Différentes techniques de chirurgie mini-invasive permettent aujourd’hui d’effectuer les procédures d'ablation de tumeurs. La cryochirurgie est une de ces techniques et fonctionne grâce à une technique de décompression très rapide de l'argon à l’extrémité d’une sonde en forme d'aiguille. La planification pré-opératoire de ce type d’intervention est très difficile pour le chirurgien, qui doit se représenter mentalement la disposition finale des aiguilles par rapport à la position des structures anatomiques complexe. Une sur-ablation ou une sous-ablation peuvent entraîner des complications donc, devant le besoin crucial d'une telle planification, dans cette thèse nous nous sommes concentrés sur la planification pré-opératoire automatisée de la cryochirurgie,avec les objectifs de assister le chirurgien grâce à une prédiction plus réaliste des zones d'ablation et proposer automatiquement un placement d'aiguille avec un risque minimal pour le patient dans un délai acceptable pour une utilisation en salle d'opération. / There exist several minimally invasive techniques to perform tumor ablation procedures.Cryosurgery is one of these techniques and works by decompressing very rapidly the argon gas through a needle-like probe. It is hard for the surgeons to imagine final results and plan the surgery in advance in a complicated anatomical environment. Over-ablation or under ablation may result in complications during the treatment. So, due to a crucial need for having such a planning tool, in this thesis we focused on an automated pre-surgical planning for cryosurgery with goals to support the physician by utilizing a more realistic prediction of ablation zones and proposing a needle placement setup with a close to minimum risk to the patient and an optimal coverage of the tumor by the iceball in an acceptable time for the use in the operation room.

Background: Sophisticated guided surgery has not been implemented into total joint replacement-surgery (TJR) of the temporomandibular joint (TMJ) so far. Design and in-house manufacturing of a new advanced drilling guide with vector and length control for a typical TJR fossa component are described in this in vitro study, and its accuracy/utilization was evaluated and compared with those of intraoperative real-time navigation and already available standard drilling guides. Methods: Skull base segmentations of five CT-datasets from different patients were used to design drilling guides with vector and length control according to virtual surgical planning (VSP) for the TJR of the TMJ. Stereolithographic models of the skull bases were printed three times for each case. Three groups were formed to compare our newly designed advanced drilling guide with a standard drilling guide and drill-tracking by real-time navigation. The deviation of screw head position, screw length and vector in the lateral skull base have been evaluated (n = 72). Results: There was no difference in the screw head position between all three groups. The deviation of vector and length was significantly lower with the use of the advanced drilling guide compared with standard guide and navigation. However, no benefit in terms of accuracy on the lateral skull base by the use of real-time navigation could be observed. Conclusion: Since guided surgery is standard in implant dentistry and other CMF reconstructions, this new approach can be introduced into clinical practice soon, in order to increase accuracy and patient safety.

Neuronavigation and transcranial magnetic stimulation (TMS) are valuable tools in clinical and research environment. Neuronavigation provides visual guidance of a given instrument during procedures of neurological interventions, relative to anatomic images. In turn, TMS allows the non-invasive study of cortical brain function and to treat several neurological disorders. Despite the well-accepted importance of both techniques, high-cost of neuronavigation systems and limited spatial accuracy of TMS in targeting brain structures, limit their applications. Therefore, the aim of this thesis was to i) develop an open-source, free neuronavigation software, ii) study a possible combination of neuronavigation and 3D printing for surgical planning, and iii) construct a multi-channel TMS coil with electronic control of electric field (E-field) orientation. In the first part, we developed and characterized a neuronavigation software compatible with multiple spatial tracking devices, the InVesalius Navigator. The created co-registration algorithm enabled tracking position and orientation of instruments with an intuitive graphical interface. Measured accuracy was similar to that of commercial systems. In the second part, we created 3D printed models from patients with neurological disorders and assessed the errors of localizing anatomical landmarks during neuronavigation. Localization errors were below 3 mm, considered acceptable for clinical applications. Finally, in the last part, we combined a set of two thin, overlapping coils to allow electronic control of the E-field orientation and investigated how the motor evoked responses depend on the stimulus orientation. The developed coil enabled the stimulation of the motor cortex with high angular resolution. Motor responses showed the highest amplitude and lowest latency with E-field approximately perpendicular to the central sulcus. In summary, this thesis provides new methods to improve spatial accuracy of techniques to brain interventions. / A neuronavegação e a estimulação magnética transcraniana (EMT ou TMS, do termo em inglês transcranial magnetic stimulation) têm sido apresentadas como ferramentas valiosas em aplicações clínicas e de pesquisa. A neuronavegação possibilita a localização de instrumentos em relação a imagens anatômicas durante procedimentos de intervenção neurológica. Por sua vez, a EMT permite o estudo não invasivo da função cerebral e o tratamento de doenças neurológicas. Apesar da importância de ambas as técnicas, o alto custo dos sistemas de neuronavegação e a reduzida precisão espacial da EMT em ativar estruturas cerebrais limitam suas aplicações. Sendo assim, o objetivo desta tese foi: i) desenvolver um software de neuronavegação gratuito e de código aberto, ii) estudar a combinação entre neuronavegação e impressão 3D para planejamento cirúrgico, e iii) construir uma bobina de EMT multicanal com controle eletrônico da orientação do campo elétrico (CE). Na primeira parte, desenvolvemos e caracterizamos um software de neuronavegação compatível com vários rastreadores espaciais, o InVesalius Navigator. O algoritmo criado possibilitou o rastreamento de instrumentos por uma interface gráfica intuitiva. A precisão medida foi semelhante à de sistemas comerciais. Na segunda parte, imprimimos modelos 3D de pacientes com patologias neurológicas e avaliamos os erros de localização de marcos anatômicos durante a neuronavegação. Os erros de localização foram inferiores a 3 mm, considerados aceitáveis para aplicações clínicas. Por fim, na última parte, combinamos duas bobinas sobrepostas para controlar eletronicamente a orientação do CE, e investigamos como as respostas motoras evocadas dependem da orientação da corrente. A bobina desenvolvida possibilitou estimular o córtex motor com alta resolução angular. As respostas motoras apresentaram maior amplitude e menor latência para orientação do CE aproximadamente perpendicular ao sulco central. Em suma, esta tese fornece novos métodos para melhorar a precisão espacial de técnicas de intervenção com o cérebro.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-08-14T20:25:49Z No. of bitstreams: 1 JoaoDallyson.pdf: 6621483 bytes, checksum: 19e928fa3d5789994cc1db5d829e0575 (MD5) / Made available in DSpace on 2017-08-14T20:25:49Z (GMT). No. of bitstreams: 1 JoaoDallyson.pdf: 6621483 bytes, checksum: 19e928fa3d5789994cc1db5d829e0575 (MD5) Previous issue date: 2013-07-05 / Strabismus is a condition that affects approximately 4% of the population causing aesthetic problems, reversible at any age, and irreversible sensory changes that modify the mechanism of vision. The Hirschberg test is one of the types of existing tests to detect such a condition. Detection Systems and computeraided diagnosis are being used with some success in helping health professionals. However, in spite of the increasing routine use of high-tech technologies, the diagnosis and therapy in ophthalmology is not a reality within the strabismus subspecialty. Thus, this thesis aims to present a methodology to detect and automatically diagnose and propose the plan of strabismus surgery through digital images. To do this, the study is organized in seven steps: (1) face segmentation; (2) eye region detection; (3) eyes location; (4) limbus and brilliance location; (5) detection, (6) diagnosis and (7) surgical planning of strabismus. The effectiveness of the study in the indication of the diagnosis and surgical plan was evaluated by the mean diference between the results provided by the methodology and the original indication of the expert. Patients were evaluated for eye positions: PPO, INFRA, SUPRA, DEXTRO and LEVO. The method was 88% accurate in identifying esotropias (ET), 100% in exotropias (XT), 80.33% in hipertropias (HT) and 83.33% in hipotropias (HoT). The overall average error in diagnosis was 5:6 and 3:83 for horizontal and vertical desviations, respectivelly. In planning surgeries of medial rectus muscles the average error was 0.6 mm for recession, and 0.9 mm for ressection. For lateral rectus muscles, the average error was 0.8 mm for recession, and 1 mm for resection. / O estrabismo é uma patologia que afeta cerca de 4% da população, provocando problemas estéticos (reversíveis a qualquer idade) e alterações sensoriais irreversíveis, modi cando o mecanismo da visão. O teste de Hirschberg é um dos tipos de exames existentes para detectar tal patologia. Sistemas de Detecção e Diagnóstico auxiliados por computador estão sendo usados com relativo sucesso no auxílio aos pro fissionais de saúde. No entanto, o emprego rotineiro de recursos de alta tecnologia no auxílio diagnóstico e terapêutico em oftalmologia não é uma realidade dentro da subespecialidade estrabismo. Sendo assim, o presente trabalho tem como objetivo apresentar uma metodologia para detectar e diagnosticar automaticamente, além de propor o plano cirúrgico do estrabismo por meio de imagens digitais. Para tanto, o estudo está organizado em sete estágios: (1) segmentação da face; (2) detecção da região dos olhos; (3) localização dos olhos; (4) localização do limbo e do brilho; (5) detecção; (6) diagnóstico e (7) planejamento cirúrgico do estrabismo. A e ficácia do estudo na indicação do diagnóstico e do plano cirúrgico foi avaliada pela m édia da diferença entre os resultados fornecidos pela metodologia e as indicações originais do especialista. Os pacientes foram avaliados nas posições do olhar: PPO, INFRA, SUPRA, DEXTRO e LEVO. O método obteve acuracia de 88% na identi cação de esotropias (ET), 100% nas exotropias (XT), 80,33% nas hipertropias (HT) e 83,33% nas hipotropias (HoT). O erro médio global na realização do diagnóstico foi de 5:6 e 3:83 para desvios horizontais e verticais, respectivamente. No planejamento de cirurgias de músculos retos mediais obteve-se erro médio de 0,6 mm para recuo, e 0,9 mm para ressecção. Para os músculos retos laterais, o erro médio foi de 0,8 mm para recuo e 1 mm para ressecção.

Neuronavigation and transcranial magnetic stimulation (TMS) are valuable tools in clinical and research environment. Neuronavigation provides visual guidance of a given instrument during procedures of neurological interventions, relative to anatomic images. In turn, TMS allows the non-invasive study of cortical brain function and to treat several neurological disorders. Despite the well-accepted importance of both techniques, high-cost of neuronavigation systems and limited spatial accuracy of TMS in targeting brain structures, limit their applications. Therefore, the aim of this thesis was to i) develop an open-source, free neuronavigation software, ii) study a possible combination of neuronavigation and 3D printing for surgical planning, and iii) construct a multi-channel TMS coil with electronic control of electric field (E-field) orientation. In the first part, we developed and characterized a neuronavigation software compatible with multiple spatial tracking devices, the InVesalius Navigator. The created co-registration algorithm enabled tracking position and orientation of instruments with an intuitive graphical interface. Measured accuracy was similar to that of commercial systems. In the second part, we created 3D printed models from patients with neurological disorders and assessed the errors of localizing anatomical landmarks during neuronavigation. Localization errors were below 3 mm, considered acceptable for clinical applications. Finally, in the last part, we combined a set of two thin, overlapping coils to allow electronic control of the E-field orientation and investigated how the motor evoked responses depend on the stimulus orientation. The developed coil enabled the stimulation of the motor cortex with high angular resolution. Motor responses showed the highest amplitude and lowest latency with E-field approximately perpendicular to the central sulcus. In summary, this thesis provides new methods to improve spatial accuracy of techniques to brain interventions. / A neuronavegação e a estimulação magnética transcraniana (EMT ou TMS, do termo em inglês transcranial magnetic stimulation) têm sido apresentadas como ferramentas valiosas em aplicações clínicas e de pesquisa. A neuronavegação possibilita a localização de instrumentos em relação a imagens anatômicas durante procedimentos de intervenção neurológica. Por sua vez, a EMT permite o estudo não invasivo da função cerebral e o tratamento de doenças neurológicas. Apesar da importância de ambas as técnicas, o alto custo dos sistemas de neuronavegação e a reduzida precisão espacial da EMT em ativar estruturas cerebrais limitam suas aplicações. Sendo assim, o objetivo desta tese foi: i) desenvolver um software de neuronavegação gratuito e de código aberto, ii) estudar a combinação entre neuronavegação e impressão 3D para planejamento cirúrgico, e iii) construir uma bobina de EMT multicanal com controle eletrônico da orientação do campo elétrico (CE). Na primeira parte, desenvolvemos e caracterizamos um software de neuronavegação compatível com vários rastreadores espaciais, o InVesalius Navigator. O algoritmo criado possibilitou o rastreamento de instrumentos por uma interface gráfica intuitiva. A precisão medida foi semelhante à de sistemas comerciais. Na segunda parte, imprimimos modelos 3D de pacientes com patologias neurológicas e avaliamos os erros de localização de marcos anatômicos durante a neuronavegação. Os erros de localização foram inferiores a 3 mm, considerados aceitáveis para aplicações clínicas. Por fim, na última parte, combinamos duas bobinas sobrepostas para controlar eletronicamente a orientação do CE, e investigamos como as respostas motoras evocadas dependem da orientação da corrente. A bobina desenvolvida possibilitou estimular o córtex motor com alta resolução angular. As respostas motoras apresentaram maior amplitude e menor latência para orientação do CE aproximadamente perpendicular ao sulco central. Em suma, esta tese fornece novos métodos para melhorar a precisão espacial de técnicas de intervenção com o cérebro.

Les travaux de thèse présentés s’intéressent à l’optimisation des activités d’un bloc opératoire. Ces activités concernent les interventions chirurgicales à planifier et les interventions de maintenance préventive sur les équipements dans les salles d’opération. Une solution est la synchronisation de ces activités lors de la construction du planning opératoire au niveau opératoire. Nous dissocions deux stratégies de programmation opératoire : programmation ouverte et programmation avec allocation préalable des plages horaires aux chirurgiens. Pour chacune des stratégies, nous considérons deux cas : le cas où l’heure de début d’une intervention de maintenance dans la salle est fixée, ladite intervention précédant l’affection des interventions chirurgicales dans les salles. Le second cas étant celui où l’heure de début de maintenance varie dans un intervalle entre une heure de début minimum et une heure de début maximum, avec l’intervention de maintenance placée a posteriori.Nous faisons plusieurs propositions de méthodes (exactes et approchées), y compris une méthode hybride, qui repose sur le couplage entre une métaheuristique et une heuristique. Les résultats obtenus sur des instances générées en concertation avec le monde hospitalier sont intéressants. / The presented dissertation is about the optimization of hospital systems, more precisely the optimization of the activities of an operation theatre. These activities showcase the surgical procedures to be planned and the preventive maintenance interventions on the equipment in the operating rooms. One solution is the synchronization of these activities during the construction of the operational planning at the operational level.We dissociate two operating programming strategies: Open Scheduling or Open programming and Block Scheduling or Programming with prior allocation of times to surgeons. For each strategy two cases are considered: the first case is where the time of beginning of a maintenance intervention in the room is fixed - this intervention preceding the affection of the surgical interventions in the rooms. The second case is where the maintenance start time varies in the interval between a minimum start time and a maximum start time, with the maintenance intervention placed beforehand. We make several proposition’s methods (exact and approximate), including a hybrid method, which is based on the coupling between a metaheuristic and a heuristic. The results obtained on bodies generated in consultation with the hospital’s world are interesting.