and pelvic incidence were measured. Visual analog scale and American Spinal Injury Association were documented. The Konstam's angles decreased from 88.1° (range, 70-105°) preoperatively to 18.5° (range, 7-31°) (P column decancellation is an effective treatment option for severe Pott's kyphosis. The surgical planning software Surgimap Spine can be a reliable and helpful tool that provides a simplified method to evaluate and analyze the spino-pelvic parameters and simulate the osteotomy procedure. According to individual character, the appropriate surgery strategy should be selected.
Task planning systems with natural language interface
International Nuclear Information System (INIS)
Kambayashi, Shaw; Uenaka, Junji
In this report, a natural language analyzer and two different task planning systems are described. In 1988, we have introduced a Japanese language analyzer named CS-PARSER for the input interface of the task planning system in the Human Acts Simulation Program (HASP). For the purpose of a high speed analysis, we have modified a dictionary system of the CS-PARSER by using C language description. It is found that the new dictionary system is very useful for a high speed analysis and an efficient maintenance of the dictionary. For the study of the task planning problem, we have modified a story generating system named Micro TALE-SPIN to generate a story written in Japanese sentences. We have also constructed a planning system with natural language interface by using the CS-PARSER. Task planning processes and related knowledge bases of these systems are explained. A concept design for a new task planning system will be also discussed from evaluations of above mentioned systems. (author)
Self-learning computers for surgical planning and prediction of postoperative alignment.
Lafage, Renaud; Pesenti, Sébastien; Lafage, Virginie; Schwab, Frank J
In past decades, the role of sagittal alignment has been widely demonstrated in the setting of spinal conditions. As several parameters can be affected, identifying the driver of the deformity is the cornerstone of a successful treatment approach. Despite the importance of restoring sagittal alignment for optimizing outcome, this task remains challenging. Self-learning computers and optimized algorithms are of great interest in spine surgery as in that they facilitate better planning and prediction of postoperative alignment. Nowadays, computer-assisted tools are part of surgeons' daily practice; however, the use of such tools remains to be time-consuming. NARRATIVE REVIEW AND RESULTS: Computer-assisted methods for the prediction of postoperative alignment consist of a three step analysis: identification of anatomical landmark, definition of alignment objectives, and simulation of surgery. Recently, complex rules for the prediction of alignment have been proposed. Even though this kind of work leads to more personalized objectives, the number of parameters involved renders it difficult for clinical use, stressing the importance of developing computer-assisted tools. The evolution of our current technology, including machine learning and other types of advanced algorithms, will provide powerful tools that could be useful in improving surgical outcomes and alignment prediction. These tools can combine different types of advanced technologies, such as image recognition and shape modeling, and using this technique, computer-assisted methods are able to predict spinal shape. The development of powerful computer-assisted methods involves the integration of several sources of information such as radiographic parameters (X-rays, MRI, CT scan, etc.), demographic information, and unusual non-osseous parameters (muscle quality, proprioception, gait analysis data). In using a larger set of data, these methods will aim to mimic what is actually done by spine surgeons, leading
Tank waste remediation system program plan
International Nuclear Information System (INIS)
Powell, R.W.
This program plan establishes the framework for conduct of the Tank Waste Remediation System (TWRS) Project. The plan focuses on the TWRS Retrieval and Disposal Mission and is specifically intended to support the DOE mid-1998 Readiness to Proceed with Privatized Waste Treatment evaluation for establishing firm contracts for waste immobilization
Tank waste remediation system program plan
Energy Technology Data Exchange (ETDEWEB)
Powell, R.W.
This program plan establishes the framework for conduct of the Tank Waste Remediation System (TWRS) Project. The plan focuses on the TWRS Retrieval and Disposal Mission and is specifically intended to support the DOE mid-1998 Readiness to Proceed with Privatized Waste Treatment evaluation for establishing firm contracts for waste immobilization.
Making surgical missions a joint operation: NGO experiences of visiting surgical teams and the formal health care system in Guatemala.
Roche, Stephanie; Hall-Clifford, Rachel
Each year, thousands of Guatemalans receive non-emergent surgical care from short-term medical missions (STMMs) hosted by local non-governmental organizations (NGOs) and staffed by foreign visiting medical teams (VMTs). The purpose of this study was to explore the perspectives of individuals based in NGOs involved in the coordination of surgical missions to better understand how these missions articulate with the larger Guatemalan health care system. During the summers of 2011 and 2013, in-depth interviews were conducted with 25 representatives from 11 different Guatemalan NGOs with experience with surgical missions. Transcripts were analysed for major themes using an inductive qualitative data analysis process. NGOs made use of the formal health care system but were limited by several factors, including cost, issues of trust and current ministry of health policy. Participants viewed the government health care system as a potential resource and expressed a desire for more collaboration. The current practices of STMMs are not conducive to health system strengthening. The role of STMMs must be defined and widely understood by all stakeholders in order to improve patient safety and effectively utilise health resources. Priority should be placed on aligning the work of VMTs with that of the larger health care system.
Not planning a sustainable transport system
International Nuclear Information System (INIS)
Finnveden, Göran; Åkerman, Jonas
The overall objective of the Swedish transport policy is to ensure the economically efficient and sustainable provision of transport services for people and business throughout the country. More specifically, the transport sector shall, among other things, contribute to the achievement of environmental quality objectives in which the development of the transport system plays an important role in the achievement of the objectives. The aim of this study is to analyse if current transport planning supports this policy. This is done by analysing two recent cases: the National Infrastructure Plan 2010–2021, and the planning of Bypass Stockholm, a major road investment. Our results show that the plans are in conflict with several of the environmental quality objectives. Another interesting aspect of the planning processes is that the long-term climate goals are not included in the planning processes, neither as a clear goal nor as factor that will influence future transport systems. In this way, the long-term sustainability aspects are not present in the planning. We conclude that the two cases do not contribute to a sustainable transport system. Thus, several changes must be made in the processes, including putting up clear targets for emissions. Also, the methodology for the environmental assessments needs to be further developed and discussed. - Highlights: • Two cases are studied to analyse if current planning supports a sustainable transport system. • Results show that the plans are in conflict with several of the environmental quality objectives. • Long-term climate goals are not included in the planning processes. • Current practices do not contribute to a sustainable planning processes. • Methodology and process for environmental assessments must be further developed and discussed
Not planning a sustainable transport system
Energy Technology Data Exchange (ETDEWEB)
Finnveden, Göran, E-mail: firstname.lastname@example.com; Åkerman, Jonas
The overall objective of the Swedish transport policy is to ensure the economically efficient and sustainable provision of transport services for people and business throughout the country. More specifically, the transport sector shall, among other things, contribute to the achievement of environmental quality objectives in which the development of the transport system plays an important role in the achievement of the objectives. The aim of this study is to analyse if current transport planning supports this policy. This is done by analysing two recent cases: the National Infrastructure Plan 2010–2021, and the planning of Bypass Stockholm, a major road investment. Our results show that the plans are in conflict with several of the environmental quality objectives. Another interesting aspect of the planning processes is that the long-term climate goals are not included in the planning processes, neither as a clear goal nor as factor that will influence future transport systems. In this way, the long-term sustainability aspects are not present in the planning. We conclude that the two cases do not contribute to a sustainable transport system. Thus, several changes must be made in the processes, including putting up clear targets for emissions. Also, the methodology for the environmental assessments needs to be further developed and discussed. - Highlights: • Two cases are studied to analyse if current planning supports a sustainable transport system. • Results show that the plans are in conflict with several of the environmental quality objectives. • Long-term climate goals are not included in the planning processes. • Current practices do not contribute to a sustainable planning processes. • Methodology and process for environmental assessments must be further developed and discussed.
Low-Cost Interactive Image-Based Virtual Endoscopy for the Diagnosis and Surgical Planning of Suprasellar Arachnoid Cysts.
Li, Ye; Zhao, Yining; Zhang, Jiashu; Zhang, Zhizhong; Dong, Guojun; Wang, Qun; Liu, Lei; Yu, Xinguang; Xu, Bainan; Chen, Xiaolei
To investigate the feasibility and reliability of virtual endoscopy (VE) as a rapid, low-cost, and interactive tool for the diagnosis and surgical planning of suprasellar arachnoid cysts (SACs). Eighteen patients with SACs treated with endoscopic ventriculocystostomy were recruited, and 18 endoscopic patients treated with third ventriculostomy were randomly selected as a VE reconstruction control group. After loading their DICOM data into free 3D Slicer software, VE reconstruction was independently performed by 3 blinded clinicians and the time required for each reconstruction was recorded. Another 3 blinded senior neurosurgeons interactively graded the visibility of VE by watching video recordings of the endoscopic procedures. Based on the visibility scores, receiver operating characteristic curve analysis was used to investigate the reliability of VE to diagnose SACs, and Bland-Altman plots were used to assess the reliability of VE for surgical planning. In addition, the intraclass correlation coefficient was calculated to estimate the consistency among the results of 3 reconstruction performers. All 3 independent reconstructing performers successfully completed VE simulation for all cases, and the average reconstruction time was 10.2 ± 9.7 minutes. The area under the receiver operating characteristic curve of the cyst visibility score was 0.96, implying its diagnostic value for SACs. The Bland-Altman plot indicated good agreement between VE and intraoperative viewings, suggesting the anatomic accuracy of the VE for surgical planning. In addition, the intraclass correlation coefficient was 0.81, which revealed excellent interperformer consistency of our simulation method. This study substantiated the feasibility and reliability of VE as a rapid, low-cost, and interactive modality for diagnosis and surgical planning of SACs. Copyright © 2016 Elsevier Inc. All rights reserved.
Inverted L osteotomy: a new approach via intraoral access through the advances of virtual surgical planning and custom fixation
Directory of Open Access Journals (Sweden)
Peter B. Franco, DMD
Full Text Available We introduce a novel surgical approach via intraoral access to the Inverted L osteotomy utilizing virtual surgical planning (VSP and patient-specific customized mandibular fixation. VSP in orthognathic surgery has been well documented in its ability to increase preoperative and intraoperative efficiency, decrease cost and operating room time, and improve predictability and patient outcomes. In addition to occlusal splints, the adjunctive cutting guides and reference templates generated through computer-aided design and computer-aided manufacturing further aids in the precise transfer of the virtual plan to the intraoperative procedure. As the application of VSP is becoming more prevalent in the surgical treatment dentofacial deformities, 3-D virtual planning is moving beyond cutting jigs and guides and into the fabrication of patient-specific customized mandibular reconstruction plates in both the orthognathic and reconstructive arenas. Orthognathic surgery can be essential for the establishment of sound function and ideal esthetics for individuals who possess a dentofacial deformity. VSP and customized mandibular reconstruction plates have great potential to help safely guide the inverted L osteotomy and produce predictable functional and esthetic results while improving efficiency preoperatively as well as intraoperatively.
Freeform fabrication of tissue-simulating phantom for potential use of surgical planning in conjoined twins separation surgery.
Shen, Shuwei; Wang, Haili; Xue, Yue; Yuan, Li; Zhou, Ximing; Zhao, Zuhua; Dong, Erbao; Liu, Bin; Liu, Wendong; Cromeens, Barrett; Adler, Brent; Besner, Gail; Xu, Ronald X
Preoperative assessment of tissue anatomy and accurate surgical planning is crucial in conjoined twin separation surgery. We developed a new method that combines three-dimensional (3D) printing, assembling, and casting to produce anatomic models of high fidelity for surgical planning. The related anatomic features of the conjoined twins were captured by computed tomography (CT), classified as five organ groups, and reconstructed as five computer models. Among these organ groups, the skeleton was produced by fused deposition modeling (FDM) using acrylonitrile-butadiene-styrene. For the other four organ groups, shell molds were prepared by FDM and cast with silica gel to simulate soft tissues, with contrast enhancement pigments added to simulate different CT and visual contrasts. The produced models were assembled, positioned firmly within a 3D printed shell mold simulating the skin boundary, and cast with transparent silica gel. The produced phantom was subject to further CT scan in comparison with that of the patient data for fidelity evaluation. Further data analysis showed that the produced model reassembled the geometric features of the original CT data with an overall mean deviation of less than 2 mm, indicating the clinical potential to use this method for surgical planning in conjoined twin separation surgery.
Tank waste remediation system risk management plan
International Nuclear Information System (INIS)
Zimmerman, B.D.
The purpose of the Tank Waste Remediation System (TWRS) Risk Management Plan is to describe a consistent approach to risk management such that TWRS Project risks are identified and managed to achieve TWRS Project success. The Risk Management Plan implements the requirements of the Tank Waste Remediation System Systems Engineering Management Plan in the area of risk management. Figure ES-1 shows the relationship of the TWRS Risk Management Plan to other major TWRS Project documents. As the figure indicates, the Risk Management Plan is a tool used to develop and control TWRS Project work. It provides guidance on how TWRS Project risks will be assessed, analyzed, and handled, and it specifies format and content for the risk management lists, which are a primary product of the risk management process. In many instances, the Risk Management Plan references the TWRS Risk Management Procedure, which provides more detailed discussion of many risk management activities. The TWRS Risk Management Plan describes an ongoing program within the TWRS Project. The Risk Management Plan also provides guidance in support of the TWRS Readiness To-Proceed (RTP) assessment package
The da vinci robot system eliminates multispecialty surgical trainees' hand dominance in open and robotic surgical settings.
Badalato, Gina M; Shapiro, Edan; Rothberg, Michael B; Bergman, Ari; RoyChoudhury, Arindam; Korets, Ruslan; Patel, Trushar; Badani, Ketan K
Handedness, or the inherent dominance of one hand's dexterity over the other's, is a factor in open surgery but has an unknown importance in robot-assisted surgery. We sought to examine whether the robotic surgery platform could eliminate the effect of inherent hand preference. Residents from the Urology and Obstetrics/Gynecology departments were enrolled. Ambidextrous and left-handed subjects were excluded. After completing a questionnaire, subjects performed three tasks modified from the Fundamentals of Laparoscopic Surgery curriculum. Tasks were performed by hand and then with the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, California). Participants were randomized to begin with using either the left or the right hand, and then switch. Left:right ratios were calculated from scores based on time to task completion. Linear regression analysis was used to determine the significance of the impact of surgical technique on hand dominance. Ten subjects were enrolled. The mean difference in raw score performance between the right and left hands was 12.5 seconds for open tasks and 8 seconds for robotic tasks (Probot tasks, respectively (Probotic and open approaches for raw time scores (Phand, prior robotic experience, and comfort level. These findings remain to be validated in larger cohorts. The robotic technique reduces hand dominance in surgical trainees across all task domains. This finding contributes to the known advantages of robotic surgery.
Country Operational Plan and Reporting System
US Agency for International Development — This web-based information system allows for the annual entry and updating of Emergency Plan COPs, annual and semiannual program results, and budget information by...
Hanford Environmental Information System Configuration Management Plan
International Nuclear Information System (INIS)
The Hanford Environmental Information System (HEIS) Configuration Management Plan establishes the software and data configuration control requirements for the HEIS and project-related databases maintained within the Environmental Restoration Contractor's data management department
An Architecture for Proof Planning Systems
Dennis, Louise Abigail
This paper presents a generic architecture for proof planning systems in terms of an interaction between a customisable proof module and search module. These refer to both global and local information contained in reasoning states.
Draft Automatic Data Acquisition System Plan
International Nuclear Information System (INIS)
This Automatic Data Acquisition System (ADAS) Plan has been prepared in support of the requirement for detailed site characterization of the Deaf Smith County candidate repository site in salt, and describes the data acquisition system which will be used for unattended data collection from the geotechnical instrumentation installed at the site. Section 1.1 discusses the programmatic background to the plan, Section 1.2 presents the scope and purpose of the plan, and the organization of the document is given in Section 1.3. 31 refs., 34 figs., 8 tabs
Mission Operations Planning and Scheduling System (MOPSS)
Wood, Terri; Hempel, Paul
MOPSS is a generic framework that can be configured on the fly to support a wide range of planning and scheduling applications. It is currently used to support seven missions at Goddard Space Flight Center (GSFC) in roles that include science planning, mission planning, and real-time control. Prior to MOPSS, each spacecraft project built its own planning and scheduling capability to plan satellite activities and communications and to create the commands to be uplinked to the spacecraft. This approach required creating a data repository for storing planning and scheduling information, building user interfaces to display data, generating needed scheduling algorithms, and implementing customized external interfaces. Complex scheduling problems that involved reacting to multiple variable situations were analyzed manually. Operators then used the results to add commands to the schedule. Each architecture was unique to specific satellite requirements. MOPSS is an expert system that automates mission operations and frees the flight operations team to concentrate on critical activities. It is easily reconfigured by the flight operations team as the mission evolves. The heart of the system is a custom object-oriented data layer mapped onto an Oracle relational database. The combination of these two technologies allows a user or system engineer to capture any type of scheduling or planning data in the system's generic data storage via a GUI.
Direct MR-arthrography of the shoulder with maximum capsular distension for surgical planning
International Nuclear Information System (INIS)
Drescher, R.; Rothenburg, T. von; Koester, O.; Schmid, G.; Ludwig, J.
Purpose: To evaluate the effectiveness of direct MR arthrography of the glenohumeral joint with maximum distension of the joint capsule in patients with glenohumeral instability for preoperative diagnosis and for determining the method of surgical intervention. Materials and Methods: MR arthrography of the shoulder joint was performed on a 1.5 T system in 38 patients. All patients suffered from anterior or bidirectional instability. Using a fluoroscopically guided posterior approach, a 1% dilution of dimeglumine gadopentetate (5 mmol Gd-DTPA/l) was injected until full capsular stretching was achieved. MR imaging protocol included fat-saturated transversal, oblique-coronal and oblique-sagittal T1-weighted spin-echo, T1-weighted 3-D and transversal T2-weighted Flash-2D. Results: MR imaging revealed significant capsule distention in 22 patients and ventral capsule defects in 9 patients. Labral lesions were depicted in 25 patients, bicipital tendon lesions in 4 patients and partial ruptures of the rotator cuff in 3 patients. 15 of the 38 patients underwent surgery. Areas of pathologic laxity of the glenohumeral capsule were correctly described in all cases. In 12 of 15 patients, the best method of intervention could be determined prospectively. In 3 of 15 patients, the necessary operation was overestimated. Regarding labral ruptures, MRI had a sensitivity of 88%, a specificity of 86%, and a diagnostic accuracy of 87%. (orig.)
Identification systems subject to plan cybersecurity
International Nuclear Information System (INIS)
Guerrero Sanz, J.; Perez Alcaniz, T.; Garcia Garcia, I.
The implementation of a Plan Cybersecurity ensures that systems and communications networks that perform functions related to both physical security such emergency action and their support systems, and interfaces that may affect them, are protected with an effective system against cyber attacks.
Joint Performance and Planning System
US Agency for International Development — A joint State/USAID system hosted by State that integrates resource and performance information at the program level and enables more flexible and frequent entry of...
A ferromagnetic surgical system reduces phrenic nerve injury in redo congenital cardiac surgery.
Shinkawa, Takeshi; Holloway, Jessica; Tang, Xinyu; Gossett, Jeffrey M; Imamura, Michiaki
A ferromagnetic surgical system (FMwand®) is a new type of dissection device expected to reduce the risk of adjacent tissue damage. We reviewed 426 congenital cardiac operations with cardiopulmonary bypass through redo sternotomy to assess if this device prevented phrenic nerve injury. The ferromagnetic surgical system was used in 203 operations (47.7%) with regular electrocautery and scissors. The preoperative and operative details were similar between the operations with or without the ferromagnetic surgical system. The incidence of phrenic nerve injury was significantly lower with the ferromagnetic surgical system (0% vs 2.7%, P = 0.031). A logistic regression model showed that the use of the ferromagnetic surgical system was significantly associated with reduced odds of phrenic nerve injury (P < 0.001). © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Tank waste remediation system configuration management plan
International Nuclear Information System (INIS)
Vann, J.M.
The configuration management program for the Tank Waste Remediation System (TWRS) Project Mission supports management of the project baseline by providing the mechanisms to identify, document, and control the functional and physical characteristics of the products. This document is one of the tools used to develop and control the mission and work. It is an integrated approach for control of technical, cost, schedule, and administrative information necessary to manage the configurations for the TWRS Project Mission. Configuration management focuses on five principal activities: configuration management system management, configuration identification, configuration status accounting, change control, and configuration management assessments. TWRS Project personnel must execute work in a controlled fashion. Work must be performed by verbatim use of authorized and released technical information and documentation. Application of configuration management will be consistently applied across all TWRS Project activities and assessed accordingly. The Project Hanford Management Contract (PHMC) configuration management requirements are prescribed in HNF-MP-013, Configuration Management Plan (FDH 1997a). This TWRS Configuration Management Plan (CMP) implements those requirements and supersedes the Tank Waste Remediation System Configuration Management Program Plan described in Vann, 1996. HNF-SD-WM-CM-014, Tank Waste Remediation System Configuration Management Implementation Plan (Vann, 1997) will be revised to implement the requirements of this plan. This plan provides the responsibilities, actions and tools necessary to implement the requirements as defined in the above referenced documents
Accuracy and role of contrast-enhanced CT in diagnosis and surgical planning in 88 soft tissue tumours of extremities
International Nuclear Information System (INIS)
Verga, Lucia; Robiati, Sara; De Marchi, Armanda; Martorano, Domenico; Faletti, Carlo; Brach del Prever, Elena Maria; Linari, Alessandra; Boffano, Michele; Piana, Raimondo
Soft tissue tumours (STT) require accurate diagnosis in order to identify potential malignancies. Preoperative planning is fundamental to avoid inadequate treatments. The role of contrast-enhanced computed tomography (CT) for local staging remains incompletely assessed. Aims of the study were to evaluate CT accuracy in discriminating active from aggressive tumours compared to histology and evaluate the role of CT angiography (CTA) in surgical planning. This retrospective cohort series of 88 cases from 1200 patients (7 %) was locally studied by contrast-enhanced CT and CTA in a referral centre: 74 malignant tumours, 14 benign lesions. Contrast-enhancement patterns and relationship of the mass with major vessels and bone were compared with histology on surgically excised samples. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) were evaluated in discriminating active from aggressive tumours. Sensitivity in differentiating aggressive tumours from active lesions was 89 %, specificity 84 %, PPV 90 %, NPV 82 %. The relationship between mass and major vessels/bone was fundamental for surgical strategy respectively in 40 % and in 58 % of malignant tumours. Contrast-enhanced CT and CTA are effective in differentiating aggressive masses from active lesions in soft tissue and in depicting the relationship between tumour and adjacent bones and major vessels. (orig.)
Rethinking Participation in Smart Energy System Planning
Lammers, Imke; Arentsen, Maarten J.
While the technical layout of smart energy systems is well advanced, the implementation of these systems is slowed down by the current decision-making practice regarding such energy infrastructures. We call for a reorganisation of the decision-making process on local energy planning and address the
Implant-Supported PMMA Monolithic Full-Arch Rehabilitation with Surgical Computer-Planned Guide and Immediate Provisional: A Case Report with One Year Follow-Up
Directory of Open Access Journals (Sweden)
Vincenzo Luca Zizzari
Full Text Available The aim of this case report is to describe the surgical and prosthetic procedures to achieve maxillary and mandibular implant-supported PMMA monolithic full-arch rehabilitation (PMFR with surgical computer-planned guide and immediate provisional. In such cases, the correct planning of dental implants' position, length, and diameter and the prosthetic phases via computer-aided design are very important to achieve good aesthetic and functional long-lasting results.
Implant-Supported PMMA Monolithic Full-Arch Rehabilitation with Surgical Computer-Planned Guide and Immediate Provisional: A Case Report with One Year Follow-Up
Zizzari, Vincenzo Luca; Tacconelli, Gianmarco
The aim of this case report is to describe the surgical and prosthetic procedures to achieve maxillary and mandibular implant-supported PMMA monolithic full-arch rehabilitation (PMFR) with surgical computer-planned guide and immediate provisional. In such cases, the correct planning of dental implants' position, length, and diameter and the prosthetic phases via computer-aided design are very important to achieve good aesthetic and functional long-lasting results.
The SEP "Robot": A Valid Virtual Reality Robotic Simulator for the Da Vinci Surgical System?
van der Meijden, O. A. J.; Broeders, I. A. M. J.; Schijven, M. P.
The aim of the study was to determine if the concept of face and construct validity may apply to the SurgicalSim Educational Platform (SEP) "robot" simulator. The SEP robot simulator is a virtual reality (VR) simulator aiming to train users on the Da Vinci Surgical System. To determine the SEP's
Tank waste remediation system engineering plan
International Nuclear Information System (INIS)
Rifaey, S.H.
This Engineering Plan describes the engineering process and controls that will be in place to support the Technical Baseline definition and manage its evolution and implementation to the field operations. This plan provides the vision for the engineering required to support the retrieval and disposal mission through Phase 1 and 2, which includes integrated data management of the Technical Baseline. Further, this plan describes the approach for moving from the ''as is'' condition of engineering practice, systems, and facilities to the desired ''to be'' configuration. To make this transition, Tank Waste Remediation System (TWRS) Engineering will become a center of excellence for TWRS which,will perform engineering in the most effective manner to meet the mission. TWRS engineering will process deviations from sitewide systems if necessary to meet the mission most effectively
NASDA knowledge-based network planning system
Yamaya, K.; Fujiwara, M.; Kosugi, S.; Yambe, M.; Ohmori, M.
One of the SODS (space operation and data system) sub-systems, NP (network planning) was the first expert system used by NASDA (national space development agency of Japan) for tracking and control of satellite. The major responsibilities of the NP system are: first, the allocation of network and satellite control resources and, second, the generation of the network operation plan data (NOP) used in automated control of the stations and control center facilities. Up to now, the first task of network resource scheduling was done by network operators. NP system automatically generates schedules using its knowledge base, which contains information on satellite orbits, station availability, which computer is dedicated to which satellite, and how many stations must be available for a particular satellite pass or a certain time period. The NP system is introduced.
Interactive orbital proximity operations planning system
Grunwald, Arthur J.; Ellis, Stephen R.
An interactive graphical planning system for on-site planning of proximity operations in the congested multispacecraft environment about the space station is presented. The system shows the astronaut a bird's eye perspective of the space station, the orbital plane, and the co-orbiting spacecraft. The system operates in two operational modes: (1) a viewpoint mode, in which the astronaut is able to move the viewpoint around in the orbital plane to range in on areas of interest; and (2) a trajectory design mode, in which the trajectory is planned. Trajectory design involves the composition of a set of waypoints which result in a fuel-optimal trajectory which satisfies all operational constraints, such as departure and arrival constraints, plume impingement constraints, and structural constraints. The main purpose of the system is to present the trajectory and the constraints in an easily interpretable graphical format. Through a graphical interactive process, the trajectory waypoints are edited until all operational constraints are satisfied. A series of experiments was conducted to evaluate the system. Eight airline pilots with no prior background in orbital mechanics participated in the experiments. Subject training included a stand-alone training session of about 6 hours duration, in which the subjects became familiar with orbital mechanics concepts and performed a series of exercises to familiarize themselves with the control and display features of the system. They then carried out a series of production runs in which 90 different trajectory design situations were randomly addressed. The purpose of these experiments was to investigate how the planning time, planning efforts, and fuel expenditures were affected by the planning difficulty. Some results of these experiments are presented.
Strategies for automatic online treatment plan reoptimization using clinical treatment planning system: A planning parameters study
International Nuclear Information System (INIS)
Li, Taoran; Wu, Qiuwen; Zhang, You; Vergalasova, Irina; Lee, W. Robert; Yin, Fang-Fang; Wu, Q. Jackie
Purpose: Adaptive radiation therapy for prostate cancer using online reoptimization provides an improved control of interfractional anatomy variations. However, the clinical implementation of online reoptimization is currently limited by the low efficiency of current strategies and the difficulties associated with integration into the current treatment planning system. This study investigates the strategies for performing fast (∼2 min) automatic online reoptimization with a clinical fluence-map-based treatment planning system; and explores the performance with different input parameters settings: dose-volume histogram (DVH) objective settings, starting stage, and iteration number (in the context of real time planning).Methods: Simulated treatments of 10 patients were reoptimized daily for the first week of treatment (5 fractions) using 12 different combinations of optimization strategies. Options for objective settings included guideline-based RTOG objectives, patient-specific objectives based on anatomy on the planning CT, and daily-CBCT anatomy-based objectives adapted from planning CT objectives. Options for starting stages involved starting reoptimization with and without the original plan's fluence map. Options for iteration numbers were 50 and 100. The adapted plans were then analyzed by statistical modeling, and compared both in terms of dosimetry and delivery efficiency.Results: All online reoptimized plans were finished within ∼2 min with excellent coverage and conformity to the daily target. The three input parameters, i.e., DVH objectives, starting stage, and iteration number, contributed to the outcome of optimization nearly independently. Patient-specific objectives generally provided better OAR sparing compared to guideline-based objectives. The benefit in high-dose sparing from incorporating daily anatomy into objective settings was positively correlated with the relative change in OAR volumes from planning CT to daily CBCT. The use of the
Geothermal energy systems plan for Boise City
Energy Technology Data Exchange (ETDEWEB)
This is a plan for development of a downtown Boise geothermal district space heating system incorporating legal, engineering, organizational, geological, and economic requirements. Topics covered include: resource characteristics, system design and feasibility, economic feasibility, legal overview, organizational alternatives, and conservation. Included in appendices are: property ownership patterns on the Boise Front, existing hot well data, legal briefs, environmental data, decision point communications, typical building heating system retrofit schematics, and background assumptions and data for cost summary. (MHR)
Tank waste remediation system program plan
International Nuclear Information System (INIS)
Powell, R.W.
This TWRS Program plan presents the planning requirements and schedules and management strategies and policies for accomplishing the TWRS Project mission. It defines the systems and practices used to establish consistency for business practices, engineering, physical configuration and facility documentation, and to maintain this consistency throughout the program life cycle, particularly as changes are made. Specifically, this plan defines the following: Mission needs and requirements (what must be done and when must it be done); Technical objectives/approach (how well must it be done); Organizational structure and philosophy (roles, responsibilities, and interfaces); and Operational methods (objectives and how work is to be conducted in both management and technical areas). The plan focuses on the TWRS Retrieval and Disposal Mission and supports the DOE mid-1998 Readiness to Proceed with Privatized Waste Treatment evaluation for establishing contracts with private contractors for the treatment (immobilization) of Hanford tank high-level radioactive waste
Tank waste remediation system program plan
Energy Technology Data Exchange (ETDEWEB)
Powell, R.W.
This TWRS Program plan presents the planning requirements and schedules and management strategies and policies for accomplishing the TWRS Project mission. It defines the systems and practices used to establish consistency for business practices, engineering, physical configuration and facility documentation, and to maintain this consistency throughout the program life cycle, particularly as changes are made. Specifically, this plan defines the following: Mission needs and requirements (what must be done and when must it be done); Technical objectives/approach (how well must it be done); Organizational structure and philosophy (roles, responsibilities, and interfaces); and Operational methods (objectives and how work is to be conducted in both management and technical areas). The plan focuses on the TWRS Retrieval and Disposal Mission and supports the DOE mid-1998 Readiness to Proceed with Privatized Waste Treatment evaluation for establishing contracts with private contractors for the treatment (immobilization) of Hanford tank high-level radioactive waste.
Intraocular robotic interventional surgical system (IRISS): Mechanical design, evaluation, and master-slave manipulation.
Wilson, Jason T; Gerber, Matthew J; Prince, Stephen W; Chen, Cheng-Wei; Schwartz, Steven D; Hubschman, Jean-Pierre; Tsao, Tsu-Chin
Since the advent of robotic-assisted surgery, the value of using robotic systems to assist in surgical procedures has been repeatedly demonstrated. However, existing technologies are unable to perform complete, multi-step procedures from start to finish. Many intraocular surgical steps continue to be manually performed. An intraocular robotic interventional surgical system (IRISS) capable of performing various intraocular surgical procedures was designed, fabricated, and evaluated. Methods were developed to evaluate the performance of the remote centers of motion (RCMs) using a stereo-camera setup and to assess the accuracy and precision of positioning the tool tip using an optical coherence tomography (OCT) system. The IRISS can simultaneously manipulate multiple surgical instruments, change between mounted tools using an onboard tool-change mechanism, and visualize the otherwise invisible RCMs to facilitate alignment of the RCM to the surgical incision. The accuracy of positioning the tool tip was measured to be 0.205±0.003 mm. The IRISS was evaluated by trained surgeons in a remote surgical theatre using post-mortem pig eyes and shown to be effective in completing many key steps in a variety of intraocular surgical procedures as well as being capable of performing an entire cataract extraction from start to finish. The IRISS represents a necessary step towards fully automated intraocular surgery and demonstrated accurate and precise master-slave manipulation for cataract removal and-through visual feedback-retinal vein cannulation. Copyright © 2017 John Wiley & Sons, Ltd.
Left lower lobe sleeve lobectomy for lung cancer using the Da Vinci surgical system.
Zhao, Yandong; Jiao, Wenjie; Ren, Xiaoyang; Zhang, Liangdong; Qiu, Tong; Fu, Bo; Wang, Lei
Despite the robotic surgery is widely applied, sleeve lobectomy for lung cancer using the Da Vinci surgical system is still less performed. We described a sleeve lobectomy for adenocarcinoma located at the left lower lobe using the Da Vinci surgical system. A case of 57-year old female referred to our hospital. Computed tomography scan showed an occupation located at the left lower lobe and adenocarcinoma project from the lobe bronchus was diagnosed by bronchoscope examination. A sleeve lobectomy was performed using the Da Vinci surgical system and the postoperative recovery was uneventful. Robotic thoracic surgery is feasible to perform sleeve lobectomy inspite of inadequate experience.
Power system restoration: planning and simulation
Energy Technology Data Exchange (ETDEWEB)
Hazarika, D. [Assam Engineering Coll., Dept. of Electrical Engineering, Assam (India); Sinha, A.K. [Inidan Inst. of Technology, Dept. of Electrical Engineering, Kharagpur (India)
This paper describes a restoration guidance simulator, which allows power system operator/planner to simulate and plan restoration events in an interactive mode. The simulator provides a list of restoration events according to the priority based on some restoration rules and list of priority loads. It also provides in an interactive mode the list of events, which becomes possible as the system grows during restoration. Further, the selected event is validated through a load flow and other analytical tools to show the consequences of implementing the planned event. (Author)
49 CFR 659.23 - System security plan: contents.
... 49 Transportation 7 2010-10-01 2010-10-01 false System security plan: contents. 659.23 Section 659... State Oversight Agency § 659.23 System security plan: contents. The system security plan must, at a... system security plan; and (e) Document the rail transit agency's process for making its system security...
Utility of 3D Reconstruction of 2D Liver Computed Tomography/Magnetic Resonance Images as a Surgical Planning Tool for Residents in Liver Resection Surgery.
Yeo, Caitlin T; MacDonald, Andrew; Ungi, Tamas; Lasso, Andras; Jalink, Diederick; Zevin, Boris; Fichtinger, Gabor; Nanji, Sulaiman
A fundamental aspect of surgical planning in liver resections is the identification of key vessel tributaries to preserve healthy liver tissue while fully resecting the tumor(s). Current surgical planning relies primarily on the surgeon's ability to mentally reconstruct 2D computed tomography/magnetic resonance (CT/MR) images into 3D and plan resection margins. This creates significant cognitive load, especially for trainees, as it relies on image interpretation, anatomical and surgical knowledge, experience, and spatial sense. The purpose of this study is to determine if 3D reconstruction of preoperative CT/MR images will assist resident-level trainees in making appropriate operative plans for liver resection surgery. Ten preoperative patient CT/MR images were selected. Images were case-matched, 5 to 2D planning and 5 to 3D planning. Images from the 3D group were segmented to create interactive digital models that the resident can manipulate to view the tumor(s) in relation to landmark hepatic structures. Residents were asked to evaluate the images and devise a surgical resection plan for each image. The resident alternated between 2D and 3D planning, in a randomly generated order. The primary outcome was the accuracy of resident's plan compared to expert opinion. Time to devise each surgical plan was the secondary outcome. Residents completed a prestudy and poststudy questionnaire regarding their experience with liver surgery and the 3D planning software. Senior level surgical residents from the Queen's University General Surgery residency program were recruited to participate. A total of 14 residents participated in the study. The median correct response rate was 2 of 5 (40%; range: 0-4) for the 2D group, and 3 of 5 (60%; range: 1-5) for the 3D group (p surgery planning increases accuracy of resident surgical planning and decreases amount of time required. 3D reconstruction would be a useful model for improving trainee understanding of liver anatomy and surgical
Upgrade plan for HANARO control computer system
International Nuclear Information System (INIS)
Kim, Min Jin; Kim, Young Ki; Jung, Hwan Sung; Choi, Young San; Woo, Jong Sub; Jun, Byung Jin
A microprocessor based digital control system, the Multi-Loop Controller (MLC), which was chosen to control HANARO, was introduced to the market in early '80s and it had been used to control petrochemical plant, paper mill and Slowpoke reactor in Canada. Due to the development in computer technology, it has become so outdated model and the production of this model was discontinued a few years ago. Hence difficulty in acquiring the spare parts is expected. To achieve stable reactor control during its lifetime and to avoid possible technical dependency to the manufacturer, a long-term replacement plan for HANARO control computer system is on its way. The plan will include a few steps in its process. This paper briefly introduces the methods of implementation of the process and discusses the engineering activities of the plan
Treatment planning systems for high precision radiotherapy
International Nuclear Information System (INIS)
Deshpande, D.D.
Computerized Treatment Planning System (TPS) play an important role in radiotherapy with the intent to maximize tumor control and minimize normal tissue complications. Treatment planning during earlier days was generally carried out through the manual summations of standard isodose charts on to patient body contours that were generated by direct tracing or lead wire representation, and relied heavily on the careful choices of beam weights and wedging. Since then there had been tremendous advances in field of Radiation Oncology in last few decades. The linear accelerators had evolved from MLC's to IGRT, the techniques like 3DCRT, IMRT has become almost routine affair. The simulation has seen transition from simple 2D film/fluoroscopy localization to CT Simulator with added development in PET, PET- CT and MR imaging. The Networking and advances in computer technology has made it possible to direct transfer of Images, contours to the treatment planning systems
The state of the vegetative nervous system in patients with gonarthrosis for surgical treatment before and after surgical treatment
Directory of Open Access Journals (Sweden)
Karaseva T.lu.
Full Text Available Aim. Analyzing the vegetative tensity of organism» functional systems before and after surgical treatment of elderly patients with metabolic-and-dystrophic gonarthrosis. Methods. The evaluation of vegetative homeostasis, reactivity of the vegetative nervous system by the data of variation pulsometry («REAN-POLY» RGPA-6/12, Taganrog in 60 patients with gonarthrosis at the age of 50-72 years and the disease duration — 9+1.5 years before and after surgical treatment: total tunnelization (Group I, tunnelization with osteotomy of leg bones for correction of limb biomechanical axis (Group II, treatment-and-diagnostic arthroscopy (Group III. Results. The reduction of the level of hypoxia tolerance and the decrease of the processes of general adaptation one month after surgery in Group I was registered in 40% of patients. As for patients of Group II, by the end of the period of fixation with the llizarov device — in 50%. As for those of Group III after arthroscopy — in 10% of patients. Among the patients whose 1С / 1С calculated parameter after surgical treatment was registered <1.0, its values were >10.0 before treatment in 70% of cases. At rest, marked vagotonia was registered with hypersympathicotonic reaction to orthotest, as well as with sharp decrease of the proportion of second-order slow waves while transition to standing position (VLF proportion <10.0%, thereby reflecting organism»s energy deficiency state. Conclusion. Preoperative examination. When VLF proportion after orthotest is registered <10.0%, such patients should be referred to risk group and prescribed in-depth examination. The index of centralization (1С dynamics for orthotest (1С test/1С rest is one of the criteria of functional recovery level for the particular patient: its increase points to the positive dynamics of restorative rehabilitative process, and the values <1.0 —to the negative one.
Gynecomastia Classification for Surgical Management: A Systematic Review and Novel Classification System.
Waltho, Daniel; Hatchell, Alexandra; Thoma, Achilleas
Gynecomastia is a common deformity of the male breast, where certain cases warrant surgical management. There are several surgical options, which vary depending on the breast characteristics. To guide surgical management, several classification systems for gynecomastia have been proposed. A systematic review was performed to (1) identify all classification systems for the surgical management of gynecomastia, and (2) determine the adequacy of these classification systems to appropriately categorize the condition for surgical decision-making. The search yielded 1012 articles, and 11 articles were included in the review. Eleven classification systems in total were ascertained, and a total of 10 unique features were identified: (1) breast size, (2) skin redundancy, (3) breast ptosis, (4) tissue predominance, (5) upper abdominal laxity, (6) breast tuberosity, (7) nipple malposition, (8) chest shape, (9) absence of sternal notch, and (10) breast skin elasticity. On average, classification systems included two or three of these features. Breast size and ptosis were the most commonly included features. Based on their review of the current classification systems, the authors believe the ideal classification system should be universal and cater to all causes of gynecomastia; be surgically useful and easy to use; and should include a comprehensive set of clinically appropriate patient-related features, such as breast size, breast ptosis, tissue predominance, and skin redundancy. None of the current classification systems appears to fulfill these criteria.
[Dental CT in the planning of surgical procedures. Its significance in the oro-maxillofacial region from the viewpoint of the dentist].
Solar, P; Gahleitner, A
Dental computer assisted tomography (Dental CT) represents a valuable addition to the diagnostic spectrum for planning oral and maxillofacial surgery. High resolution CT and specially designed computer software allow representation of the jaws in different planes that are easy to match. They further allow the display of very small structures relevant to oral surgical interventions and reveal their spatial relationship in three dimensions. Thus communication between dentists and radiologists may be intensified and supported by usage of modern telecommunication systems. Dental CT is indicated, when clinical and conventional radiological techniques will not allow exact interpretation of the situation. It is modern oral implantology that primarily benefits from computer software enabling the assessment of surgical sites in the presurgical phase. Such planning was not yet possible using two dimensional radiographic techniques. The dental-implantological part expects from radiography sharply defined contours of the external bony contours and the mandibular canal, exactly defined relation between slices and planes, no distortion in the orthoradial planes, tools for reliable measurements of distances, angles and volumes, possibility to transmit pictures electronically or on hardcopy without loss of quality.
Systemic Planning: Dealing with Complexity by a Wider Approach to Planning
DEFF Research Database (Denmark)
Leleur, Steen
and methodology that can be helpful for planning under circumstances characterised by complexity and uncertainty. It is argued that compared to conventional, planning – referred to as systematic planning - there is a need for a wider, more systemic approach to planning that is better suited to current real......On the basis of a new book Systemic Planning this paper addresses systems thinking and complexity in a context of planning. Specifically, renewal of planning thinking on this background is set out as so-called systemic planning (SP). The principal concern of SP is to provide principles...
Anatomy and Physiology. Module Set II: Major Body Systems. Teacher Edition [and] Student Edition. Surgical Technology.
Hilley, Robert
This document, which is the second part of a two-part set of modules on anatomy and physiology for future surgical technicians, contains the teacher and student editions of an introduction to anatomy and physiology that consists of modules on the following body systems: integumentary system; skeletal system; muscular system; nervous system;…
Reliability planning in distributed electric energy systems
Energy Technology Data Exchange (ETDEWEB)
Kahn, E.
The goal of this paper is to develop tools for technology evaluation that address questions involving the economics of large-scale systems. The kind of cost discussed usually involves some dynamic aspect of the energy system. In particular, such properties as flexibility, stability, and resilience are features of entire systems. Special attention must be paid to the question of reliability, i.e., availability on demand. The storage problem and the planning for reliability in utility systems are the subjects of this paper. The introductory chapter addresses preliminary definitions--reliability planning, uncertainty, resilience, and other sensitivities. The study focuses on the contrast between conventional power generation technologies with controllable output and intermittent resources such as wind and solar electric conversion devices. The system studied is a stylized representation of California conditions. Significant differences were found in reliability planning requirements (and therefore costs) for systems dominated by central station plants as opposed to those dominated by intermittent resource technologies. It is argued that existing hydroelectric facilities need re-optimization. These plants provide the only currently existing bulk power storage in electric energy systems. 38 references. (MCW)
Strategic Planning for Management Information Systems.
Ein-Dor, Phillip; Segev, Eli
Two factors predominate in determining the appropriateness of strategic plans for management information systems (MIS)--explicitness (the degree to which the process is conscious, formal, and documented) and situational fit (the degree to which the MIS is compatible with the specific organization and its members). (Author/IRT)
Strohl, Alexis M; Vitkus, Lauren
The article reviews some commonly used orthodontic treatments as well as new strategies to assist in the correction of malocclusion. Many techniques are used in conjunction with surgical intervention and are a necessary compliment to orthognathic surgery. Basic knowledge of these practices will aid in the surgeon's ability to adequately treat the patient. Many orthodontists and surgeons are eliminating presurgical orthodontics to adopt a strategy of 'surgery first' orthodontics in orthognathic surgery. This has the benefit of immediate improvement in facial aesthetics and shorter treatment times. The advent of virtual surgical planning has helped facilitate the development of this new paradigm by making surgical planning faster and easier. Furthermore, using intraoperative surgical navigation is improving overall precision and outcomes. A variety of surgical and nonsurgical treatments may be employed in the treatment of malocclusion. It is important to be familiar with all options available and tailor the patient's treatment plan accordingly. Surgery-first orthodontics, intraoperative surgical navigation, virtual surgical planning, and 3D printing are evolving new techniques that are producing shorter treatment times and subsequently improving patient satisfaction without sacrificing long-term stability.
Decentralized planning of hydroelectric power systems
International Nuclear Information System (INIS)
Binato, S.; Pereira, M.V.F.
This paper discusses the application of marginal cost concepts to the expansion planning of hydroelectric systems. It is shown that the renumeration of hydroelectric plants should not be based on their energy production, as this leads to excessive revenues for the plant owner, and distorts the dimensioning of upstream reservoirs. In order to produce the adequate economic signals, it is necessary to separate the contributions of turbines and reservoirs. Examples from the Brazilian power system are presented and discussed
Fan, Joe King-Man; Chan, Fion Siu-Yin; Chu, Kent-Man
Surgical smoke is the gaseous by-product formed during surgical procedures. Most surgeons, operating theatre staff and administrators are unaware of its potential health risks. Surgical smoke is produced by various surgical instruments including those used in electrocautery, lasers, ultrasonic scalpels, high speed drills, burrs and saws. The potential risks include carbon monoxide toxicity to the patient undergoing a laparoscopic operation, pulmonary fibrosis induced by non-viable particles, and transmission of infectious diseases like human papilloma virus. Cytotoxicity and mutagenicity are other concerns. Minimisation of the production of surgical smoke and modification of any evacuation systems are possible solutions. In general, a surgical mask can provide more than 90% protection to exposure to surgical smoke; however, in most circumstances it cannot provide air-tight protection to the user. An at least N95 grade or equivalent respirator offers the best protection against surgical smoke, but whether such protection is necessary is currently unknown.
Wire in the Cable-Driven System of Surgical Robot
Wang, X. F.; Lv, N.; Mu, H. Z.; Xue, L. J.
During the evolution of the surgical robot, cable plays an important role. It translates motion and force precisely from surgeon's hand to the tool's tips. In the paper, the vertical wires, the composition of cable, are mathematically modeled from a geometric point of view. The cable structure and tension are analyzed according to the characteristics of wire screw twist. The structural equations of the wires in different positions are derived for both non-bent cable and bent cable, respectively. The bending moment formula of bent cable is also obtained. This will help researchers find suitable cable and design more matched pulley.
[Mechanized system for planning technological processes].
Pashchenko, V S; Shapiro, A M
A mechanized system for the production processes planning involving the use of an electronic code device for data preparation on a punched tape of the "EPECT-IT" type, at the base of which there are classifiers of standard operations and transitions to individual design members, is considered. A fragment of the classifier and a skeleton diagram of the system are presented. It is pointed out that the use of the system helps improve the quality of the design work, as well as to yield considerable economic advantages. The system is in operation at some enterprises of the medical engineering industry.
Development of a precision multimodal surgical navigation system for lung robotic segmentectomy.
Baste, Jean Marc; Soldea, Valentin; Lachkar, Samy; Rinieri, Philippe; Sarsam, Mathieu; Bottet, Benjamin; Peillon, Christophe
Minimally invasive sublobar anatomical resection is becoming more and more popular to manage early lung lesions. Robotic-assisted thoracic surgery (RATS) is unique in comparison with other minimally invasive techniques. Indeed, RATS is able to better integrate multiple streams of information including advanced imaging techniques, in an immersive experience at the level of the robotic console. Our aim was to describe three-dimensional (3D) imaging throughout the surgical procedure from preoperative planning to intraoperative assistance and complementary investigations such as radial endobronchial ultrasound (R-EBUS) and virtual bronchoscopy for pleural dye marking. All cases were operated using the DaVinci System TM . Modelisation was provided by Visible Patient™ (Strasbourg, France). Image integration in the operative field was achieved using the Tile Pro multi display input of the DaVinci console. Our experience was based on 114 robotic segmentectomies performed between January 2012 and October 2017. The clinical value of 3D imaging integration was evaluated in 2014 in a pilot study. Progressively, we have reached the conclusion that the use of such an anatomic model improves the safety and reliability of procedures. The multimodal system including 3D imaging has been used in more than 40 patients so far and demonstrated a perfect operative anatomic accuracy. Currently, we are developing an original virtual reality experience by exploring 3D imaging models at the robotic console level. The act of operating is being transformed and the surgeon now oversees a complex system that improves decision making.
PSSD - Planning System for Sustainable Development
DEFF Research Database (Denmark)
PSSD - Planning System for Sustainable Development - is a part of the Baltic Sea Region's INTERREG II C program. The current report describes some theories, methods and tools developed under the PSSD project. First, the theoretical foundation of the project is described. Secondly, the role...... of indicators in sustainable development is discussed and a Web-based indicator generator is described. Thirdly, we describe a number of methods and tools, which support planning for sustainable development. Finally, some technical interface tools - especially a Web-based interface to the methods and tools...
Extension planning for electrical energy supply systems
International Nuclear Information System (INIS)
Bieselt, R.
In the future as well as in the past, and in particular in the next decade a considerable increase in electrical energy demand can be expected. To satisfy this demand in a reliable and sufficient manner will force the utilities to invest large sums of money for the operation and the extension of power generation and distribution plants. The size of these investments justifies the search for more and more comprehensive and at the same time more detailed planning methods. With the help of system analysis a planning model for the electricity supply industry of a major supply area will be designed. (orig./RW) [de
Pipesworld : applying planning systems to pipeline transportation
Energy Technology Data Exchange (ETDEWEB)
Milidiu, R.L.; Santos Liporace, F. [Pontificia Univ. Catolica, Rio de Janeiro (Brazil). Dept. de Informatica
This paper explored issues facing the complex task of managing pipelines that transport large volumes of petroleum products over long distances. Since oil pipelines are generally a few inches wide and several miles long, reasonable amounts of distinct products can be transported with very small loss due to the mixing at liquid boundaries. Optimizing the transportation through oil pipelines in terms of maintenance and environmental safety is a high priority for pipeline operators. This paper presented the Pipesworld model which takes into account features such as product interface constraints, limited product storage capacities and due dates for product delivery. It has been benchmarked as a start-of-art general purpose artificial planning system. This paper also reported the results derived by general purpose artificial intelligence planning systems when applied to the Pipesworld model. It demonstrated how various modelling techniques can be used to enhance the planners performance. Current work in developing Plumber was also presented. This dedicated solver that addresses operational situations uses both general purpose planning techniques as well as domain specific knowledge. When Plumber was incorporated into Pipesworld, its outperformed Fast-Forward, one of the best available general purpose planning systems, suggesting that improved versions of Plumber have the potential to deal with various problem scenarios in pipeline operations. 11 refs., 2 tabs., 3 figs.
Early experience using the da Vinci Surgical System for the treatment of mediastinal tumors.
Kajiwara, Naohiro; Taira, Masahiro; Yoshida, Koichi; Hagiwara, Masaru; Kakihana, Masatoshi; Usuda, Jitsuo; Uchida, Osamu; Ohira, Tatsuo; Kawate, Norihiko; Ikeda, Norihiko
The da Vinci Surgical System has been used in only a few cases for treating mediastinal tumors in Japan. Recently, we used the da Vinci Surgical System for various types of anterior and middle mediastinal tumors in clinical practice. We report our early experience using the da Vinci Surgical System. Seven patients gave written informed consent to undergo robotic surgery for mediastinal tumor dissection using the da Vinci Surgical System. We evaluated the safety and feasibility of this system for the surgical treatment of mediastinal tumors. Two specialists in thoracic surgery who are certified to use the da Vinci S Surgical System and another specialist acted as an assistant performed the tumor dissection. We were able to access difficult-to-reach areas, such as the mediastinum, safely. All the resected tumors were classified as benign tumors histologically. The average da Vinci setting time was 14.0 min, the average working time was 55.7 min, and the average overall operating time was 125.9 min. The learning curve for the da Vinci setup and manipulation time was short. Robotic surgery enables mediastinal tumor dissection in certain cases more safely and easily than conventional video-assisted thoracoscopic surgery and less invasively than open thoracotomy.
3D-visualization by MRI for surgical planning of Wilms tumors; 3-D-Visualisierung in der MRT zur Operationsplanung von Wilms-Tumoren
Energy Technology Data Exchange (ETDEWEB)
Schenk, J.P.; Wunsch, R.; Jourdan, C.; Troeger, J. [Universitaetsklinik Heidelberg (Germany). Abteilung Paediatrische Radiologie; Waag, K.-L.; Guenther, P. [Universitaetsklinik Heidelberg (Germany). Abteilung Kinderchirurgie; Graf, N. [Universitaetsklinik Homburg (Germany). Abteilung Paediatrische Haematologie und Onkologie; Behnisch, W. [Universitaetsklinik Heidelberg (Germany). Abteilung Paediatrische Haematologie und Onkologie
Purpose: To improve surgical planning of kidney tumors in childhood (Wilms tumor, mesoblastic nephroma) after radiologic verification of the presumptive diagnosis with interactive colored 3D-animation in MRI. Materials and Methods: In 7 children (1 boy, 6 girls) with a mean age of 3 years (1 month to 11 years), the MRI database (DICOM) was processed with a raycasting-based 3D-volume-rendering software (VG Studio Max 1.1/Volume Graphics). The abdominal MRI-sequences (coronal STIR, coronal T1 TSE, transverse T1/T2 TSE, sagittal T2 TSE, transverse and coronal T1 TSE post contrast) were obtained with a 0.5T unit in 4-6 mm slices. Additionally, phase-contrast-MR-angiography was applied to delineate the large abdominal and retroperitoneal vessels. A notebook was used to demonstrate the 3D-visualization for surgical planning before surgery and during the surgical procedure. Results: In all 7 cases, the surgical approach was influenced by interactive 3D-animation and the information found useful for surgical planning. Above all, the 3D-visualization demonstrates the mass effect of the Wilms tumor and its anatomical relationship to the renal hilum and to the rest of the kidney as well as the topographic relationship of the tumor to the critical vessels. One rupture of the tumor capsule occurred as a surgical complication. For the surgeon, the transformation of the anatomical situation from MRI to the surgical situs has become much easier. Conclusion: For surgical planning of Wilms tumors, the 3D-visualization with 3D-animation of the situs helps to transfer important information from the pediatric radiologist to the pediatric surgeon and optimizes the surgical preparation. A reduction of complications is to be expected. (orig.)
OCRWM Systems Engineering Management Plan (SEMP)
International Nuclear Information System (INIS)
The Office of Civilian Radioactive Waste Management Systems Engineering Management Plan (OCRWM SEMP) specifies the technical management approach for the development of the waste management system, and specifies the approach for the development of each of the system elements -- the waste acceptance system, the transportation system, the Monitored Retrievable Storage (MRS) facility, and the mined geologic disposal system, which includes site characterization activity. The SEMP also delineates how systems engineering will be used by OCRWM to describe the system development process; it identifies responsibilities for its implementation, and specifies the minimum requirements for systems engineering. It also identifies the close interrelationship of system engineering and licensing processes. This SEMP, which is a combined OCRWM and M ampersand O SEMP, is part of the top-level program documentation and is prepared in accordance with the direction provided in the Program Management System Manual (PMSM). The relationship of this document to other top level documents in the CRWMS document hierarchy is defined in the PMSM. A systems engineering management plan for each project, which specifies the actions to be taken in implementing systems engineering at the project level, shall be prepared by the respective project managers. [''Program'' refers to the CRWMS-wide activity and ''project'' refers to that level responsible for accomplishing the specific activities of that segment of the program.] The requirements for the project level SEMPs are addressed in Section 126.96.36.199. They represent the minimum set of requirements, and do not preclude the broadening of systems engineering activities to meet the specific needs of each project
Replacement of Cross-Site Transfer System Startup Plan
International Nuclear Information System (INIS)
Gerken, M.D.
This Startup Plan provides a discussion of organizational responsibilities, work planning, quality assurance (QA), personnel qualifications, and testing requirements for the Cross-Site Transfer System
Improvements in patient treatment planning systems
International Nuclear Information System (INIS)
Wheeler, F.J.; Wessol, D.E.; Nigg, D.W.; Atkinson, C.A.; Babcock, R.; Evans, J.
The Boron Neutron Capture Therapy, Radiation treatment planning environment (BNCT-Rtpe) software system is used to develop treatment planning information. In typical use BNCT-Rtpe consists of three main components: (1) Semi-automated geometric modeling of objects (brain, target, eyes, sinus) derived from MRI, CT, and other medical imaging modalities, (2) Dose computations for these geometric models with rtt-MC, the INEL Monte Carlo radiation transport computer code, and (3) Dose contouring overlaid on medical images as well as generation of other dose displays. We continue to develop a planning system based on three-dimensional image-based reconstructions using Bspline surfaces. Even though this software is in an experimental state, it has been applied for large animal research and for an isolated case of treatment for a human glioma. Radiation transport is based on Monte Carlo, however there will be implementations of faster methods (e.g. diffusion theory) in the future. The important thing for treatment planning is the output which must convey, to the radiologist, the deposition of dose to healthy and target tissue. Many edits are available such that one can obtain contours registered to medical image, dose/volume histograms and most information required for treatment planning and response assessment. Recent work has been to make the process more automatic and easier to use. The interface, now implemented for contouring and reconstruction, utilizes the Xwindowing system and the MOTIF graphical users interface for effective interaction with the planner. Much work still remains before the tool can be applied in a routine clinical setting
The galenic venous system: Surgical anatomy and its angiographic and magnetic resonance venographic correlations
International Nuclear Information System (INIS)
Kilic, Tuerker; Ozduman, Koray; Cavdar, Safiye; Oezek, M. Memet; Pamir, M. Necmettin
Objective: This study aims at evaluating the adequacy of digital subtraction angiography and magnetic resonance venography in imaging of the galenic venous system for surgical planning of approaches to the pineal region. Anatomical dissections were carried out in 10 cadavers of several age groups and these were compared to imaging findings in 10 living subjects. Methods: The presence or absence of 10 predetermined veins or vein groupings belonging to the galenic venous system were prospectively analyzed in 10 cadaver dissections and imaging findings of 10 age matched human subjects. The studied vessels were the vein of galen, the internal cerebral veins, both basal vein of Rosenthals, internal occipital vein, occipitotemporal veins, precentral cerebellar veins, tectal veins, pineal veins, superior vermian veins (including superior cerebellar veins (SCVs)) and posterior pericallosal veins. Each of the subjects had both digital subtraction angiography and magnetic resonance venography studies performed. Diagnostic digital subtraction angiography was performed using the transfemoral route and the venous phase was used for the study. Magnetic resonance venography was performed in 1.5 T MRI equipment using the 2D-TOF sequence. All studies were reported to be normal. Results: There was wide variation in the anatomy of the galenic venous system. There were interpersonal, intrapersonal and age related variations. Both the digital subtraction angiography and the magnetic resonance venography were efficient at demonstrating large veins. However, smaller veins were less readily demonstrated in either study. The general sensitivities of the digital subtraction angiography and the magnetic resonance venography for the galenic venous system were 45.5% and 32.5%, respectively. Surgically important veins were missed in most studies. Conclusions: Anatomically, the galenic venous system is highly variable. This variability is caused by interpersonal, intrapersonal and age related
The galenic venous system: Surgical anatomy and its angiographic and magnetic resonance venographic correlations
Energy Technology Data Exchange (ETDEWEB)
Kilic, Tuerker [Marmara University, Department of Neurosurgery, PK 53, Maltepe, 81532 Istanbul (Turkey) and Marmara University, Department of Anatomy, Istanbul (Turkey)]. E-mail: firstname.lastname@example.com; Ozduman, Koray [Marmara University, Department of Neurosurgery, PK 53, Maltepe, 81532 Istanbul (Turkey); Cavdar, Safiye [Marmara University, Department of Anatomy, Istanbul (Turkey); Oezek, M. Memet [Marmara University, Department of Neurosurgery, PK 53, Maltepe, 81532 Istanbul (Turkey); Pamir, M. Necmettin [Marmara University, Department of Neurosurgery, PK 53, Maltepe, 81532 Istanbul (Turkey)
Objective: This study aims at evaluating the adequacy of digital subtraction angiography and magnetic resonance venography in imaging of the galenic venous system for surgical planning of approaches to the pineal region. Anatomical dissections were carried out in 10 cadavers of several age groups and these were compared to imaging findings in 10 living subjects. Methods: The presence or absence of 10 predetermined veins or vein groupings belonging to the galenic venous system were prospectively analyzed in 10 cadaver dissections and imaging findings of 10 age matched human subjects. The studied vessels were the vein of galen, the internal cerebral veins, both basal vein of Rosenthals, internal occipital vein, occipitotemporal veins, precentral cerebellar veins, tectal veins, pineal veins, superior vermian veins (including superior cerebellar veins (SCVs)) and posterior pericallosal veins. Each of the subjects had both digital subtraction angiography and magnetic resonance venography studies performed. Diagnostic digital subtraction angiography was performed using the transfemoral route and the venous phase was used for the study. Magnetic resonance venography was performed in 1.5 T MRI equipment using the 2D-TOF sequence. All studies were reported to be normal. Results: There was wide variation in the anatomy of the galenic venous system. There were interpersonal, intrapersonal and age related variations. Both the digital subtraction angiography and the magnetic resonance venography were efficient at demonstrating large veins. However, smaller veins were less readily demonstrated in either study. The general sensitivities of the digital subtraction angiography and the magnetic resonance venography for the galenic venous system were 45.5% and 32.5%, respectively. Surgically important veins were missed in most studies. Conclusions: Anatomically, the galenic venous system is highly variable. This variability is caused by interpersonal, intrapersonal and age related
Prevention of respiratory complications of the surgical patient: actionable plan for continued process improvement.
Ruscic, Katarina J; Grabitz, Stephanie D; Rudolph, Maíra I; Eikermann, Matthias
Postoperative respiratory complications (PRCs) increase hospitalization time, 30-day mortality and costs by up to $35 000. These outcomes measures have gained prominence as bundled payments have become more common. Results of recent quantitative effectiveness studies and clinical trials provide a framework that helps develop center-specific treatment guidelines, tailored to minimize the risk of PRCs. The implementation of those protocols should be guided by a local, respected, and visible facilitator who leads proper implementation while inviting center-specific input from surgeons, anesthesiologists, and other perioperative stakeholders. Preoperatively, patients should be risk-stratified for PRCs to individualize intraoperative choices and postoperative pathways. Laparoscopic compared with open surgery improves respiratory outcomes. High-risk patients should be treated by experienced providers based on locally developed bundle-interventions to optimize intraoperative treatment and ICU bed utilization. Intraoperatively, lung-protective ventilation (procedure-specific positive end-expiratory pressure utilization, and low driving pressure) and moderately restrictive fluid therapy should be used. To achieve surgical relaxation, high-dose neuromuscular blocking agents (and reversal agents) as well as high-dose opioids should be avoided; inhaled anesthetics improve surgical conditions while protecting the lungs. Patients should be extubated in reverse Trendelenburg position. Postoperatively, continuous positive airway pressure helps prevent airway collapse and protocolized, early mobilization improves cognitive and respiratory function.
Surgical PACS for the digital operating room. Systems engineering and specification of user requirements.
Korb, Werner; Bohn, Stefan; Burgert, Oliver; Dietz, Andreas; Jacobs, Stephan; Falk, Volkmar; Meixensberger, Jürgen; Strauss, Gero; Trantakis, Christos; Lemke, Heinz U
For better integration of surgical assist systems into the operating room, a common communication and processing plattform that is based on the users needs is needed. The development of such a system, a Surgical Picture Aquisition and Communication System (S-PACS), according the systems engineering cycle is oulined in this paper. The first two steps (concept and specification) for the engineering of the S-PACS are discussed.A method for the systematic integration of the users needs', the Quality Function Deployment (QFD), is presented. The properties of QFD for the underlying problem and first results are discussed. Finally, this leads to a first definition of an S-PACS system.
77 FR 21161 - National Forest System Land Management Planning
... 219 National Forest System Land Management Planning; Final Rule #0;#0;Federal Register / Vol. 77 , No... Forest Service 36 CFR Part 219 RIN 0596-AD02 National Forest System Land Management Planning AGENCY... Agriculture is adopting a new National Forest System land management planning rule (planning rule). The new...
An Observational Assessment of Anesthesia Capacity in Madagascar as a Prerequisite to the Development of a National Surgical Plan.
Baxter, Linden S; Ravelojaona, Vaonandianina A; Rakotoarison, Hasiniaina N; Herbert, Alison; Bruno, Emily; Close, Kristin L; Andean, Vanessa; Andriamanjato, Hery H; Shrime, Mark G; White, Michelle C
The global lack of anesthesia capacity is well described, but country-specific data are needed to provide country-specific solutions. We aimed to assess anesthesia capacity in Madagascar as part of the development of a Ministry of Health national surgical plan. As part of a nationwide surgical safety quality improvement project, we surveyed 19 of 22 regional hospitals, representing surgical facilities caring for 75% of the total population. The assessment was divided into 3 areas: anesthesia workforce density, infrastructure and equipment, and medications. Data were obtained by semistructured interviews with Ministry of Health officials, hospital directors, technical directors, statisticians, pharmacists, and anesthesia providers and through on-site observations. Interview questions were adapted from the World Health Organization Situational Analysis Tool and the World Federation of Societies of Anaesthesiologists International Standards for Safe Practice of Anaesthesia. Additional data on workforce density were collected from the 3 remaining regions so that workforce density data are representative of all 22 regions. Anesthesia physician workforce density is 0.26 per 100,000 population and 0.19 per 100,000 outside of the capital region. Less than 50% of hospitals surveyed reported having a reliable electricity and oxygen supply. The majority of anesthesia providers work without pulse oximetry (52%) or a functioning vaporizer (52%). All the hospitals surveyed had very basic pediatric supplies, and none had a pediatric pulse oximetry probe. Ketamine is universally available but more than 50% of hospitals lack access to opioids. None of the 19 regional hospitals surveyed was able to completely meet the World Federation of Societies of Anaesthesiologists' standards for monitoring. Improving anesthesia care is complex. Capacity assessment is a first step that would enable progress to be tracked against specific targets. In Madagascar, scale-up of the anesthesia
Environmental Restoration Project - Systems Engineering Management Plan
International Nuclear Information System (INIS)
Anderson, T.D.
This Environmental Restoration (ER) Project Systems Engineering Management Plan (SEMP) describes relevant Environmental Restoration Contractor (ERC) management processes and shows how they implement systems engineering. The objective of this SEMP is to explain and demonstrate how systems engineering is being approached and implemented in the ER Project. The application of systems engineering appropriate to the general nature and scope of the project is summarized in Section 2.0. The basic ER Project management approach is described in Section 3.0. The interrelation and integration of project practices and systems engineering are outlined in Section 4.0. Integration with sitewide systems engineering under the Project Hanford Management Contract is described in Section 5.0
Three-dimensional surgical simulation.
Cevidanes, Lucia H C; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael
In this article, we discuss the development of methods for computer-aided jaw surgery, which allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3-dimensional surface models from cone-beam computed tomography, dynamic cephalometry, semiautomatic mirroring, interactive cutting of bone, and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intraoperative guidance. The system provides further intraoperative assistance with a computer display showing jaw positions and 3-dimensional positioning guides updated in real time during the surgical procedure. The computer-aided surgery system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training, and assessing the difficulties of the surgical procedures before the surgery. Computer-aided surgery can make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.
Review of the FAA 1982 National Airspace System plan
The National Airspace (NAS) Plan outlines the Federal Aviation Administration's most recent proposals for modernizing the facilities and equipment that make up the air traffic control (ATC) system. This review of the NAS Plan examines the Plan at two...
Intelligent transportation systems business plan for Kentucky : final report.
This report presents a Business Plan for Intelligent Transportation Systems (ITS) in Kentucky. The purpose of the Business Plan is to define ITS projects that are planned for implementation from 2002 through 2007. The list of projects contained withi...
The efficacy and utilisation of preoperative multiparametric magnetic resonance imaging in robot-assisted radical prostatectomy: does it change the surgical dissection plan?
Tavukçu, Hasan Hüseyin; Aytaç, Ömer; Balcı, Numan Cem; Kulaksızoğlu, Haluk; Atuğ, Fatih
We investigated the effect of the use of multiparametric prostate magnetic resonance imaging (mp-MRI) on the dissection plan of the neurovascular bundle and the oncological results of our patients who underwent robot-assisted radical prostatectomy. We prospectively evaluated 60 consecutive patients, including 30 patients who had (Group 1), and 30 patients who had not (Group 2) mp-MRI before robot-assisted radical prostatectomy. Based on the findings of mp-MRI, the dissection plan was changed as intrafascial, interfascial, and extrafascial in the mp-MRI group. Two groups were compared in terms of age, prostate-specific antigen (PSA), Gleason sum scores and surgical margin positivity. There was no statistically significant difference between the two groups in terms of age, PSA, biopsy Gleason score, final pathological Gleason score and surgical margin positivity. mp-MRI changed the initial surgical plan in 18 of 30 patients (60%) in Group 1. In seventeen of these patients (56%) surgical plan was changed from non-nerve sparing to interfascial nerve sparing plan. In one patient dissection plan was changed to non-nerve sparing technique which had extraprostatic extension on final pathology. Surgical margin positivity was similar in Groups 1, and 2 (16% and 13%, respectively) although, Group 1 had higher number of high- risk patients. mp-MRI confirmed the primary tumour localisation in the final pathology in 27 of of 30 patients (90%). Preoperative mp-MRI effected the decision to perform a nerve-sparing technique in 56% of the patients in our study; moreover, changing the dissection plan from non-nerve-sparing technique to a nerve sparing technique did not increase the rate of surgical margin positivity.
Development and validation of a surgical-pathologic staging and scoring system for cervical cancer.
Li, Shuang; Li, Xiong; Zhang, Yuan; Zhou, Hang; Tang, Fangxu; Jia, Yao; Hu, Ting; Sun, Haiying; Yang, Ru; Chen, Yile; Cheng, Xiaodong; Lv, Weiguo; Wu, Li; Zhou, Jin; Wang, Shaoshuai; Huang, Kecheng; Wang, Lin; Yao, Yuan; Yang, Qifeng; Yang, Xingsheng; Zhang, Qinghua; Han, Xiaobing; Lin, Zhongqiu; Xing, Hui; Qu, Pengpeng; Cai, Hongbing; Song, Xiaojie; Tian, Xiaoyu; Shen, Jian; Xi, Ling; Li, Kezhen; Deng, Dongrui; Wang, Hui; Wang, Changyu; Wu, Mingfu; Zhu, Tao; Chen, Gang; Gao, Qinglei; Wang, Shixuan; Hu, Junbo; Kong, Beihua; Xie, Xing; Ma, Ding
Most cervical cancer patients worldwide receive surgical treatments, and yet the current International Federation of Gynecology and Obstetrics (FIGO) staging system do not consider surgical-pathologic data. We propose a more comprehensive and prognostically valuable surgical-pathologic staging and scoring system (SPSs). Records from 4,220 eligible cervical cancer cases (Cohort 1) were screened for surgical-pathologic risk factors. We constructed a surgical-pathologic staging and SPSs, which was subsequently validated in a prospective study of 1,104 cervical cancer patients (Cohort 2). In Cohort 1, seven independent risk factors were associated with patient outcome: lymph node metastasis (LNM), parametrial involvement, histological type, grade, tumor size, stromal invasion, and lymph-vascular space invasion (LVSI). The FIGO staging system was revised and expanded into a surgical-pathologic staging system by including additional criteria of LNM, stromal invasion, and LVSI. LNM was subdivided into three categories based on number and location of metastases. Inclusion of all seven prognostic risk factors improves practical applicability. Patients were stratified into three SPSs risk categories: zero-, low-, and high-score with scores of 0, 1 to 3, and ≥4 (P=1.08E-45; P=6.15E-55). In Cohort 2, 5-year overall survival (OS) and disease-free survival (DFS) outcomes decreased with increased SPSs scores (P=9.04E-15; P=3.23E-16), validating the approach. Surgical-pathologic staging and SPSs show greater homogeneity and discriminatory utility than FIGO staging. Surgical-pathologic staging and SPSs improve characterization of tumor severity and disease invasion, which may more accurately predict outcome and guide postoperative therapy.
Early clinical experience with the da Vinci Xi Surgical System in general surgery.
Hagen, Monika E; Jung, Minoa K; Ris, Frederic; Fakhro, Jassim; Buchs, Nicolas C; Buehler, Leo; Morel, Philippe
The da Vinci Xi Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) has been released in 2014 to facilitate minimally invasive surgery. Novel features are targeted towards facilitating complex multi-quadrant procedures, but data is scarce so far. Perioperative data of patients who underwent robotic general surgery with the da Vinci Xi system within the first 6 month after installation were collected and analyzed. The gastric bypass procedures performed with the da Vinci Xi Surgical System were compared to an equal amount of the last procedures with the da Vinci Si Surgical System. Thirty-one foregut (28 Roux-en-Y gastric bypasses), 6 colorectal procedures and 1 revisional biliary procedure were performed. The mean operating room (OR) time was 221.8 (±69.0) minutes for gastric bypasses and 306.5 (±48.8) for colorectal procedures with mean docking time of 9.4 (±3.8) minutes. The gastric bypass procedure was transitioned from a hybrid to a fully robotic approach. In comparison to the last 28 gastric bypass procedures performed with the da Vinci Si Surgical System, the OR time was comparable (226.9 versus 230.6 min, p = 0.8094), but the docking time significantly longer with the da Vinci Xi Surgical System (8.5 versus 6.1 min, p = 0.0415). All colorectal procedures were performed with a single robotic docking. No intraoperative and two postoperative complications occurred. The da Vinci Xi might facilitate single-setups of totally robotic gastric bypass and colorectal surgeries. However, further comparable research is needed to clearly determine the significance of this latest version of the da Vinci Surgical System.
Linking human and natural systems in the planning process
Susan I. Stewart; Miranda H. Mockrin; Roger B. Hammer
Planning links human and natural systems in the urban-rural interface by engaging people in consideration of the future of natural resources. We review evolving ideas about what planning entails, who it involves, and what its outcomes should be. Sense of place, collaboration, emergent planning, and other new developments in planning are discussed. Smaller plans,...
71: Three dimensional radiation treatment planning system
International Nuclear Information System (INIS)
Purdy, J.A.; Wong, J.W.; Harms, W.B.; Drzymala, R.E.; Emami, B.
A prototype 3-dimensional (3-D) radiation treatment planning (RTP) system has been developed and is in use. The system features a real-time display device and an array processor for computer intensive computations. The dose distribution can be displayed as 2-D isodose distributions superimposed on 2-D gray scale images of the patient's anatomy for any arbitrary plane and as a display of isodose surfaces in 3-D. In addition, dose-volume histograms can be generated. 7 refs.; 2 figs
Solar thermal systems successful planning and construction
Peuser, Dr Felix A; Schnauss, Martin
Solar Thermal Systems summarizes the theoretical and practical knowledge gained from over 20 years of research, implementation and operation of thermal solar installations. This work provides answers to a variety of key questions by examining current solar installations, drawing upon past experiences and making proposals for future planning.- how do system components and materials behave under continuous operation?- which components have proven themselves and how are they used properly?- what are the causes of defects and how can they be avoided?- how long is the service life of modern solar i
Combined heuristic with fuzzy system to transmission system expansion planning
Energy Technology Data Exchange (ETDEWEB)
Silva Sousa, Aldir; Asada, Eduardo N. [University of Sao Paulo, Sao Carlos School of Engineering, Department of Electrical Engineering Av. Trabalhador Sao-carlense, 400, 13566-590 Sao Carlos, SP (Brazil)
A heuristic algorithm that employs fuzzy logic is proposed to the power system transmission expansion planning problem. The algorithm is based on the divide to conquer strategy, which is controlled by the fuzzy system. The algorithm provides high quality solutions with the use of fuzzy decision making, which is based on nondeterministic criteria to guide the search. The fuzzy system provides a self-adjusting mechanism that eliminates the manual adjustment of parameters to each system being solved. (author)
Three-Dimensional Liver Surgery Simulation: Computer-Assisted Surgical Planning with Three-Dimensional Simulation Software and Three-Dimensional Printing.
Oshiro, Yukio; Ohkohchi, Nobuhiro
To perform accurate hepatectomy without injury, it is necessary to understand the anatomical relationship among the branches of Glisson's sheath, hepatic veins, and tumor. In Japan, three-dimensional (3D) preoperative simulation for liver surgery is becoming increasingly common, and liver 3D modeling and 3D hepatectomy simulation by 3D analysis software for liver surgery have been covered by universal healthcare insurance since 2012. Herein, we review the history of virtual hepatectomy using computer-assisted surgery (CAS) and our research to date, and we discuss the future prospects of CAS. We have used the SYNAPSE VINCENT medical imaging system (Fujifilm Medical, Tokyo, Japan) for 3D visualization and virtual resection of the liver since 2010. We developed a novel fusion imaging technique combining 3D computed tomography (CT) with magnetic resonance imaging (MRI). The fusion image enables us to easily visualize anatomic relationships among the hepatic arteries, portal veins, bile duct, and tumor in the hepatic hilum. In 2013, we developed an original software, called Liversim, which enables real-time deformation of the liver using physical simulation, and a randomized control trial has recently been conducted to evaluate the use of Liversim and SYNAPSE VINCENT for preoperative simulation and planning. Furthermore, we developed a novel hollow 3D-printed liver model whose surface is covered with frames. This model is useful for safe liver resection, has better visibility, and the production cost is reduced to one-third of a previous model. Preoperative simulation and navigation with CAS in liver resection are expected to help planning and conducting a surgery and surgical education. Thus, a novel CAS system will contribute to not only the performance of reliable hepatectomy but also to surgical education.
OCRWM Systems Engineering Management Plan (SEMP)
International Nuclear Information System (INIS)
The Nuclear Waste Policy Act of 1982 established the Office of Civilian Radioactive Waste Management (OCRWM) in the Department of Energy (DOE) to implement a program for the safe and permanent disposal of spent nuclear fuel and high-level radioactive waste. To achieve this objective, the OCRWM is developing an integrated waste-management system consisting of three elements: the transportation system, the monitored retrievable storage (MRS) facility, and the mined geologic disposal system (MGDS). The development of such a system requires management of many diverse disciplines that are involved in research, siting, design, licensing, and external interactions. The purpose of this Systems Engineering Management Plan (SEMP) is to prescribe how the systems-engineering process will be implemented in the development of the waste-management system. Systems engineering will be used by the OCRWM to manage, integrate, and document all aspects of the technical development of the waste-management system and its system elements to ensure that the requirements of the waste-management program are met. It will be applied to all technical activities of the OCRWM program. It will be used by the OCRWM to specify the sequence of technical activities necessary to define the requirements the waste-management system must satisfy, to develop the waste-management system, to relate system elements to each other, and to determine how the waste-management system can be optimized to most effectively satisfy the requirements. Furthermore, systems engineering will be used in the management of Program activities at the program, program-element, and project levels by specifying procedures, studies, reviews, and documentation requirements. 9 refs., 1 fig
Prospective validation of a surgical complications grading system in a cohort of 2114 patients.
Mazeh, Haggi; Cohen, Oded; Mizrahi, Ido; Hamburger, Tamar; Stojadinovic, Alexander; Abu-Wasel, Bassam; Alaiyan, Bilal; Freund, Herbert R; Eid, Ahmed; Nissan, Aviram
We recently reported a grading system for surgical complications. This system proved to have a high sensitivity for recording minor but meaningful complications prolonging hospital stay in patients after colorectal surgery. We aimed to prospectively validate the complication grading system in a general surgery department over 1 year. All surgical procedures and related complications were prospectively recorded between January 1st and December 31st, 2009. Surgical complications were graded on a severity scale of 1-5. The system classifies short-term outcome by grade emphasizing intensity of therapy required for treatment of the defined complication. During the study period, 2114 patients underwent surgery. Elective and oncological surgeries were performed in 1606 (76%) and 465 (22%) patients, respectively. There were 422 surgical complications in 304 (14%) patients (Grade 1/2: 203 [67%]; Grade 3/4: 90 [29%]; Grade 5: 11 [4%]). Median length of stay correlated significantly with complication severity: 2.3 d for no complication, 6.2 and 11.8 d for Grades 1/2 and 3/4, respectively (P 2 (OR 2.07, P Grade (OR 1.85, P = 0.001), oncological (OR 2.82, P 120 min (OR 2.08, P grading surgical complications permits standardized reporting of surgical morbidity according to the severity of impact. Prospective validation of this system supports its use in a general surgery setting as a tool for surgical outcome assessment and quality assurance. Copyright © 2014 Elsevier Inc. All rights reserved.
Research of the master-slave robot surgical system with the function of force feedback.
Shi, Yunyong; Zhou, Chaozheng; Xie, Le; Chen, Yongjun; Jiang, Jun; Zhang, Zhenfeng; Deng, Ze
Surgical robots lack force feedback, which may lead to operation errors. In order to improve surgical outcomes, this research developed a new master-slave surgical robot, which was designed with an integrated force sensor. The new structure designed for the master-slave robot employs a force feedback mechanism. A six-dimensional force sensor was mounted on the tip of the slave robot's actuator. Sliding model control was adopted to control the slave robot. According to the movement of the master system manipulated by the surgeon, the slave's movement and the force feedback function were validated. The motion was completed, the standard deviation was calculated, and the force data were detected. Hence, force feedback was realized in the experiment. The surgical robot can help surgeons to complete trajectory motions with haptic sensation. Copyright © 2017 John Wiley & Sons, Ltd.
Effect of sensory substitution on suture-manipulation forces for robotic surgical systems.
Kitagawa, Masaya; Dokko, Daniell; Okamura, Allison M; Yuh, David D
Direct haptic (force or tactile) feedback is not yet available in commercial robotic surgical systems. Previous work by our group and others suggests that haptic feedback might significantly enhance the execution of surgical tasks requiring fine suture manipulation, specifically those encountered in cardiothoracic surgery. We studied the effects of substituting direct haptic feedback with visual and auditory cues to provide the operating surgeon with a representation of the forces he or she is applying with robotic telemanipulators. Using the robotic da Vinci surgical system (Intuitive Surgical, Inc, Sunnyvale, Calif), we compared applied forces during a standardized surgical knot-tying task under 4 different sensory-substitution scenarios: no feedback, auditory feedback, visual feedback, and combined auditory-visual feedback. The forces applied with these sensory-substitution modes more closely approximate suture tensions achieved under ideal haptic conditions (ie, hand ties) than forces applied without such sensory feedback. The consistency of applied forces during robot-assisted suture tying aided by visual feedback or combined auditory-visual feedback sensory substitution is superior to that achieved with hand ties. Robot-assisted ties aided with auditory feedback revealed levels of consistency that were generally equivalent or superior to those attained with hand ties. Visual feedback and auditory feedback improve the consistency of robotically applied forces. Sensory substitution, in the form of visual feedback, auditory feedback, or both, confers quantifiable advantages in applied force accuracy and consistency during the performance of a simple surgical task.
Patient-specific system for prognosis of surgical treatment outcomes of human cardiovascular system
Golyadkina, Anastasiya A.; Kalinin, Aleksey A.; Kirillova, Irina V.; Kossovich, Elena L.; Kossovich, Leonid Y.; Menishova, Liyana R.; Polienko, Asel V.
Object of study: Improvement of life quality of patients with high stroke risk ia the main goal for development of system for patient-specific modeling of cardiovascular system. This work is dedicated at increase of safety outcomes for surgical treatment of brain blood supply alterations. The objects of study are common carotid artery, internal and external carotid arteries and bulb. Methods: We estimated mechanical properties of carotid arteries tissues and patching materials utilized at angioplasty. We studied angioarchitecture features of arteries. We developed and clinically adapted computer biomechanical models, which are characterized by geometrical, physical and mechanical similarity with carotid artery in norm and with pathology (atherosclerosis, pathological tortuosity, and their combination). Results: Collaboration of practicing cardiovascular surgeons and specialists in the area of Mathematics and Mechanics allowed to successfully conduct finite-element modeling of surgical treatment taking into account various features of operation techniques and patching materials for a specific patient. Numerical experiment allowed to reveal factors leading to brain blood supply decrease and atherosclerosis development. Modeling of carotid artery reconstruction surgery for a specific patient on the basis of the constructed biomechanical model demonstrated the possibility of its application in clinical practice at approximation of numerical experiment to the real conditions.
Conversion of helical tomotherapy plans to step-and-shoot IMRT plans--Pareto front evaluation of plans from a new treatment planning system.
Petersson, Kristoffer; Ceberg, Crister; Engström, Per; Benedek, Hunor; Nilsson, Per; Knöös, Tommy
The resulting plans from a new type of treatment planning system called SharePlan have been studied. This software allows for the conversion of treatment plans generated in a TomoTherapy system for helical delivery, into plans deliverable on C-arm linear accelerators (linacs), which is of particular interest for clinics with a single TomoTherapy unit. The purpose of this work was to evaluate and compare the plans generated in the SharePlan system with the original TomoTherapy plans and with plans produced in our clinical treatment planning system for intensity-modulated radiation therapy (IMRT) on C-arm linacs. In addition, we have analyzed how the agreement between SharePlan and TomoTherapy plans depends on the number of beams and the total number of segments used in the optimization. Optimized plans were generated for three prostate and three head-and-neck (H&N) cases in the TomoTherapy system, and in our clinical treatment planning systems (TPS) used for IMRT planning with step-and-shoot delivery. The TomoTherapy plans were converted into step-and-shoot IMRT plans in SharePlan. For each case, a large number of Pareto optimal plans were created to compare plans generated in SharePlan with plans generated in the Tomotherapy system and in the clinical TPS. In addition, plans were generated in SharePlan for the three head-and-neck cases to evaluate how the plan quality varied with the number of beams used. Plans were also generated with different number of beams and segments for other patient cases. This allowed for an evaluation of how to minimize the number of required segments in the converted IMRT plans without compromising the agreement between them and the original TomoTherapy plans. The plans made in SharePlan were as good as or better than plans from our clinical system, but they were not as good as the original TomoTherapy plans. This was true for both the head-and-neck and the prostate cases, although the differences between the plans for the latter were
Planning for rural energy system: Part 2
International Nuclear Information System (INIS)
Devadas, V.
This paper discusses the central importance of energy inputs in development, and presents the complex interactions within subsystems that contribute a Rural Energy System. This paper also brings about the importance of the primary data for realistic renewable energy planning at the micro level in a given rural system. Factors that render secondary data somewhat inadequate for such applications are discussed. The differences between energy related data from secondary and primary sources in respect of representative villages in Kanyakumari District of Tamil Nadu, India, are detailed. A rural system model for computing the output from various components of a rural system is also presented. This projection is made by making use of a set of technical coefficients, which relate the inputs to the outputs from individual segments of the rural production system. While some of the technical coefficients are developed based on previously published data, a large number have been quantified on the basis of careful survey. The usefulness of the model is discussed. The paper also presents a Linear Programming Model for optimum resource allocation in a rural system. The objective function of the Linear Programming Model is maximizing the revenue of the rural system where in optimum resource allocation is made subject to a number of energy and non-energy related relevant constraints. The model also quantifies the major yields as well as the byproducts of different sectors of the rural economic system. (Author)
Design and implementation of a PC-based image-guided surgical system.
Stefansic, James D; Bass, W Andrew; Hartmann, Steven L; Beasley, Ryan A; Sinha, Tuhin K; Cash, David M; Herline, Alan J; Galloway, Robert L
In interactive, image-guided surgery, current physical space position in the operating room is displayed on various sets of medical images used for surgical navigation. We have developed a PC-based surgical guidance system (ORION) which synchronously displays surgical position on up to four image sets and updates them in real time. There are three essential components which must be developed for this system: (1) accurately tracked instruments; (2) accurate registration techniques to map physical space to image space; and (3) methods to display and update the image sets on a computer monitor. For each of these components, we have developed a set of dynamic link libraries in MS Visual C++ 6.0 supporting various hardware tools and software techniques. Surgical instruments are tracked in physical space using an active optical tracking system. Several of the different registration algorithms were developed with a library of robust math kernel functions, and the accuracy of all registration techniques was thoroughly investigated. Our display was developed using the Win32 API for windows management and tomographic visualization, a frame grabber for live video capture, and OpenGL for visualization of surface renderings. We have begun to use this current implementation of our system for several surgical procedures, including open and minimally invasive liver surgery.
A cable-driven soft robot surgical system for cardiothoracic endoscopic surgery: preclinical tests in animals.
Wang, Hesheng; Zhang, Runxi; Chen, Weidong; Wang, Xiaozhou; Pfeifer, Rolf
Minimally invasive surgery attracts more and more attention because of the advantages of minimal trauma, less bleeding and pain and low complication rate. However, minimally invasive surgery for beating hearts is still a challenge. Our goal is to develop a soft robot surgical system for single-port minimally invasive surgery on a beating heart. The soft robot described in this paper is inspired by the octopus arm. Although the octopus arm is soft and has more degrees of freedom (DOFs), it can be controlled flexibly. The soft robot is driven by cables that are embedded into the soft robot manipulator and can control the direction of the end and middle of the soft robot manipulator. The forward, backward and rotation movement of the soft robot is driven by a propulsion plant. The soft robot can move freely by properly controlling the cables and the propulsion plant. The soft surgical robot system can perform different thoracic operations by changing surgical instruments. To evaluate the flexibility, controllability and reachability of the designed soft robot surgical system, some testing experiments have been conducted in vivo on a swine. Through the subxiphoid, the soft robot manipulator could enter into the thoracic cavity and pericardial cavity smoothly and perform some operations such as biopsy, ligation and ablation. The operations were performed successfully and did not cause any damage to the surrounding soft tissues. From the experiments, the flexibility, controllability and reachability of the soft robot surgical system have been verified. Also, it has been shown that this system can be used in the thoracic and pericardial cavity for different operations. Compared with other endoscopy robots, the soft robot surgical system is safer, has more DOFs and is more flexible for control. When performing operations in a beating heart, this system maybe more suitable than traditional endoscopy robots.
Engineering task plan for purged light system
International Nuclear Information System (INIS)
A purged, closed circuit television system is currently used to video inside of waste tanks. The video is used to support inspection and assessment of the tank interiors, waste residues, and deployed hardware. The system is also used to facilitate deployment of new equipment. A new light source has been requested by Characterization Project Operations (CPO) for the video system. The current light used is mounted on the camera and provides 75 watts of light, which is insufficient for clear video. Other light sources currently in use on the Hanford site either can not be deployed in a 4-inch riser or do not meet the ignition source controls. The scope of this Engineering Task Plan is to address all activities associated with the specification and procurement of a light source for use with the existing CPO video equipment. The installation design change to tank farm facilities is not within the scope of this ETP
Integrated surgical emergency training plan in the internship: A step toward improving the quality of training and emergency center management.
Akhlaghi, Mohammad Reza; Vafamehr, Vajiheh; Dadgostarnia, Mohammad; Dehghani, Alireza
In this study, by using a problem-oriented approach in the needs assessment, identifying the defects and deficiencies in emergency health training centers has been determined as the basis for the requirements. The main objective of the study was the implementation of surgical emergencies integration of the five surgical groups (general surgery, urology, orthopedics, neurosurgery, and ENT) to meet the needs and determining its efficacy. THIS INTERVENTIONAL STUDY WAS CONDUCTED IN THREE PHASES: (1) Phase I (design and planning): Needs assessment, recognition of implementation barriers and providing the objectives and training program for integrated emergencies. (2) Phase II (implementation): Justification of the main stakeholders of the project, preparation of students' duties in the emergency department, preparation of on-duty plans, supervising the implementation of the program, and reviewing the plan in parallel with the implementation based on the problems. (3) Phase III (evaluation): Reviewing the evidences based on the amount of efficiency of the plan and justification for its continuation. In the first and the second phase, the data were collected through holding focus group meetings and interviews. In the third phase, the opened-reply and closed-reply researcher-made questionnaires were used. The questionnaire face and content validity were confirmed by experts and the reliability was assessed by calculating the Cronbach's alpha. ACCORDING TO THE VIEWS OF THE INTERNS, ASSISTANTS, TEACHERS, AND EMERGENCY PERSONNEL, THE POSITIVE FEATURES OF THE PLAN INCLUDED THE FOLLOWING: Increasing the patients' satisfaction, reducing the patients' stay in the Emergency Department, increasing the speed of handling the patients, balancing the workloads of the interns, direct training of interns by young teachers of emergency medicine, giving the direct responsibility of the patient to the intern, practical and operational training of emergency issues, increasing the teamwork
Statistical modeling to support power system planning
Staid, Andrea
This dissertation focuses on data-analytic approaches that improve our understanding of power system applications to promote better decision-making. It tackles issues of risk analysis, uncertainty management, resource estimation, and the impacts of climate change. Tools of data mining and statistical modeling are used to bring new insight to a variety of complex problems facing today's power system. The overarching goal of this research is to improve the understanding of the power system risk environment for improved operation, investment, and planning decisions. The first chapter introduces some challenges faced in planning for a sustainable power system. Chapter 2 analyzes the driving factors behind the disparity in wind energy investments among states with a goal of determining the impact that state-level policies have on incentivizing wind energy. Findings show that policy differences do not explain the disparities; physical and geographical factors are more important. Chapter 3 extends conventional wind forecasting to a risk-based focus of predicting maximum wind speeds, which are dangerous for offshore operations. Statistical models are presented that issue probabilistic predictions for the highest wind speed expected in a three-hour interval. These models achieve a high degree of accuracy and their use can improve safety and reliability in practice. Chapter 4 examines the challenges of wind power estimation for onshore wind farms. Several methods for wind power resource assessment are compared, and the weaknesses of the Jensen model are demonstrated. For two onshore farms, statistical models outperform other methods, even when very little information is known about the wind farm. Lastly, chapter 5 focuses on the power system more broadly in the context of the risks expected from tropical cyclones in a changing climate. Risks to U.S. power system infrastructure are simulated under different scenarios of tropical cyclone behavior that may result from climate
Guide to Developing an Environmental Management System - Plan
This page takes you though the basic steps (Plan, Do, Check, Act) of building an Environmental Management System (EMS) as they are outlined in the 2001 Second Edition of Environmental Management Systems: An Implementation Guide. Plan section.
Tank waste remediation system retrieval and disposal mission infrastructure plan
International Nuclear Information System (INIS)
Root, R.W.
This system plan presents the objectives, organization, and management and technical approaches for the Infrastructure Program. This Infrastructure Plan focuses on the Tank Waste Remediation System (TWRS) Project's Retrieval and Disposal Mission
Systemic antimicrobial therapy (minocycline) as an adjunct to non-surgical approach to recurrent chronic generalized gingival hyperplasia.
Khatri, Parag M; Bacha, Shraddanand
Systemic antibiotic treatment has emerged as a powerful adjunct to conventional mechanical debridement for therapeutic management of the periodontal diseases. The conceptual basis for treating periodontal diseases as infections is particularly attractive in part because of substantial data indicating that these diseases may be associated with specific putative pathogens. Further, discrete groups of patients respond well to systemic antibiotics and exhibit improvement of clinical parameters, including attachment level and inflammation. This bacterial-host interaction, which is ever-so-present in periodontitis, directs us toward utilizing antimicrobial agents along with the routine mechanical debridement. This case report presents a case of a female patient with recurrence of the chronic generalized periodontitis with gingival enlargement, which is treated thrice by referral dentist. A through clinical examination was carried out pre-operatively and treatment was planned with systemic minocycline in conjunction with the conventional non-surgical approach. There was a significant reduction of pocket depth, gain in attachment with dramatic improvement clinically.
Contributory factors in surgical incidents as delineated by a confidential reporting system.
Mushtaq, F; O'Driscoll, C; Smith, Fct; Wilkins, D; Kapur, N; Lawton, R
Background Confidential reporting systems play a key role in capturing information about adverse surgical events. However, the value of these systems is limited if the reports that are generated are not subjected to systematic analysis. The aim of this study was to provide the first systematic analysis of data from a novel surgical confidential reporting system to delineate contributory factors in surgical incidents and document lessons that can be learned. Methods One-hundred and forty-five patient safety incidents submitted to the UK Confidential Reporting System for Surgery over a 10-year period were analysed using an adapted version of the empirically-grounded Yorkshire Contributory Factors Framework. Results The most common factors identified as contributing to reported surgical incidents were cognitive limitations (30.09%), communication failures (16.11%) and a lack of adherence to established policies and procedures (8.81%). The analysis also revealed that adverse events were only rarely related to an isolated, single factor (20.71%) - with the majority of cases involving multiple contributory factors (79.29% of all cases had more than one contributory factor). Examination of active failures - those closest in time and space to the adverse event - pointed to frequent coupling with latent, systems-related contributory factors. Conclusions Specific patterns of errors often underlie surgical adverse events and may therefore be amenable to targeted intervention, including particular forms of training. The findings in this paper confirm the view that surgical errors tend to be multi-factorial in nature, which also necessitates a multi-disciplinary and system-wide approach to bringing about improvements.
Opportunities for system level improvement in antibiotic use across the surgical pathway
Directory of Open Access Journals (Sweden)
E. Charani
Full Text Available Optimizing antibiotic prescribing across the surgical pathway (before, during, and after surgery is a key aspect of tackling important drivers of antimicrobial resistance and simultaneously decreasing the burden of infection at the global level. In the UK alone, 10 million patients undergo surgery every year, which is equivalent to 60% of the annual hospital admissions having a surgical intervention. The overwhelming majority of surgical procedures require effectively limited delivery of antibiotic prophylaxis to prevent infections. Evidence from around the world indicates that antibiotics for surgical prophylaxis are administered ineffectively, or are extended for an inappropriate duration of time postoperatively. Ineffective antibiotic prophylaxis can contribute to the development of surgical site infections (SSIs, which represent a significant global burden of disease. The World Health Organization estimates SSI rates of up to 50% in postoperative surgical patients (depending on the type of surgery, with a particular problem in low- and middle-income countries, where SSIs are the most frequently reported healthcare-associated infections. Across European hospitals, SSIs alone comprise 19.6% of all healthcare-acquired infections. Much of the scientific research in infection management in surgery is related to infection prevention and control in the operating room, surgical prophylaxis, and the management of SSIs, with many studies focusing on infection within the 30-day postoperative period. However it is important to note that SSIs represent only one of the many types of infection that can occur postoperatively. This article provides an overview of the surgical pathway and considers infection management and antibiotic prescribing at each step of the pathway. The aim was to identify the implications for research and opportunities for system improvement.
Opportunities for system level improvement in antibiotic use across the surgical pathway.
Charani, E; Ahmad, R; Tarrant, C; Birgand, G; Leather, A; Mendelson, M; Moonesinghe, S R; Sevdalis, N; Singh, S; Holmes, A
Optimizing antibiotic prescribing across the surgical pathway (before, during, and after surgery) is a key aspect of tackling important drivers of antimicrobial resistance and simultaneously decreasing the burden of infection at the global level. In the UK alone, 10 million patients undergo surgery every year, which is equivalent to 60% of the annual hospital admissions having a surgical intervention. The overwhelming majority of surgical procedures require effectively limited delivery of antibiotic prophylaxis to prevent infections. Evidence from around the world indicates that antibiotics for surgical prophylaxis are administered ineffectively, or are extended for an inappropriate duration of time postoperatively. Ineffective antibiotic prophylaxis can contribute to the development of surgical site infections (SSIs), which represent a significant global burden of disease. The World Health Organization estimates SSI rates of up to 50% in postoperative surgical patients (depending on the type of surgery), with a particular problem in low- and middle-income countries, where SSIs are the most frequently reported healthcare-associated infections. Across European hospitals, SSIs alone comprise 19.6% of all healthcare-acquired infections. Much of the scientific research in infection management in surgery is related to infection prevention and control in the operating room, surgical prophylaxis, and the management of SSIs, with many studies focusing on infection within the 30-day postoperative period. However it is important to note that SSIs represent only one of the many types of infection that can occur postoperatively. This article provides an overview of the surgical pathway and considers infection management and antibiotic prescribing at each step of the pathway. The aim was to identify the implications for research and opportunities for system improvement. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Radioisotope thermoelectric generator transportation system subsystem 143 software development plan
International Nuclear Information System (INIS)
King, D.A.
This plan describes the activities to be performed and the controls to be applied to the process of specifying, developing, and qualifying the data acquisition software for the Radioisotope Thermoelectric Generator (RTG) Transportation System Subsystem 143 Instrumentation and Data Acquisition System (IDAS). This plan will serve as a software quality assurance plan, a verification and validation (V and V) plan, and a configuration management plan
Development of an integrated automated retinal surgical laser system.
Barrett, S F; Wright, C H; Oberg, E D; Rockwell, B A; Cain, C; Rylander, H G; Welch, A J
Researchers at the University of Texas and the USAF Academy have worked toward the development of a retinal robotic laser system. The overall goal of this ongoing project is to precisely place and control the depth of laser lesions for the treatment of various retinal diseases such as diabetic retinopathy and retinal tears. Separate low speed prototype subsystems have been developed to control lesion depth using lesion reflectance feedback parameters and lesion placement using retinal vessels as tracking landmarks. Both subsystems have been successfully demonstrated in vivo on pigmented rabbits using an argon continuous wave laser. Preliminary testing on rhesus primate subjects have been accomplished with the CW argon laser and also the ultrashort pulse laser. Recent efforts have concentrated on combining the two subsystems into a single prototype capable of simultaneously controlling both lesion depth and placement. We have designated this combined system CALOSOS for Computer Aided Laser Optics System for Ophthalmic Surgery. Several interesting areas of study have developed in integrating the two subsystems: 1) "doughnut" shaped lesions that occur under certain combinations of laser power, spot size, and irradiation time complicating measurements of central lesion reflectance, 2) the optimal retinal field of view (FOV) to achieve both tracking and lesion parameter control, and 3) development of a hybrid analog/digital tracker using confocal reflectometry to achieve retinal tracking speeds of up to 100 dgs. This presentation will discuss these design issues of this clinically significant prototype system. Details of the hybrid prototype system are provided in "Hybrid Eye Tracking for Computer-Aided Retinal Surgery" at this conference. The paper will close with remaining technical hurdles to clear prior to testing the full-up clinical prototype system.
49 CFR 659.21 - System security plan: general requirements.
... 49 Transportation 7 2010-10-01 2010-10-01 false System security plan: general requirements. 659.21... State Oversight Agency § 659.21 System security plan: general requirements. (a) The oversight agency shall require the rail transit agency to implement a system security plan that, at a minimum, complies...
An expert system for a local planning environment
Meester, G.J.; Meester, G.J.
In this paper, we discuss the design of an Expert System (ES) that supports decision making in a Local Planning System (LPS) environment. The LPS provides the link between a high level factory planning system (rough cut capacity planning and material coordination) and the actual execution of jobs on
Robot-Assisted Fracture Surgery: Surgical Requirements and System Design.
Georgilas, Ioannis; Dagnino, Giulio; Tarassoli, Payam; Atkins, Roger; Dogramadzi, Sanja
The design of medical devices is a complex and crucial process to ensure patient safety. It has been shown that improperly designed devices lead to errors and associated accidents and costs. A key element for a successful design is incorporating the views of the primary and secondary stakeholders early in the development process. They provide insights into current practice and point out specific issues with the current processes and equipment in use. This work presents how information from a user-study conducted in the early stages of the RAFS (Robot Assisted Fracture Surgery) project informed the subsequent development and testing of the system. The user needs were captured using qualitative methods and converted to operational, functional, and non-functional requirements based on the methods derived from product design and development. This work presents how the requirements inform a new workflow for intra-articular joint fracture reduction using a robotic system. It is also shown how the various elements of the system are developed to explicitly address one or more of the requirements identified, and how intermediate verification tests are conducted to ensure conformity. Finally, a validation test in the form of a cadaveric trial confirms the ability of the designed system to satisfy the aims set by the original research question and the needs of the users.
A Fully Sensorized Cooperative Robotic System for Surgical Interventions
Tovar-Arriaga, Saúl; Vargas, José Emilio; Ramos, Juan M.; Aceves, Marco A.; Gorrostieta, Efren; Kalender, Willi A.
In this research a fully sensorized cooperative robot system for manipulation of needles is presented. The setup consists of a DLR/KUKA Light Weight Robot III especially designed for safe human/robot interaction, a FD-CT robot-driven angiographic C-arm system, and a navigation camera. Also, new control strategies for robot manipulation in the clinical environment are introduced. A method for fast calibration of the involved components and the preliminary accuracy tests of the whole possible errors chain are presented. Calibration of the robot with the navigation system has a residual error of 0.81 mm (rms) with a standard deviation of ±0.41 mm. The accuracy of the robotic system while targeting fixed points at different positions within the workspace is of 1.2 mm (rms) with a standard deviation of ±0.4 mm. After calibration, and due to close loop control, the absolute positioning accuracy was reduced to the navigation camera accuracy which is of 0.35 mm (rms). The implemented control allows the robot to compensate for small patient movements. PMID:23012551
Development of surgical CW Nd:YAG laser with optical fiber delivery system
International Nuclear Information System (INIS)
Kim, Cheol Jung; Kim, Jeong Mook; Jung, Chin Mann; Kim, Kwang Suk; Kim, Min Suk; Cho, Jae Wan; Kim, Duk Hyun
We developed a surgical CW Nd:YAG laser with optical fiber delivery system. Several commercial models have been investigated in design and performance. We improved its quality to the level of commercial Nd:YAG laser by an endurance test for each parts of laser system. The maximum power of our surgical laser was 150 W and the laser pulse width could be controlled to 99 sec continuously by 0.1 sec. Many optical parts were localized and lowered much in cost. Only few parts were imported and almost 90% in cost were localized. Also, to find out the maintenance problem of this surgical laser, it was applicated to the production line of our joint company. (Author)
Cone-beam computed tomography for planning and assessing surgical outcomes of osteo-odonto-keratoprosthesis.
Berg, Britt-Isabelle; Dagassan-Berndt, Dorothea; Goldblum, David; Kunz, Christoph
The aim of this study was to investigate the feasibility and effectiveness of cone-beam computed tomography (CBCT) in the planning, assessment, and follow-up for osteo-odonto-keratoprosthesis (OOKP). Six OOKP patients received a CBCT scan. CBCT scans were performed before and/or between ∼5 and 504 months after the primary OOKP intervention. Preoperative and postoperative results of the CBCT were assessed, regarding the available teeth and to assess the loss of bone in 1 patient, respectively. Resorption of the osteo-odonto-lamina was measured and graded. Five different measurements (I-V) were performed in the coronal and transversal views of CBCT. Four CBCT scans were performed preoperatively and 4 postoperatively. The follow-up time of the patients is between ∼1 to 528 months. Visualization of the potential donor teeth resulted in accurate 3-dimensional visualization of the tooth-lamina-bone complex. CBCT was found to help in the preoperative decision-making process (diameter of optical implant) and in enabling accurate postoperative evaluation of the bone volume and resorption zones of the OOKP. Loss of bone could be measured in a precise range and showed in the completed cases an average loss of 20.2%. The use of CBCT simplifies the preoperative decision making and ordering process. It also helps in determining the postoperative structure and resorption of the prosthesis.
Making Safe Surgery Affordable: Design of a Surgical Drill Cover System for Scale.
Buchan, Lawrence L; Black, Marianne S; Cancilla, Michael A; Huisman, Elise S; Kooyman, Jeremy J R; Nelson, Scott C; O'Hara, Nathan N; O'Brien, Peter J; Blachut, Piotr A
Many surgeons in low-resource settings do not have access to safe, affordable, or reliable surgical drilling tools. Surgeons often resort to nonsterile hardware drills because they are affordable, robust, and efficient, but they are impossible to sterilize using steam. A promising alternative is to use a Drill Cover system (a sterilizable fabric bag plus surgical chuck adapter) so that a nonsterile hardware drill can be used safely for surgical bone drilling. Our objective was to design a safe, effective, affordable Drill Cover system for scale in low-resource settings. We designed our device based on feedback from users at Mulago Hospital (Kampala, Uganda) and focused on 3 main aspects. First, the design included a sealed barrier between the surgical field and hardware drill that withstands pressurized fluid. Second, the selected hardware drill had a maximum speed of 1050 rpm to match common surgical drills and reduce risk of necrosis. Third, the fabric cover was optimized for ease of assembly while maintaining a sterile technique. Furthermore, with the Drill Cover approach, multiple Drill Covers can be provided with a single battery-powered drill in a "kit," so that the drill can be used in back-to-back surgeries without requiring immediate sterilization. The Drill Cover design presented here provides a proof-of-concept for a product that can be commercialized, produced at scale, and used in low-resource settings globally to improve access to safe surgery.
SURGNET: An Integrated Surgical Data Transmission System for Telesurgery.
Natarajan, Sriram; Ganz, Aura
Remote surgery information requires quick and reliable transmission between the surgeon and the patient site. However, the networks that interconnect the surgeon and patient sites are usually time varying and lossy which can cause packet loss and delay jitter. In this paper we propose SURGNET, a telesurgery system for which we developed the architecture, algorithms and implemented it on a testbed. The algorithms include adaptive packet prediction and buffer time adjustment techniques which reduce the negative effects caused by the lossy and time varying networks. To evaluate the proposed SURGNET system, at the therapist site, we implemented a therapist panel which controls the force feedback device movements and provides image analysis functionality. At the patient site we controlled a virtual reality applet built in Matlab. The varying network conditions were emulated using NISTNet emulator. Our results show that even for severe packet loss and variable delay jitter, the proposed integrated synchronization techniques significantly improve SURGNET performance.
SU-E-J-64: Feasibility Study of Surgical Clips for Fiducial Tracking in CyberKnife System
International Nuclear Information System (INIS)
Lee, H; Yoon, J; Lee, E; Cho, S; Park, K; Choi, W; Baek, J; Keum, K; Koom, W
Purpose: To investigate the ability of CyberKnife to track surgical clips used as fiducial markers. Methods: The Octavius 1000SRS detector and solid water (RW3) slab phantom were used with motion platform to evaluate the study. The RW3 slab phantom was set up to measure the dose distribution from coronal plane. It consists of 9 plates and the thickness of each plate is 10mm. Among them, one plate was attached with 3 surgical clips, which are orthogonally positioned on outer region of array. The length of attached clip was represented as 1cm on planning CT. The clip plate was placed on the 1000SRS detector and 3 slabs were stacked up on the plate to build the measuring depth. Below the detector, 5 slabs were set. The two-axis motion platform was programmed with 1D sinusoidal movement (20mm peak-to-peak, 3s period) toward superior/inferior and left/right directions to simulate target motion. During delivery, two clips were extracted by two X-ray imagers, which led to translational error correction only. Synchrony was also used for dynamic tracking. After the irradiation, the measured dose distribution of coronal plane was compared with the planar dose distribution calculated by the CyberKnife treatment planning system (Multiplan) for cross verification. The results were assessed by comparing the absolute Gamma (γ) index. Results: The dose distributions measured by the 1000SRS detector were in good agreements with those calculated by Multiplan. In the dosimetric comparison using γ-function criteria based on the distance-to-agreement of 3mm and the local dose difference of 3%, the passing rate with γ- parameter ≤1 was 91% in coronal plane. Conclusion: The surgical clips can be considered as new fiducials for robotic radiosurgery delivery by considering the target margin with less than 5mm
Thorascopic resection of an apical paraspinal schwannoma using the da Vinci surgical system.
Finley, David; Sherman, Jonathan H; Avila, Edward; Bilsky, Mark
Posterior mediastinal neurogenic tumors have traditionally been resected via an open posterolateral thoracotomy. Video-assisted thorascopic surgery has emerged as an alternative technique allowing for improved morbidity with decreased blood loss, less postoperative pain, and a shorter recovery period, among others. The da Vinci surgical system, as first described for urologic procedures, has recently been reported for lung lobectomy. This technique provides the advantages of instrumentation with 6 degrees of freedom, stable operating arms, and improved visualization with the three-dimensional high-definition camera. We describe the technique for thorascopic resection of an apical paraspinal schwannoma of the T1 nerve root with the da Vinci surgical system. This technique used a specialized intraoperative neuromonitoring probe for free-running electromyography (EMG) and triggered EMG. We demonstrate successful resection of a posterior paraspinal schwannoma with the da Vinci surgical system while preserving neurologic function. The patient displayed stable intraoperative monitoring of the T1 nerve root and full intrinsic hand strength postoperatively. The technique described in this article introduces robotic system accuracy and precludes the need for an open thoracotomy. In addition, this approach demonstrates the ability of the da Vinci surgical system to safely dissect tumors from their neural attachments and is applicable to other such lesions of similar size and location. Georg Thieme Verlag KG Stuttgart · New York.
Compact teleoperated laparoendoscopic single-site robotic surgical system: Kinematics, control, and operation.
Isaac-Lowry, Oran Jacob; Okamoto, Steele; Pedram, Sahba Aghajani; Woo, Russell; Berkelman, Peter
To date a variety of teleoperated surgical robotic systems have been developed to improve a surgeon's ability to perform demanding single-port procedures. However typical large systems are bulky, expensive, and afford limited angular motion, while smaller designs suffer complications arising from limited motion range, speed, and force generation. This work was to develop and validate a simple, compact, low cost single site teleoperated laparoendoscopic surgical robotic system, with demonstrated capability to carry out basic surgical procedures. This system builds upon previous work done at the University of Hawaii at Manoa and includes instrument and endoscope manipulators as well as compact articulated instruments designed to overcome single incision geometry complications. A robotic endoscope holder was used for the base, with an added support frame for teleoperated manipulators and instruments fabricated mostly from 3D printed parts. Kinematics and control methods were formulated for the novel manipulator configuration. Trajectory following results from an optical motion tracker and sample task performance results are presented. Results indicate that the system has successfully met the goal of basic surgical functionality while minimizing physical size, complexity, and cost. Copyright © 2017 John Wiley & Sons, Ltd.
Development of stereo endoscope system with its innovative master interface for continuous surgical operation.
Kim, Myungjoon; Lee, Chiwon; Hong, Nhayoung; Kim, Yoon Jae; Kim, Sungwan
Although robotic laparoscopic surgery has various benefits when compared with conventional open surgery and minimally invasive surgery, it also has issues to overcome and one of the issues is the discontinuous surgical flow that occurs whenever control is swapped between the endoscope system and the operating robot arm system. This can lead to problems such as collision between surgical instruments, injury to patients, and increased operation time. To achieve continuous surgical operation, a wireless controllable stereo endoscope system is proposed which enables the simultaneous control of the operating robot arm system and the endoscope system. The proposed system consists of two improved novel master interfaces (iNMIs), a four-degrees of freedom (4-DOFs) endoscope control system (ECS), and a simple three-dimensional (3D) endoscope. In order to simultaneously control the proposed system and patient side manipulators of da Vinci research kit (dVRK), the iNMIs are installed to the master tool manipulators of dVRK system. The 4-DOFs ECS consists of four servo motors and employs a two-parallel link structure to provide translational and fulcrum point motion to the simple 3D endoscope. The images acquired by the endoscope undergo stereo calibration and rectification to provide a clear 3D vision to the surgeon as available in clinically used da Vinci surgical robot systems. Tests designed to verify the accuracy, data transfer time, and power consumption of the iNMIs were performed. The workspace was calculated to estimate clinical applicability and a modified peg transfer task was conducted with three novice volunteers. The iNMIs operated for 317 min and moved in accordance with the surgeon's desire with a mean latency of 5 ms. The workspace was calculated to be 20378.3 cm 3 , which exceeds the reference workspace of 549.5 cm 3 . The novice volunteers were able to successfully execute the modified peg transfer task designed to evaluate the proposed system's overall
Person or system - What leads to surgical advances?
Hughes, Sean Pf
To understand the relationship between standardisation and originality in surgery, the contributions of three surgeons in the 20th century are analysed. The individual Arbuthnot Lane, the collectivist Robert Jones and the scientist Alexis Carrel changed the practice of orthopaedic surgery. It is argued that the factors influencing innovation are not binary but multifactorial and that advances in surgery occur when individual freedom is permitted within a system. It is concluded that innovation and standardisation in orthopaedic surgery need not conflict with each other.
Commercialization plan laser-based decoating systems
International Nuclear Information System (INIS)
Freiwald, J.; Freiwald, D.A.
F2 Associates Inc. (F2) is a small, high-technology firm focused on developing and commercializing environmentally friendly laser ablation systems for industrial-rate removal of surface coatings from metals, concrete, and delicate substrates such as composites. F2 has a contract with the US Department of Energy Federal Energy Technology Center (FETC) to develop and test a laser-based technology for removing contaminated paint and other contaminants from concrete and metal surfaces. Task 4.1 in Phase 2 of the Statement of Work for this DOE contract requires that F2 ''document its plans for commercializing and marketing the stationary laser ablation system. This document shall include a discussion of prospects for commercial customers and partners and may require periodic update to reflect changing strategy. This document shall be submitted to the DOE for review.'' This report is being prepared and submitted in fulfillment of that requirement. This report describes the laser-based technology for cleaning and coatings removal, the types of laser-based systems that have been developed by F2 based on this technology, and the various markets that are emerging for this technology. F2's commercialization and marketing plans are described, including how F2's organization is structured to meet the needs of technology commercialization, F2's strategy and marketing approach, and the necessary steps to receive certification for removing paint from aircraft and DOE certification for D and D applications. The future use of the equipment built for the DOE contract is also discussed
[Establishing a clinical information system for surgical ophthalmology and orthopedics specialties with reference to GSG '93].
Dick, B; Basad, E
As a result of new health care guidelines (Gesundheitsstrukturgesetz) and the federal hospital and nursing ordinance, there has been a large increase in the documentation required for diagnoses (ICD-9) and service ("Operationenschlüssel nach section 301 SGB V" = ICPM), all of which is done in the form of a numeric code. The method of coding diagnoses is supposed to make possible data entry and statistical evaluation of plausibility controls, as well as conspicuous and random testing of economic feasibility. Our data processing system is designed to assist in the planning and organization of clinical activities, while at the same time making documentation in accordance with health care guidelines easier and providing scientific documentation and evaluation. The application MedAccess was developed by clinicians on the basis of a relational client-server database. The application has been in use since June 1992 and has been further developed during operation according to the requirements and wishes of clinic and administrative staff. In cooperation with the Institute for Medical Information Technology, a computer interface with the patient check-in system was created, making possible the importing of patient data. The application is continuously updated according to the current needs of the clinic and administration. The primary functions of MedAccess include managing patient data, planning of in-patient admissions, surgical planning, organization, documentation (surgery book, reports with follow-up treatment records), administration of the tissue bank, clinic communications, clinic work processing, and management of the staff duty roster. Clinical data are entered into a computer and processed on site, and the user is assisted by practical applications which do not require special knowledge of data processing or encoding systems. The data is entered only once, but can be further used for other purposes, such as evaluations or selective transfer, for example, to
Soft tissue models: easy and inexpensive flexible 3D printing as a help in surgical planning of cardiovascular disorders
Starosolski, Zbigniew; Ezon, David S.; Krishnamurthy, Rajesh; Dodd, Nicholas; Heinle, Jeffrey; Mckenzie, Dean E.; Annapragada, Ananth
We developed a technology that allows a simple desktop 3D printer with dual extruder to fabricate 3D flexible models of Major AortoPulmonary Collateral Arteries. The study was designed to assess whether the flexible 3D printed models could help during surgical planning phase. Simple FDM 3D printers are inexpensive, versatile in use and easy to maintain, but complications arise when the designed model is complex and has tubular structures with small diameter less than 2mm. The advantages of FDM printers are cost and simplicity of use. We use precisely selected materials to overcome the obstacles listed above. Dual extruder allows to use two different materials while printing, which is especially important in the case of fragile structures like pulmonary vessels and its supporting structures. The latter should not be removed by hand to avoid a truncation of the model. We utilize the water soluble PVA as a supporting structure and Poro-Lay filament for flexible model of AortoPulmonary collateral arteries. Poro-Lay filament is different as compared to all the other flexible ones like polymer-based. Poro-Lay is rigid while printing and this allows printing of structures small in diameter. It achieves flexibility after washing out of printed model with water. It becomes soft in touch and gelatinous. Using both PVA and Poro-Lay gives a huge advantage allowing to wash out the supporting structures and achieve flexibility in one washing operation, saving time and avoiding human error with cleaning the model. We evaluated 6 models for MAPCAS surgical planning study. This approach is also cost-effective - an average cost of materials for print is less than $15; models are printed in facility without any delays. Flexibility of 3D printed models approximate soft tissues properly, mimicking Aortopulmonary collateral arteries. Second utilization models has educational value for both residents and patients' family. Simplification of 3D flexible process could help in other models
Business System Planning Project, Alternatives Analysis
International Nuclear Information System (INIS)
The CHG Chief Information Officer (CIO) requested a study of alternatives to the current business system computing environment. This Business Systems Planning (BSP) Project Alternatives Analysis document presents an analysis of the current Project Controls, Work Management, and Business Management systems environment and alternative solutions that support the business functions. The project team has collected requirements and priorities from stakeholders in each business area and documented them in the BSP System Requirements Specification (SRS), RPP-6297. The alternatives analysis process identifies and measures possible solutions in each of the business process areas against the requirements as documented in the SRS. The team gathered input from both internal and external sources to identify and grade the possible solutions. This document captures the results of that activity and recommends a suite of software products. This study was to select the best product based on how well the product met the requirements, not to determine the platform or hardware environment that would be used. Additional analysis documentation can be found in BSP project files
Information System Architectures: Representation, Planning and Evaluation
Directory of Open Access Journals (Sweden)
André Vasconcelos
Full Text Available In recent years organizations have been faced with increasingly demanding business environments - pushed by factors like market globalization, need for product and service innovation and product life cycle reduction - and with new information technologies changes and opportunities- such as the Component-off-the-shelf paradigm, the telecommunications improvement or the Enterprise Systems off-the-shelf modules availability - all of which impose a continuous redraw and reorganization of business strategies and processes. Nowadays, Information Technology makes possible high-speed, efficient and low cost access to the enterprise information, providing the means for business processes automation and improvement. In spite of these important technological progresses, information systems that support business, do not usually answer efficiently enough to the continuous demands that organizations are faced with, causing non-alignment between business and information technologies (IT and therefore reducing organization competitive abilities. This article discusses the vital role that the definition of an Information System Architecture (ISA has in the development of Enterprise Information Systems that are capable of staying fully aligned with organization strategy and business needs. In this article the authors propose a restricted collection of founding and basis operations, which will provide the conceptual paradigm and tools for proper ISA handling. These tools are then used in order to represent, plan and evaluate an ISA of a Financial Group.
Flexible power generation systems and their planning
International Nuclear Information System (INIS)
Schwarzenbach, A.; Wunsch, A.K.
By determining their specific annual costs and expressing them in relation to the period of utilization or to the load factor, it is possible to compare the relative merits of different combinbations of power generation systems. This method, with which unsuitable planning variants can be eliminated without having to go through long, intricate calculations and without taking up costly computer time, has the advantage that it points up the origin of the costs and at the same time makes clear how improvement can be achieved by combining base-load, medium-load and peak-load plants. The different types of power plant (hydro-electric, nuclear, steam, gas-turbine, combined cycle, cogeneration and coal gasification) are characterized by their approximate specific capital investment, construction period, efficiency, fuel, duty, and time from cold start to full load. They are compared by plotting their total specific annual costs in SFr/kWa against the load factor. The special benefits which combined cycle plants, with gas turbines, heat-recovery boilers and steam plant, can offer today (not only high fuel utilization and relatively low first-time costs, but also the short time needed for planning and construction) are underlined. 5 refs.; 9 figs.; 3 tabs
LED surgical lighting system with multiple free-form surfaces for highly sterile operating theater application.
Liu, Peng; Zhang, Yaqin; Zheng, Zhenrong; Li, Haifeng; Liu, Xu
Although the ventilation system is widely employed in the operating theater, a strictly sterile surgical environment still cannot be ensured because of laminar disturbance, which is mainly caused by the surgical lighting system. Abandoning traditional products, we propose an LED surgical lighting system, which can alleviate the laminar disturbance and provide an appropriate lighting condition for surgery. It contains a certain amount of LED lens units, which are embedded in the ceiling and arranged around the air supply smallpox. The LED lens unit integrated with an LED light source and a free-form lens is required to produce a uniform circular illumination with a large tolerance to the change of lighting distance. To achieve such a dedicated lens, two free-form refractive surfaces, which are converted into two ordinary differential equations by the design method presented in this paper, are used to deflect the rays. The results show that the LED surgical lighting system can provide an excellent illumination environment for surgery, and, apparently, the laminar disturbance also can be relieved.
The surgical algorithm for the AOSpine thoracolumbar spine injury classification system
Vaccaro, Alexander R.; Schroeder, Gregory D.; Kepler, Christopher K.; Cumhur Oner, F.; Vialle, Luiz R.; Kandziora, Frank; Koerner, John D.; Kurd, Mark F.; Reinhold, Max; Schnake, Klaus J.; Chapman, Jens; Aarabi, Bizhan; Fehlings, Michael G.; Dvorak, Marcel F.
Purpose: The goal of the current study is to establish a surgical algorithm to accompany the AOSpine thoracolumbar spine injury classification system. Methods: A survey was sent to AOSpine members from the six AO regions of the world, and surgeons were asked if a patient should undergo an initial
[Short-term efficacy of da Vinci robotic surgical system on rectal cancer in 101 patients].
Zeng, Dong-Zhu; Shi, Yan; Lei, Xiao; Tang, Bo; Hao, Ying-Xue; Luo, Hua-Xing; Lan, Yuan-Zhi; Yu, Pei-Wu
To investigate the feasibility and safety of da Vinci robotic surgical system in rectal cancer radical operation, and to summarize its short-term efficacy and clinical experience. Data of 101 cases undergoing da Vinci robotic surgical system for rectal cancer radical operation from March 2010 to September 2012 were retrospectively analyzed. Evaluation was focused on operative procedure, complication, recovery and pathology. All the 101 cases underwent operation successfully and safely without conversion to open procedure. Rectal cancer radical operation with da Vinci robotic surgical system included 73 low anterior resections and 28 abdominoperineal resections. The average operative time was (210.3±47.2) min. The average blood lose was (60.5±28.7) ml without transfusion. Lymphadenectomy harvest was 17.3±5.4. Passage of first flatus was (2.7±0.7) d. Distal margin was (5.3±2.3) cm without residual cancer cells. The complication rate was 6.9%, including anastomotic leakage(n=2), perineum incision infection(n=2), pulmonary infection (n=2), urinary retention (n=1). There was no postoperative death. The mean follow-up time was(12.9±8.0) months. No local recurrence was found except 2 cases with distant metastasis. Application of da Vinci robotic surgical system in rectal cancer radical operation is safe and patients recover quickly The short-term efficacy is satisfactory.
Surgical strategy for giant pituitary adenoma based on evaluation of fine feeding system and angioarchitecture
Directory of Open Access Journals (Sweden)
Yoshikazu Ogawa, M.D., Ph.D.
Conclusion: Major blood supply was different from the normal supply to the anterior pituitary gland and did not necessarily correspond to tumor shape and extension. Surgical strategy should be established based on the tumor feeding systems and hemodynamics in giant pituitary adenomas.
Tank waste remediation system systems engineering management plan
International Nuclear Information System (INIS)
Peck, L.G.
This Systems Engineering Management Plan (SEMP) describes the Tank Waste Remediation System (TWRS) implementation of the US Department of Energy (DOE) systems engineering policy provided in 97-IMSD-193. The SEMP defines the products, process, organization, and procedures used by the TWRS Project to implement the policy. The SEMP will be used as the basis for tailoring the systems engineering applications to the development of the physical systems and processes necessary to achieve the desired end states of the program. It is a living document that will be revised as necessary to reflect changes in systems engineering guidance as the program evolves. The US Department of Energy-Headquarters has issued program management guidance, DOE Order 430. 1, Life Cycle Asset Management, and associated Good Practice Guides that include substantial systems engineering guidance
Virtual Reality Training System for Anytime/Anywhere Acquisition of Surgical Skills: A Pilot Study.
Zahiri, Mohsen; Booton, Ryan; Nelson, Carl A; Oleynikov, Dmitry; Siu, Ka-Chun
This article presents a hardware/software simulation environment suitable for anytime/anywhere surgical skills training. It blends the advantages of physical hardware and task analogs with the flexibility of virtual environments. This is further enhanced by a web-based implementation of training feedback accessible to both trainees and trainers. Our training system provides a self-paced and interactive means to attain proficiency in basic tasks that could potentially be applied across a spectrum of trainees from first responder field medical personnel to physicians. This results in a powerful training tool for surgical skills acquisition relevant to helping injured warfighters.
Planning, Anticipatory Systems, and Kinds of Actors
Jorna, René; van Wezel, Wout
Anticipation and planning have much in common. Anticipation means being ahead of things. Planning means not only anticipating on things to come, but also trying to determine a course of action to reach a goal. Planning is investigated in many domains, for example, in economy, biology, and in the cognitive sciences. Each of these domains uses its own research methodologies, languages, ontologies, and models. Although there are many differences between the various approaches and models, there must of course also be similarities, since they all deal with establishing a future course of actions to reach a goal. We will compare several planning approaches on a number of aspects, e.g., the kind of entity that makes the plan (natural or artificial), whether the plan is executed by the planner or by another entity, representational issues, and the domain that the plan is executed in. Our article focuses on analytical dimensions in the extended field of planning. We do not discuss empirical results.
Designing of network planning system for small-scale manufacturing
Kapulin, D. V.; Russkikh, P. A.; Vinnichenko, M. V.
The paper presents features of network planning in small-scale discrete production. The procedure of explosion of the production order, considering multilevel representation, is developed. The software architecture is offered. Approbation of the network planning system is carried out. This system allows carrying out dynamic updating of the production plan.
The strategic planning of health management information systems.
Smith, J
This paper discusses the roles and functions of strategic planning of information systems in health services. It selects four specialised methodologies of strategic planning for analysis with respect to their applicability in the health field. It then examines the utilisation of information planning in case studies of three health organisations (two State departments of health and community services and one acute care institution). Issues arising from the analysis concern the planning process, the use to which plans are put, and implications for management.
Planning, anticipatory systems, and kinds of actors
Jorna, R; van Wezel, W; Dubois, DM
Anticipation and planning have much in common. Anticipation means being ahead of things. Planning means not only anticipating on things to come, but also trying to determine a course of action to reach a goal. Planning is investigated in many domains, for example, in economy, biology, and in the
Planning and Design: A Systems Approach.
Bozeman, William C.; Clements, Mary A.
Explains "purpose design," a planning and problem-solving strategy involving determination of planning purposes, generation and selection of solutions, specification of solution details, implementation, and evaluation. Describes the application of purpose design to the planning of an alumni association at Black Hawk College, a community…
Integrated maintenance planning in manufacturing systems
Al-Turki, Umar M; Yilbas, Bekir Sami; Sahin, Ahmet Ziyaettin
This book introduces the concept of integrated planning for maintenance and production taken into account quality and safety for high global socio-economic impact. It provides insight into the planning process at a global level starting from the business level and ending with the operational level where the plan is implemented and controlled.
WEP. A wind energy planning system
International Nuclear Information System (INIS)
Larsen, H.V.
The report describes the Wind Energy Planning system (WEP). It is intended as a decision support system to be used in the economic evaluation of wind energy projects. Such projects could be minor projects with only a single wind turbine or large wind farm projects consisting of several wind turbine plants. In the WEP system, a wind turbine is described by data on initial investment, possible later reinvestments, O and M costs, expected yearly production, life time, and capacity factor. The raising of loans are modelled, too. Depending on which output report is created, the value of the wind generated electricity is calculated in two different ways: either the electricity is assumed to be sold at a price (time series) given by the user, or the alternative conventional power production is modelled by its specific investment, O and M costs, life time, effectivity, fuel mix, and time series for fuel prices. Using these data, capacity credit and saved fuel and O and M costs are calculated. Due to the flexible data structure of the model, the user can easily create a scenario that models a large scale introduction of wind power. In such a scenario the gradual build up through several years of the wind power capacity can be modelled. The report describes in detail the menu structure, the input facilities, the output reports, and the organization of data. Also included is an example with full input documentation and output reports. (au)
Radiation Planning Assistant - A Streamlined, Fully Automated Radiotherapy Treatment Planning System
Court, Laurence E.; Kisling, Kelly; McCarroll, Rachel; Zhang, Lifei; Yang, Jinzhong; Simonds, Hannah; du Toit, Monique; Trauernicht, Chris; Burger, Hester; Parkes, Jeannette; Mejia, Mike; Bojador, Maureen; Balter, Peter; Branco, Daniela; Steinmann, Angela; Baltz, Garrett; Gay, Skylar; Anderson, Brian; Cardenas, Carlos; Jhingran, Anuja; Shaitelman, Simona; Bogler, Oliver; Schmeller, Kathleen; Followill, David; Howell, Rebecca; Nelson, Christopher; Peterson, Christine; Beadle, Beth
The Radiation Planning Assistant (RPA) is a system developed for the fully automated creation of radiotherapy treatment plans, including volume-modulated arc therapy (VMAT) plans for patients with head/neck cancer and 4-field box plans for patients with cervical cancer. It is a combination of specially developed in-house software that uses an application programming interface to communicate with a commercial radiotherapy treatment planning system. It also interfaces with a commercial secondary dose verification software. The necessary inputs to the system are a Treatment Plan Order, approved by the radiation oncologist, and a simulation computed tomography (CT) image, approved by the radiographer. The RPA then generates a complete radiotherapy treatment plan. For the cervical cancer treatment plans, no additional user intervention is necessary until the plan is complete. For head/neck treatment plans, after the normal tissue and some of the target structures are automatically delineated on the CT image, the radiation oncologist must review the contours, making edits if necessary. They also delineate the gross tumor volume. The RPA then completes the treatment planning process, creating a VMAT plan. Finally, the completed plan must be reviewed by qualified clinical staff. PMID:29708544
Application of 3D Printing in the Surgical Planning of Trimalleolar Fracture and Doctor-Patient Communication
Directory of Open Access Journals (Sweden)
Long Yang
Full Text Available To evaluate the effect of 3D printing in treating trimalleolar fractures and its roles in physician-patient communication, thirty patients with trimalleolar fractures were randomly divided into the 3D printing assisted-design operation group (Group A and the no-3D printing assisted-design group (Group B. In Group A, 3D printing was used by the surgeons to produce a prototype of the actual fracture to guide the surgical treatment. All patients underwent open reduction and internal fixation. A questionnaire was designed for doctors and patients to verify the verisimilitude and effectiveness of the 3D-printed prototype. Meanwhile, the operation time and the intraoperative blood loss were compared between the two groups. The fracture prototypes were accurately printed, and the average overall score of the verisimilitude and effectiveness of the 3D-printed prototypes was relatively high. Both the operation time and the intraoperative blood loss in Group A were less than those in Group B (P<0.05. Patient satisfaction using the 3D-printed prototype and the communication score were 9.3±0.6 points. A 3D-printed prototype can faithfully reflect the anatomy of the fracture site; it can effectively help the doctors plan the operation and represent an effective tool for physician-patient communication.
Analysis of edentulous maxillae using computed tomography and panoramic radiography in the surgical planning of dental implants
International Nuclear Information System (INIS)
Sahuinco, Humberto Lazaro Choquepuma; Souza, Ricardo Pires de
Objective: to determine agreement of three observers on analysis of linear measurements of edentulous maxillae using computed tomography and panoramic radiography in the surgical planning of dental implants. Material and Method: the samples of 17 patients were analyzed with computed tomography and panoramic radiography. Linear measurements obtained from both methods were made at the following anatomical points: left tuberosity, left canine pillar, incisive foramen, right canine pillar and right tuberosity. Kendall's W test was applied to assess the level of agreement. Results: measured W-values from the samples of the anatomical points mentioned above, analyzed with panoramic radiography and computed tomography, were: 0.75 and 0.901; 0.916 and 0.956; 0.843 and 0.964; 0.963 and 0.931; 0.95 and 0.89 respectively. Statistical analysis showed that there was no statistically significant difference. Conclusion: agreement occurred in the measurements of variables.That means that if the three observers were to select an implant to be placed in each of the anatomical regions studied, there would be a good chance whey would choose the same type. (author)
Louisiana Airport System Plan Five-Year Capital Improvement Program.
The Louisiana Airport System Plan (LASP) Five-Year-Capital Improvement Program (CIP) is a development plan for all commercial service, reliever, and general aviation airports in Louisiana. It is a detailed listing of potential projects based on the a...
Virtual reality system for diagnosis and therapeutic planning of cerebral aneurysms.
Mo, Da-peng; Bao, Sheng-de; Li, Liang; Yi, Zhi-qiang; Zhang, Jia-yong; Zhang, Yang
The virtual reality (VR) system can provide the neurosurgeon to intuitively interact with and manipulate the three dimensional (3-D) image similarly to manipulate a real object. It was seldom reported that the system was used in diagnosis and treatment of cerebral aneurysms. This study aimed to investigate the application of VR system in diagnosis and therapeutic planning of cerebral aneurysms. A total of 24 cases of cerebral aneurysms were enrolled in this study from 2006 to 2008, which diagnosed by 3-D digital subtraction angiography (3D-DSA) or VR-based computed tomography angiographies (CTA). The VR system and 3D-DSA system were used to observe and measure aneurysms and the adjacent vessels. The data of observation and measurements were compared between VR image and 3D-DSA image. All the patients underwent surgical plan and simulated neurosurgical procedures in the VR system. There were 28 aneurysms detected in VR system and 3D-DSA system. The VR system generated clear and vivid 3-D virtual images which clearly displayed the location and size of the aneurysms and their precise anatomical spatial relations to the parent arteries and skull. The location, size and shape of the aneurysms and their anatomical relationship with the adjacent vessels were similar between 3-D virtual image and 3D-DSA, but the spatial relationship between aneurysms and skull only been displayed by VR system. This VR system also could simulate simple surgical procedures and surgical environments. The VR system can provide a highly effective way to provide precise imaging details as same as 3D-DSA system and assist the diagnosis of cerebral aneurysms with virtual 3-D data based on CTA. It significantly enhances the chosen therapeutic strategy of cerebral aneurysms.
3D virtual planning in orthognathic surgery and CAD/CAM surgical splints generation in one patient with craniofacial microsomia: a case report
Vale, Francisco; Scherzberg, Jessica; Cavaleiro, João; Sanz, David; Caramelo, Francisco; Maló, Luísa; Marcelino, João Pedro
Objective: In this case report, the feasibility and precision of tridimensional (3D) virtual planning in one patient with craniofacial microsomia is tested using Nemoceph 3D-OS software (Software Nemotec SL, Madrid, Spain) to predict postoperative outcomes on hard tissue and produce CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) surgical splints. Methods: The clinical protocol consists of 3D data acquisition of the craniofacial complex by cone-beam computed tomography (CBCT) and surface scanning of the plaster dental casts. The ''virtual patient'' created underwent virtual surgery and a simulation of postoperative results on hard tissues. Surgical splints were manufactured using CAD/CAM technology in order to transfer the virtual surgical plan to the operating room. Intraoperatively, both CAD/CAM and conventional surgical splints are comparable. A second set of 3D images was obtained after surgery to acquire linear measurements and compare them with measurements obtained when predicting postoperative results virtually. Results: It was found a high similarity between both types of surgical splints with equal fitting on the dental arches. The linear measurements presented some discrepancies between the actual surgical outcomes and the predicted results from the 3D virtual simulation, but caution must be taken in the analysis of these results due to several variables. Conclusions: The reported case confirms the clinical feasibility of the described computer-assisted orthognathic surgical protocol. Further progress in the development of technologies for 3D image acquisition and improvements on software programs to simulate postoperative changes on soft tissue are required. PMID:27007767
The Efficacy and Utilisation of Preoperative Magnetic Resonance Imaging in Robot-assisted Radical Prostatectomy: Does it Change the Surgical Dissection Plan? A Preliminary Report
Directory of Open Access Journals (Sweden)
Hasan Hüseyin Tavukçu
Full Text Available Purpose: We investigated the effect of prostate magnetic resonance imaging (MRI on the dissection plan of the neurovascular bundle and the oncological results of our patients who underwent robotic radical prostatectomy operation. Materials and Methods: We prospectively evaluated 30 consecutive patients, 15 of whom had prostate MRI before the operation, and 15 of whom did not. With the findings of MRI, the dissection plan was changed as intrafascial, interfascial, and extrafascial technique in the MRI group. Two groups were compared in terms of age, prostate-specific antigen (PSA, and Gleason scores (GSs. Surgical margin status was also checked with the final pathology. Results: There was no significant difference between the two groups in terms of age, PSA, biopsy GS, and final pathological GS. MRI changed the initial surgical plan to a nerve-sparing technique in 7 of the 15 patients. Only one patient in the MRI group had a positive surgical margin on bladder neck. MRI was confirmed as the primary tumour localisation in the final pathology in 93.3% of patients. Conclusion: Preoperative prostate MRI influenced the decision to carry out a nerve-sparing technique in 46% of the patients in our study; however, the change to a nerve-sparing technique did not seem to compromise the surgical margin positivity.
Prototyping a Hybrid Cooperative and Tele-robotic Surgical System for Retinal Microsurgery.
Balicki, Marcin; Xia, Tian; Jung, Min Yang; Deguet, Anton; Vagvolgyi, Balazs; Kazanzides, Peter; Taylor, Russell
This paper presents the design of a tele-robotic microsurgical platform designed for development of cooperative and tele-operative control schemes, sensor based smart instruments, user interfaces and new surgical techniques with eye surgery as the driving application. The system is built using the distributed component-based cisst libraries and the Surgical Assistant Workstation framework. It includes a cooperatively controlled EyeRobot2, a da Vinci Master manipulator, and a remote stereo visualization system. We use constrained optimization based virtual fixture control to provide Virtual Remote-Center-of-Motion (vRCM) and haptic feedback. Such system can be used in a hybrid setup, combining local cooperative control with remote tele-operation, where an experienced surgeon can provide hand-over-hand tutoring to a novice user. In another scheme, the system can provide haptic feedback based on virtual fixtures constructed from real-time force and proximity sensor information.
A system architecture for holonic manufacturing planning and control (EtoPlan)
Wullink, Gerhard; Giebels, M.M.T.; Kals, H.J.J.
In this paper, we present the system architecture of a flexible manufacturing planning and control system, named EtoPlan. The concept is based on the holonic control approach of building multiple and temporary hierarchies (holarchies). This paper describes the system architecture for flexible
Soft system methodology and decision making in community planning system
Křupka, Jiří; Kašparová, Miloslava; Jirava, Pavel; Mandys, Jan; Ferynová, Lenka; Duplinský, Josef
A model of community planning was defined in this paper. The model was designed for the city of Pardubice and works with real questionnaire research data sets in its evaluation phase. Questionnaires were submitted to fill users, providers and sponsors of social services. When creating the model was used Checkland's soft system methodology. Also soft computing methods and decision trees were used to create the model. The model was implemented in the data mining tool IBM SPSS Modeler 14.
Lens subluxation grading system: predictive value for ectopia lentis surgical outcomes
Mauro Waiswol; Niro Kasahara
Objective: To present a classification system to grade ectopia lentis and to assess its usefulness as a predictor for surgical outcomes. Methods: Fifty-one eyes of 28 patients with either simple (19 patients) or Marfan syndrome-associated ectopia lentis (nine patients) with variable degrees of subluxation were operated on. Lens subluxation intensity was graded according to the lens subluxation grading system (LSGS) from grade 1 (lens on the whole pupillary area) up to grade 4 (lens absent fro...
Developing Customized Dental Miniscrew Surgical Template from Thermoplastic Polymer Material Using Image Superimposition, CAD System, and 3D Printing
Wang, Yu-Tzu; Yu, Jian-Hong; Lo, Lun-Jou; Hsu, Pin-Hsin; Lin, CHun-Li
This study integrates cone-beam computed tomography (CBCT)/laser scan image superposition, computer-aided design (CAD), and 3D printing (3DP) to develop a technology for producing customized dental (orthodontic) miniscrew surgical templates using polymer material. Maxillary bone solid models with the bone and teeth reconstructed using CBCT images and teeth and mucosa outer profile acquired using laser scanning were superimposed to allow miniscrew visual insertion planning and permit surgical ...
A Portable Shoulder-Mounted Camera System for Surgical Education in Spine Surgery.
Pham, Martin H; Ohiorhenuan, Ifije E; Patel, Neil N; Jakoi, Andre M; Hsieh, Patrick C; Acosta, Frank L; Wang, Jeffrey C; Liu, John C
The past several years have demonstrated an increased recognition of operative videos as an important adjunct for resident education. Currently lacking, however, are effective methods to record video for the purposes of illustrating the techniques of minimally invasive (MIS) and complex spine surgery. We describe here our experiences developing and using a shoulder-mounted camera system for recording surgical video. Our requirements for an effective camera system included wireless portability to allow for movement around the operating room, camera mount location for comfort and loupes/headlight usage, battery life for long operative days, and sterile control of on/off recording. With this in mind, we created a shoulder-mounted camera system utilizing a GoPro HERO3+, its Smart Remote (GoPro, Inc., San Mateo, California), a high-capacity external battery pack, and a commercially available shoulder-mount harness. This shoulder-mounted system was more comfortable to wear for long periods of time in comparison to existing head-mounted and loupe-mounted systems. Without requiring any wired connections, the surgeon was free to move around the room as needed. Over the past several years, we have recorded numerous MIS and complex spine surgeries for the purposes of surgical video creation for resident education. Surgical videos serve as a platform to distribute important operative nuances in rich multimedia. Effective and practical camera system setups are needed to encourage the continued creation of videos to illustrate the surgical maneuvers in minimally invasive and complex spinal surgery. We describe here a novel portable shoulder-mounted camera system setup specifically designed to be worn and used for long periods of time in the operating room.
Lens subluxation grading system: predictive value for ectopia lentis surgical outcomes
Directory of Open Access Journals (Sweden)
Mauro Waiswol
Full Text Available Objective: To present a classification system to grade ectopia lentis and to assess its usefulness as a predictor for surgical outcomes. Methods: Fifty-one eyes of 28 patients with either simple (19 patients or Marfan syndrome-associated ectopia lentis (nine patients with variable degrees of subluxation were operated on. Lens subluxation intensity was graded according to the lens subluxation grading system (LSGS from grade 1 (lens on the whole pupillary area up to grade 4 (lens absent from the pupillary area. Thirty eyes underwent cataract extraction ("dry" aspiration with endocapsular ring and in-the-bag intraocular lens (IOL implantation. Twenty-one eyes underwent cataract extraction ("dry" aspiration with scleral fixation of the IOL. The predictive value of the LSGS was assessed by analyzing the post-operative outcomes, including visual acuity (VA, endothelial cell loss, and complications for each grade on the grading system. Rresults: Patients were classified into grade 1 (19.6%, grade 2 (51% and grade 3 (29.4%. Post-operative VA was lower for eyes with larger degrees of subluxation. The higher the subluxation grade, the higher the endothelial cell loss, as well as, the frequency of vitreous loss and surgical time. Higher subluxation grades prevented optimal surgical outcomes with endocapsular ring and in-the-bag IOL implantation. Cconclusions: The LSGS provides an estimate of the surgical success of ectopia lentis. Adequate standardization of lens subluxation is crucial for understanding studies dealing with the surgical correction of this disorder.
Single-use surgical clothing system for reduction of airborne bacteria in the operating room.
Tammelin, A; Ljungqvist, B; Reinmüller, B
It is desirable to maintain a low bacterial count in the operating room air to prevent surgical site infection. This can be achieved by ventilation or by all staff in the operating room wearing clothes made from low-permeable material (i.e. clean air suits). We investigated whether there was a difference in protective efficacy between a single-use clothing system made of polypropylene and a reusable clothing system made of a mixed material (cotton/polyester) by testing both in a dispersal chamber and during surgical procedures. Counts of colony-forming units (cfu)/m(3) air were significantly lower when using the single-use clothing system in both settings. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
Decision support in hierarchical planning systems: The case of procurement planning in oil refining industries
DEFF Research Database (Denmark)
Kallestrup, Kasper Bislev; Lynge, Lasse Hadberg; Akkerman, Renzo
In this paper, we discuss the development of decision support systems for hierarchically structured planning approaches, such as commercially available advanced planning systems. We develop a framework to show how such a decision support system can be designed with the existing organization in mind...... and from the perspective of the organizational aspects involved. To exemplify and develop our framework, we use a case study of crude oil procurement planning in the refining industry. The results of the case study indicate an improved organizational embedding of the DSS, leading to significant savings...... in terms of planning efforts and procurement costs. In general, our framework aims to support the continuous improvement of advanced planning systems, increasing planning quality in complex supply chain settings....
Air quality and future energy system planning
Sobral Mourao, Zenaida; Konadu, Dennis; Lupton, Rick
energy system planning. Some example applications of this work are: (1) to discover conflicts and synergies between air quality regulations and future developments in the energy system and land use change; (2) to show the drivers of air quality in a given spatial context; (3) to explore effective ways to visualize impacts of different energy, land use and emissions control policies on air quality. An initial test case for the Bay Area in California will be presented, extending the scope of the existing California ForeseerTM tool to identify impacts of different policies within the water-energy-land nexus on local air quality.
Intelligent control of a planning system for astronaut training.
Ortiz, J; Chen, G
This work intends to design, analyze and solve, from the systems control perspective, a complex, dynamic, and multiconstrained planning system for generating training plans for crew members of the NASA-led International Space Station. Various intelligent planning systems have been developed within the framework of artificial intelligence. These planning systems generally lack a rigorous mathematical formalism to allow a reliable and flexible methodology for their design, modeling, and performance analysis in a dynamical, time-critical, and multiconstrained environment. Formulating the planning problem in the domain of discrete-event systems under a unified framework such that it can be modeled, designed, and analyzed as a control system will provide a self-contained theory for such planning systems. This will also provide a means to certify various planning systems for operations in the dynamical and complex environments in space. The work presented here completes the design, development, and analysis of an intricate, large-scale, and representative mathematical formulation for intelligent control of a real planning system for Space Station crew training. This planning system has been tested and used at NASA-Johnson Space Center.
On treatment of uncertainty in system planning
International Nuclear Information System (INIS)
Flage, R.; Aven, T.
In system planning and operation considerable efforts and resources are spent to reduce uncertainties, as a part of project management, uncertainty management and safety management. The basic idea seems to be that uncertainties are purely negative and should be reduced. In this paper we challenge this way of thinking, using a common industry practice as an example. In accordance with this industry practice, three uncertainty interval categories are used: ±40% intervals for the feasibility phase, ±30% intervals for the concept development phase and ±20% intervals for the engineering phase. The problem is that such a regime could easily lead to a conservative management regime encouraging the use of existing methods and tools, as new activities and novel solutions and arrangements necessarily mean increased uncertainties. In the paper we suggest an alternative approach based on uncertainty and risk descriptions, but having no predefined uncertainty reduction structures. The approach makes use of risk assessments and economic optimisation tools such as the expected net present value, but acknowledges the need for broad risk management processes which extend beyond the analyses. Different concerns need to be balanced, including economic aspects, uncertainties and risk, and practicability
Planning a radar system for protection from the airborne threat
International Nuclear Information System (INIS)
Greneker, E.F.; McGee, M.C.
A planning methodology for developing a radar system to protect nuclear materials facilities from the airborne threat is presented. Planning for physical security to counter the airborne threat is becoming even more important because hostile acts by terrorists are increasing and airborne platforms that can be used to bypass physical barriers are readily available. The comprehensive system planning process includes threat and facility surveys, defense hardening, analysis of detection and early warning requirements, optimization of sensor mix and placement, and system implementation considerations
Strategic planning for health care management information systems.
Rosenberger, H R; Kaiser, K M
Using a planning methodology and a structured design technique for analyzing data and data flow, information requirements can be derived to produce a strategic plan for a management information system. Such a long-range plan classifies information groups and assigns them priorities according to the goals of the organization. The approach emphasizes user involvement.
Slovenian spatial planning system: Key changes of past decade
Directory of Open Access Journals (Sweden)
Lavrenčić Valentina
Full Text Available Spatial planning has a long tradition in Slovenia. It was always a part of the integrated planning process, first institutionalized in 1968. The planning system was quite unique, combining economic, social, and spatial aspects in one, a so called long-term and medium-term social plan. At the national level its spatial part consisted of the national spatial plan, the defining concept for settlement management and growth, public service delivery, use of space and landscape transformation, protection of the environment, and guidelines for conflict management. Today, this form of planning is substituted by the national strategies and programs of each sector.
Model of strategic planning in active systems | Nasim | Journal of ...
African Journals Online (AJOL)
Annotation The work is dedicated to the mathematical formulation of the needing for strategic planning in active systems. At the same time, the possibility of the TAC (theory of active systems) for an assessment of conditions of effective strategic planning and development of an active system are shown. Keywords Active ...
Tourism and recreation system planning in Alberta provincial parks
Paul F.J. Eagles; Angela M. Gilmore; Luis X. Huang; Denise A. Keltie; Kimberley Rae; Hong Sun; Amy K. Thede; Meagan L. Wilson; Jennifer A. Woronuk; Ge Yujin
Traditionally, system planning in parks and protected areas concentrated on biogeographical concepts, while neglecting tourism and recreation. The existing system plan for parks and protected areas in Alberta, Canada, divides the province into six natural regions based on a geographic classifi cation system (Grassland, Parkland, Foothills, Rocky Mountains, Boreal...
A Sociotechnical Systems Approach To Coastal Marine Spatial Planning
SYSTEMS APPROACH TO COASTAL MARINE SPATIAL PLANNING by Tyler B. McDonald December 2016 Thesis Advisor: Karen Holness Co-Advisor: Tom...2016 3. REPORT TYPE AND DATES COVERED Master's thesis 4. TITLE AND SUBTITLE A SOCIOTECHNICAL SYSTEMS APPROACH TO COASTAL MARINE SPATIAL PLANNING...engineering perspective and specifically used a sociotechnical systems approach . The research investigated aquaculture permitting from the
Combination of AC Transmission Expansion Planning and Reactive Power Planning in the restructured power system
International Nuclear Information System (INIS)
Hooshmand, Rahmat-Allah; Hemmati, Reza; Parastegari, Moein
Highlights: ► To overcome the disadvantages of DC model in Transmission Expansion Planning, AC model should be used. ► The Transmission Expansion Planning associated with Reactive Power Planning results in fewer new transmission lines. ► Electricity market concepts should be considered in Transmission Expansion Planning problem. ► Reliability aspects should be considered in Transmission Expansion Planning problem. ► Particle Swarm Optimization is a suitable optimization method to solve Transmission Expansion Planning problem. - Abstract: Transmission Expansion Planning (TEP) is an important issue in power system studies. It involves decisions on location and number of new transmission lines. Before deregulation of the power system, the goal of TEP problem was investment cost minimization. But in the restructured power system, nodal prices, congestion management, congestion surplus and so on, have been considered too. In this paper, an AC model of TEP problem (AC-TEP) associated with Reactive Power Planning (RPP) is presented. The goals of the proposed planning problem are to minimize investment cost and maximize social benefit at the same time. In the proposed planning problem, in order to improve the reliability of the system the Expected Energy Not Supplied (EENS) index of the system is limited by a constraint. For this purpose, Monte Carlo simulation method is used to determine the EENS. Particle Swarm Optimization (PSO) method is used to solve the proposed planning problem which is a nonlinear mixed integer optimization problem. Simulation results on Garver and RTS systems verify the effectiveness of the proposed planning problem for reduction of the total investment cost, EENS index and also increasing social welfare of the system.
Surgical planning of total hip arthroplasty: accuracy of computer-assisted EndoMap software in predicting component size
International Nuclear Information System (INIS)
Davila, Jesse A.; Kransdorf, Mark J.; Duffy, Gavan P.
The purpose of our study was to assess the accuracy of a computer-assisted templating in the surgical planning of patients undergoing total hip arthroplasty utilizing EndoMap software (Siemans AG, Medical Solutions, Erlangen, Germany). Endomap Software is an electronic program that uses DICOM images to analyze standard anteroposterior radiographs for determination of optimal prosthesis component size. We retrospectively reviewed the preoperative radiographs of 36 patients undergoing uncomplicated primary total hip arthroplasty, utilizing EndoMap software, Version VA20. DICOM anteroposterior radiographs were analyzed using standard manufacturer supplied electronic templates to determine acetabular and femoral component sizes. No additional clinical information was reviewed. Acetabular and femoral component sizes were assessed by an orthopedic surgeon and two radiologists. Mean and estimated component size was compared with component size as documented in operative reports. The mean estimated acetabular component size was 53 mm (range 48-60 mm), 1 mm larger than the mean implanted size of 52 mm (range 48-62 mm). Thirty-one of 36 acetabular component sizes (86%) were accurate within one size. The mean calculated femoral component size was 4 (range 2-7), 1 size smaller than the actual mean component size of 5 (range 2-9). Twenty-six of 36 femoral component sizes (72%) were accurate within one size, and accurate within two sizes in all but four cases (94%). EndoMap Software predicted femoral component size well, with 72% within one component size of that used, and 94% within two sizes. Acetabular component size was predicted slightly better with 86% within one component size and 94% within two component sizes. (orig.)
Planning a transportation system for US Defense Transuranic waste
International Nuclear Information System (INIS)
Gilbert, K.V.; Hurley, J.D.; Smith, L.J.; McFadden, M.H.; Raudenbush, M.H.; Fedie, M.L.
The development and planning of a transportation system for US Department of Energy (USDOE) Defense Transuranic (TRU) waste has required the talents and expertise of many people. Coordination activities, design activities, fabrication, research and development, operations, and transportation are but a few of the areas around which this system is built. Due to the large number of organizations, regulations and personalities the planning task becomes extremely complex. The intent of this paper is to discuss the steps taken in planning this system, to identify the various organizations around which this system is designed, and to discuss program progress to date, scheduling, and future plans. 9 figures, 1 table
Preliminary Validation and Verification Plan for CAREM Reactor Protection System
International Nuclear Information System (INIS)
Fittipaldi, Ana; Maciel Felix
The purpose of this paper, is to present a preliminary validation and verification plan for a particular architecture proposed for the CAREM reactor protection system with software modules (computer based system).These software modules can be either own design systems or systems based in commercial modules such as programmable logic controllers (PLC) redundant of last generation.During this study, it was seen that this plan can also be used as a validation and verification plan of commercial products (COTS, commercial off the shelf) and/or smart transmitters.The software life cycle proposed and its features are presented, and also the advantages of the preliminary validation and verification plan
Planning a transportation system for US defense transuranic waste
International Nuclear Information System (INIS)
Gilbert, K.V.; Hurley, J.D.; Smith, L.J.; McFadden, M.H.; Raudenbush, M.H.; Fedie, M.L.
The development and planning of a transportation system for US Department of Energy (USDOE) Defense Transuranic (TRU) waste has required the talents and expertise of many people. Coordination activities, design activities, fabrication, research and development, operations, and transportation are but a few of the areas around which this system is built. Due to the large number of organizations, regulations and personalities the planning task becomes extremely complex. The intent of this paper is to discuss the steps taken in planning this system, to identify the various organizations around which this system is designed, and to discuss program progress to date, scheduling, and future plans
FY1995 development of a endoscopic surgical system utilizing multi-modal functional images; 1995 nendo tashu kino gazo wo mochiiru teishinshu naishikyo shujutsu system no kaihatsu
Energy Technology Data Exchange (ETDEWEB)
The purpose of this study is to develop an endoscope system for neurosurgery that can provide not only conventional endoscopic images but also ultraviolet-visible spectra, fluorescence spectra, near infrared spectra, and ultra-soundimages of tissue aiming for real-time identification of pathological tissue. The system also incorporates surgical manipulator and devices such as micro forceps and laser surgical instruments for endoscopic image guided surgery. Surgical Manipulator should be a high performance and easy to operate surgical instrument as well as conventional surgical tools such as scissors and knife. Since living tissue deforms during surgical operation, pre-operative three dimensional information for registration of pathological tissue should be modified based on information obtained during surgery. Thus surgical manipulator should be operated under guidance of surgeon's observation. Consequently, surgical manipulator should have various types of imaging and measurement devices such as an endoscope and an ultrasound imaging probe at its end effectors. Based on this concept, a prototype of a new multi channel surgical manipulator system CM cube (CM3, Computer aided Micro Multichannel Manipulator) that has various types of imaging and measurement devices such as ultra-violet-visible camera for spectroscopic measurement, ultra-sound imaging probe, three dimensional endoscope, together with micro surgical instruments and laser surgical systems has been developed. Its performance was evaluated through in vitro/in vivo experiments and clinical application. (NEDO)
The availability of the step optimization in Monaco planning system
International Nuclear Information System (INIS)
Kim, Dae Sup
We present a method to reduce this gap and complete the treatment plan, to be made by the re-optimization is performed in the same conditions as the initial treatment plan different from Monaco treatment planning system. The optimization is carried in two steps when performing the inverse calculation for volumetric modulated radiation therapy or intensity modulated radiation therapy in Monaco treatment planning system. This study was the first plan with a complete optimization in two steps by performing all of the treatment plan, without changing the optimized condition from Step 1 to Step 2, a typical sequential optimization performed. At this time, the experiment was carried out with a pencil beam and Monte Carlo algorithm is applied In step 2. We compared initial plan and re-optimized plan with the same optimized conditions. And then evaluated the planning dose by measurement. When performing a re-optimization for the initial treatment plan, the second plan applied the step optimization. When the common optimization again carried out in the same conditions in the initial treatment plan was completed, the result is not the same. From a comparison of the treatment planning system, similar to the dose-volume the histogram showed a similar trend, but exhibit different values that do not satisfy the conditions best optimized dose, dose homogeneity and dose limits. Also showed more than 20% different in comparison dosimetry. If different dose algorithms, this measure is not the same out. The process of performing a number of trial and error, and you get to the ultimate goal of treatment planning optimization process. If carried out to optimize the completion of the initial trust only the treatment plan, we could be made of another treatment plan. The similar treatment plan could not satisfy to optimization results. When you perform re-optimization process, you will need to apply the step optimized conditions, making sure the dose distribution through the optimization
Usage of fMRI for pre-surgical planning in brain tumor and vascular lesion patients: Task and statistical threshold effects on language lateralization
Directory of Open Access Journals (Sweden)
Tanvi N. Nadkarni
Conclusion: Our results suggest that the type of task and the applied statistical threshold influence LI and that the threshold effects on LI may be task-specific. Thus identifying critical functional regions and computing LIs should be conducted on an individual subject basis, using a continuum of threshold values with different tasks to provide the most accurate information for surgical planning to minimize post-operative language deficits.
Dosimetry audit of radiotherapy treatment planning systems
International Nuclear Information System (INIS)
Bulski, Wojciech; Chelminski, Krzysztof; Rostkowska, Joanna
In radiotherapy Treatment Planning Systems (TPS) various calculation algorithms are used. The accuracy of dose calculations has to be verified. Numerous phantom types, detectors and measurement methodologies are proposed to verify the TPS calculations with dosimetric measurements. A heterogeneous slab phantom has been designed within a Coordinated Research Project (CRP) of the IAEA. The heterogeneous phantom was developed in the frame of the IAEA CRP. The phantom consists of frame slabs made with polystyrene and exchangeable inhomogeneity slabs equivalent to bone or lung tissue. Special inserts allow to position thermoluminescent dosimeters (TLD) capsules within the polystyrene slabs below the bone or lung equivalent slabs and also within the lung equivalent material. Additionally, there are inserts that allow to position films or ionisation chamber in the phantom. Ten Polish radiotherapy centres (of 30 in total) were audited during on-site visits. Six different TPSs and five calculation algorithms were examined in the presence of inhomogeneities. Generally, most of the results from TLD were within 5 % tolerance. Differences between doses calculated by TPSs and measured with TLD did not exceed 4 % for bone and polystyrene equivalent materials. Under the lung equivalent material, on the beam axis the differences were lower than 5 %, whereas inside the lung equivalent material, off the beam axis, in some cases they were of around 7 %. The TLD results were confirmed with the ionisation chamber measurements. The comparison results of the calculations and the measurements allow to detect limitations of TPS calculation algorithms. The audits performed with the use of heterogeneous phantom and TLD seem to be an effective tool for detecting the limitations in the TPS performance or beam configuration errors at audited radiotherapy departments. (authors)
Dosimetry audit of radiotherapy treatment planning systems.
Bulski, Wojciech; Chełmiński, Krzysztof; Rostkowska, Joanna
In radiotherapy Treatment Planning Systems (TPS) various calculation algorithms are used. The accuracy of dose calculations has to be verified. Numerous phantom types, detectors and measurement methodologies are proposed to verify the TPS calculations with dosimetric measurements. A heterogeneous slab phantom has been designed within a Coordinated Research Project (CRP) of the IAEA. The heterogeneous phantom was developed in the frame of the IAEA CRP. The phantom consists of frame slabs made with polystyrene and exchangeable inhomogeneity slabs equivalent to bone or lung tissue. Special inserts allow to position thermoluminescent dosimeters (TLD) capsules within the polystyrene slabs below the bone or lung equivalent slabs and also within the lung equivalent material. Additionally, there are inserts that allow to position films or ionisation chamber in the phantom. Ten Polish radiotherapy centres (of 30 in total) were audited during on-site visits. Six different TPSs and five calculation algorithms were examined in the presence of inhomogeneities. Generally, most of the results from TLD were within 5 % tolerance. Differences between doses calculated by TPSs and measured with TLD did not exceed 4 % for bone and polystyrene equivalent materials. Under the lung equivalent material, on the beam axis the differences were lower than 5 %, whereas inside the lung equivalent material, off the beam axis, in some cases they were of around 7 %. The TLD results were confirmed with the ionisation chamber measurements. The comparison results of the calculations and the measurements allow to detect limitations of TPS calculation algorithms. The audits performed with the use of heterogeneous phantom and TLD seem to be an effective tool for detecting the limitations in the TPS performance or beam configuration errors at audited radiotherapy departments. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: email@example.com.
Directory of Open Access Journals (Sweden)
Laszlo STICZ
Full Text Available Defense planning in the Alliance is a fundamental element of the arrangements which enable its member countries to enjoy the crucial political, military and resource advantages of collective defense and other common military efforts to enhance security and stability. In this respect, the aim of this paper is to outline the role of the Armed Forces and the specific processes aiming to achieve the ultimate goal of a nation regarding national security, with focus on defense planning and the PDPS.
Application of 3D printing in the surgical planning of hypertrophic obstructive cardiomyopathy and physician-patient communication: a preliminary study.
Guo, Hong-Chang; Wang, Yang; Dai, Jiang; Ren, Chang-Wei; Li, Jin-Hua; Lai, Yong-Qiang
The aim of this study was to evaluate the effect of 3-dimensional (3D) printing in treatment of hypertrophic obstructive cardiomyopathy (HOCM) and its roles in doctor-patient communication. 3D-printed models were constructed preoperatively and postoperatively in seven HOCM patients received surgical treatment. Based on multi-slice computed tomography (CT) images, regions of disorder were segmented using the Mimics 19.0 software (Materialise, Leuven, Belgium). After generating an STL-file (StereoLithography file) with patients' data, the 3D printer (Objet350 Connex3, Stratasys Ltd., USA) created a 3D model. The pre- and post-operative 3D-printed models were used to make the surgical plan preoperatively and evaluate the outcome postoperatively. Meanwhile, a questionnaire was designed for patients and their relatives to learn the effectiveness of the 3D-printed prototypes in the preoperative conversations. The heart anatomies were accurately printed with 3D technology. The 3D-printed prototypes were useful for preoperative evaluation, surgical planning, and practice. Preoperative and postoperative echocardiographic evaluation showed left ventricular outflow tract (LVOT) obstruction was adequately relieved (82.71±31.63 to 14.91±6.89 mmHg, P3D model in preoperative conversations and the communication score was 9.11±0.38 points. A 3D-printed model is a useful tool in individualized planning for myectomies and represent a useful tool for physician-patient communication.
Expert system for aiding fuel exchange planning
International Nuclear Information System (INIS)
Shiratori, Yoshitake.
A fuel exchange plan is prepared based on intelligence bases such as a method of zoning a reactor core, a fuel arrangement rule and a procedure for fuel exchange, as well as initial data. Then, the fuel exchange plans are patterned to several groups based on the intelligence bases such as patterning of fuel arrangement. A typical pattern is analyzed by a reactor core analyzing code and allowance or rejection for the analyzed patterns is judged based on intelligence bases regarding life time of the reactor core, thermal limit value of fuels, burning of fuel for irradiation test. The result of the judgement is fed-back as an estimation information and the initial data and the intelligence data are added to prepare a plan again. A similar analysis is also conducted for the plan of the rejected group. The allowance or rejection is judged for all of the plans in the same manner. The intelligence bases are used and the result of the judgement is fed-back as a condition for estimation, thereby enabling to remarkably save labors and time and prepare non-typical exchange plans. (N.H.)
Load evaluation of the da Vinci surgical system for transoral robotic surgery.
Fujiwara, Kazunori; Fukuhara, Takahiro; Niimi, Koji; Sato, Takahiro; Kitano, Hiroya
Transoral robotic surgery, performed with the da Vinci surgical system (da Vinci), is a surgical approach for benign and malignant lesions of the oral cavity and laryngopharynx. It provides several unique advantages, which include a 3-dimensional magnified view and ability to see and work around curves or angles. However, the current da Vinci surgical system does not provide haptic feedback. This is problematic because the potential risks specific to the transoral use of the da Vinci include tooth injury, mucosal laceration, ocular injury and mandibular fracture. To assess the potential for intraoperative injuries, we measured the load of the endoscope and the instrument of the da Vinci Si surgical system. We pressed the endoscope and instrument of the da Vinci Si against Load cell six times each and measured the dynamic load and the time-to-maximum load. We also struck the da Vinci Si endoscope and instrument against the Load cell six times each and measured the impact load. The maximum dynamic load was 7.27 ± 1.31 kg for the endoscope and 1.90 ± 0.72 for the instrument. The corresponding time-to-maximum loads were 1.72 ± 0.22 and 1.29 ± 0.34 s, but the impact loads were significantly lower than the dynamic load. It remains possible that a major load is exerted on adjacent structures by continuous contact with the endoscope and instrument of da Vinci Si. However, there is a minor delay in reaching the maximum load. Careful monitoring by an on-site assistant may, therefore, help prevent contiguous injury.
2: Local area networks as a multiprocessor treatment planning system
International Nuclear Information System (INIS)
Neblett, D.L.; Hogan, S.E.
The creation of a local area network (LAN) of interconnected computers provides an environment of multi computer processors that adds a new dimension to treatment planning. A LAN system provides the opportunity to have two or more computers working on the plan in parallel. With high speed interprocessor transfer, events such as the time consuming task of correcting several individual beams for contours and inhomogeneities can be performed simultaneously; thus, effectively creating a parallel multiprocessor treatment planning system
Evaluation of IMRT plans of prostate carcinoma from four treatment planning systems based on Monte Carlo
International Nuclear Information System (INIS)
Chi Zifeng; Han Chun; Liu Dan; Cao Yankun; Li Runxiao
Objective: With the Monte Carlo method to recalculate the IMRT dose distributions from four TPS to provide a platform for independent comparison and evaluation of the plan quality.These results will help make a clinical decision as which TPS will be used for prostate IMRT planning. Methods: Eleven prostate cancer cases were planned with the Corvus, Xio, Pinnacle and Eclipse TPS. The plans were recalculated by Monte Carlo using leaf sequences and MUs for individual plans. Dose-volume-histograms and isodose distributions were compared. Other quantities such as D min (the minimum dose received by 99% of CTV/PTV), D max (the maximum dose received by 1% of CTV/PTV), V 110% , V 105% , V 95% (the volume of CTV/PTV receiving 110%, 105%, 95% of the prescription dose), the volume of rectum and bladder receiving >65 Gy and >40 Gy, and the volume of femur receiving >50 Gy were evaluated. Total segments and MUs were also compared. Results: The Monte Carlo results agreed with the dose distributions from the TPS to within 3%/3 mm. The Xio, Pinnacle and Eclipse plans show less target dose heterogeneity and lower V 65 and V 40 for the rectum and bladder compared to the Corvus plans. The PTV D min is about 2 Gy lower for Xio plans than others while the Corvus plans have slightly lower female head V 50 (0.03% and 0.58%) than others. The Corvus plans require significantly most segments (187.8) and MUs (1264.7) to deliver and the Pinnacle plans require fewest segments (82.4) and MUs (703.6). Conclusions: We have tested an independent Monte Carlo dose calculation system for dose reconstruction and plan evaluation. This system provides a platform for the fair comparison and evaluation of treatment plans to facilitate clinical decision making in selecting a TPS and beam delivery system for particular treatment sites. (authors)
Application of a uniform anatomic grading system to measure disease severity in eight emergency general surgical illnesses.
Crandall, Marie L; Agarwal, Suresh; Muskat, Peter; Ross, Steven; Savage, Stephanie; Schuster, Kevin; Tominaga, Gail T; Shafi, Shahid
Emergent general surgical diseases encompass a broad spectrum of anatomy and pathophysiology, creating challenges for outcomes assessment, research, and surgical training. The goal of this study was to measure anatomic disease severity for eight emergent general surgical diseases using the uniform grading system of the American Association for the Surgery of Trauma (AAST). The Committee on Patient Assessment and Outcomes of AAST applied the previously developed uniform grading system to eight emergent general surgical diseases using a consensus of experts. It was then reviewed and approved by the Board of Managers of AAST. Severity grades for eight commonly encountered emergent general surgical conditions were created: breast abscess, esophageal perforation, infectious colitis, pelvic inflammatory disease, perirectal abscess, pleural space infections, soft tissue infections, and surgical site infections. The range of grades from I through V, reflect progression from mild disease, limited to within the organ itself, to widespread severe disease. This article provides a uniform grading system for measuring anatomic severity of eight emergent general surgical diseases. Consistent adoption of these grades could improve standardization for quality assurance, outcomes research, and surgical training.
Hemodynamic behavior modeling of a Virtual Surgical Patient based on a Fuzzy Expert System.
Directory of Open Access Journals (Sweden)
Paulo Farias Paiva
Full Text Available The Virtual Reality (VR allows its users to experience a sense of being immersed in synthetic 3D scenarios generated by computer graphics. The so-called Virtual Environments (VEs based on RV can be applied to medical education, enabling: repetitive training and the development of psychomotor skills in surgical procedures without compromising real patients. Surgical simulators that feature Dynamic Virtual Patients (VPs, that is, reacts physiologically to interventions and medical decisions made during the training. These systems present more realism while it offers the possibility of varying clinical cases. This work has as main objective to discuss important issues of modeling the hemodynamic performance of a VP, specifically to simulate blood pressure values (both sistolic and diastolic variables. The model of a VP is presented as result as well as is presented an architecture for its integration to simulators based on VR.
The effect of a robot-assisted surgical system on the kinematics of user movements.
Nisky, Ilana; Hsieh, Michael H; Okamura, Allison M
Teleoperated robot-assisted surgery (RAS) offers many advantages over traditional minimally invasive surgery. However, RAS has not yet realized its full potential, and it is not clear how to optimally train surgeons to use these systems. We hypothesize that the dynamics of the master manipulator impact the ability of users to make desired movements with the robot. We compared freehand and teleoperated movements of novices and experienced surgeons. To isolate the effects of dynamics from procedural knowledge, we chose simple movements rather than surgical tasks. We found statistically significant effects of teleoperation and user expertise in several aspects of motion, including target acquisition error, movement speed, and movement smoothness. Such quantitative assessment of human motor performance in RAS can impact the design of surgical robots, their control, and surgeon training methods, and eventually, improve patient outcomes.
Optical augmented reality assisted navigation system for neurosurgery teaching and planning
Wu, Hui-Qun; Geng, Xing-Yun; Wang, Li; Zhang, Yuan-Peng; Jiang, Kui; Tang, Le-Min; Zhou, Guo-Min; Dong, Jian-Cheng
This paper proposed a convenient navigation system for neurosurgeon's pre-operative planning and teaching with augmented reality (AR) technique, which maps the three-dimensional reconstructed virtual anatomy structures onto a skull model. This system included two parts, a virtual reality system and a skull model scence. In our experiment, a 73 year old right-handed man initially diagnosed with astrocytoma was selected as an example to vertify our system. His imaging data from different modalities were registered and the skull soft tissue, brain and inside vessels as well as tumor were reconstructed. Then the reconstructed models were overlayed on the real scence. Our findings showed that the reconstructed tissues were augmented into the real scence and the registration results were in good alignment. The reconstructed brain tissue was well distributed in the skull cavity. The probe was used by a neurosurgeon to explore the surgical pathway which could be directly posed into the tumor while not injuring important vessels. In this way, the learning cost for students and patients' education about surgical risks reduced. Therefore, this system could be a selective protocol for image guided surgery(IGS), and is promising for neurosurgeon's pre-operative planning and teaching.
Setting planned leadtimes in customer-order-driven assembly systems
Atan, Z.; Kok, de A.G.; Dellaert, N.P.; Janssen, F.B.S.L.P.; Boxel, van R.
We study an assembly system with a number of parallel multistage processes feeding a multistage final assembly process. Each stage has a stochastic throughput time. We assume that the system is controlled by planned leadtimes at each stage. From these planned leadtimes the start and due times of all
Information security management system planning for CBRN facilities
International Nuclear Information System (INIS)
Lenaeu, Joseph D.; O'Neil, Lori Ross; Leitch, Rosalyn M.; Glantz, Clifford S.; Landine, Guy P.; Bryant, Janet L.; Lewis, John; Mathers, Gemma; Rodger, Robert; Johnson, Christopher
The focus of this document is to provide guidance for the development of information security management system planning documents at chemical, biological, radiological, or nuclear (CBRN) facilities. It describes a risk-based approach for planning information security programs based on the sensitivity of the data developed, processed, communicated, and stored on facility information systems.
Information security management system planning for CBRN facilities
Energy Technology Data Exchange (ETDEWEB)
Lenaeu, Joseph D. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); O' Neil, Lori Ross [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Leitch, Rosalyn M. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Glantz, Clifford S. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Landine, Guy P. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Bryant, Janet L. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Lewis, John [National Nuclear Lab., Workington (United Kingdom); Mathers, Gemma [National Nuclear Lab., Workington (United Kingdom); Rodger, Robert [National Nuclear Lab., Workington (United Kingdom); Johnson, Christopher [National Nuclear Lab., Workington (United Kingdom)
The focus of this document is to provide guidance for the development of information security management system planning documents at chemical, biological, radiological, or nuclear (CBRN) facilities. It describes a risk-based approach for planning information security programs based on the sensitivity of the data developed, processed, communicated, and stored on facility information systems.
Succession Planning in a Two-Year Technical College System
Neefe, Diane Osterhaus
The study explores the organizational characteristics of strategic planning, succession planning and career management and the processes impact on the hiring location of academic leaders from within the college, external to the college but within the system, and external to the system. The study was conducted in the 16 college Wisconsin…
Enterprise Architecture Planning in developing A planning Information System: a Case Study of Semarang State University
Directory of Open Access Journals (Sweden)
Budiman Kholiq
Full Text Available This research has applied an integrated design and development of planning information system, which is been designed using Enterprise Architecture Planning. Frequent discrepancy between planning and realization of the budget that has been made, resulted in ineffective planning, is one of the reason for doing this research. The design using EAP aims to keep development aligned and in line with the strategic direction of the organization. In the practice, EAP is carried out in several stages of the planning initiation, identification and definition of business functions, proceeded with architectural design and EA implementation plan that has been built. In addition to the design of the Enterprise Architecture, this research carried out the implementation, and was tested by several methods of black box and white box. Black box testing method is used to test the fundamental aspects of the software, tested by two kinds of testing, first is using User Acceptance Testing and the second is using software functionality testing. White box testing method is used to test the effectiveness of the code in the software, tested using unit testing. Tests conducted using white box and black box on the integrated planning information system, is declared successful. Success in the software testing can not be ascertained if the software built has not shown any distinction from prior circumstance to the development of this integrated planning information system. For ensuring the success of this system implementation, the authors test consistency between the planning of data and the realization of prior-use of the information system, until after-use information system. This consistency test is done by reducing the time data of the planning and realization time. From the tabulated data, the planning information system that has been built reduces the difference between the planning time and the realization time, in which indicates that the planning information system
Enterprise Architecture Planning in developing A planning Information System: a Case Study of Semarang State University
Budiman, Kholiq; Prahasto, Toni; Kusumawardhani, Amie
This research has applied an integrated design and development of planning information system, which is been designed using Enterprise Architecture Planning. Frequent discrepancy between planning and realization of the budget that has been made, resulted in ineffective planning, is one of the reason for doing this research. The design using EAP aims to keep development aligned and in line with the strategic direction of the organization. In the practice, EAP is carried out in several stages of the planning initiation, identification and definition of business functions, proceeded with architectural design and EA implementation plan that has been built. In addition to the design of the Enterprise Architecture, this research carried out the implementation, and was tested by several methods of black box and white box. Black box testing method is used to test the fundamental aspects of the software, tested by two kinds of testing, first is using User Acceptance Testing and the second is using software functionality testing. White box testing method is used to test the effectiveness of the code in the software, tested using unit testing. Tests conducted using white box and black box on the integrated planning information system, is declared successful. Success in the software testing can not be ascertained if the software built has not shown any distinction from prior circumstance to the development of this integrated planning information system. For ensuring the success of this system implementation, the authors test consistency between the planning of data and the realization of prior-use of the information system, until after-use information system. This consistency test is done by reducing the time data of the planning and realization time. From the tabulated data, the planning information system that has been built reduces the difference between the planning time and the realization time, in which indicates that the planning information system can motivate the
Knowledge-based treatment planning and its potential role in the transition between treatment planning systems.
Masi, Kathryn; Archer, Paul; Jackson, William; Sun, Yilun; Schipper, Matthew; Hamstra, Daniel; Matuszak, Martha
Commissioning a new treatment planning system (TPS) involves many time-consuming tasks. We investigated the role that knowledge-based planning (KBP) can play in aiding a clinic's transition to a new TPS. Sixty clinically treated prostate/prostate bed intensity-modulated radiation therapy (IMRT) plans were exported from an in-house TPS and were used to create a KBP model in a newly implemented commercial application. To determine the benefit that KBP may have in a TPS transition, the model was tested on 2 groups of patients. Group 1 consisted of the first 10 prostate/prostate bed patients treated in the commercial TPS after the transition from the in-house TPS. Group 2 consisted of 10 patients planned in the commercial TPS after 8 months of clinical use. The KBP-generated plan was compared with the clinically used plan in terms of plan quality (ability to meet planning objectives and overall dose metrics) and planning efficiency (time required to generate clinically acceptable plans). The KBP-generated plans provided a significantly improved target coverage (p = 0.01) compared with the clinically used plans for Group 1, but yielded plans of comparable target coverage to the clinically used plans for Group 2. For the organs at risk, the KBP-generated plans produced lower doses, on average, for every normal-tissue objective except for the maximum dose to 0.1 cc of rectum. The time needed for the KBP-generated plans ranged from 6 to 15 minutes compared to 30 to 150 and 15 to 60 minutes for manual planning in Groups 1 and 2, respectively. KBP is a promising tool to aid in the transition to a new TPS. Our study indicates that high-quality treatment plans could have been generated in the newly implemented TPS more efficiently compared with not using KBP. Even after 8 months of the clinical use, KBP still showed an increase in plan quality and planning efficiency compared with manual planning. Copyright © 2017 American Association of Medical Dosimetrists. Published
Software Configuration Management Plan for the Sodium Removal System
International Nuclear Information System (INIS)
This document establishers the Software Configuration Management Plan (SCMP) for the software associated with the control system of the Sodium Removal System (SRS) located in the Interim Examination and Maintenance (IEM Cell) Facility of the FFTF Flux Test
[Successful treatment of surgically induced necrotizing sclerokeratitis (SINS) with systemic immunosuppresive agents and amniotic membrane grafting].
Cordero-Coma, M; Franco-Benito, M; García-Ruiz-de-Morales, J M; Alonso-Orcajo, N; Del Barrio-Manso, I
We report the case of a 74-year-old female who developed a necrotizing sclerokeratitis affecting her left eye after uncomplicated cataract surgery. She had no previous history of systemic autoimmune disease. Histopathology of the lesion revealed necrotic granulomatosis with an increased number of plasma cells. Surgically induced necrotizing sclerokeratitis (SINS) is a serious entity which requires prompt and aggressive therapy to prevent its potential devastating ocular consequences. Conjunctival resection and amniotic membrane grafting may be necessary to temporarily interrupt local immunologic events in severe cases. However, associated systemic immunomodulatory therapy seems to be mandatory (Arch Soc Esp Oftalmol 2009; 84: 577-580).
Planning Cultures and Histories: Influences on the Evolution of Planning Systems and Spatial Development Patterns
Stead, D.; de Vries, J.; Tasan-Kok, T.
This special issue addresses the influences of planning cultures and histories on the evolution of planning systems and spatial development. As well as providing an international comparative perspective on these issues, the collection of articles also engages in a search for new conceptual
Towards an integration of process planning and production planning and control for flexible manufacturing systems
Gaalman, GJC; Slomp, J; Suresh, NC
This introduction article attempts to present some major issues relating to the integration of process planning and production planning and control (PPC) for flexible manufacturing systems (FMSs). It shows that the performance of an FMS can be significantly improved and FMS capabilities more
Planning Security Services for IT Systems
Henderson, Marie; Page, Howard Philip
Often the hardest job is to get business representatives to look at security as something that makes managing their risks and achieving their objectives easier, with security compliance as just part of that journey. This paper addresses that by making planning for security services a 'business tool'.
Planning for Online Education: A Systems Model
Picciano, Anthony G.
The purpose of this article is to revisit the basic principles of technology planning as applied to online education initiatives. While not meant to be an exhaustive treatment of the topic, the article is timely because many colleges and universities are considering the development and expansion of online education as part of their planning…
Using value-based analysis to influence outcomes in complex surgical systems.
Kirkpatrick, John R; Marks, Stanley; Slane, Michele; Kim, Donald; Cohen, Lance; Cortelli, Michael; Plate, Juan; Perryman, Richard; Zapas, John
Value-based analysis (VBA) is a management strategy used to determine changes in value (quality/cost) when a usual practice (UP) is replaced by a best practice (BP). Previously validated in clinical initiatives, its usefulness in complex systems is unknown. To answer this question, we used VBA to correct deficiencies in cardiac surgery at Memorial Healthcare System. Cardiac surgery is a complex surgical system that lends itself to VBA because outcomes metrics provided by the Society of Thoracic Surgeons provide an estimate of quality; cost is available from Centers for Medicare and Medicaid Services and other contemporary sources; the UP can be determined; and the best practice can be established. Analysis of the UP at Memorial Healthcare System revealed considerable deficiencies in selection of patients for surgery; the surgery itself, including choice of procedure and outcomes; after care; follow-up; and control of expenditures. To correct these deficiencies, each UP was replaced with a BP. Changes included replacement of most of the cardiac surgeons; conversion to an employed physician model; restructuring of a heart surgery unit; recruitment of cardiac anesthesiologists; introduction of an interactive educational program; eliminating unsafe practices; and reducing cost. There was a significant (p value (quality/cost) in a complex surgical system. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Design and Performance Evaluation of Real-time Endovascular Interventional Surgical Robotic System with High Accuracy.
Wang, Kundong; Chen, Bing; Lu, Qingsheng; Li, Hongbing; Liu, Manhua; Shen, Yu; Xu, Zhuoyan
Endovascular interventional surgery (EIS) is performed under a high radiation environment at the sacrifice of surgeons' health. This paper introduces a novel endovascular interventional surgical robot that aims to reduce radiation to surgeons and physical stress imposed by lead aprons during fluoroscopic X-ray guided catheter intervention. The unique mechanical structure allowed the surgeon to manipulate the axial and radial motion of the catheter and guide wire. Four catheter manipulators (to manipulate the catheter and guide wire), and a control console which consists of four joysticks, several buttons and two twist switches (to control the catheter manipulators) were presented. The entire robotic system was established on a master-slave control structure through CAN (Controller Area Network) bus communication, meanwhile, the slave side of this robotic system showed highly accurate control over velocity and displacement with PID controlling method. The robotic system was tested and passed in vitro and animal experiments. Through functionality evaluation, the manipulators were able to complete interventional surgical motion both independently and cooperatively. The robotic surgery was performed successfully in an adult female pig and demonstrated the feasibility of superior mesenteric and common iliac artery stent implantation. The entire robotic system met the clinical requirements of EIS. The results show that the system has the ability to imitate the movements of surgeons and to accomplish the axial and radial motions with consistency and high-accuracy. Copyright © 2018 John Wiley & Sons, Ltd.
Study on real-time force feedback for a master-slave interventional surgical robotic system.
Guo, Shuxiang; Wang, Yuan; Xiao, Nan; Li, Youxiang; Jiang, Yuhua
In robot-assisted catheterization, haptic feedback is important, but is currently lacking. In addition, conventional interventional surgical robotic systems typically employ a master-slave architecture with an open-loop force feedback, which results in inaccurate control. We develop herein a novel real-time master-slave (RTMS) interventional surgical robotic system with a closed-loop force feedback that allows a surgeon to sense the true force during remote operation, provide adequate haptic feedback, and improve control accuracy in robot-assisted catheterization. As part of this system, we also design a unique master control handle that measures the true force felt by a surgeon, providing the basis for the closed-loop control of the entire system. We use theoretical and empirical methods to demonstrate that the proposed RTMS system provides a surgeon (using the master control handle) with a more accurate and realistic force sensation, which subsequently improves the precision of the master-slave manipulation. The experimental results show a substantial increase in the control accuracy of the force feedback and an increase in operational efficiency during surgery.
Surgical clothing systems in laminar airflow operating room: a numerical assessment.
Sadrizadeh, Sasan; Holmberg, Sture
This study compared two different laminar airflow distribution strategies - horizontal and vertical - and investigated the effectiveness of both ventilation systems in terms of reducing the sedimentation and distribution of bacteria-carrying particles. Three different staff clothing systems, which resulted in source strengths of 1.5, 4 and 5 CFU/s per person, were considered. The exploration was conducted numerically using a computational fluid dynamics technique. Active and passive air sampling methods were simulated in addition to recovery tests, and the results were compared. Model validation was performed through comparisons with measurement data from the published literature. The recovery test yielded a value of 8.1 min for the horizontal ventilation scenario and 11.9 min for the vertical ventilation system. Fewer particles were captured by the slit sampler and in sedimentation areas with the horizontal ventilation system. The simulated results revealed that under identical conditions in the examined operating room, the horizontal laminar ventilation system performed better than the vertical option. The internal constellation of lamps, the surgical team and objects could have a serious effect on the movement of infectious particles and therefore on postoperative surgical site infections. Copyright © 2014 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.
Image-Guided Surgical Robotic System for Percutaneous Reduction of Joint Fractures.
Dagnino, Giulio; Georgilas, Ioannis; Morad, Samir; Gibbons, Peter; Tarassoli, Payam; Atkins, Roger; Dogramadzi, Sanja
Complex joint fractures often require an open surgical procedure, which is associated with extensive soft tissue damages and longer hospitalization and rehabilitation time. Percutaneous techniques can potentially mitigate these risks but their application to joint fractures is limited by the current sub-optimal 2D intra-operative imaging (fluoroscopy) and by the high forces involved in the fragment manipulation (due to the presence of soft tissue, e.g., muscles) which might result in fracture malreduction. Integration of robotic assistance and 3D image guidance can potentially overcome these issues. The authors propose an image-guided surgical robotic system for the percutaneous treatment of knee joint fractures, i.e., the robot-assisted fracture surgery (RAFS) system. It allows simultaneous manipulation of two bone fragments, safer robot-bone fixation system, and a traction performing robotic manipulator. This system has led to a novel clinical workflow and has been tested both in laboratory and in clinically relevant cadaveric trials. The RAFS system was tested on 9 cadaver specimens and was able to reduce 7 out of 9 distal femur fractures (T- and Y-shape 33-C1) with acceptable accuracy (≈1 mm, ≈5°), demonstrating its applicability to fix knee joint fractures. This study paved the way to develop novel technologies for percutaneous treatment of complex fractures including hip, ankle, and shoulder, thus representing a step toward minimally-invasive fracture surgeries.
Development and Assessment of Memorial Sloan Kettering Cancer Center's Surgical Secondary Events Grading System
Strong, Vivian E.; Selby, Luke V.; Sovel, Mindy; Disa, Joseph J.; Hoskins, William; DeMatteo, Ronald; Scardino, Peter; Jaques, David P.
Background Studying surgical secondary events is an evolving effort with no current established system for database design, standard reporting, or definitions. Using the Clavien-Dindo classification as a guide, in 2001 we developed a Surgical Secondary Events database based on grade of event and required intervention to begin prospectively recording and analyzing all surgical secondary events (SSE). Study Design Events are prospectively entered into the database by attending surgeons, house staff, and research staff. In 2008 we performed a blinded external audit of 1,498 operations that were randomly selected to examine the quality and reliability of the data. Results 1,498 of 4,284 operations during the 3rd quarter of 2008 were audited. 79% (N=1,180) of the operations did not have a secondary event while 21% (N=318) of operations had an identified event. 91% (1,365) of operations were correctly entered into the SSE database. 97% (129/133) of missed secondary events were Grades I and II. Three Grade III (2%) and one Grade IV (1%) secondary event were missed. There were no missed Grade 5 secondary events. Conclusion Grade III – IV events are more accurately collected than Grade I – II events. Robust and accurate secondary events data can be collected by clinicians and research staff and these data can safely be used for quality improvement projects and research. PMID:25319579
Integrating Robot Task Planning into Off-Line Programming Systems
DEFF Research Database (Denmark)
Sun, Hongyan; Kroszynski, Uri
a system architecture for integrated robot task planning. It identifies and describes the components considered necessary for implementation. The focus is on functionality of these elements as well as on the information flow. A pilot implementation of such an integrated system architecture for a robot......The addition of robot task planning in off-line programming systems aims at improving the capability of current state-of-the-art commercially available off-line programming systems, by integrating modeling, task planning, programming and simulation together under one platform. This article proposes...... assembly task is discussed....
Effectiveness of the Thoracic Pedicle Screw Placement Using the Virtual Surgical Training System: A Cadaver Study.
Hou, Yang; Lin, Yanping; Shi, Jiangang; Chen, Huajiang; Yuan, Wen
The virtual simulation surgery has initially exhibited its promising potentials in neurosurgery training. To evaluate effectiveness of the Virtual Surgical Training System (VSTS) on novice residents placing thoracic pedicle screws in a cadaver study. A total of 10 inexperienced residents participated in this study and were randomly assigned to 2 groups. The group using VSTS to learn thoracic pedicle screw fixation was the simulation training (ST) group and the group receiving an introductory teaching session was the control group. Ten fresh adult spine specimens including 6 males and 4 females with a mean age of 58.5 yr (range: 33-72) were collected and randomly allocated to the 2 groups. After exposing anatomic structures of thoracic spine, the bilateral pedicle screw placement of T6-T12 was performed on each cadaver specimen. The postoperative computed tomography scan was performed on each spine specimen, and experienced observers independently reviewed the placement of the pedicle screws to assess the incidence of pedicle breach. The screw penetration rates of the ST group (7.14%) was significantly lower in comparison to the control group (30%, P < .05). Statistically significant difference in acceptable rates of screws also occurred between the ST (100%) and control (92.86%) group (P < .05). In addition, the average screw penetration distance in control group (2.37 mm ± 0.23 mm) was significantly greater than ST group (1.23 mm ± 0.56 mm, P < .05). The virtual reality surgical training of thoracic pedicle screw instrumentation effectively improves surgical performance of novice residents compared to those with traditional teaching method, and can help new beginners to master the surgical technique within shortest period of time.
Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey for ambulatory surgical centers - Facility
U.S. Department of Health & Human Services — A list of ambulatory surgical center ratings for the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey....
MDOT implementation plan for global positioning systems (GPS) technology in planning, design, and construction delivery.
Global Positioning System (GPS) technology offers advantages to transportation agencies in the planning, design and construction stages of project delivery. This research study will develop a guide for Mississippi Department of Transportation (MDOT) ...
Incidence of surgical-site infections and the validity of the National Nosocomial Infections Surveillance System risk index in a general surgical ward in Santa Cruz, Bolivia.
Soleto, Lorena; Pirard, Marianne; Boelaert, Marleen; Peredo, Remberto; Vargas, Reinerio; Gianella, Alberto; Van der Stuyft, Patrick
To estimate the frequency of and risk factors for surgical-site infections (SSIs) in Bolivia, and to study the performance of the National Nosocomial Infections Surveillance (NNIS) System risk index in a developing country. A prospective study with patient follow-up until the 30th postoperative day. A general surgical ward of a public hospital in Santa Cruz, Bolivia. Patients admitted to the ward between July 1998 and June 1999 on whom surgical procedures were performed. Follow-up was complete for 91.5% of 376 surgical procedures. The overall SSI rate was 12%. Thirty-four (75.6%) of the 45 SSIs were culture positive. A logistic regression model retained an American Society of Anesthesiologists score of more than 1 (odds ratio [OR], 1.87), a not-clean wound class (OR, 2.28), a procedure duration of more than 1 hour (OR, 1.81), and drain (OR, 1.98) as independent risk factors for SSI. There was no significant association between the NNIS System risk index and SSI rates. However, a "local" risk index constructed with the above cutoff points showed a linear trend with SSI (P < .001) and a relative risk of 3.18 for risk class 3 versus a class of less than 3. SSIs cause considerable morbidity in Santa Cruz. Appropriate nosocomial infection surveillance and control should be introduced. The NNIS System risk index did not discriminate between patients at low and high risk for SSI in this hospital setting, but a risk score based on local cutoff points performed substantially better.
Volume definition system for treatment planning
International Nuclear Information System (INIS)
Alakuijala, Jyrki; Pekkarinen, Ari; Puurunen, Harri
Purpose: Volume definition is a difficult and time consuming task in 3D treatment planning. We have studied a systems approach for constructing an efficient and reliable set of tools for volume definition. Our intent is to automate body outline, air cavities and bone volume definition and accelerate definition of other anatomical structures. An additional focus is on assisting in definition of CTV and PTV. The primary goals of this work are to cut down the time used in contouring and to improve the accuracy of volume definition. Methods: We used the following tool categories: manual, semi-automatic, automatic, structure management, target volume definition, and visualization tools. The manual tools include mouse contouring tools with contour editing possibilities and painting tools with a scaleable circular brush and an intelligent brush. The intelligent brush adapts its shape to CT value boundaries. The semi-automatic tools consist of edge point chaining, classical 3D region growing of single segment and competitive volume growing of multiple segments. We tuned the volume growing function to take into account both local and global region image values, local volume homogeneity, and distance. Heuristic seeding followed with competitive volume growing finds the body outline, couch and air automatically. The structure management tool stores ICD-O coded structures in a database. The codes have predefined volume growing parameters and thus are able to accommodate the volume growing dissimilarity function for different volume types. The target definition tools include elliptical 3D automargin for CTV to PTV transformation and target volume interpolation and extrapolation by distance transform. Both the CTV and the PTV can overlap with anatomical structures. Visualization tools show the volumes as contours or color wash overlaid on an image and displays voxel rendering or translucent triangle mesh rendering in 3D. Results: The competitive volume growing speeds up the
Planning Model for Peruvian University System
Chiyon, Isabel; Yague, Jose Luis
This paper arises from observing the effect that the education policy has had on the European Higher Education Area that promotes the primary objective of this research: the preparation of a planning model that contributes, based on the European experience, the basic elements for the quality of higher education in Peru. To appraise the timeliness and usefulness of the aforementioned model, the scope of the Spanish model is selected and specifically adapted to the Peruvian model, which can be ...
Systemic antimicrobial therapy (minocycline as an adjunct to non-surgical approach to recurrent chronic generalized gingival hyperplasia
Directory of Open Access Journals (Sweden)
Parag M Khatri
Full Text Available Systemic antibiotic treatment has emerged as a powerful adjunct to conventional mechanical debridement for therapeutic management of the periodontal diseases. The conceptual basis for treating periodontal diseases as infections is particularly attractive in part because of substantial data indicating that these diseases may be associated with specific putative pathogens. Further, discrete groups of patients respond well to systemic antibiotics and exhibit improvement of clinical parameters, including attachment level and inflammation. This bacterial-host interaction, which is ever-so-present in periodontitis, directs us toward utilizing antimicrobial agents along with the routine mechanical debridement. This case report presents a case of a female patient with recurrence of the chronic generalized periodontitis with gingival enlargement, which is treated thrice by referral dentist. A through clinical examination was carried out pre-operatively and treatment was planned with systemic minocycline in conjunction with the conventional non-surgical approach. There was a significant reduction of pocket depth, gain in attachment with dramatic improvement clinically.
Characterization of HDR Ir-192 source for 3D planning system
International Nuclear Information System (INIS)
Fonseca, Gabriel P.; Yoriyaz, Helio; Antunes, Paula C.G.; Siqueira, Paulo T.D.; Rubo, Rodrigo; Ferreira, Louise A.
Brachytherapy treatment involves surgical or cavitary insertion of radioactive sources for diseases treatments, such as: lung, gynecologic or prostate cancer. This technique has great ability to administer high doses to the tumor, with adjacent normal tissue preservation equal or better than external beam radiation therapy. Several innovations have been incorporated in this treatment technique, such as, 3D treatment planning system and computer guided sources. In detriment to scientific advances there are no protocols that relate dose with tumor volume, organs or A point, established by ICRU38 and used to prescribe dose in treatment planning system. Several international studies, like as EMBRACE, the multicentre international study, has been trying to correlate the dose volume using 3D planning systems and medical images, as those obtained by CT or MRI, to establish treatment protocols. With the objective of analyzing the 3D dose distribution, a micro Selectron-HDR remote afterloading device for high dose-rate (HDR) was characterized in the present work. Through the data provided by the manufacturer the source was simulated, using the MCNP5 code to calculate American Association of Physicists in Medicine Task Group No. 43 report (AAPM TG43) specified parameters. The simulations have shown great agreement when compared to the ONCENTRA planning system results and those provided by literature. The micro Selectron-HDR remote afterloading device will be utilized to simulate 3D dose distribution through CT images processed by an auxiliary software which process DICOM images. (author)
Characterization of HDR Ir-192 source for 3D planning system
Energy Technology Data Exchange (ETDEWEB)
Fonseca, Gabriel P.; Yoriyaz, Helio; Antunes, Paula C.G.; Siqueira, Paulo T.D., E-mail: email@example.com, E-mail: email@example.com, E-mail: email@example.com [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil); Rubo, Rodrigo [Universidade de Sao Paulo (HC/FMUSP), Sao Paulo, SP (Brazil). Hospital das Clinicas. Servico de Radioterapia; Minamisawa, Renato A., E-mail: firstname.lastname@example.com [Paul Scherrer Institut (PSI), Villigen (Switzerland); Ferreira, Louise A. [Universidade Estadual de Maringa (UEM), PR (Brazil). Fac. de Medicina
Brachytherapy treatment involves surgical or cavitary insertion of radioactive sources for diseases treatments, such as: lung, gynecologic or prostate cancer. This technique has great ability to administer high doses to the tumor, with adjacent normal tissue preservation equal or better than external beam radiation therapy. Several innovations have been incorporated in this treatment technique, such as, 3D treatment planning system and computer guided sources. In detriment to scientific advances there are no protocols that relate dose with tumor volume, organs or A point, established by ICRU38 and used to prescribe dose in treatment planning system. Several international studies, like as EMBRACE, the multicentre international study, has been trying to correlate the dose volume using 3D planning systems and medical images, as those obtained by CT or MRI, to establish treatment protocols. With the objective of analyzing the 3D dose distribution, a micro Selectron-HDR remote afterloading device for high dose-rate (HDR) was characterized in the present work. Through the data provided by the manufacturer the source was simulated, using the MCNP5 code to calculate American Association of Physicists in Medicine Task Group No. 43 report (AAPM TG43) specified parameters. The simulations have shown great agreement when compared to the ONCENTRA planning system results and those provided by literature. The micro Selectron-HDR remote afterloading device will be utilized to simulate 3D dose distribution through CT images processed by an auxiliary software which process DICOM images. (author)
Electronic systems for the organization and planning of school
Vodová, Alena
TITLE: Electronic systems for the organization and planning of school AUTHOR: Alena Vodová DEPARTMENT: The Center of School management SUPERVISOR: Ing. Petr Svoboda Ph.D. ABSTRACT: The bachelor thesis gives comprehensive overview electronic systems for organization and planning of school. Maps of species, describes their function, demonstrates the benefits, modes and applications to use in school. In the research part individuals system compares between them and validates their use in schools...
Mission Planning System Increment 5 (MPS Inc 5)
2016 Major Automated Information System Annual Report Mission Planning System Increment 5 (MPS Inc 5) Defense Acquisition Management Information...President's Budget RDT&E - Research, Development, Test, and Evaluation SAE - Service Acquisition Executive TBD - To Be Determined TY - Then Year...Phone: 845-9625 DSN Fax: Date Assigned: May 19, 2014 Program Information Program Name Mission Planning System Increment 5 (MPS Inc 5) DoD
The role of robotic surgical system in the management of vascular disease.
Lin, Judith C
The evolution of minimally invasive treatment for aneurysms and occlusive disease has led to the development of endovascular, laparoscopic, and robot-assisted techniques. This article reviews the current literature on the clinical use of robotic surgical systems in the treatment of patients with aneurysms and occlusive disease. A MEDLINE search was performed using the keywords "robotic, vascular, AND surgery." All pertinent articles concerning the use of the robotic surgical system on aneurysms and occlusive disease were reviewed. The author's personal experience consisted of a retrospective review of a prospectively maintained confidential database on all procedures performed with the da Vinci(®) surgical system. Several robot-assisted laparoscopic series on the treatment of aortic disease were identified, including review articles of potential clinical applications in hybrid, laparoscopic vascular, and endovascular treatments for vascular patients using robotic technology. The use of computer-enhanced or robotic technology as a sole modality for bypass of occlusive disease and repair of abdominal aortic, splenic, and renal aneurysms was described in case series with satisfactory patient outcomes. Current robotic endovascular technology was also described. Minimally invasive techniques using endovascular, laparoscopic, or robot-assisted technology have revolutionized the treatment of aortoiliac, splanchnic, and renal aneurysms and occlusive disease. However, robot-assisted techniques for aortic disease may involve a learning curve and increased operating times. Although endovascular therapy is preferred because of faster recovery, this preference for improved short-term outcomes will be balanced with the superiority and durability of robot-assisted endoscopic methods as comparable to open surgery. Copyright © 2013 Elsevier Inc. All rights reserved.
High frequency system project implementation plan
International Nuclear Information System (INIS)
Moon, L.L.
The High Frequency System is a new mobile, digital diagnostic recording system for use at the Nevada Test Site. Many different kinds of event data will be digitized in real-time by this system, and these data will be recorded and stored for later read-out and transmission to NADCEN. The hardware and software requirements of the High Frequency System are examined, and the parameters of the system are proposed
System Planning With The Hanford Waste Operations Simulator
International Nuclear Information System (INIS)
Crawford, T.W.; Certa, P.J.; Wells, M.N.
At the U. S. Department of Energy's Hanford Site in southeastern Washington State, 216 million liters (57 million gallons) of nuclear waste is currently stored in aging underground tanks, threatening the Columbia River. The River Protection Project (RPP), a fully integrated system of waste storage, retrieval, treatment, and disposal facilities, is in varying stages of design, construction, operation, and future planning. These facilities face many overlapping technical, regulatory, and financial hurdles to achieve site cleanup and closure. Program execution is ongoing, but completion is currently expected to take approximately 40 more years. Strategic planning for the treatment of Hanford tank waste is by nature a multi-faceted, complex and iterative process. To help manage the planning, a report referred to as the RPP System Plan is prepared to provide a basis for aligning the program scope with the cost and schedule, from upper-tier contracts to individual facility operating plans. The Hanford Tank Waste Operations Simulator (HTWOS), a dynamic flowsheet simulation and mass balance computer model, is used to simulate the current planned RPP mission, evaluate the impacts of changes to the mission, and assist in planning near-term facility operations. Development of additional modeling tools, including an operations research model and a cost model, will further improve long-term planning confidence. The most recent RPP System Plan, Revision 4, was published in September 2009.
Identification systems subject to plan cybersecurity; Identificacion de sistemas sujetos al plan de Ciberseguridad
Energy Technology Data Exchange (ETDEWEB)
Guerrero Sanz, J.; Perez Alcaniz, T.; Garcia Garcia, I.
The implementation of a Plan Cybersecurity ensures that systems and communications networks that perform functions related to both physical security such emergency action and their support systems, and interfaces that may affect them, are protected with an effective system against cyber attacks.
Kilowatt isotope power system. Phase II plan. Volume I. Phase II program plan
International Nuclear Information System (INIS)
The development of a Kilowatt Isotope Power System (KIPS) was begun in 1975 for the purpose of satisfying the power requirements of satellites in the 1980's. The KIPS is a 238 PuO 2 -fueled organic Rankine cycle turbine power system to provide a design output of 500 to 2000 W. Phase II of the overall 3-phase KIPS program is described. This volume presents a program plan for qualifying the organic Rankine power system for flight test in 1982. The program plan calls for the design and fabrication of the proposed flight power system; conducting a development and a qualification program including both environmental and endurance testing, using an electrical and a radioisotope heat source; planning for flight test and spacecraft integration; and continuing ground demonstration system testing to act as a flight system breadboard and to accumulate life data
Implementation of a Web-Based Collaborative Process Planning System
Wang, Huifen; Liu, Tingting; Qiao, Li; Huang, Shuangxi
Under the networked manufacturing environment, all phases of product manufacturing involving design, process planning, machining and assembling may be accomplished collaboratively by different enterprises, even different manufacturing stages of the same part may be finished collaboratively by different enterprises. Based on the self-developed networked manufacturing platform eCWS(e-Cooperative Work System), a multi-agent-based system framework for collaborative process planning is proposed. In accordance with requirements of collaborative process planning, share resources provided by cooperative enterprises in the course of collaboration are classified into seven classes. Then a reconfigurable and extendable resource object model is built. Decision-making strategy is also studied in this paper. Finally a collaborative process planning system e-CAPP is developed and applied. It provides strong support for distributed designers to collaboratively plan and optimize product process though network.
ATIPS: Automatic Travel Itinerary Planning System for Domestic Areas.
Chang, Hsien-Tsung; Chang, Yi-Ming; Tsai, Meng-Tze
Leisure travel has become a topic of great interest to Taiwanese residents in recent years. Most residents expect to be able to relax on a vacation during the holidays; however, the complicated procedure of travel itinerary planning is often discouraging and leads them to abandon the idea of traveling. In this paper, we design an automatic travel itinerary planning system for the domestic area (ATIPS) using an algorithm to automatically plan a domestic travel itinerary based on user intentions that allows users to minimize the process of trip planning. Simply by entering the travel time, the departure point, and the destination location, the system can automatically generate a travel itinerary. According to the results of the experiments, 70% of users were satisfied with the result of our system, and 82% of users were satisfied with the automatic user preference learning mechanism of ATIPS. Our algorithm also provides a framework for substituting modules or weights and offers a new method for travel planning.
Anomalous Systemic Artery to the Left Lower Lobe: Literature Review and a New Surgical Technique.
Miller, Jacob R; Lancaster, Timothy S; Abarbanell, Aaron M; Manning, Peter B; Eghtesady, Pirooz
Anomalous systemic arterial supply to the basal segments of the left lower lobe without coexisting pulmonary artery connection is a rare anomaly. Most feel treatment is necessary; however, the ideal strategy is unclear. Treatments described include embolization, pulmonary resection, or anastomosis to the native pulmonary artery. We recently encountered an infant with this anomaly and present a literature review summarizing all recent reports. Additionally, we describe a novel surgical technique to create a tension-free anastomosis utilizing segmental aortic translocation that we employed in our patient due to a large distance between the anomalous vessel and native left pulmonary artery.
Supporting strategic spatial planning : planning support systems for the spatial planning of metropolitan landscapes
Carsjens, G.J.
Een belangrijke opgave voor de ruimtelijke planning is en balans te vinden tussen de toegenomen druk op de open groene ruimte door verstedelijking en economische ontwikkeling enerzijds, en de noodzaak van het behouden van deze landelijke gebieden voor natuur, recreatie, landschap en voedselproductie
Virtual Whipple: preoperative surgical planning with volume-rendered MDCT images to identify arterial variants relevant to the Whipple procedure.
Brennan, Darren D; Zamboni, Giulia; Sosna, Jacob; Callery, Mark P; Vollmer, Charles M V; Raptopoulos, Vassilios D; Kruskal, Jonathan B
The purposes of this study were to combine a thorough understanding of the technical aspects of the Whipple procedure with advanced rendering techniques by introducing a virtual Whipple procedure and to evaluate the utility of this new rendering technique in prediction of the arterial variants that cross the anticipated surgical resection plane. The virtual Whipple is a novel technique that follows the complex surgical steps in a Whipple procedure. Three-dimensional reconstructed angiographic images are used to identify arterial variants for the surgeon as part of the preoperative radiologic assessment of pancreatic and ampullary tumors.
SBNCT plan: A 3-dimensional treatment planning system for boron neutron capture therapy
International Nuclear Information System (INIS)
Reinstein, L.E.; Ramsay, E.B.; Gajewski, J.; Ramamoorthy, S.; Meek, A.G.
The need for accurate and comprehensive 3-dimensional treatment planning for boron neutron capture therapy (BNCT) has been debated for the past several years. Although many argue against the need for elaborate and expensive treatment planning programs which mimic conventional radiotherapy planning systems, it is clear that in order to realize significant gains over conventional fractionated radiation therapy, patients must be treated to the edge of normal tissue tolerance. Just how close to this edge is dictated by the uncertainties in dosimetry. Hence the focus of BNCT planning is the determination of dose distribution throughout normal tissue volumes. Although precise geometric manipulation of the epithermal neutron beam is not achievable, the following variables play an important role in BNCT optimization: patient orientation, dose fractionation, number of fields, megawatt-minutes per fraction, use of surface bolus, and use of collimation. Other variables which are not as easily adjustable and would not, therefore, be part of treatment planning optimization, include external patient contour, internal patient heterogeneities, boron compound distributions, and RBE's. The boron neutron capture therapy planning system developed at SUNY Stony Brook (SBNCT-Plan) was designed as an interactive graphic tool to assist the radiation oncologist in generating the optimum plan for a neutron capture treatment
Sequence Coding and Search System Backfit Quality Assurance Program Plan
International Nuclear Information System (INIS)
Lovell, C.J.; Stepina, P.L.
The Sequence Coding and Search System is a computer-based encoding system for events described in Licensee Event Reports. This data system contains LERs from 1981 to present. Backfit of the data system to include LERs prior to 1981 is required. This report documents the Quality Assurance Program Plan that EG and G Idaho, Inc. will follow while encoding 1980 LERs
Planning and Optimization Methods for Active Distribution Systems
DEFF Research Database (Denmark)
Abbey, Chad; Baitch, Alex; Bak-Jensen, Birgitte
distribution planning. Active distribution networks (ADNs) have systems in place to control a combination of distributed energy resources (DERs), defined as generators, loads and storage. With these systems in place, the AND becomes an Active Distribution System (ADS). Distribution system operators (DSOs) have...
NIF Projects Controls and Information Systems Software Quality Assurance Plan
Energy Technology Data Exchange (ETDEWEB)
Fishler, B
Quality achievement for the National Ignition Facility (NIF) and the National Ignition Campaign (NIC) is the responsibility of the NIF Projects line organization as described in the NIF and Photon Science Directorate Quality Assurance Plan (NIF QA Plan). This Software Quality Assurance Plan (SQAP) is subordinate to the NIF QA Plan and establishes quality assurance (QA) activities for the software subsystems within Controls and Information Systems (CIS). This SQAP implements an activity level software quality assurance plan for NIF Projects as required by the LLNL Institutional Software Quality Assurance Program (ISQAP). Planned QA activities help achieve, assess, and maintain appropriate quality of software developed and/or acquired for control systems, shot data systems, laser performance modeling systems, business applications, industrial control and safety systems, and information technology systems. The objective of this SQAP is to ensure that appropriate controls are developed and implemented for management planning, work execution, and quality assessment of the CIS organization's software activities. The CIS line organization places special QA emphasis on rigorous configuration control, change management, testing, and issue tracking to help achieve its quality goals.
NIF Projects Controls and Information Systems Software Quality Assurance Plan
International Nuclear Information System (INIS)
Fishler, B.
Quality achievement for the National Ignition Facility (NIF) and the National Ignition Campaign (NIC) is the responsibility of the NIF Projects line organization as described in the NIF and Photon Science Directorate Quality Assurance Plan (NIF QA Plan). This Software Quality Assurance Plan (SQAP) is subordinate to the NIF QA Plan and establishes quality assurance (QA) activities for the software subsystems within Controls and Information Systems (CIS). This SQAP implements an activity level software quality assurance plan for NIF Projects as required by the LLNL Institutional Software Quality Assurance Program (ISQAP). Planned QA activities help achieve, assess, and maintain appropriate quality of software developed and/or acquired for control systems, shot data systems, laser performance modeling systems, business applications, industrial control and safety systems, and information technology systems. The objective of this SQAP is to ensure that appropriate controls are developed and implemented for management planning, work execution, and quality assessment of the CIS organization's software activities. The CIS line organization places special QA emphasis on rigorous configuration control, change management, testing, and issue tracking to help achieve its quality goals.
Master planning for successful safeguard/security systems engineering
International Nuclear Information System (INIS)
Bruckner, D.G.
The development and phased implementation of an overall master plan for weapons systems and facilities engaged in the complexities of high technology provides a logical road map for system accomplishment. An essential factor in such a comprehensive plan is development of an integrated systems security engineering plan. Some DOD programs use new military regulations and policy directives to mandate consideration of the safeguard/security disciplines be considered for weapons systems and facilities during the entire life cycle of the program. The emphasis is to make certain the weapon system and applicable facilities have complementary security features. Together they must meet the needs of the operational mission and, at the same time, provide the security forces practical solutions to their requirements. This paper discusses the process of meshing the safe- guards/security requirements with an overall the master plan and the challenges attendant to this activity
Surface moisture measurement system acceptance testing work plan
International Nuclear Information System (INIS)
Ritter, G.A.
This work plan addresses testing of the Surface Moisture Measurement System (SMMS) at the Fuels and Materials Examination Facility (FMEF). The purpose of this plan is to define the scope of work, identify organizational responsibilities, describe test control requirements, and provide estimated costs and schedule associated with acceptance testing
Strategic environmental evaluation of National Transmission System Plan in Italy
International Nuclear Information System (INIS)
Lanadio, E.; Motawi, A.; Rizzuto, R.; Cappiello, A.; Micotti, M.
The entry into force of part II of D. Lgs. 152/2006 establishing the procedures for strategic environmental assessment for plans and programs. The application of legislation to the development plan of the electric network of the National Transmission System verify testing conducted by Terna with ministries and authorities with environmental competences [it
Research Perspectives for Material Requirements Planning Systems. Paper No. 434.
Berry, W. L.; Whybark, D. Clay
Material requirements planning (MRP) systems are described as management tools for planning and controlling production operations. A wide variety of industries and production organizations are credited as reporting significant operating improvements in such areas as inventory control, production scheduling, delivery performance, and production…
Impact of structural reforms on planning systems and policies
DEFF Research Database (Denmark)
Galland, Daniel; Enemark, Stig
spatial development processes. The reasoning behind this argument stems from the case of Denmark, where a structural reform that changed the country's geographies of inter-governmental arrangements significantly transformed the configuration and functioning of the national spatial planning system. Once...... concerning how the scope of Danish spatial planning has been reoriented over time in light of three interrelated strands of understanding....
Automated transportation management system (ATMS) software project management plan (SPMP)
Energy Technology Data Exchange (ETDEWEB)
Weidert, R.S., Westinghouse Hanford
The Automated Transportation Management System (ATMS) Software Project Management plan (SPMP) is the lead planning document governing the life cycle of the ATMS and its integration into the Transportation Information Network (TIN). This SPMP defines the project tasks, deliverables, and high level schedules involved in developing the client/server ATMS software.
Benefits of advanced software techniques for mission planning systems
Gasquet, A.; Parrod, Y.; Desaintvincent, A.
The increasing complexity of modern spacecraft, and the stringent requirement for maximizing their mission return, call for a new generation of Mission Planning Systems (MPS). In this paper, we discuss the requirements for the Space Mission Planning and the benefits which can be expected from Artificial Intelligence techniques through examples of applications developed by Matra Marconi Space.
... instruction, including: Microbiology Pathophysiology Pharmacology Anatomy and physiology Medical terminology Curriculum . Course content includes: Advanced surgical anatomy Surgical microbiology Surgical pharmacology Anesthesia methods and agents Bioscience Ethical ...
Consumer assessment of healthcare providers and systems surgical care survey: benefits and challenges.
Schulz, Kristine A; Rhee, John S; Brereton, Jean M; Zema, Carla L; Witsell, David L
To describe the feasibility and initial results of the implementation of a continuous quality improvement project using the newly available Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS), in a small cohort of otolaryngology-head and neck surgery practices. Prospective observational study using a newly validated health care consumer survey. Two community-based and 2 university-based otolaryngology-head and neck surgery outpatient clinic practices. Fourteen board-certified otolaryngology, head and neck surgeons from 4 practice sites voluntarily participated in this project. All adult patients scheduled for surgery during a 12-month period were asked to complete the S-CAHPS survey through an electronic data capture (EDC) system 7 to 28 days after surgery. The surgeons were not directly involved in administration or collection of survey data. Three sites successfully implemented the S-CAHPS project. A 39.9% response rate was achieved for the cohort of surgical patients entered into the EDC system. While most patients rated their surgeons very high (mean of 9.5 or greater out of 10), subanalysis revealed there is variability among sites and surgeons in communication practices. From these data, a potential surgeon Quality Improvement report was developed that highlights priority areas to improve surgeon-patient rapport. The S-CAHPS survey can be successfully implemented in most otolaryngology practices, and our initial work holds promise for how the survey can be best deployed and analyzed for the betterment of both the surgeon and the patient.
Hybrid procedure for total laryngectomy with a flexible robot-assisted surgical system.
Schuler, Patrick J; Hoffmann, Thomas K; Veit, Johannes A; Rotter, Nicole; Friedrich, Daniel T; Greve, Jens; Scheithauer, Marc O
Total laryngectomy is a standard procedure in head-and-neck surgery for the treatment of cancer patients. Recent clinical experiences have indicated a clinical benefit for patients undergoing transoral robot-assisted total laryngectomy (TORS-TL) with commercially available systems. Here, a new hybrid procedure for total laryngectomy is presented. TORS-TL was performed in human cadavers (n = 3) using a transoral-transcervical hybrid procedure. The transoral approach was performed with a robotic flexible robot-assisted surgical system (Flex®) and compatible flexible instruments. Transoral access and visualization of anatomical landmarks were studied in detail. Total laryngectomy is feasible with a combined transoral-transcervical approach using the flexible robot-assisted surgical system. Transoral visualization of all anatomical structures is sufficient. The flexible design of the robot is advantageous for transoral surgery of the laryngeal structures. Transoral robot assisted surgery has the potential to reduce morbidity, hospital time and fistula rates in a selected group of patients. Initial clinical studies and further development of supplemental tools are in progress. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
Application of action planning to PES systems
Paredes Cuervo, Diego; Arango Ramírez, Alejandro
Buscando aportar una de las primeras aproximaciones metodológicas al tema del pago por servicios ambientales (PSA) en la cuenca del río Otún (Risaralda, Colombia) se propuso un plan de acción para la instalación de un sistema de PSA en la zona. El resultado principal de este proceso fue la definición de las actividades, responsabilidades y recursos para la implementación de un proyecto piloto de PSA enfocado en la calidad hídrica y la conservación de la biodiversidad y que incluirá como p...
Systems Engineering Assessment & Workforce Development Plan
Government or its technical domains. Other fields, such as culinary and healthcare, have also identified these emerging and growing issues (Calhoun...et al. (2009). "The Art and Science of Systems Engineering." Systems Research Forum 3(2): 81-100. Shenhar, A. and B. Sauser, Eds. (2009). Systems
The SEP "robot": a valid virtual reality robotic simulator for the Da Vinci Surgical System?
van der Meijden, O A J; Broeders, I A M J; Schijven, M P
The aim of the study was to determine if the concept of face and construct validity may apply to the SurgicalSim Educational Platform (SEP) "robot" simulator. The SEP robot simulator is a virtual reality (VR) simulator aiming to train users on the Da Vinci Surgical System. To determine the SEP's face validity, two questionnaires were constructed. First, a questionnaire was sent to users of the Da Vinci system (reference group) to determine a focused user-group opinion and their recommendations concerning VR-based training applications for robotic surgery. Next, clinical specialists were requested to complete a pre-tested face validity questionnaire after performing a suturing task on the SEP robot simulator. To determine the SEP's construct validity, outcome parameters of the suturing task were compared, for example, relative to participants' endoscopic experience. Correlations between endoscopic experience and outcome parameters of the performed suturing task were tested for significance. On an ordinal five-point, scale the average score for the quality of the simulator software was 3.4; for its hardware, 3.0. Over 80% agreed that it is important to train surgeons and surgical trainees to use the Da Vinci. There was a significant but marginal difference in tool tip trajectory (p = 0.050) and a nonsignificant difference in total procedure time (p = 0.138) in favor of the experienced group. In conclusion, the results of this study reflect a uniform positive opinion using VR training in robotic surgery. Concepts of face and construct validity of the SEP robotic simulator are present; however, these are not strong and need to be improved before implementation of the SEP robotic simulator in its present state for a validated training curriculum to be successful .
The study of surgical image quality evaluation system by subjective quality factor method
Zhang, Jian J.; Xuan, Jason R.; Yang, Xirong; Yu, Honggang; Koullick, Edouard
GreenLightTM procedure is an effective and economical way of treatment of benign prostate hyperplasia (BPH); there are almost a million of patients treated with GreenLightTM worldwide. During the surgical procedure, the surgeon or physician will rely on the monitoring video system to survey and confirm the surgical progress. There are a few obstructions that could greatly affect the image quality of the monitoring video, like laser glare by the tissue and body fluid, air bubbles and debris generated by tissue evaporation, and bleeding, just to name a few. In order to improve the physician's visual experience of a laser surgical procedure, the system performance parameter related to image quality needs to be well defined. However, since image quality is the integrated set of perceptions of the overall degree of excellence of an image, or in other words, image quality is the perceptually weighted combination of significant attributes (contrast, graininess …) of an image when considered in its marketplace or application, there is no standard definition on overall image or video quality especially for the no-reference case (without a standard chart as reference). In this study, Subjective Quality Factor (SQF) and acutance are used for no-reference image quality evaluation. Basic image quality parameters, like sharpness, color accuracy, size of obstruction and transmission of obstruction, are used as subparameter to define the rating scale for image quality evaluation or comparison. Sample image groups were evaluated by human observers according to the rating scale. Surveys of physician groups were also conducted with lab generated sample videos. The study shows that human subjective perception is a trustworthy way of image quality evaluation. More systematic investigation on the relationship between video quality and image quality of each frame will be conducted as a future study.
Implementation of surgical debriefing programs in large health systems: an exploratory qualitative analysis.
Brindle, Mary E; Henrich, Natalie; Foster, Andrew; Marks, Stanley; Rose, Michael; Welsh, Robert; Berry, William
The role of the "debrief" to address issues related to patient safety and systematic flaws in care is frequently overlooked. In our study, we interview surgical leaders who have developed successful strategies of debriefing within a comprehensive program of quality improvement. Semi-structured interviews of four implementation leaders were performed. The observations, beliefs and strategies of surgical leaders are compared and contrasted. Common themes are identified related to program success and failure. Quality and safety researchers performed, coded and categorized the interviews and coordinated the analysis and interpretation of the results. The authors from the four institutions aided in interpretation and framing of the results. The debriefing programs evaluated were part of comprehensive quality improvement projects. Seven high-level themes and 24 subthemes were identified from the interviews. Themes related to leadership included early engagement, visible ongoing commitment and enforcement. Success appeared to depend upon meaningful and early debriefing feedback. The culture of safety that promoted success included a commitment to open and fair communication and continuous improvement. There were many challenges to the success of debriefing programs. The loss of institutional commitment of resources and personnel was the instigating factor behind the collapse of the program at Michigan. Other areas of potential failure included communication issues and loss of early and meaningful feedback. Leaders of four surgical systems with strong debriefing programs report success using debriefing to improve system performance. These findings are consistent with previously published studies. Success requires commitment of resources, and leadership engagement. The greatest gains may be best achieved by programs that provide meaningful debriefing feedback in an atmosphere dedicated to open communication.
Pipelines, utilities plan over 150 scada systems
International Nuclear Information System (INIS)
This paper reports that North American pipelines and utilities will spend more than $170 million on new or upgraded supervisory control and data acquisition (scada) systems during the 30-month period that commenced Sept. 1. Another $12.5 million will be spent on peripherals and consulting. Among the 699 various projects to be implemented during the period, companies will install 151 scada systems, add 154 remote-terminal units (RTUs) to existing scada units, and install 196 communications systems. Scada systems are computerized hardware and software systems that perform a set of monitoring and control functions. In gas utilities, these systems perform functions normally associated with gas transmission and distribution as well as production plant process control. In gas and oil pipelines, the systems perform these functions as well as such specialized functions as batch tracking, leak detection, and gas load flow
The da Vinci telerobotic surgical system: the virtual operative field and telepresence surgery.
Ballantyne, Garth H; Moll, Fred
The United States Department of Defense developed the telepresence surgery concept to meet battlefield demands. The da Vinci telerobotic surgery system evolved from these efforts. In this article, the authors describe the components of the da Vinci system and explain how the surgeon sits at a computer console, views a three-dimensional virtual operative field, and performs the operation by controlling robotic arms that hold the stereoscopic video telescope and surgical instruments that simulate hand motions with seven degrees of freedom. The three-dimensional imaging and handlike motions of the system facilitate advanced minimally invasive thoracic, cardiac, and abdominal procedures. da Vinci has recently released a second generation of telerobots with four arms and will continue to meet the evolving challenges of surgery.
Truth in Reporting: How Data Capture Methods Obfuscate Actual Surgical Site Infection Rates within a Health Care Network System.
Bordeianou, Liliana; Cauley, Christy E; Antonelli, Donna; Bird, Sarah; Rattner, David; Hutter, Matthew; Mahmood, Sadiqa; Schnipper, Deborah; Rubin, Marc; Bleday, Ronald; Kenney, Pardon; Berger, David
Two systems measure surgical site infection rates following colorectal surgeries: the American College of Surgeons National Surgical Quality Improvement Program and the Centers for Disease Control and Prevention National Healthcare Safety Network. The Centers for Medicare & Medicaid Services pay-for-performance initiatives use National Healthcare Safety Network data for hospital comparisons. This study aimed to compare database concordance. This is a multi-institution cohort study of systemwide Colorectal Surgery Collaborative. The National Surgical Quality Improvement Program requires rigorous, standardized data capture techniques; National Healthcare Safety Network allows 5 data capture techniques. Standardized surgical site infection rates were compared between databases. The Cohen κ-coefficient was calculated. This study was conducted at Boston-area hospitals. National Healthcare Safety Network or National Surgical Quality Improvement Program patients undergoing colorectal surgery were included. Standardized surgical site infection rates were the primary outcomes of interest. Thirty-day surgical site infection rates of 3547 (National Surgical Quality Improvement Program) vs 5179 (National Healthcare Safety Network) colorectal procedures (2012-2014). Discrepancies appeared: National Surgical Quality Improvement Program database of hospital 1 (N = 1480 patients) routinely found surgical site infection rates of approximately 10%, routinely deemed rate "exemplary" or "as expected" (100%). National Healthcare Safety Network data from the same hospital and time period (N = 1881) revealed a similar overall surgical site infection rate (10%), but standardized rates were deemed "worse than national average" 80% of the time. Overall, hospitals using less rigorous capture methods had improved surgical site infection rates for National Healthcare Safety Network compared with standardized National Surgical Quality Improvement Program reports. The correlation coefficient
The Role of MR Imaging for the Surgical Treatment Planning of Breast Cancer: Comparison with US and the Whole-Excised Breast Histopathologic Correlation
International Nuclear Information System (INIS)
Hwang, Ji Young; Choi, Hye Young; Lee, Jee Eun; Baek, Seung Yon; Sung, Sun Hee
We wanted to evaluate the effectiveness of breast magnetic resonance (MR) imaging as a preoperative evaluation modality, as compared with ultrasonography (US) imaging, and we wanted to determine the correlation of MRI and US with using the whole-excised breast histopathology as the standard reference. (Check this and adjust it as needed.) From October 2004 to March 2008, among the 245 patients with breast cancer, 82 patients underwent modified radical mastectomy (MRM). Seven patients were excluded due to receiving neoadjuvant chemotherapy before MRI (n=4) or mammotome excision (n=2) or non-visualization of the mass on US and MR imaging (n=1). The remaining 76 breasts in 75 women (one bilateral) were examined preoperatively with MR imaging and US. On US, 42 cases showed unifocal cancer, 16 showed multifocal cancer and 18 showed multicentric breast cancers. On MRI, 39 cases showed unifocal cancer, 11 showed multifocal cancer and 26 showed multicentric breast cancers. We assessed the US findings to identify the patients who were eligible for breast conservative surgery, and then we evaluated the cancers that were treated with conversion to MRM based on the MR imaging. Histopathologic analysis revealed 45 unifocal, 10 multifocal and 22 multicentric breast cancers. Fifty five of the 76 breasts were indicated for MRM based on the US findings due to multicentric cancers (n=18), unifocal or multifocal lesions near the nipple (n=31), or unifocal or multifocal lesions showing extension towards the nipple (n=6). The remaining 21 breasts were classified as suitable for BCS on US, but 5 patients who desired MRM were excluded. Sixteen breasts were altered to MRM based on the additional findings that were suspicious for malignancy on the MR imaging. Among them, 14 (88%) breasts were adequately converted on the surgical plan to MRM based on the histopathologic verification. The remaining 2 breasts had been overestimated. Breast MRI has a significant effect for the preoperative
Using TELOS for the planning of the information system audit
Drljaca, D. P.; Latinovic, B.
This paper intent is to analyse different aspects of information system audit and to synthesise them into the feasibility study report in order to facilitate decision making and planning of information system audit process. The TELOS methodology provides a comprehensive and holistic review for making feasibility study in general. This paper examines the use of TELOS in the identification of possible factors that may influence the decision on implementing information system audit. The research question relates to TELOS provision of sufficient information to decision makers to plan an information system audit. It was found that the TELOS methodology can be successfully applied in the process of approving and planning of information system audit. The five aspects of the feasibility study, if performed objectively, can provide sufficient information to decision makers to commission an information system audit, and also contribute better planning of the audit. Using TELOS methodology can assure evidence-based and cost-effective decision-making process and facilitate planning of the audit. The paper proposes an original approach, not examined until now. It is usual to use TELOS for different purposes and when there is a need for conveying of the feasibility study, but not in the planning of the information system audit. This gives originality to the paper and opens further research questions about evaluation of the feasibility study and possible research on comparative and complementary methodologies.
Patient education self-management during surgical recovery: combining mobile (iPad) and a content management system.
Cook, David J; Moradkhani, Anilga; Douglas, Kristin S Vickers; Prinsen, Sharon K; Fischer, Erin N; Schroeder, Darrell R
The objective of this investigation was to assess whether a new electronic health (e-health) platform, combining mobile computing and a content management system, could effectively deliver modular and "just-in-time" education to older patients following cardiac surgery. Patients were provided with iPad(®) (Apple(®), Cupertino, CA) tablets that delivered educational modules as part of a daily "to do" list in a plan of care. The tablet communicated wirelessly to a dashboard where data were aggregated and displayed for providers. A surgical population of 149 patients with a mean age of 68 years utilized 5,267 of 6,295 (84%) of education modules delivered over a 5.3-day hospitalization. Increased age was not associated with decreased use. We demonstrate that age, hospitalization, and major surgery are not significant barriers to effective patient education if content is highly consumable and relevant to patients' daily care experience. We also show that mobile technology, even if unfamiliar to many older patients, makes this possible. The combination of mobile computing with a content management system allows for dynamic, modular, personalized, and "just-in-time" education in a highly consumable format. This approach presents a means by which patients may become informed participants in new healthcare models.
An image-guided planning system for endosseous oral implants.
Verstreken, K; Van Cleynenbreugel, J; Martens, K; Marchal, G; van Steenberghe, D; Suetens, P
A preoperative planning system for oral implant surgery was developed which takes as input computed tomographies (CT's) of the jaws. Two-dimensional (2-D) reslices of these axial CT slices orthogonal to a curve following the jaw arch are computed and shown together with three-dimensional (3-D) surface rendered models of the bone and computer-aided design (CAD)-like implant models. A technique is developed for scanning and visualizing an eventual existing removable prosthesis together with the bone structures. Evaluation of the planning done with the system shows a difference between 2-D and 3-D planning methods. Validation studies measure the benefits of the 3-D approach by comparing plans made in 2-D mode only with those further adjusted using the full 3-D visualization capabilities of the system. The benefits of a 3-D approach are then evident where a prosthesis is involved in the planning. For the majority of the patients, clinically important adjustments and optimizations to the 2-D plans are made once the 3-D visualization is enabled, effectively resulting in a better plan. The alterations are related to bone quality and quantity (p biomechanics (p < 0.005), and esthetics (p < 0.005), and are so obvious that the 3-D plan stands out clearly (p < 0.005). The improvements often avoid complications such as mandibular nerve damage, sinus perforations, fenestrations, or dehiscences.
Planning Support Systems (PSS-Based Spatial Plan Alternatives and Environmental Assessment
Directory of Open Access Journals (Sweden)
Hee-Sun Choi
Full Text Available Spatial planning is at the core of national land and urban development. Many countries and cities seek sustainable development through various means such as coordinated environmental planning, environmental assessment, and internalization of environmental analysis and planning. A Planning Support System (PSS is a GIS (Geographic Information System-based, spatial decision-making support system that incorporates a variety of theories and pertinent models. This study adopted the "What if?" model to design an alternative spatial plan that includes generation of predictive scenarios and is relatively easy to use. In the cities studied, we identified a total of six scenarios based on the main drivers of development—namely, population and spatial policies. Subsequently, we assessed the alternatives for their environmental impact, preparing sensitivity maps for each major environmental issue in the target area (natural ecosystem, air and microclimate, natural disasters. One projected advantage of the "What if?" model is that its digital visualization of proposed plans may improve public awareness and involvement. Furthermore, the tool is expected to be highly useful in ensuring the objectivity of quantitative analyses. However, it is necessary to develop a PSS that is both standardized and tailored to the particular needs of each area. Finally, the development of an e-governance system will be beneficial in ensuring public access to the decision making process.
Clinical Experience of the Treatment of Solitary Pulmonary Nodules with Da Vinci Surgical System
Directory of Open Access Journals (Sweden)
Xiangdong TONG
Full Text Available Background and objective A solitary pulmonary nodule (SPN is defined as a round intraparenchimal lung lesion less than 3 cm in size, not associated with atelectasis or adenopathy. The aim of this study is to learn clinical experience of the treatment of SPN with Da Vinci Surgical System. Methods A total of 9 patients with solitary pulmonary nodules (SPN less than 3 cm in diameter was treated with Da Vinci Surgical System (Intuitive Surgical, California in thoracic surgery department from General Hospital of Shenyang Militrary Region from November 2011 to March 2014. This group of patients included 3 males and 6 females, and the mean age was 51±9.9 yr (range: 41-74 yr. Most of the patients were no obvious clinical symptoms (7 cases were found by physical examination, others were with cough and expectoration. Their median medical history was 12 mo (range: 4 d-3 yr. All the lesions of patients were peripheral pulmonary nodules and the mean diameter of those was (1.4±0.6 cm(range: 0.8-2.8 cm. Wedge-shaped resection or lobectomy was performed depending on the result of rapid pathology and systemic lymph node dissection was done for malignant leision. We used general anesthesis with double lumens trachea cannula. We set the patients in lateral decubitus position with jackknife. The patient cart enter from top of the patient. The position of trocars would be set according to the position of lesion. A 12 mm incision was positioned at the 8th intercostal space in the posterior axillary line as vision port, and two 8 mm incisions were positioned at the 5th intercostal space between the anterior axillary line and midclavicular line, and the 8th infrascapular line as robotic instrument ports about 10 cm apart from the vision port. One additional auxiliary small incision for instrument without retracting ribs was set at the 7th intercostal space in the middle axillary line. Results There were 4 benign leisions and 5 malignancies identified. Wedge
The public transportation system security and emergency preparedness planning guide
Recent events have focused renewed attention on the vulnerability of the nation's critical infrastructure to major events, including terrorism. The Public Transportation System Security and Emergency Preparedness Planning Guide has been prepared to s...
300 Area waste acid treatment system closure plan. Revision 1
International Nuclear Information System (INIS)
This section provides a description of the Hanford Site, identifies the proposed method of 300 Area Waste Acid Treatment System (WATS) closure, and briefly summarizes the contents of each chapter of this plan
Joint C4ISR Architecture Planning/Analysis System (JCAPS)
National Research Council Canada - National Science Library
Wostbrock, Bill
The contractor satisfactorily completed all tasks under both efforts, providing the technology and technical expertise in the development of the Joint C4ISR Architecture Planning/Analysis System (JCAPS) Database Tool...
Equipment acquisition plans for the SSCL magnet excitation power system
International Nuclear Information System (INIS)
Winje, R.
This report gives a brief description of the major electrical technical equipment used in the Superconducting Super Collider accelerators systems and the present laboratory plans for the acquisition of the equipment
Remedial Action Plan for Expanded Bioventing System Facility 6454
National Research Council Canada - National Science Library
This draft remedial action plan (RAP) presents the scope for an expanded bioventing system for in situ treatment of fuel-contaminated soils at Site 6454 at Vandenberg Air Force Base (AFB), California...
Tank Waste Remediation System Projects Document Control Plan
International Nuclear Information System (INIS)
Slater, G.D.; Halverson, T.G.
The purpose of this Tank Waste Remediation System Projects Document Control Plan is to provide requirements and responsibilities for document control for the Hanford Waste Vitrification Plant (HWVP) Project and the Initial Pretreatment Module (IPM) Project
I-15 integrated corridor management system : project management plan.
The Project Management Plan (PMP) assists the San Diego ICM Team by defining a procedural framework for : management and control of the I-15 Integrated Corridor Management Demonstration Project, and development and : deployment of the ICM System. The...
300 Area waste acid treatment system closure plan. Revision 1
Energy Technology Data Exchange (ETDEWEB)
This section provides a description of the Hanford Site, identifies the proposed method of 300 Area Waste Acid Treatment System (WATS) closure, and briefly summarizes the contents of each chapter of this plan.
Implementation Issues for Departure Planning Systems
Hansman, R. John; Feron, Eric; Clarke, John-Paul; Odoni, Amedeo
The objective of the proposed effort is to investigate issues associated with the design and implementation of decision aiding tools to assist in improving the departure process at congested airports. This effort follows a preliminary investigation of potential Departure Planning approaches and strategies, which identified potential benefits in departure efficiency, and also in reducing the environmental impact of aircraft in the departure queue. The preliminary study bas based, in large part, on observations and analysis of departure processes at Boston, Logan airport. The objective of this follow-on effort is to address key implementation issues and to expand the observational base to include airports with different constraints and traffic demand. Specifically, the objectives of this research are to: (1) Expand the observational base to include airports with different underlying operational dynamics. (2) Develop prototype decision aiding algorithms/approaches and assess potential benefits. and (3) Investigate Human Machine Integration (HMI) issues associated with decision aids in tower environments.
Systems engineering implementation plan for the liquid effluents services program
International Nuclear Information System (INIS)
Lowe, S.S.
A graded approach is being taken by the Liquid Effluents Services Program in implementing systems engineering because of the advanced state of the program. The approach is cost-effective and takes credit for related work already completed, yet retains the benefits of systems engineering. This plan describes how the Liquid Effluents Services Program will implement systems engineering so there is a common understanding. Systems engineering work to be performed and the products of that work are identified. The relation to the current planning process and integration with the sitewide systems engineering effort is described
Implementation of three dimensional treatment planning system for external radiotherapy
International Nuclear Information System (INIS)
Major, Tibor; Kurup, P.G.G.; Stumpf, Janos
A three dimensional (3D) treatment planning system was installed at Apollo Cancer Hospital, Chennai, India in 1995. This paper gives a short description of the system including hardware components, calculation algorithm, measured data requirements and specific three dimensional features. The concept and the structure of the system are shortly described. The first impressions along with critical opinions and the experiences are gained during the data acquisition are mentioned. Some improvements in the user interface are suggested. It is emphasized that although a 3D system offers more detailed and accurate dose distributions compared to a 2D system, it also introduces a greatly increased workload for the planning staff. (author)
The vacuum-assisted closure (V.A.C®) system for surgical site infection with involved vascular grafts.
Saziye, Karaca; Afksendiyos, Kalangos
In vascular surgery, surgical site infection is the most common postoperative morbidity, occurring in 5-10% of vascular patients. The optimal management of surgical site infection with involved lower limb vascular grafts remains controversial. We present our 6-year results of using the V.A.C.® system in surgical site infection with involved vascular grafts. A retrospective 6-year review of patient who underwent a VAC® therapy for postoperative surgical site infection in lower limb with involved vascular grafts in our department between January 2006 and December 2011. V.A.C therapy was used in 40 patients. All patients underwent surgical wound revision with VAC® therapy and antibiotics. The mean time of use of the V.A.C. system was 14.2 days. After mean of 12 days in 34 of 40 patients, in whom the use of VAC® therapy resulted in delayed primary closure or healing by secondary intention. The mean postoperative follow-up time was 61.67 months, during which 3 patients died. We showed that the V.A.C.® system is valuable for managing specifically surgical site infection with involved vascular grafts. Using the V.A.C.® system, reoperation rates are reduced; 85% of patients avoided graft replacement. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...
Computer versus paper system for recognition and management of sepsis in surgical intensive care.
Croft, Chasen A; Moore, Frederick A; Efron, Philip A; Marker, Peggy S; Gabrielli, Andrea; Westhoff, Lynn S; Lottenberg, Lawrence; Jordan, Janeen; Klink, Victoria; Sailors, R Matthew; McKinley, Bruce A
A system to provide surveillance, diagnosis, and protocolized management of surgical intensive care unit (SICU) sepsis was undertaken as a performance improvement project. A system for sepsis management was implemented for SICU patients using paper followed by a computerized system. The hypothesis was that the computerized system would be associated with improved process and outcomes. A system was designed to provide early recognition and guide patient-specific management of sepsis including (1) modified early warning signs-sepsis recognition score (MEWS-SRS; summative point score of ranges of vital signs, mental status, white blood cell count; after every 4 hours) by bedside nurse; (2) suspected site assessment (vascular access, lung, abdomen, urinary tract, soft tissue, other) at bedside by physician or extender; (3) sepsis management protocol (replicable, point-of-care decisions) at bedside by nurse, physician, and extender. The system was implemented first using paper and then a computerized system. Sepsis severity was defined using standard criteria. In January to May 2012, a paper system was used to manage 77 consecutive sepsis encounters (3.9 ± 0.5 cases per week) in 65 patients (77% male; age, 53 ± 2 years). In June to December 2012, a computerized system was used to manage 132 consecutive sepsis encounters (4.4 ± 0.4 cases per week) in 119 patients (63% male; age, 58 ± 2 years). MEWS-SRS elicited 683 site assessments, and 201 had sepsis diagnosis and protocol management. The predominant site of infection was abdomen (paper, 58%; computer, 53%). Recognition of early sepsis tended to occur more using the computerized system (paper, 23%; computer, 35%). Hospital mortality rate for surgical ICU sepsis (paper, 20%; computer, 14%) was less with the computerized system. A computerized sepsis management system improves care process and outcome. Early sepsis is recognized and managed with greater frequency compared with severe sepsis or septic shock. The system
DEFF Research Database (Denmark)
Sveistrup, Daniel; Jørgensen, Rasmus Nyholm; Green, Ole
Earlier works have shown field trial designs to be very labor extensive, even when combining autoguidancesystems with conventional machinery.Designing routes for semi-automated systems in a controlled manner is both resource demandingand complicated. Different types of auto-guidance systems vary ...
Tank Farm Contractor Waste Remediation System and Utilization Plan
International Nuclear Information System (INIS)
The Tank Waste Remediation System Operation and Utilization Plan updates the operating scenario and plans for the delivery of feed to BNFL Inc., retrieval of waste from single-shell tanks, and the overall process flowsheets for Phases I and II of the privatization of the Tank Waste Remediation System. The plans and flowsheets are updated with the most recent tank-by-tank inventory and sludge washing data. Sensitivity cases were run to evaluate the impact or benefits of proposed changes to the BNFL Inc. contract and to evaluate a risk-based SST retrieval strategy
Directory of Open Access Journals (Sweden)
F. N. Shago
Full Text Available Complication of information security management systems leads to the necessity of improving the scientific and methodological apparatus for these systems auditing. Planning is an important and determining part of information security management systems auditing. Efficiency of audit will be defined by the relation of the reached quality indicators to the spent resources. Thus, there is an important and urgent task of developing methods and techniques for optimization of the audit planning, making it possible to increase its effectiveness. The proposed technique gives the possibility to implement optimal distribution for planning time and material resources on audit stages on the basis of dynamics model for the ISMS quality. Special feature of the proposed approach is the usage of a priori data as well as a posteriori data for the initial audit planning, and also the plan adjustment after each audit event. This gives the possibility to optimize the usage of audit resources in accordance with the selected criteria. Application examples of the technique are given while planning audit information security management system of the organization. The result of computational experiment based on the proposed technique showed that the time (cost audit costs can be reduced by 10-15% and, consequently, quality assessments obtained through audit resources allocation can be improved with respect to well-known methods of audit planning.
IMPERA: Integrated Mission Planning for Multi-Robot Systems
Directory of Open Access Journals (Sweden)
Daniel Saur
Full Text Available This paper presents the results of the project IMPERA (Integrated Mission Planning for Distributed Robot Systems. The goal of IMPERA was to realize an extraterrestrial exploration scenario using a heterogeneous multi-robot system. The main challenge was the development of a multi-robot planning and plan execution architecture. The robot team consists of three heterogeneous robots, which have to explore an unknown environment and collect lunar drill samples. The team activities are described using the language ALICA (A Language for Interactive Agents. Furthermore, we use the mission planning system pRoPhEt MAS (Reactive Planning Engine for Multi-Agent Systems to provide an intuitive interface to generate team activities. Therefore, we define the basic skills of our team with ALICA and define the desired goal states by using a logic description. Based on the skills, pRoPhEt MAS creates a valid ALICA plan, which will be executed by the team. The paper describes the basic components for communication, coordinated exploration, perception and object transportation. Finally, we evaluate the planning engine pRoPhEt MAS in the IMPERA scenario. In addition, we present further evaluation of pRoPhEt MAS in more dynamic environments.
The Settings, Pros and Cons of the New Surgical Robot da Vinci Xi System for Transoral Robotic Surgery (TORS): A Comparison With the Popular da Vinci Si System.
Kim, Da Hee; Kim, Hwan; Kwak, Sanghyun; Baek, Kwangha; Na, Gina; Kim, Ji Hoon; Kim, Se Heon
The da Vinci system (da Vinci Surgical System; Intuitive Surgical Inc.) has rapidly developed in several years from the S system to the Si system and now the Xi System. To investigate the surgical feasibility and to provide workflow guidance for the newly released system, we used the new da Vinci Xi system for transoral robotic surgery (TORS) on a cadaveric specimen. Bilateral supraglottic partial laryngectomy, hypopharyngectomy, lateral oropharyngectomy, and base of the tongue resection were serially performed in search of the optimal procedures with the new system. The new surgical robotic system has been upgraded in all respects. The telescope and camera were incorporated into one system, with a digital end-mounted camera. Overhead boom rotation allows multiquadrant access without axis limitation, the arms are now thinner and longer with grabbing movements for easy adjustments. The patient clearance button dramatically reduces external collisions. The new surgical robotic system has been optimized for improved anatomic access, with better-equipped appurtenances. This cadaveric study of TORS offers guidance on the best protocol for surgical workflow with the new Xi system leading to improvements in the functional results of TORS.
Coding and Billing in Surgical Education: A Systems-Based Practice Education Program.
Ghaderi, Kimeya F; Schmidt, Scott T; Drolet, Brian C
Despite increased emphasis on systems-based practice through the Accreditation Council for Graduate Medical Education core competencies, few studies have examined what surgical residents know about coding and billing. We sought to create and measure the effectiveness of a multifaceted approach to improving resident knowledge and performance of documenting and coding outpatient encounters. We identified knowledge gaps and barriers to documentation and coding in the outpatient setting. We implemented a series of educational and workflow interventions with a group of 12 residents in a surgical clinic at a tertiary care center. To measure the effect of this program, we compared billing codes for 1 year before intervention (FY2012) to prospectively collected data from the postintervention period (FY2013). All related documentation and coding were verified by study-blinded auditors. Interventions took place at the outpatient surgical clinic at Rhode Island Hospital, a tertiary-care center. A cohort of 12 plastic surgery residents ranging from postgraduate year 2 through postgraduate year 6 participated in the interventional sequence. A total of 1285 patient encounters in the preintervention group were compared with 1170 encounters in the postintervention group. Using evaluation and management codes (E&M) as a measure of documentation and coding, we demonstrated a significant and durable increase in billing with supporting clinical documentation after the intervention. For established patient visits, the monthly average E&M code level increased from 2.14 to 3.05 (p coding and billing of outpatient clinic encounters. Using externally audited coding data, we demonstrate significantly increased rates of higher complexity E&M coding in a stable patient population based on improved documentation and billing awareness by the residents. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Waste feed delivery program systems engineering implementation plan
International Nuclear Information System (INIS)
O'Toole, S.M.; Hendel, B.J.
This document defines the systems engineering processes and products planned by the Waste Feed Delivery Program to develop the necessary and sufficient systems to provide waste feed to the Privatization Contractor for Phase 1. It defines roles and responsibilities for the performance of the systems engineering processes and generation of products
Metis Hub: The Development of an Intuitive Project Planning System
Energy Technology Data Exchange (ETDEWEB)
McConnell, Rachael M. [Oregon State Univ., Corvallis, OR (United States); Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)
The goal is to develop an intuitive, dynamic, and consistent interface for the Metis Planning System by combining user requirements and human engineering concepts. The system is largely based upon existing systems so some tools already have working models that we can follow. However, the web-based interface is completely new.
The ETA systems plans for supercomputers
International Nuclear Information System (INIS)
Swanson, C.D.
The ETA Systems, is a class VII supercomputer featuring multiprocessing, a large hierarchical memory system, high performance input/output, and network support for both batch and interactive processing. Advanced technology used in the ETA 10 includes liquid nitrogen cooled CMOS logic with 20,000 gates per chip, a single printed circuit board for each CPU, and high density static and dynamic MOS memory chips. Software for the ETA 10 includes an underlying kernel that supports multiple user environments, a new ETA FORTRAN compiler with an advanced automatic vectorizer, a multitasking library and debugging tools. Possible developments for future supercomputers from ETA Systems are discussed
Planning for impact management: a systems perspective
International Nuclear Information System (INIS)
Leistritz, F.L.; Halstead, J.M.; Chase, R.A.; Murdock, S.H.
The authors develop a conceptual basis for viewing impact events and their subsequent management, and thus for designing impact management programs. Following an examination of the pragmatic rationales for an impact management program for large-scale projects, such as a nuclear waste repository, they discuss the interrelated nature of impact events that clarify the need for an integrated systems-orientated socioeconomic impact management framework. They then present the key components of such a system and discusss its implementation. Although a concerted systems approach is difficult to implement and is complex in design, it will be more difficult to complete the repository siting process without one. 4 tables
Surgical treatment of female stress urinary incontinence with the Gynecare TVT Secur™ System – preliminary report
Directory of Open Access Journals (Sweden)
Włodzimierz Baranowski
Full Text Available Introduction: Sling procedures were first introduced over 100 years ago in the treatment of stress urinaryincontinence. Since then they have evolved to become less invasive and safer. The sling procedure using theGynecare TVT Secur™ system is a new therapeutic option for women with stress urinary incontinence.Objectives: To evaluate the efficacy and safety of Gynecare TVT Secur™ in the surgical treatment of stressurinary incontinence in women. Material and methods: The study comprised consecutive female patients admitted to the Department ofGynaecology and Gynaecological Oncology of the Military Institute of Health Services in Warsaw, Poland, whohad been qualified for surgical treatment of stress urinary incontinence on the basis of physical signs and symptomsand the findings of a urodynamic study. The procedure was performed using the Gynecare TVT Secur™system with tapes introduced in an H- or U-shape mode. Results: Between October 2006 and September 2009, 77 sling procedures using the Gynecare TVT Secur™system were performed in women with stress urinary incontinence. Their mean age was 55.1 (30-76 years, meanBMI 28.5 (20.2-43.8 kg/m2. Sixty-nine implants were positioned in H-shape mode, 8 in U-shape mode. Fortyninewomen (63.6% were menopausal, 14 (18.2% previously had three or more natural deliveries, 13 (16.8%had a history of gynaecological surgeries. Thirty-one procedures were performed under general anaesthesia and46 under local anaesthesia. The mean duration of the surgery was 9 (4-42 minutes. It was possible to dischargefifty-seven (74% women on the day of the surgery. Urine retention was observed only in 1 (1.7% woman. Noother complications were recorded. Conclusions: The surgical treatment of urinary incontinence with sling procedures using the Gynecare TVTSecur™ system shows good immediate efficacy and safety. Considering this as well as the short duration ofthe procedure and its good tolerability under local anaesthesia, use
Career Planning Modules for the Officer Career Information and Planning System.
Phillips, Susan D.; And Others
This discussion of the modules in an experimental computer-aided system for officer career information and planning system (OCIPS) includes the reasons for its development, a description of the seven modules, and the findings of a preliminary test of four of the modules for feasibility and credibility. Initially developed in response to a need…
Surgical camps: the Ugandan experience
African Journals Online (AJOL)
. The planned visits were advertised locally and in the national media. Screening of the patients was done first by the local medical teams and later by the visiting surgical teams. The surgical teams were comprised of the following personnel:.
Microsurgical robotic system for the deep surgical field: development of a prototype and feasibility studies in animal and cadaveric models.
Morita, Akio; Sora, Shigeo; Mitsuishi, Mamoru; Warisawa, Shinichi; Suruman, Katopo; Asai, Daisuke; Arata, Junpei; Baba, Shoichi; Takahashi, Hidechika; Mochizuki, Ryo; Kirino, Takaaki
To enhance the surgeon's dexterity and maneuverability in the deep surgical field, the authors developed a master-slave microsurgical robotic system. This concept and the results of preliminary experiments are reported in this paper. The system has a master control unit, which conveys motion commands in six degrees of freedom (X, Y, and Z directions; rotation; tip flexion; and grasping) to two arms. The slave manipulator has a hanging base with an additional six degrees of freedom; it holds a motorized operating unit with two manipulators (5 mm in diameter, 18 cm in length). The accuracy of the prototype in both shallow and deep surgical fields was compared with routine freehand microsurgery. Closure of a partial arteriotomy and complete end-to-end anastomosis of the carotid artery (CA) in the deep operative field were performed in 20 Wistar rats. Three routine surgical procedures were also performed in cadavers. The accuracy of pointing with the nondominant hand in the deep surgical field was significantly improved through the use of robotics. The authors successfully closed the partial arteriotomy and completely anastomosed the rat CAs in the deep surgical field. The time needed for stitching was significantly shortened over the course of the first 10 rat experiments. The robotic instruments also moved satisfactorily in cadavers, but the manipulators still need to be smaller to fit into the narrow intracranial space. Computer-controlled surgical manipulation will be an important tool for neurosurgery, and preliminary experiments involving this robotic system demonstrate its promising maneuverability.
Research on the Evaluation System for Rural Public Safety Planning
Institute of Scientific and Technical Information of China (English)
Ming; SUN; Jianxin; YAN
The indicator evaluation system is introduced to the study of rural public safety planning in this article.By researching the current rural public safety planning and environmental carrying capacity,we select some carrying capacity indicators influencing the rural public safety,such as land,population,ecological environment,water resources,infrastructure,economy and society,to establish the environmental carrying capacity indicator system.We standardize the indicators,use gray correlation analysis method to determine the weight of indicators,and make DEA evaluation of the indicator system,to obtain the evaluation results as the basis for decision making in rural safety planning,and provide scientific and quantified technical support for rural public safety planning.
Planning and control of maintenance systems modelling and analysis
Duffuaa, Salih O
Analyzing maintenance as an integrated system with objectives, strategies and processes that need to be planned, designed, engineered, and controlled using statistical and optimization techniques, the theme of this book is the strategic holistic system approach for maintenance. This approach enables maintenance decision makers to view maintenance as a provider of a competitive edge not a necessary evil. Encompassing maintenance systems; maintenance strategic and capacity planning, planned and preventive maintenance, work measurements and standards, material (spares) control, maintenance operations and control, planning and scheduling, maintenance quality, training, and others, this book gives readers an understanding of the relevant methodology and how to apply it to real-world problems in industry. Each chapter includes a number exercises and is suitable as a textbook or a reference for a professionals and practitioners whilst being of interest to industrial engineering, mechanical engineering, electrical en...
Information System for Land-Use Planning and Management
Institute of Scientific and Technical Information of China (English)
YU Xiao; MIAO Fang
In order to maintain the overall social interest in land use and improve the level of land administration, an information system for land-use planning and management (ISLUPM) was established, which is composed of presentation layer, business logic layer and data layer in the general structure. The application support platform of the ISLUPM, built based on COM, COM+ and .NET standard components, includes data engine, data management, assemblies, components management, operation management, and interface. Then, an elaboration was made on major functions of the ISLUPM, such as planning revision scheme, planning operation flow, digital processing, thematic analysis and inquiry, and preparation of the chart of reserved land resources. The developed system has been successfully applied to the land-use planning and management work of Longquanyi District, Chengdu, China. It may provide a reference for development of geographic information system (GIS) for land and resources.
Clinical Application of 3D-CISS MRI Sequences for Diagnosis and Surgical Planning of Spinal Arachnoid Diverticula and Adhesions in Dogs.
Tauro, Anna; Jovanovik, Jelena; Driver, Colin John; Rusbridge, Clare
Abnormalities within the spinal arachnoid space are often treated surgically, but they can be challenging to detect with conventional magnetic resonance imaging (MRI) sequences. 3D-CISS sequences are considered superior in evaluating structures surrounded by cerebrospinal fluid (CSF) due to the high signal-to-noise ratio, high contrast-to-noise ratio and intrinsic insensitivity to motion with minimal signal loss due to CSF pulsations. Our objective was to describe findings and advantages in adding 3D-CISS sequences to routine MRI in patients affected by spinal arachnoid diverticula (SAD) or arachnoid adhesions. This article is a retrospective review of medical records of 19 dogs admitted at Fitzpatrick Referrals between 2013 and 2017 that were diagnosed with SAD and confirmed surgically. Inclusion criterions were the presence of clinical signs compatible with compressive myelopathy and an MRI diagnosis, which included the 3D-CISS sequence. Our database was searched for additional 19 dogs diagnosed with other spinal lesions other than SAD that had the same MR sequences. All MR images were anonymized and evaluated by two assessors. 3D-CISS sequence appears to improve confidence in diagnosing and surgical planning (Mann-Whitney U -test: p CSF hydrodynamics and providing more anatomical details than conventional MRI sequences. The clinical data in combination with imaging findings would limit over interpretation, when concurrent pathology within the arachnoid space is present. Schattauer GmbH Stuttgart.
Surgical management of gastroesophageal reflux disease in patients with systemic sclerosis.
Yan, Jingliang; Strong, Andrew T; Sharma, Gautam; Gabbard, Scott; Thota, Prashanti; Rodriguez, John; Kroh, Matthew
Systemic sclerosis (scleroderma) is frequently associated with both gastroesophageal reflux disease (GERD) and simultaneous esophageal dysmotility. Anti-reflux procedures in this patient population must account for the existing physiology of each patient and likely disease progression. We aim to compare perioperative and intermediate outcomes of fundoplication versus gastric bypass for the treatment of GERD. After IRB approval, patients with systemic sclerosis undergoing fundoplication or gastric bypass for the treatment of GERD from 2004 to 2016 were identified. Demographics, perioperative data, immediate complications, and symptom improvement were retrieved and analyzed. Fourteen patients with systemic sclerosis underwent surgical treatment of GERD during the defined study period. Average body mass index was 26 kg/m 2 . Seven fundoplications (2 Nissens, 4 Toupets, and 1 Dor) and 7 Roux-en-Y gastric bypasses (RYGB) were performed. No 30-day mortality was observed in either group. Median follow-up was 97 months for the fundoplication group (range 28-204 months), and 19 months for the RYGB group (range 1-164 months). Preoperatively, dysphagia, heartburn, and regurgitation were present in 71% (n = 10), 86% (n = 12), and 64% (n = 9) of patients, respectively. Eleven patients had pH study prior to surgical intervention, and 91% of them had abnormal acid exposure. Esophagitis was evident in 85% (n = 11) of patients during preoperative upper endoscopy, and two patients had Barrett's esophagus. Impaired esophageal motility was present in all RYGB patients and 71% of fundoplication patients. Of the patients who had assessment of their GERD symptoms at follow-up, all five patients in the RYGB group and only 3 (50%) patients in the fundoplication group reported symptom improvement or resolution. Laparoscopic RYGB as an anti-reflux procedure is safe and may provide an alternative to fundoplication in the treatment of GERD for systemic sclerosis patients
Drainage Systems Effect on Surgical Site Infection in Children with Perforated Appendicitis
Directory of Open Access Journals (Sweden)
Seref Kilic
Full Text Available Aim: Effect of replacing open drainage system to closed drainage system on surgical site infection (SSI in children operated for perforated appendicitis was evaluated. Material and Method: Hospital files and computer records of perforated appendicitis cases operated in 2004-2010 were evaluated retrospectively. Open drainage systems were used for 70 in cases (group I and closed systems were used in the others (group II. Results: Eleven of SSI cases had superficial infection and 3 had the organ/space infection. SSI rate was 15.7% for group I and 7.5% for the group II. The antibiotic treatment length was 7.5 ± 3.4 days for group I and 6.4 ± 2.2 days for group II and the difference between groups was not statistically significant. Hospitalization length for group I was 8.2 ± 3.1 days and 6.8 ± 1.9 days for group II and the difference was statistically significant. Discussion: SSI is an important problem increasing morbidity and treatment costs through increasing hospitalization and antibiotic treatment length. Open drainage system used in operation in patients with perforated appendicitis leads an increased frequency of SSI when compared to the closed drainage system. Thus, closed drainage systems should be preferred in when drainage is necessary in operations for perforated appendicitis in children.
Automatic Scheduling and Planning (ASAP) in future ground control systems
Matlin, Sam
This report describes two complementary approaches to the problem of space mission planning and scheduling. The first is an Expert System or Knowledge-Based System for automatically resolving most of the activity conflicts in a candidate plan. The second is an Interactive Graphics Decision Aid to assist the operator in manually resolving the residual conflicts which are beyond the scope of the Expert System. The two system designs are consistent with future ground control station activity requirements, support activity timing constraints, resource limits and activity priority guidelines.
The comprehensive intermodal planning system in distributed environment
Directory of Open Access Journals (Sweden)
Olgierd Dziamski
Full Text Available Background: Goods distribution by containers has opened new opportunities for them in the global supply chain network. Standardization of transportation units allow to simplify transport logistics operations and enable the integration of different types of transport. Currently, container transport is the most popular means of transport by sea, but recent studies show an increase in its popularity in land transport. In the paper presented the concept of a comprehensive intermodal planning system in a distributed environment which enables more efficient use containers in the global transport. The aim of this paper was to formulate and develop new concept of Internet Intermodal Planning System in distribution environment, supporting the common interests of the consignors and the logistic service providers by integrating the transportation modes, routing, logistics operations and scheduling in order to create intermodal transport plans. Methods: In the paper presented and discussed the new approach to the management of logistics resources used in international intermodal transport. Detailed analysis of proposed classification of variety transportation means has been carried out along with their specific properties, which may affect the time and cost of transportation. Have been presented the modular web-based distribution planning system supporting container transportation planning. Conducted the analysis of the main planning process and curried out the discussion on the effectiveness of the new web-based container transport planning system. Result and conclusions: This paper presents a new concept of the distributed container transport planning system integrating the available on the market logistics service providers with freight exchange. Specific to container planning new transport categories has been identified which simplify and facilitate the management of intermodal planning process. The paper presents a modular structure of Integrated
ARM Unmanned Aerial Systems Implementation Plan
Energy Technology Data Exchange (ETDEWEB)
Schmid, Beat [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Ivey, Mark [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)
Recent advances in Unmanned Aerial Systems (UAS) coupled with changes in the regulatory environment for operations of UAS in the National Airspace increase the potential value of UAS to the U.S. Department of Energy (DOE) Atmospheric Radiation Measurement (ARM) Climate Research Facility. UAS include unmanned aerial vehicles (UAV) and tethered balloon systems (TBS). The roles UAVs and TBSs could play within the ARM Facility, particularly science questions they could help address, have been discussed in several workshops, reports, and vision documents, including: This document describes the implementation of a robust and vigorous program for use of UAV and TBS for the science missions ARM supports.
[Applicability of the da Vinci robotic system in the skull base surgical approach. Preclinical investigation].
Fernandez-Nogueras Jimenez, Francisco J; Segura Fernandez-Nogueras, Miguel; Jouma Katati, Majed; Arraez Sanchez, Miguel Ángel; Roda Murillo, Olga; Sánchez Montesinos, Indalecio
The role of robotic surgery is well established in various specialties such as urology and general surgery, but not in others such as neurosurgery and otolaryngology. In the case of surgery of the skull base, it has just emerged from an experimental phase. To investigate possible applications of the da Vinci surgical robot in transoral skull base surgery, comparing it with the authors' experience using conventional endoscopic transnasal surgery in the same region. A transoral transpalatal approach to the nasopharynx and medial skull base was performed on 4 cryopreserved cadaver heads. We used the da Vinci robot, a 30° standard endoscope 12mm thick, dual camera and dual illumination, Maryland forceps on the left terminal and curved scissors on the right, both 8mm thick. Bone drilling was performed manually. For the anatomical study of this region, we used 0.5cm axial slices from a plastinated cadaver head. Various skull base structures at different depths were reached with relative ease with the robot terminals Transoral robotic surgery with the da Vinci system provides potential advantages over conventional endoscopic transnasal surgery in the surgical approach to this region. Copyright © 2014 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.
Developing Customized Dental Miniscrew Surgical Template from Thermoplastic Polymer Material Using Image Superimposition, CAD System, and 3D Printing
Directory of Open Access Journals (Sweden)
Yu-Tzu Wang
Full Text Available This study integrates cone-beam computed tomography (CBCT/laser scan image superposition, computer-aided design (CAD, and 3D printing (3DP to develop a technology for producing customized dental (orthodontic miniscrew surgical templates using polymer material. Maxillary bone solid models with the bone and teeth reconstructed using CBCT images and teeth and mucosa outer profile acquired using laser scanning were superimposed to allow miniscrew visual insertion planning and permit surgical template fabrication. The customized surgical template CAD model was fabricated offset based on the teeth/mucosa/bracket contour profiles in the superimposition model and exported to duplicate the plastic template using the 3DP technique and polymer material. An anterior retraction and intrusion clinical test for the maxillary canines/incisors showed that two miniscrews were placed safely and did not produce inflammation or other discomfort symptoms one week after surgery. The fitness between the mucosa and template indicated that the average gap sizes were found smaller than 0.5 mm and confirmed that the surgical template presented good holding power and well-fitting adaption. This study addressed integrating CBCT and laser scan image superposition; CAD and 3DP techniques can be applied to fabricate an accurate customized surgical template for dental orthodontic miniscrews.
Developing Customized Dental Miniscrew Surgical Template from Thermoplastic Polymer Material Using Image Superimposition, CAD System, and 3D Printing.
Wang, Yu-Tzu; Yu, Jian-Hong; Lo, Lun-Jou; Hsu, Pin-Hsin; Lin, CHun-Li
This study integrates cone-beam computed tomography (CBCT)/laser scan image superposition, computer-aided design (CAD), and 3D printing (3DP) to develop a technology for producing customized dental (orthodontic) miniscrew surgical templates using polymer material. Maxillary bone solid models with the bone and teeth reconstructed using CBCT images and teeth and mucosa outer profile acquired using laser scanning were superimposed to allow miniscrew visual insertion planning and permit surgical template fabrication. The customized surgical template CAD model was fabricated offset based on the teeth/mucosa/bracket contour profiles in the superimposition model and exported to duplicate the plastic template using the 3DP technique and polymer material. An anterior retraction and intrusion clinical test for the maxillary canines/incisors showed that two miniscrews were placed safely and did not produce inflammation or other discomfort symptoms one week after surgery. The fitness between the mucosa and template indicated that the average gap sizes were found smaller than 0.5 mm and confirmed that the surgical template presented good holding power and well-fitting adaption. This study addressed integrating CBCT and laser scan image superposition; CAD and 3DP techniques can be applied to fabricate an accurate customized surgical template for dental orthodontic miniscrews.
Computerized planning system for nuclear power plant evaluation
International Nuclear Information System (INIS)
Bonczek, R.H.; Holsapple, C.W.; Whinston, A.B.
A computerized system is described for information storage and query processing adapted to complex socio-technological issues. The system is referred to as GPLAN (Generalized Planning System) and can accommodate both qualitative (verbal) and quantitative data. The issue illustrated is the construction of a nuclear power plant, and involves interdisciplinary research and planning. The system's outstanding features are the use of the network variety of data base, the selective retrieval of any configuration of data from a particular network structure, automatic execution of any desired application program from a standard or special library of applications, user interface with a data base and applications by submitting English-like, non-procedural queries, and generality which allows tailoring to specific applications and provides a basis for integration of planning and research activities. The system is general and can be used for a wide variety of socio-technological issues which involve complex data relationships
Methods for planning of ATES systems
Bloemendal, J.M.; Jaxa-Rozen, M.; Olsthoorn, T.N.
Aquifer Thermal Energy Storage (ATES) systems contribute to reducing fossil energy consumption by providing sustainable space heating and cooling for buildings by seasonal storage of heat. ATES is important for the energy transition in many urban areas in North America, Europe and Asia. Despite
Motion Planning in Multi-robot Systems using Timed Automata
DEFF Research Database (Denmark)
Andersen, Michael. S.; Jensen, Rune S.; Bak, Thomas
This paper dscribes how interacting timed automata can be used to model, analyze, and verify motion planning problems for systems with multiple mobile robots. The method assumes an infra-structure of simple unicycle type robots, moving om a planar grid. The motion of the robots, including simple...... kinematics, is captured in an automata formalism that allows formal composition and symbolic reasoning. The verification software UppAal is used to verify specification requirements formulated in computational tree logic (CTL), generating all feasible trajectories that satisfy specifications. The results...... of the planning are demonstrateted in a testbed that allows execution of the planned paths and motion primitives by synchronizing the planning results from UppAal with actual robotic vehicles. The planning problem may be modified online by moving obstacles in the physical environment, which causes a re...
The reorientation of spatial planning systems and policies
DEFF Research Database (Denmark)
Galland, Daniel; Enemark, Stig
Danish spatial planning has been increasingly subjected to profound reorientations over the past two decades. The comprehensive frame wherein planning policies and practices operated across different levels of administration has become significantly altered. This has been particularly evident after...... the implementation of a structural reform that changed the political and administrative structure in the country. Most importantly, the reform abolished the county level, which caused that planning policies, functions and responsibilities were re-scaled to municipal and national levels. This situation brought about...... radical shifts in terms of the scope of planning policies, the implementation of land-use tasks as well as the performance of the institutional arrangements operating within and beyond the planning system. Based on an in-depth analysis concerned with these changes, the paper endeavours into discussing how...
Evaluation of a commercial biologically based IMRT treatment planning system
International Nuclear Information System (INIS)
Semenenko, Vladimir A.; Reitz, Bodo; Day, Ellen; Qi, X. Sharon; Miften, Moyed; Li, X. Allen
A new inverse treatment planning system (TPS) for external beam radiation therapy with high energy photons is commercially available that utilizes both dose-volume-based cost functions and a selection of cost functions which are based on biological models. The purpose of this work is to evaluate quality of intensity-modulated radiation therapy (IMRT) plans resulting from the use of biological cost functions in comparison to plans designed using a traditional TPS employing dose-volume-based optimization. Treatment planning was performed independently at two institutions. For six cancer patients, including head and neck (one case from each institution), prostate, brain, liver, and rectal cases, segmental multileaf collimator IMRT plans were designed using biological cost functions and compared with clinically used dose-based plans for the same patients. Dose-volume histograms and dosimetric indices, such as minimum, maximum, and mean dose, were extracted and compared between the two types of treatment plans. Comparisons of the generalized equivalent uniform dose (EUD), a previously proposed plan quality index (fEUD), target conformity and heterogeneity indices, and the number of segments and monitor units were also performed. The most prominent feature of the biologically based plans was better sparing of organs at risk (OARs). When all plans from both institutions were combined, the biologically based plans resulted in smaller EUD values for 26 out of 33 OARs by an average of 5.6 Gy (range 0.24 to 15 Gy). Owing to more efficient beam segmentation and leaf sequencing tools implemented in the biologically based TPS compared to the dose-based TPS, an estimated treatment delivery time was shorter in most (five out of six) cases with some plans showing up to 50% reduction. The biologically based plans were generally characterized by a smaller conformity index, but greater heterogeneity index compared to the dose-based plans. Overall, compared to plans based on dose
Fujian electric system analysis and nuclear power planning
International Nuclear Information System (INIS)
Lin Jianwen; Fu Qiang; Cheng Ping
The objective of the study is to conduct a long term electric expansion planning and nuclear power planning for Fujian Province. The Wien Automatic System Planning Package (WASP-III) is used to optimize the electric system. Probabilistic Simulation is one of the most favorite techniques for middle and long term generation and production cost planning of electric power system. The load duration curve is obtained by recording the load data of a time interval into a monotone non-increasing sense. Polynomial function is used to describe the load duration curve (LDC), and this LDC is prepared for probabilistic simulation in WASP-III. WASP-III is a dynamic optimizing module in the area of supply modelling. It could find out the economically optimal expansion plan for a power generating system over a period of up to thirty years, with the constraints given by the planners. The optimum is evaluated in terms of minimum discounted total costs. Generating costs, amount of energy not served and reliability of the system are analyzed in the system expansion planning by using the probabilistic simulation method. The following conclusions can be drawn from this study. Hydro electricity is the cheapest one of all available technologies and resources. After the large hydro station is committed at the end of 1995, more base load power plants are needed in the system. Coal-fired power plants with capacity of 600 MWe will be the most competitive power plants in the future of the system. At the end of the studying period, about half of the stalled capacity will be composed of these power plants. Nuclear power plants with capacity of 600 MWe are suitable for the system after the base load increases to a certain level. Oil combustion units will decrease the costs of the system. (12 tabs., 6 figs.)
Surgical outcomes of robot-assisted rectal cancer surgery using the da Vinci Surgical System: a multi-center pilot Phase II study.
Tsukamoto, Shunsuke; Nishizawa, Yuji; Ochiai, Hiroki; Tsukada, Yuichiro; Sasaki, Takeshi; Shida, Dai; Ito, Masaaki; Kanemitsu, Yukihide
We conducted a multi-center pilot Phase II study to examine the safety of robotic rectal cancer surgery performed using the da Vinci Surgical System during the introduction period of robotic rectal surgery at two institutes based on surgical outcomes. This study was conducted with a prospective, multi-center, single-arm, open-label design to assess the safety and feasibility of robotic surgery for rectal cancer (da Vinci Surgical System). The primary endpoint was the rate of adverse events during and after robotic surgery. The secondary endpoint was the completion rate of robotic surgery. Between April 2014 and July 2016, 50 patients were enrolled in this study. Of these, 10 (20%) had rectosigmoid cancer, 17 (34%) had upper rectal cancer, and 23 (46%) had lower rectal cancer; six underwent high anterior resection, 32 underwent low anterior resection, 11 underwent intersphincteric resection, and one underwent abdominoperineal resection. Pathological stages were Stage 0 in 1 patient, Stage I in 28 patients, Stage II in 7 patients and Stage III in 14 patients. Pathologically complete resection was achieved in all patients. There was no intraoperative organ damage or postoperative mortality. Eight (16%) patients developed complications of all grades, of which 2 (4%) were Grade 3 or higher, including anastomotic leakage (2%) and conversion to open surgery (2%). The present study demonstrates the feasibility and safety of robotic rectal cancer surgery, as reflected by low morbidity and low conversion rates, during the introduction period. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: firstname.lastname@example.com
Integrating design and production planning with knowledge-based inspection planning system
International Nuclear Information System (INIS)
Abbasi, Ghaleb Y.; Ketan, Hussein S.; Adil, Mazen B.
In this paper an intelligent environment to integrate design and inspection earlier to the design stage. A hybrid knowledge-based approach integrating computer-aided design (CAD) and computer-aided inspection planning (CAIP) was developed, thereafter called computer-aided design and inspection planning (CADIP). CADIP was adopted for automated dimensional inspection planning. Critical functional features were screened based on certain attributes for part features for inspection planning application. Testing the model resulted in minimizing the number of probing vectors associated with the most important features in the inspected prismatic part, significant reduction in inspection costs and release of human labor. In totality, this tends to increase customer satisfaction as a final goal of the developed system. (author)
Strategic planning--a plan for excellence for South Haven Health System.
Urbanski, Joanne; Baskel, Maureen; Martelli, Mary
South Haven Health System has developed an innovative approach to strategic planning. The key to success of this process has been the multidisciplinary involvement of all stakeholders from the first planning session through the final formation of a strategic plan with measurable objectives for each goal. The process utilizes a Conversation Café method for identifying opportunities and establishing goals, Strategic Oversight Teams to address each goal and a Champion for implementation of each objective. Progress is measured quarterly by Strategic Oversight Team report cards. Transparency of communication within the organization and the sharing of information move the plan forward. The feedback from participant evaluations has been overwhelmingly positive. They are involved and excited.
Surgical Management of Renal Cell Carcinoma Extending Into Venous System: A 20-Year Experience.
Xiao, X; Zhang, L; Chen, X; Cui, L; Zhu, H; Pang, D; Yang, Y; Wang, Q; Wang, M; Gao, C
The purpose of this study is to report our 20-year experience with the surgical management of renal cell carcinoma extending into the inferior vena cava using a novel classification system. We retrospectively reviewed the data of 103 patients (69 males, 34 females, mean age: 52.9 ± 12.6 years) with renal cell carcinoma involving the venous system treated between 1993 and 2014. The inferior vena cava tumor thrombus was classified into five levels: 0 (renal vein, n = 12), 1 (infrahepatic, n = 33), 2a (low retrohepatic, n = 26), 2b (high retrohepatic, n = 19), and 3 (supradiaphragmatic, n = 13). Clinical data were summarized, and overall survival, cancer-specific survival, and disease-free survival were examined by Cox regression analysis. All patients underwent radical surgery. Complete resections of the renal tumor and thrombus were achieved in 101 patients (98.1%). Two intraoperative and one postoperative in-hospital deaths (2.9%) occurred. In total, 19 patients (18.8%) had a total of 29 postoperative complications. Mean follow-up time was 46 months (range, 1-239 months). The 5- and 10-year overall survival rates were 62.9% and 56.0%, respectively. Metastasis, rather than thrombus level, was a significant risk factor associated with overall survival (hazard ratio = 4.89, 95% confidence interval: 2.24-10.67, p system can be used to select the optimal surgical approach and method for patients with renal cell carcinoma and venous thrombus. Its use is associated with prolonged survival and relatively few complications. Metastasis is an independent risk factor of overall survival.
Resource Planning Model: An Integrated Resource Planning and Dispatch Tool for Regional Electric Systems
Energy Technology Data Exchange (ETDEWEB)
Mai, T.; Drury, E.; Eurek, K.; Bodington, N.; Lopez, A.; Perry, A.
This report introduces a new capacity expansion model, the Resource Planning Model (RPM), with high spatial and temporal resolution that can be used for mid- and long-term scenario planning of regional power systems. Although RPM can be adapted to any geographic region, the report describes an initial version of the model adapted for the power system in Colorado. It presents examples of scenario results from the first version of the model, including an example of a 30%-by-2020 renewable electricity penetration scenario.
Planning bioinformatics workflows using an expert system
Chen, Xiaoling; Chang, Jeffrey T.
Abstract Motivation: Bioinformatic analyses are becoming formidably more complex due to the increasing number of steps required to process the data, as well as the proliferation of methods that can be used in each step. To alleviate this difficulty, pipelines are commonly employed. However, pipelines are typically implemented to automate a specific analysis, and thus are difficult to use for exploratory analyses requiring systematic changes to the software or parameters used. Results: To automate the development of pipelines, we have investigated expert systems. We created the Bioinformatics ExperT SYstem (BETSY) that includes a knowledge base where the capabilities of bioinformatics software is explicitly and formally encoded. BETSY is a backwards-chaining rule-based expert system comprised of a data model that can capture the richness of biological data, and an inference engine that reasons on the knowledge base to produce workflows. Currently, the knowledge base is populated with rules to analyze microarray and next generation sequencing data. We evaluated BETSY and found that it could generate workflows that reproduce and go beyond previously published bioinformatics results. Finally, a meta-investigation of the workflows generated from the knowledge base produced a quantitative measure of the technical burden imposed by each step of bioinformatics analyses, revealing the large number of steps devoted to the pre-processing of data. In sum, an expert system approach can facilitate exploratory bioinformatic analysis by automating the development of workflows, a task that requires significant domain expertise. Availability and Implementation: https://github.com/jefftc/changlab Contact: firstname.lastname@example.com PMID:28052928
Integrating information technologies as tools for surgical research.
Schell, Scott R
Surgical research is dependent upon information technologies. Selection of the computer, operating system, and software tool that best support the surgical investigator's needs requires careful planning before research commences. This manuscript presents a brief tutorial on how surgical investigators can best select these information technologies, with comparisons and recommendations between existing systems, software, and solutions. Privacy concerns, based upon HIPAA and other regulations, now require careful proactive attention to avoid legal penalties, civil litigation, and financial loss. Security issues are included as part of the discussions related to selection and application of information technology. This material was derived from a segment of the Association for Academic Surgery's Fundamentals of Surgical Research course.
A simple planning technique of craniospinal irradiation in the eclipse treatment planning system
Directory of Open Access Journals (Sweden)
Hemalatha Athiyaman
Full Text Available A new planning method for Craniospinal Irradiation by Eclipse treatment planning system using Field alignment, Field-in-Field technique was developed. Advantage of this planning method was also studied retrospectively for previously treated five patients of medulloblastoma with variable spine length. Plan consists of half beam blocked parallel opposed cranium, and a single posterior cervicospine field was created by sharing the same isocenter, which obviates divergence matching. Further, a single symmetrical field was created to treat remaining Lumbosacral spine. Matching between a inferior diverging edge of cervicospine field and superior diverging edge of a Lumbosacral field was done using the field alignment option. ′Field alignment′ is specific option in the Eclipse Treatment Planning System, which automatically matches the field edge divergence as per field alignment rule. Multiple segments were applied in both the spine field to manage with hot and cold spots created by varying depth of spinal cord. Plan becomes fully computerized using this field alignment option and multiple segments. Plan evaluation and calculated mean modified Homogeneity Index (1.04 and 0.1 ensured that dose to target volume is homogeneous and critical organ doses were within tolerance. Dose variation at the spinal field junction was verified using ionization chamber array (I′MatriXX for matched, overlapped and gap junction spine fields; the delivered dose distribution confirmed the ideal clinical match, over exposure and under exposure at the junction, respectively. This method is simple to plan, executable in Record and Verify mode and can be adopted for various length of spinal cord with only two isocenter in shorter treatment time.
Integration of Renewable Generation in Power System Defence Plans
DEFF Research Database (Denmark)
Das, Kaushik
Increasing levels of penetration of wind power and other renewable generations in European power systems pose challenges to power system security. The power system operators are continuously challenged especially when generations from renewables are high thereby reducing online capacity of conven......Increasing levels of penetration of wind power and other renewable generations in European power systems pose challenges to power system security. The power system operators are continuously challenged especially when generations from renewables are high thereby reducing online capacity......, one of them being the North East area with high share of wind power generation.The aim of this study is to investigate how renewable generations like wind power can contribute to the power system defence plans. This PhD project "Integration of Renewable Generation in Power System Defence Plans...
Factors affecting cataract surgical coverage and outcomes: a retrospective cross-sectional study of eye health systems in sub-Saharan Africa.
Lewallen, Susan; Schmidt, Elena; Jolley, Emma; Lindfield, Robert; Dean, William H; Cook, Colin; Mathenge, Wanjiku; Courtright, Paul
Recently there has been a great deal of new population based evidence on visual impairment generated in sub-Saharan Africa (SSA), thanks to the Rapid Assessment of Avoidable Blindness (RAAB) survey methodology. The survey provides information on the magnitude and causes of visual impairment for planning services and measuring their impact on eye health in administrative "districts" of 0.5-5 million people. The survey results describing the quantity and quality of cataract surgeries vary widely between study sites, often with no obvious explanation. The purpose of this study was to examine health system characteristics that may be associated with cataract surgical coverage and outcomes in SSA in order to better understand the determinants of reducing the burden of avoidable blindness due to cataract. This was a descriptive study using secondary and primary data. The outcome variables were collected from existing surveys. Data on potential district level predictor variables were collected through a semi-structured tool using routine data and key informants where appropriate. Once collected the data were coded and analysed using statistical methods including t-tests, ANOVA and the Kruskal-Wallis analysis of variance test. Higher cataract surgical coverage was positively associated with having at least one fixed surgical facility in the area; availability of a dedicated operating theatre; the number of surgeons per million population; and having an eye department manager in the facility. Variables that were associated with better outcomes included having biometry and having an eye department manager in the facility. There are a number of health system factors at the district level that seem to be associated with both cataract surgical coverage and post-operative visual acuity outcomes. This study highlights the needs for better indicators and tools by which to measure and monitor the performance of eye health systems at the district level. It is unlikely that
Production Planning and Planting Pattern Scheduling Information System for Horticulture
Vitadiar, Tanhella Zein; Farikhin; Surarso, Bayu
This paper present the production of planning and planting pattern scheduling faced by horticulture farmer using two methods. Fuzzy time series method use to predict demand on based on sales amount, while linear programming is used to assist horticulture farmers in making production planning decisions and determining the schedule of cropping patterns in accordance with demand predictions of the fuzzy time series method, variable use in this paper is size of areas, production advantage, amount of seeds and age of the plants. This research result production planning and planting patterns scheduling information system with the output is recommendations planting schedule, harvest schedule and the number of seeds will be plant.
Tank Waste Remediation System Characterization Project Programmatic Risk Management Plan
International Nuclear Information System (INIS)
Baide, D.G.; Webster, T.L.
The TWRS Characterization Project has developed a process and plan in order to identify, manage and control the risks associated with tank waste characterization activities. The result of implementing this process is a defined list of programmatic risks (i.e. a risk management list) that are used by the Project as management tool. This concept of risk management process is a commonly used systems engineering approach which is being applied to all TWRS program and project elements. The Characterization Project risk management plan and list are subset of the overall TWRS risk management plan and list
Risk evaluation system for facility safeguards and security planning
International Nuclear Information System (INIS)
Udell, C.J.; Carlson, R.L.
The Risk Evaluation System (RES) is an integrated approach to determining safeguards and security effectiveness and risk. RES combines the planning and technical analysis into a format that promotes an orderly development of protection strategies, planning assumptions, facility targets, vulnerability and risk determination, enhancement planning, and implementation. In addition, the RES computer database program enhances the capability of the analyst to perform a risk evaluation of the facility. The computer database is menu driven using data input screens and contains an algorithm for determining the probability of adversary defeat and risk. Also, base case and adjusted risk data records can be maintained and accessed easily
Miscroservices usage in creating enterprise resource planning systems
Ubartas, Vytautas
Microservices helps to ease system development process and them are gaining popularity every day. They are suaitable for such big systems like Enterprise Resource Planning (ERP). The notions of microservices and ERP are clarified in this work. Microservices architecural style advantages and main principles are stated also. Work objective is to assess the benefits of microservices and to develop a demo ERP system based on microservices. After microservices principles and ERP systems main parts...
Transformation Planning of Ecotourism Systems to Invigorate Responsible Tourism
Yun Eui Choi; Minsun Doh; Samuel Park; Jinhyung Chon
The purpose of this study is to introduce transformation plans that can stimulate responsible ecotourism by using systems thinking to solve ecotourism problems in Korea. Systems thinking is a research method used to understand the operating mechanisms of the variables that influence an entire system, in order to identify its problems. The four types of ecotourism systems are classified as follows: low-infrastructure and resident-initiated, high-infrastructure and resident-initiated, high-infr...
Planning of Maintenance and Repair of Complicated Technical Systems
Directory of Open Access Journals (Sweden)
N. I. Liseychikov
Full Text Available It is expedient to use mathematical models for substantiation of operational material consumption at maintenance of complicated technical systems. The appropriate tasks have been considered: minimization of operational material consumption; determination of maximum scope of work to be executed while maintaining one system; optimization of operational material consumption while organizing maintenance of a system group; planning of technical maintenance and determination of a number of systems to be maintained. Formalization and solution of the above problems have been accomplished.
Acceptance test plan for the Waste Information Control System
International Nuclear Information System (INIS)
Flynn, D.F.
This document describes the acceptance test plan for the WICS system. The Westinghouse Hanford Company (WHC) Hazardous Material Control Group (HMC) of the 222-S Laboratory has requested the development of a system to help resolve many of the difficulties associated with tracking and data collection of containers and drums of waste. This system has been identified as Waste Information and Control System (WICS). The request for developing and implementing WICS has been made to the Automation and Simulation Engineering Group (ASE)
Surgical scheduling categorization system (SSCS): A novel classification system to improve coordination and scheduling of operative cases in a tertiary pediatric medical system.
Gantwerker, Eric A; Bannos, Cassandra; Cunningham, Michael J; Rahbar, Reza
To describe a surgical categorization system to create a universal nomenclature, delineating patient complexity as a first step toward developing a true risk stratification system. Retrospective database review of all otolaryngology surgical procedures performed in a tertiary pediatric hospital system over one academic year (July 2012-June 2013). All otolaryngology surgical procedures were reviewed, encompassing 8478 procedures on 5711 patients. The attending otolaryngologist assigned surgical scheduling category (SSCS) at the time of case booking based on an institution specific guidelines. The guidelines are as follow: Category I was assigned to American Society of Anesthesiologists physical status classification (ASA) I/II patients, designating them appropriate for institution's suburban ambulatory surgery centers; Category II was ASA I/II patients with social or transportation issues; Category III was ASA I/II patients who required case coordination with other medical or surgical departments; Category IV was reserved for patients of any ASA class whom the surgeon designated to be of a higher complexity. 8478 total procedures analyzed with 7198 having complete records. 48% were Category I, 13.6% were Category II, 1.9% were Category III and 36.5% were Category IV. The ASA were 34.7% ASA I, 50% ASA II, 13.39% ASA III, and 1.9% ASA IV. Although the largest proportion of patients were ASA II (50%), 39.6% of all ASA II were Category IV. Category IV was split into 54.2% ASA II and 34% ASA III and shows that peri-operative surgical concerns were not encompassed by the ASA system. This surgical categorization system streamlines surgical scheduling in a tertiary pediatric hospital system, particularly with respect to the designation of cases as ambulatory surgery center or main operating room appropriate. The case mix complexity is also readily apparent, enhancing recognition of the coordination and attention required for the perioperative management of high complexity
Motion Planning for a Direct Metal Deposition Rapid Prototyping System
Energy Technology Data Exchange (ETDEWEB)
A motion planning strategy was developed and implemented to generate motion control instructions from solid model data for controlling a robotically driven solid free-form fabrication process. The planning strategy was tested using a PUMA type robot arm integrated into a LENS{trademark} (Laser Engineered Net Shape) system. Previous systems relied on a series of x, y, and z stages, to provide a minimal coordinated motion control capability. This limited the complexity of geometries that could be constructed. With the coordinated motion provided by a robotic arm, the system can produce three dimensional parts by ''writing'' material onto any face of existing material. The motion planning strategy relied on solid model geometry evaluation and exploited robotic positioning flexibility to allow the construction of geometrically complex parts. The integration of the robotic manipulator into the LENS{trademark} system was tested by producing metal parts directly from CAD models.
Green Decision Making: Sustainable Transport and Systemic Planning (SP)
DEFF Research Database (Denmark)
Leleur, Steen
and infrastructure assessment and on the methodology and process of systemic planning (SP). SP theory development has interchanged with practical application and testing of the SP approach in a large number of cases. The word systemic in SP indicates that complex planning problems and provision of decision support...... in today's strategic planning needs a focus on what may be addressed as systemic insights in balance with more conventional, systematically-based findings where causal linkages can be modelled and made use of. In practice this means that SP is based on a study-specific combination of hard (quantitative......) and soft (qualitative) operations research (OR) methods; especially the latter have a function as regards knowledge generation that relates to obtaining systemic insights. Furthermore, SP applies a process that drives group-based learning forward. The group should be formed with the different stakeholder...
Corporate planning and LAN information systems as forums
Sabre, Ru Michael
Corporate Planning and LAN: Information Systems as Forums provides information pertinent to the Forum Information System (FIS), a conceptual basis for all corporate planning. This book presents an information system which, by means of LAN, organizational development style prototyping, and organizational learning utilization, can open communications among managers, executives, owners, and employees in a corporate setting.Organized into 10 chapters, this book begins with an overview of the four phases to the eventual use of the FIS in a corporate setting. This text then explores FIS as part of a
Optimal planning of integrated multi-energy systems
DEFF Research Database (Denmark)
van Beuzekom, I.; Gibescu, M.; Pinson, Pierre
In this paper, a mathematical approach for the optimal planning of integrated energy systems is proposed. In order to address the challenges of future, RES-dominated energy systems, the model deliberates between the expansion of traditional energy infrastructures, the integration...... and sustainability goals for 2030 and 2045. Optimal green- and brownfield designs for a district's future integrated energy system are compared using a one-step, as well as a two-step planning approach. As expected, the greenfield designs are more cost efficient, as their results are not constrained by the existing...
IBM PC/IX operating system evaluation plan
Dominick, Wayne D. (Editor); Granier, Martin; Hall, Philip P.; Triantafyllopoulos, Spiros
An evaluation plan for the IBM PC/IX Operating System designed for IBM PC/XT computers is discussed. The evaluation plan covers the areas of performance measurement and evaluation, software facilities available, man-machine interface considerations, networking, and the suitability of PC/IX as a development environment within the University of Southwestern Louisiana NASA PC Research and Development project. In order to compare and evaluate the PC/IX system, comparisons with other available UNIX-based systems are also included.
Tank monitor and control system (TMACS) software configuration management plan
International Nuclear Information System (INIS)
This Software Configuration Management Plan (SCMP) describes the methodology for control of computer software developed and supported by the Systems Development and Integration (SD and I) organization of Lockheed Martin Services, Inc. (LMSI) for the Tank Monitor and Control System (TMACS). This plan controls changes to the software and configuration files used by TMACS. The controlled software includes the Gensym software package, Gensym knowledge base files developed for TMACS, C-language programs used by TMACS, the operating system on the production machine, language compilers, and all Windows NT commands and functions which affect the operating environment. The configuration files controlled include the files downloaded to the Acromag and Westronic field instruments
A decision support system for strategic planning on pig farms
Backus, Ge B.C.; Timmer, G. Th.; Dijkhuizen, A.A.; Eidman, V.R.; Vos, F.
This paper reported on a decision support system (DSS) for strategic planning on pig farms. The DSS was based . on a stochastic simulation model of investment decisions (ISM). ISM described a farm with one loan and one building using 23 variables. The simulation model calculated the results of a strategic plan for an individual pig farm over a time horizon of a maximum of 20 years for a given scenario. For six distinct replacement strategies, regression metamodels were specified to describe t...
Innovation Cycles Concerning Strategic Planning of Product-Service-Systems
Hepperle, Clemens;Mörtl, Markus;Lindemann, Udo
This paper proposes a research program for identifying, understanding and describing innovation cycles concerning strategic planning of product-service-systems. A general overview about the background of cycle management in innovation processes, which the proposed research program is part of, is given before focusing cycles concerning strategic planning. As companies offer more and more complex products in order to satisfy market needs, the innovation process of such products becomes also mor...
Directory of Open Access Journals (Sweden)
Anita Bernatek
Full Text Available Small hydropower plants are present in the land use system planning in Poland. At the national level the important role of spatial planning in the development of renewable energy was highlighted, included small hydroplants. However, it seems that at the regional level this demand has not been realized. The necessity of developing small hydroplants as a renewable energy was highlighted, but negative environmental impact was not indicated. At local level legal instrument of small hydropower plants is specified.
Surgical anatomy of the hypoglossal nerve: A new classification system for selective upper airway stimulation.
Heiser, Clemens; Knopf, Andreas; Hofauer, Benedikt
Selective upper airway stimulation (UAS) has shown effectiveness in treating patients with obstructive sleep apnea (OSA). The terminating branches of the hypoglossal nerve show a wide complexity, requiring careful discernment of a functional breakpoint between branches for inclusion and exclusion from the stimulation cuff electrode. The purpose of this study was to describe and categorize the topographic phenotypes of these branches. Thirty patients who received an implant with selective UAS from July 2015 to June 2016 were included. All implantations were recorded using a microscope and resultant tongue motions were captured perioperatively for comparison. Eight different variations of the branches were encountered and described, both in a tabular numeric fashion and in pictorial schema. The examinations showed the complex phenotypic surgical anatomy of the hypoglossal nerve. A schematic classification system has been developed to help surgeons identify the optimal location for cuff placement in UAS. © 2017 Wiley Periodicals, Inc.
Enhancement on infectious diseases nursing plan information system.
Yeh, Mei-Lin; Hao, Te-Hui; Hsu, Chien-Yeh
Based on researches, the most time-consuming nursing activities, in teaching hospital, are: room patrols, the blood pressure survey, the body temperature pulse breath survey, the nursing record maintenance. The nursing record is one way to communicate data. It can allow the medical service team to understand what measures the nursing staff once did for sickness, as well as responses from sickness. Nevertheless, it is the key component to utilize the record with a clinical nursing plan, so as to provide a proficient health management. Since the maintenance of nursing plan is costly and time-consuming, therefore, it is essential to establish the nursing plan information system, which can effectively promote the nursing quality. This research main body comes from one infectious disease division nursing plan information system, which was developed in 1992, and its data base covers entire courtyard compatibility and various faculties characteristic nursing plan. The nursing staff often complained that this system is not user-friendly, its contents are not comprehensive, and sometimes it does not let staff choose the right diagnosis. Therefore this research is based on history analysis and the questionnaire survey procedure first, the infectious disease nursing plan use number of times, the frequency and the project content, then by the literature scientific theory and result of the improvement group discussion together. The original 38 infectious disease division nursing plan will be expanded to 45 nursing plans. Moreover, the common 38 infectious disease code (ICD-9), and its corresponding diagnosis items, shall automatically appear in the disease diagnose code field, so it would be better off for the nursing staff to set up the nursing plan efficiently. Infectious disease division nursing plan information system utilization ratio is promoted 9.6-folds, according to research outcome. Each task consumes 3.68 minutes beforehand-including computer program operation, the
FOCUS: a fire management planning system -- final report
Frederick W. Bratten; James B. Davis; George T. Flatman; Jerold W. Keith; Stanley R. Rapp; Theodore G. Storey
FOCUS (Fire Operational Characteristics Using Simulation) is a computer simulation model for evaluating alternative fire management plans. This final report provides a broad overview of the FOCUS system, describes two major modules-fire suppression and cost, explains the role in the system of gaming large fires, and outlines the support programs and ways of...
Automated Procurement System (APS) revised project management plan (DS-03)
Murphy, Diane R.
The Project Plan is the governing document for the implementation of the Automated Procurement System (APS). It includes a description of the proposed system, describes the work to be done, establishes a schedule of deliverables, and discusses the major standards and procedures to be followed.
2015 Plan. Project 5: transmission systems of electric power
International Nuclear Information System (INIS)
The planning aspects of transmission system expansion in Brazil are described, mentioning the evolution at long date of the transmission system, emphasizing the qualitative and strategic aspects. The engineering aspects and the technological development are also presented. (C.G.C.)
Information system for strategic planning the university sustainable development
International Nuclear Information System (INIS)
Drevs, Yu.G.
Issues of designing the information system which helps the University principal's office to take decisions as concerns the strategic planning are discussed. The importance of having the University simulation model is emphasized; model representation in terms of system dynamics is given [ru
Advanced methodology for generation expansion planning including interconnected systems
Energy Technology Data Exchange (ETDEWEB)
Zhao, M; Yokoyama, R; Yasuda, K [Tokyo Metropolitan Univ. (Japan); Sasaki, H [Hiroshima Univ. (Japan); Ogimoto, K [Electric Power Development Co. Ltd., Tokyo (Japan)
This paper reviews advanced methodology for generation expansion planning including interconnected systems developed in Japan, putting focus on flexibility and efficiency in a practical application. First, criteria for evaluating flexibility of generation planning considering uncertainties are introduced. Secondly, the flexible generation mix problem is formulated as a multi-objective optimization with more than two objective functions. The multi-objective optimization problem is then transformed into a single objective problem by using the weighting method, to obtain the Pareto optimal solution, and solved by a dynamics programming technique. Thirdly, a new approach for electric generation expansion planning of interconnected systems is presented, based on the Benders Decomposition technique. That is, large scale generation problem constituted by the general economic load dispatch problem, and several sub problems which are composed of smaller scale isolated system generation expansion plans. Finally, the generation expansion plan solved by an artificial neural network is presented. In conclusion, the advantages and disadvantages of this method from the viewpoint of flexibility and applicability to practical generation expansion planning are presented. (author) 29 refs., 10 figs., 4 tabs.
Directory of Open Access Journals (Sweden)
Thales Botelho de Sousa
Full Text Available Currently, the activities of the planning and control of companies are becoming increasingly complex and the managers of this area are constantly pressured to reduce operating costs, maintain inventories at adequate levels, to fully meet the demand of customers, and to respond effectively to changes that occur. The planning and scheduling task is important for most companies, so according to some authors, there is a need for further analysis of the practical use of production planning and control systems. Within the context of production planning and control systems development, in the 1990s were launched the APS systems, which represent an innovation when compared to their predecessors. This paper intended to provide through a literature review, the concepts, structure, capabilities, implementation process and benefits of using APS systems in the companies production planning and control. The main contribution of this research is to show a strong conceptual understanding regarding APS systems, which can be used as a solid theoretical reference for future researches.
Using mean duration and variation of procedure times to plan a list of surgical operations to fit into the scheduled list time.
Pandit, Jaideep J; Tavare, Aniket
It is important that a surgical list is planned to utilise as much of the scheduled time as possible while not over-running, because this can lead to cancellation of operations. We wished to assess whether, theoretically, the known duration of individual operations could be used quantitatively to predict the likely duration of the operating list. In a university hospital setting, we first assessed the extent to which the current ad-hoc method of operating list planning was able to match the scheduled operating list times for 153 consecutive historical lists. Using receiver operating curve analysis, we assessed the ability of an alternative method to predict operating list duration for the same operating lists. This method uses a simple formula: the sum of individual operation times and a pooled standard deviation of these times. We used the operating list duration estimated from this formula to generate a probability that the operating list would finish within its scheduled time. Finally, we applied the simple formula prospectively to 150 operating lists, 'shadowing' the current ad-hoc method, to confirm the predictive ability of the formula. The ad-hoc method was very poor at planning: 50% of historical operating lists were under-booked and 37% over-booked. In contrast, the simple formula predicted the correct outcome (under-run or over-run) for 76% of these operating lists. The calculated probability that a planned series of operations will over-run or under-run was found useful in developing an algorithm to adjust the planned cases optimally. In the prospective series, 65% of operating lists were over-booked and 10% were under-booked. The formula predicted the correct outcome for 84% of operating lists. A simple quantitative method of estimating operating list duration for a series of operations leads to an algorithm (readily created on an Excel spreadsheet, http://links.lww.com/EJA/A19) that can potentially improve operating list planning.
Prospective study of Centurion® versus Infiniti® phacoemulsification systems: surgical and visual outcomes
Directory of Open Access Journals (Sweden)
Lawrence J. Oh
Full Text Available AIM: To evaluate surgical outcomes (SOs and visual outcomes (VOs in cataract surgery comparing the Centurion® phacoemulsification system (CPS with the Infiniti® phacoemulsification system (IPS. METHODS: Prospective, consecutive study in a single-site private practice. Totally 412 patients undergoing cataract surgery with either the CPS using the 30-degree balanced® tip (n=207 or the IPS using the 30-degree Kelman® tip (n=205. Intraoperative and postoperative outcomes were documented prospectively up to one month follow-up. Nuclear sclerosis (NS grade, cumulated dissipated energy (CDE, preoperative corrected distance visual acuity (CDVA, and CDVA at one month were recorded. RESULTS: CDE was 13.50% less in the whole CPS compared with the whole IPS subcohort. In eyes with NS grade III or greater, CDE was 28.87% less with CPS (n=70 compared with IPS (n=44 (P=0.010. Surgical complications were not statistically different between the two subcohorts (P=0.083, but in the one case of vitreous loss using the CPS, CDVA of 6/4 was achieved at one month. The mean CDVAs (VOs at one month for NS grade III and above cataracts were -0.17 logMAR (6/4.5 in the CPS and -0.15 logMAR (6/4.5 in the IPS subcohort respectively (P=0.033. CONCLUSION: CDE is 28.87% less, and VOs are significantly improved, in denser cataracts in the CPS compared with the IPS. The authors recommend the CPS for cases with denser nuclei.
Prospective study of Centurion® versus Infiniti® phacoemulsification systems: surgical and visual outcomes.
Oh, Lawrence J; Nguyen, Chu Luan; Wong, Eugene; Wang, Samuel S Y; Francis, Ian C
To evaluate surgical outcomes (SOs) and visual outcomes (VOs) in cataract surgery comparing the Centurion ® phacoemulsification system (CPS) with the Infiniti ® phacoemulsification system (IPS). Prospective, consecutive study in a single-site private practice. Totally 412 patients undergoing cataract surgery with either the CPS using the 30-degree balanced ® tip ( n =207) or the IPS using the 30-degree Kelman ® tip ( n =205). Intraoperative and postoperative outcomes were documented prospectively up to one month follow-up. Nuclear sclerosis (NS) grade, cumulated dissipated energy (CDE), preoperative corrected distance visual acuity (CDVA), and CDVA at one month were recorded. CDE was 13.50% less in the whole CPS compared with the whole IPS subcohort. In eyes with NS grade III or greater, CDE was 28.87% less with CPS ( n =70) compared with IPS ( n =44) ( P =0.010). Surgical complications were not statistically different between the two subcohorts ( P =0.083), but in the one case of vitreous loss using the CPS, CDVA of 6/4 was achieved at one month. The mean CDVAs (VOs) at one month for NS grade III and above cataracts were -0.17 logMAR (6/4.5) in the CPS and -0.15 logMAR (6/4.5) in the IPS subcohort respectively ( P =0.033). CDE is 28.87% less, and VOs are significantly improved, in denser cataracts in the CPS compared with the IPS. The authors recommend the CPS for cases with denser nuclei.
Clinical use of the hyperthermia treatment planning system HyperPlan to predict effectiveness and toxicity
International Nuclear Information System (INIS)
Sreenivasa, Geetha; Gellermann, Johanna; Rau, Beate; Nadobny, Jacek; Schlag, Peter; Deuflhard, Peter; Felix, Roland; Wust, Peter
Purpose: The main aim is to prove the clinical practicability of the hyperthermia treatment planning system HyperPlan on a β-test level. Data and observations obtained from clinical hyperthermia are compared with the numeric methods FE (finite element) and FDTD (finite difference time domain), respectively. Methods and Materials: The planning system HyperPlan is built on top of the modular, object-oriented platform for visualization and model generation AMIRA. This system already contains powerful algorithms for image processing, geometric modeling, and three-dimensional graphics display. A number of hyperthermia-specific modules are provided, enabling the creation of three-dimensional tetrahedral patient models suitable for treatment planning. Two numeric methods, FE and FDTD, are implemented in HyperPlan for solving Maxwell's equations. Both methods base their calculations on segmented (contour based) CT or MR image data. A tetrahedral grid is generated from the segmented tissue boundaries, consisting of approximately 80,000 tetrahedrons per patient. The FE method necessitates, primarily, this tetrahedral grid for the calculation of the E-field. The FDTD method, on the other hand, calculates the E-field on a cubical grid, but also requires a tetrahedral grid for correction at electrical interfaces. In both methods, temperature distributions are calculated on the tetrahedral grid by solving the bioheat transfer equation with the FE method. Segmentation, grid generation, E-field, and temperature calculation can be carried out in clinical practice at an acceptable time expenditure of about 1-2 days. Results: All 30 patients we analyzed with cervical, rectal, and prostate carcinoma exhibit a good correlation between the model calculations and the attained clinical data regarding acute toxicity (hot spots), prediction of easy-to-heat or difficult-to-heat patients, and the dependency on various other individual parameters. We could show sufficient agreement between
The planning system and its impact on sustainable urban form and energy demand
Wolsink, M.; Attali, S.; Métreau, E.; Prône, M.; Tillerson, K.
The Dutch physical planning system is at a turning point. Recently the Government proposed a new institutional framework for spatial planning. Theoretically, existing planning hierarchy suggests that planning in the Netherlands is conducted systematically, including a strong notion of integrated
A simple weighted scoring system to guide surgical decision-making in patients with parapneumonic pleural effusion.
Chang, Che-Chia; Chen, Tzu-Ping; Yeh, Chi-Hsiao; Huang, Pin-Fu; Wang, Yao-Chang; Yin, Shun-Ying
The selection of ideal candidates for surgical intervention among patients with parapneumonic pleural effusion remains challenging. In this retrospective study, we sought to identify the main predictors of surgical treatment and devise a simple scoring system to guide surgical decision-making. Between 2005 and 2014, we identified 276 patients with parapneumonic pleural effusion. Patients in the training set (n=201) were divided into two groups according to their treatment modality (non-surgery vs. surgery). Using multivariable logistic regression analysis, we devised a scoring system to guide surgical decision-making. The score was subsequently validated in an independent set of 75 patients. A white blood cell count >13,500/µL, pleuritic pain, loculations, and split pleura sign were identified as independent predictors of surgical treatment. A weighted score based on these factors was devised, as follows: white blood cell count >13,500/µL (one point), pleuritic pain (one point), loculations (two points), and split pleura sign (three points). A score >4 was associated with a surgical approach with a sensitivity of 93.4%, a specificity of 82.4%, and an area under curve (AUC) of 0.879 (95% confidence interval: 0.828-0.930). In the validation set, a sensitivity of 94.3% and a specificity of 79.6% were found (AUC=0.869). The proposed scoring system reliably identifies patients with parapneumonic pleural effusion who are candidates for surgery. Pending independent external validation, our score may inform the appropriate use of surgical interventions in this clinical setting.
Study of the Operational Safety of a Vascular Interventional Surgical Robotic System
Directory of Open Access Journals (Sweden)
Jian Guo
Full Text Available This paper proposes an operation safety early warning system based on LabView (2014, National Instruments Corporation, Austin, TX, USA for vascular interventional surgery (VIS robotic system. The system not only provides intuitive visual feedback information for the surgeon, but also has a safety early warning function. It is well known that blood vessels differ in their ability to withstand stress in different age groups, therefore, the operation safety early warning system based on LabView has a vascular safety threshold function that changes in real-time, which can be oriented to different age groups of patients and a broader applicable scope. In addition, the tracing performance of the slave manipulator to the master manipulator is also an important index for operation safety. Therefore, we also transformed the slave manipulator and integrated the displacement error compensation algorithm in order to improve the tracking ability of the slave manipulator to the master manipulator and reduce master–slave tracking errors. We performed experiments "in vitro" to validate the proposed system. According to previous studies, 0.12 N is the maximum force when the blood vessel wall has been penetrated. Experimental results showed that the proposed operation safety early warning system based on LabView combined with operating force feedback can effectively avoid excessive collisions between the surgical catheter and vessel wall to avoid vascular puncture. The force feedback error of the proposed system is maintained between ±20 mN, which is within the allowable safety range and meets our design requirements. Therefore, the proposed system can ensure the safety of surgery.
High-Level Waste Systems Plan. Revision 7 (U)
International Nuclear Information System (INIS)
Brooke, J.N.; Gregory, M.V.; Paul, P.; Taylor, G.; Wise, F.E.; Davis, N.R.; Wells, M.N.
This revision of the High-Level Waste (HLW) System Plan aligns SRS HLW program planning with the DOE Savannah River (DOE-SR) Ten Year Plan (QC-96-0005, Draft 8/6), which was issued in July 1996. The objective of the Ten Year Plan is to complete cleanup at most nuclear sites within the next ten years. The two key principles of the Ten Year Plan are to accelerate the reduction of the most urgent risks to human health and the environment and to reduce mortgage costs. Accordingly, this System Plan describes the HLW program that will remove HLW from all 24 old-style tanks, and close 20 of those tanks, by 2006 with vitrification of all HLW by 2018. To achieve these goals, the DWPF canister production rate is projected to climb to 300 canisters per year starting in FY06, and remain at that rate through the end of the program in FY18, (Compare that to past System Plans, in which DWPF production peaked at 200 canisters per year, and the program did not complete until 2026.) An additional $247M (FY98 dollars) must be made available as requested over the ten year planning period, including a one-time $10M to enhance Late Wash attainment. If appropriate resources are made available, facility attainment issues are resolved and regulatory support is sufficient, then completion of the HLW program in 2018 would achieve a $3.3 billion cost savings to DOE, versus the cost of completing the program in 2026. Facility status information is current as of October 31, 1996
Knowledge in communicative planning practice : a different perspective for planning support systems
Pelzer, Peter; Geertman, Stan; van der Heijden, Rob
Although planning support systems (PSS) have now undergone more than two decades of research and development, this is not reflected in their practical application. In this paper we argue that one of the reasons for this is that too much emphasis is put on the instrument rather than the usage and
Systems Engineering Plan and project record Configuration Management Plan for the Mixed Waste Disposal Initiative
International Nuclear Information System (INIS)
Bryan, W.E.; Oakley, L.B.
This document summarizes the systems engineering assessment that was performed for the Mixed Waste Disposal Initiative (MWDI) Project to determine what types of documentation are required for the success of the project. The report also identifies the documents that will make up the MWDI Project Record and describes the Configuration Management Plan describes the responsibilities and process for making changes to project documentation
Surgical versus Non-surgical Management of Rotator Cuff Tears: Predictors of Treatment Allocation
Kweon, Christopher Y.; Gagnier, Joel Joseph; Robbins, Christopher; Bedi, Asheesh; Carpenter, James E.; Miller, Bruce S.
Objectives: Rotator cuff tears are a common shoulder disorder resulting in significant disability to patients and strain on the health care system. While both surgical and non-surgical management are accepted treatment options, little data exist to guide the surgeon in treatment allocation. Defining variables to guide treatment allocation may be important for patient education and counseling, as well as to deliver the most efficient care plan at the time of presentation. The objective of this...