In Total Knee Replacement Arthroplasty (TKA), surgical robotics can provide image-guided navigation to fit implants with high precision. Its tracking approach highly relies on inserting bone pins into the bones tracked by the optical tracking system. This is normally done by invasive, radiative manners (implantable markers and CT scans), which introduce unnecessary trauma and prolong the preparation time for patients. To tackle this issue, ultrasound-based bone tracking could offer an alternative. In this study, we proposed a novel deep learning structure to improve the accuracy of bone tracking by an A-mode ultrasound (US). We first obtained a set of ultrasound dataset from the cadaver experiment, where the ground truth locations of bones were calculated using bone pins. These data were used to train the proposed CasAtt-UNet to predict bone location automatically and robustly. The ground truth bone locations and those locations of US were recorded simultaneously. Therefore, we could label bone peaks in the raw US signals. As a result, our method achieved sub millimeter precision across all eight bone areas with the only exception of one channel in the ankle. This method enables the robust measurement of lower extremity bone positions from 1D raw ultrasound signals. It shows great potential to apply A-mode ultrasound in orthopedic surgery from safe, convenient, and efficient perspectives.
This work presents an RL-based agent for outpatient hysteroscopy training. Hysteroscopy is a gynecological procedure for examination of the uterine cavity. Recent advancements enabled performing this type of intervention in the outpatient setup without anaesthesia. While being beneficial to the patient, this approach introduces new challenges for clinicians, who should take additional measures to maintain the level of patient comfort and prevent tissue damage. Our prior work has presented a platform for hysteroscopic training with the focus on the passage of the cervical canal. With this work, we aim to extend the functionality of the platform by designing a subsystem that autonomously performs the task of the passage of the cervical canal. This feature can later be used as a virtual instructor to provide educational cues for trainees and assess their performance. The developed algorithm is based on the soft actor critic approach to smooth the learning curve of the agent and ensure uniform exploration of the workspace. The designed algorithm was tested against the performance of five clinicians. Overall, the algorithm demonstrated high efficiency and reliability, succeeding in 98% of trials and outperforming the expert group in three out of four measured metrics.