Comparative Analysis of Autonomous Robotic and Manual Techniques for Ultrasonic Sacral Osteotomy: A Preliminary Study

In this paper, we introduce an autonomous Ultrasonic Sacral Osteotomy (USO) robotic system that integrates an ultrasonic osteotome with a seven-degree-of-freedom (DoF) robotic manipulator guided by an optical tracking system. To assess multi-directional control along both the surface trajectory and cutting depth of this system, we conducted quantitative comparisons between manual USO (MUSO) and robotic USO (RUSO) in Sawbones phantoms under identical osteotomy conditions. The RUSO system achieved sub-millimeter trajectory accuracy (0.11 mm RMSE), an order of magnitude improvement over MUSO (1.10 mm RMSE). Moreover, MUSO trials showed substantial over-penetration (16.0 mm achieved vs. 8.0 mm target), whereas the RUSO system maintained precise depth control (8.1 mm). These results demonstrate that robotic procedures can effectively overcome the critical limitations of manual osteotomy, establishing a foundation for safer and more precise sacral resections.

Image-Guided Surgery: Technology, Quality, Innovation, and Opportunities for Medical Physics

The science and clinical practice of medical physics has been integral to the advancement of radiology and radiation therapy for over a century. In parallel, advances in surgery - including intraoperative imaging, registration, and other technologies within the expertise of medical physicists - have advanced primarily in connection to other disciplines, such as biomedical engineering and computer science, and via somewhat distinct translational paths. This review article briefly traces the parallel and convergent evolution of such scientific, engineering, and clinical domains with an eye to a potentially broader, more impactful role of medical physics in research and clinical practice of surgery. A review of image-guided surgery technologies is offered, including intraoperative imaging, tracking / navigation, image registration, visualization, and surgical robotics across a spectrum of surgical applications. Trends and drivers for research and innovation are traced, including federal funding and academic-industry partnership, and some of the major challenges to achieving major clinical impact are described. Opportunities for medical physicists to expand expertise and contribute to the advancement of surgery in the decade ahead are outlined, including research and innovation, data science approaches, improving efficiency through operations research and optimization, improving patient safety, and bringing rigorous quality assurance to technologies and processes in the circle of care for surgery. Challenges abound but appear tractable, including domain knowledge, professional qualifications, and the need for investment and clinical partnership.