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CRIGOS

Development, integration and evaluation of a
Compact Robot for Image Guided Orthopedic Surgery

Coordinator

RWTH Aachen / Lehrstuhl für Biomedizinische Technik
Head and Director: Univ.-Prof. Dr. rer. nat. G. Rau
Helmholtz-Institute for Biomedical Engineering, Surgical Therapy Technology Lab
Pauwelsstrasse 20, D-52074 Aachen, Germany

Final Report

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Funding

EC/DGXII BIOMED 2
Project No.: BHM4-CT97-2427
(Project term: 08/1997-01/2001)

Project Summary

The main activities in orthopaedic surgery are surgical interventions on bone structures and joints for the treatment of congenital or acquired disorders of the human skeleton and motion apparatus. The exact relations and geometries of the surgical planning and its exact reproduction within the operating site play an important role. The exact coupling ofthe geometries of the real bone structure, the image-based model being the base of the surgical planning and finally the guidance of the surgeon according to his planning often can not be guaranteed by conventional technical means. The basic idea of Computer Assisted Surgery is to help the surgeon to define an accurate surgical planning on multimodal pre-and per-operative images and then to help to perform the operation as planned thanks tothe use of robotic guiding systems. In Europe, there are about 1.000.000 patients/year in orthopaedic surgery (the cost estimated at 3.000.000.000 Ecus/year). Potential benefits of Computer Assisted Surgery are the reduction of invasiveness, improvement of accuracy, safety and reliability of operation, standardisation, shorter time of intervention and faster return to normal activities for patients as well as reduction of x-ray exposure of the medical staff. However, the introduction of robotics technologyin the operating room must be made according to accurate medical specifications andconstraints. To meet these objectives, CRIGOS gathers five clinical sites of four different European countries, two universities and two complementary SME specialised in software and mechanical design with quality assurance for medical applications. Additionally, one of the world's leading manufacturer for surgical equipment and instrumentation, contributes to the project providing special experience concerning the integration of modular devices, computer assisted surgery systems and end effectors as well as the preparation of industrial exploitation. Different orthopaedic applications will betaken into account in the specifications and development according to a 3-step-procedure:

  • robotic manipulator moveable via user interfaces such as joysticks or speech control providing an accurate link between bi-planar x-ray imaging and movement of instruments (reducing the need of work under permanent x-ray control)->instrument moves in the initial x-ray images as it would move under permanent x-ray control
  • semiautomatic image guided positioning of linear toolguides (e.g. punction of cystic cavities, drilling for ACL-reconstruction, the fixation of pedicle screws or for intramedullary nails will be actively performed by the surgeon)
  • robot actively works on bone (for instance total cemented and uncemented hip or knee replacement) providing highly accurate results and reproducible milling parameters

The general objective of the project is to develop a new system for image guidedorthopaedic surgery consisting of a new compact robot, special devices for the adaptation to specific surgical applications and a software system for planning and execution of the surgical interventions especially based on pre- and intraoperative imageacquisition. The detailed analysis of user needs, intraoperative bottlenecks and boundary conditions, will be the base of the work. A modular architecture of the CRIGOS-system offering various medical functionalities will be designed on the basis of key technologies for which CRIGOS partners have an important know how. One of the key technologies to be developed will be a small, safe, slow, sterilizable, compact and accurate robot based on a parallel architecture. Another key technology will be a surgical planning system based on multimodal images. We intend to publish both the medical and interface specifications at the end of the project so that both components (robot and planning platform) could serve as general tools for different applications in the area of CAS. From the technical pointof view we are very confident in the chosen approach as good results have been already achieved by joint R&D efforts preparing this proposed project and demonstrating the technical feasibility of the approach and the access to key technologies  (1st labtype of a 6 DOF parallel compact robot device, 2D-3D registration, calibration, multimodal imageprocessing).

Each of the developmental topics will strongly include the investigation and development of concepts concerning ergonomic system design, safety and quality control. During the on-going project quality assurance is based on standards and QA systems of the industrial partners as well as on permanent reviews of the development and evaluation by expert surgeons.

Concept of x-ray image-guided robotic assistance

1st labtype of a compact robot for bone surgery (weight 4kg, 6 de-grees of freedom)

List of project related oral presentations and publications

Oral Presentations

  • Rau, G., K. Radermacher: Operationsplanung und -ausführung in der computerunterstützten Chirurgie. 31. Jahrestagung der Deutschen Gesellschaft für Biomedizinische Technik, 22.-24. Oktober 1997, München
  • Radermacher, K.: Kompaktroboter für die bildgeführte orthopädische Chirurgie. ACEFrühjahrstagung 1998, 8.5.-9.5.1998, Essen, Germany
  • Radermacher, K., Brandt, G., Lavallee, S., "An Optimized Robot for Computer Assisted Orthopaedic Surgery", 2nd Annual North American Symposium on Computer Assisted Surgery (CAOS/USA´98), June 18-20, Pittsburgh, Pennsylvania, U.S.A.
  • Brandt, G., Radermacher, K., Zimolong, A., Rau, G., Anton, M., Staudte, H.-W., "Development of an Integrated Compact Robot System for Orthopaedic Surgery", Proc. Advanced Robotics: Beyond 2000, The 29th International Symposium on Robotics and the Automation and Robotics Show ´98, 27th April - 1st May 1998, N.E.C., Birmingham, United Kingdom
  • Brandt, G., Radermacher, K., Staudte, H.-W., Rau, G.: Development of a X-ray Image Guided Parallel Robot for Orthopedic Surgery. Workshop on Medical Robotics, 10.-12. 11. 1997, Heidelberg, Germany
  • Brandt, G.: Parallel Robot for surgery: Chances and Challenges. Tutorial on Image Guided Interventions and Robotics, 2nd Int Conf. Medical Image Computing & Computer-Assisted Interventions MICCAI 99, 19.-22. September 1999, Cambridge, UK (invited tutorial lecture)
  • Zimolong, A, Radermacher, K., Hachmöller, C., Rau, G. "Ergonomic Evaluation of systems for computer aided surgery", 4th CAOS Meeting, Davos, Switzerland, March 17-19, 1999
  • Brandt, G., Zimolong, A., Carrat, L., Radermacher, K., Lavallée, S., Rau, G., "CRIGOS -A modular robotic system designed as a general tool for computer assisted orthopaedic surgery", 4th CAOS Meeting, Davos, Switzerland, March 17-19, 1999
  • Radermacher, K.: CRIGOS-Development, Integration and Evaluation of a Compact Robot for Image Guided Orthopedic Surgery. EU-BIOMED 2-Workshop, 5th Conference of the European Society for Engineering and Medicine --ESEM 99, 30.5.-2.6.1999, Barcelona, Spanien
  • Radermacher, K.: Trends and Goals in Computer Assisted Surgery. 4th European Conference on Engineering and Medicine, May 25-28, 1997, Warsaw, Poland (invited)
  • Radermacher, K., Brandt, G., Rau, G.Staudte, H.-W.: A Compact Robot Device for X-ray Image Guided Orthopedic Surgery. Proc. 1st North American Symposium on Computer Assisted Orthopaedic Surgery (CAOS/USA´97), June 12-14, 1997, Pittsburgh, Pennsylvania, U.S.A. (invited)
  • Radermacher, K.: Kompaktroboter für die bildgeführte orthopädische Chirurgie. ACEFrühjahrstagung, 8.5.-9.5.1998, Essen, 1998 (invited)
  • Radermacher, K.: The Future of Medical Robotics. International Conference on Robotics and Automation, May 18, 1998, Leuven, Belgium (invited)
  • Radermacher, K., Brandt, G., Lavallée, St.: An Optimized Robot for Computer Assisted Orthopaedic Surgery. 2nd North American Symposium on Computer Assisted Orthopaedic Surgery (CAOS/USA´98), June 18-20, 1998, Pittsburgh, Pennsylvania, U.S.A. (invited)
  • Radermacher, K.: CRIGOS - Ein Kompaktroboter für die bildgeführte Chirurgie. Roboter und Computer in Orthopädie und Traumatologie, 10-11.Dezember 1999, Neuss (invited)
  • Radermacher, K.: Ergonomische Evaluierung von Systemen für die CAOS: Roboter und Computer in Orthopädie und Traumatologie, 10-11.Dezember 1999, Neuss (invited)
  • Radermacher, K.: Surgical Therapy Technology Research at the Helmholtz-Institute Aachen. 1st Meeting of the South-Western Computer Assisted Orthopedic Surgery Association, August 19, 1999, Exeter, UK
  • Radermacher, K.: Aspects of Surgical Therapy Technology Research. Princess Elizabeth Orthopedic Center, August 20, 1999, Exeter, UK (invited)
  • Radermacher, K.: Navigation und computerassistiertes Operieren - aus technischer Sicht –Symposium Orthopädisch Chirurgische Therapietechnik, Deutscher Orthopädenkongreß 1999, 14.-17. Oktober, Wiesbaden, 1999 (invited)
  • Radermacher, K.: Pre-operative planning systems. Orthopaedic Computing 2000 symposium, Royal College of Surgeons of England, 15 September 2000, London. (invited)
  • Radermacher, K.: Robotics in Orthopaedic Surgery. The Elbow 2000 – Int. Congr. German Soc. f. Shoulder and Elbow Surgery, 2nd – 5th March 2000, Düsseldorf (invited)
  • Radermacher, K., Zimolong, A.: Risikoanalyse und Ergonomie bei CAOS-Systemen. Symposium Qualitätsmanagement und Endoprothetik in der Orthopädie, 1.-2. September 2000, Heidelberg (invited)
  • Radermacher, K.: Alternative CAOS-Lösungsansätze. Symposium Qualitätsmanagement und Endoprothetik in der Orthopädie, 1.-2. September 2000, Heidelberg (invited)
  • Radermacher, K.: MRCAS in Forschung und/oder breiter klinischer Anwendung – Rechtfertigung, Alternativen und Perspektiven. CAS – 2000 Pro und Kontra. 17.-18. November 2000, Berlin (invited)
  • Radermacher, K.: Zukunftsperspektiven der chirurgischen Instrumenten- und Gerätetechnik. Jahreskongreß der Arbeitsgemeinschaft Endoprothetik, 30.11.-2.12.2000, Hamburg (invited)
  • Radermacher, K.: Planung, Chirurgierobotik, Automation und Navigation in der orthopädischen Chirurgie. 3. WGP Symposium - Neue Technologien für die Medizin -, 10.-11.5.2001, Aachen (invited)
  • Radermacher, K.: Approaches towards Computer and Robot Assisted Orthopaedic Surgery. Seminar Lecture, Lerner Institute - Cleveland Clinic Foundation, June 29th, 2001, Cleveland, Ohio, U.S.A. (invited)
  • Radermacher, K.: Robotics – Zukunft oder Fehlinvestition? Orthopädisches Symposium, Universität Halle, 31.8.-1.9.2001 (invited)
  • Radermacher, K.: CRIGOS – A new modular system approach for computer and robot assisted surgery. Second International Symposium on Computer Assisted Total Joint Surgery. Tuttlingen, Germany, September 6-7, 2001 (invited)
  • Radermacher, K.: Ergonomie und Sicherheit in der CAOS – Bedeutung des essentiellen (Fehl-) Leistungsfaktors Mensch bei der Gestaltung chirurgischer Arbeitsplätze. 26. Baden-Württemberg-Kolloquium, 24.-28.9.2001, Ulm (invited)
  • Radermacher, K.: Medizinisch-technische Problemanalyse und benutzerzentrierte Gestaltung alternativer Lösungsansätze in der CAOS. 26. Baden-Württemberg- Kolloquium, 24.-28.9.2001, Ulm (invited)
  • Rau, G., Radermacher, K.: Computerunterstützung in der bildgebenden Chirurgie: - Lösungsansätze und Entwicklungstrends - . 61. Jahreskongreß der Deutschen Gesellschaft für Unfallchiurgie, 19.-22. November 1997, Berlin (invited)
  • Brandt, G., Radermacher, K., Lavallee, S., Staudte, H.-W., and Rau, G.: A medical robot system for orthopedic interventions: Computer Assisted Radiology and Surgery (CAR97), 25.-28. June 1997, Berlin (invited)
  • Rau, G., Radermacher, K., Lavallée, St., Brandt, G.: Development, integration and evaluation of a compact robot for image guided orthopaedic surgery (CRIGOS). Lecture ESEM Workshop on Biomedical Research and Industrial Participation in Europe: Trends and Future, April 27-28, 1998 Brussels, Belgium (invited)
  • Zimolong, A., Radermacher, K., Rau, G.: Evaluation of Ergonomic Design of Systems for Image Guided Surgery. 5th Conference of the European Society for Engineering and Medicine --ESEM 99, 30.5.-2.6.1999, Barcelona, Spanien
  • Zimolong, A., Radermacher, K., Hachmöller, C., Rau, G.: Ergonomic Evaluation of Systems for Computer Assisted Surgery. 4th International Symposium on Compter Assisted Surgery - CAOS '99, 17-19. März 1999, Davos, Schweiz
  • Zimolong, A., Radermacher, K., Rau, G.: Bewertung der benutzer- und aufgabenorientierten Gestaltung bildgeführter Chirurgiesysteme. 3. Berliner Werkstatt Mensch-Maschine-Systeme, 6.-8. Oktober, 1999, Berlin
  • Zimolong, A., Friedrichs, D., Portheine, F., Radermacher, K., Traub, F., Staudte, H.-W.: Fluoroscopic Image Based Planning for Femoral Neck Surgery. 6th CAOS Symposium, 7.-10.02.2001, Davos, CH
  • Radermacher, K.: Computerunterstützte Planung und Führung chirurgischer Eingriffe mittels individueller Frässchablonen, Navigation oder Robotersystemen. Dies Academicus, RWTH-Aachen, 27.6.2001, Aachen
  • Portheine, F., Frömel, M., Radermacher, K.: Computerunterstützte Knie- Totalendoprothetik mit planungsspezifischen Bearbeitungsschablonen. BMT 2001 - DGBMT-Jahrestagung, 19.-21. Sept. 2001, Bochum, Germany
  • Radermacher, K., Schkommodau, E., Brandt, G., Zimolong, A., Carrat, L., Merloz, Ph., Klos, T.V.S., Robb, J., Wirtz, D.C., Staudte, H.-W., Rau, G.: CRIGOS – Ein Kompaktrobotersystem für die bildgeführte Orthopädische Chirurgie. BMT 2001 - DGBMT-Jahrestagung, 19.-21. Sept. 2001, Bochum, Germany
  • Radermacher, K., Westrich, D., Heilige, M., Brandt, G., Jungk, A., Rau, G.: PAROMIS – Ein Parallelrobotersystem für die sprachgesteuerte Kameraführung in der MIC. BMT 2001 - DGBMT-Jahrestagung, 19.-21. Sept. 2001, Bochum, Germany

Publications

  • Fleute, M., Lavallee, S. "Elastic 3D/2D registration of images using statistical models. Ch. Taylor, A. Colchester (eds.): Medical Image Computing and Computer Assisted Interventions MICCAI´99, Lecture Notes in Computer Science, Springer, 1999, pp. 138-147
  • Brandt, G., Zimolong, A., Carrat, L., Radermacher, K., Lavallee, S., Rau, G.: CRIGOS -A modular system designed as a general tool for computer assisted orthopaedic surgery. Proc. 4th CAOS Symposium´99, Davos, 1999, p. 33
  • Radermacher, K., Brandt, G., Lavallee, S., "An Optimized Robot for Computer Assisted Orthopaedic Surgery", Syllabus Annual North American Symposium on Computer Assisted Surgery (CAOS/USA´98), June 18-20, Pittsburgh, Pennsylvanian, U.S.A., pp. 278-280
  • Brandt, G., Radermacher, K., Lavallee, S., Staudte, H.-W., and Rau, G: "A medical robot system for orthopedic interventions". in: Lemke, Vannier, Inamura (eds.): Computer Assisted Radiology and Surgery, Elsevier, 1997, pp. 950 - 955
  • Brandt , G., Radermacher, K., Lavallee, S., Staudte, H.-W., Rau, G., A Compact Robot for Image Guided Orthopedic Surgery - Concept and Preliminary Results. in: Troccaz, J. Grimson, E., Mösges, R. (eds.): CVRMED II and MRCAS III, Lecture Notes in Computer Science, Springer-Verlag, 1997, pp. 767-777
  • Kempe, L.: Robotersysteme - Stählerne Helfer im Operationssaal. Deutsches Ärzteblatt 94, Heft 51-52, 22. December 1997, p. 50
  • Rau, G., Radermacher, K.: Computerunterstützung in der bildgebenden Chirurgie: - Lösungsansätze und Entwicklungstrends -. in: Oestern, H.-J. (Hrsg.): Tagungsband 61. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, Blackwell Wissenschafts-Verlag, 1998
  • Rau, G., Radermacher, K.: Operationsplanung und -ausführung in der computerunterstützten Chirurgie. Zeitschrift für Biomedizinische Technik (Ergänzungsband)
  • Zimolong, A., Radermacher, K., Rau, G.: Evaluation of Ergonomic Design of Systems for Image Guided Surgery. Proc. 5th Conference of the European Society for Engineering and Medicine, 1999, pp. 65-66
  • Brandt , G., Radermacher, K., Lavallee, S., Staudte, H.-W., Rau, G., A Compact Robot for Image Guided Orthopedic Surgery - Concept and Preliminary Results. in: Troccaz, J. Grimson, E., Mösges, R. (eds.): CVRMED II and MRCAS III, Lecture Notes in Computer Science, Springer-Verlag, 1997,pp. 767-777
  • Brandt, G., Radermacher, K., Lavallee, S., Staudte, H.-W., and Rau, G: "A medical robot system for orthopedic interventions" in: Lemke, Vannier, Inamura (eds.): Computer Assisted Radiology and Surgery, Elsevier, 1997, pp. 950 – 955
  • Radermacher, K., Brandt, G., Rau, G.: Robot and Computer Assisted Medical Interventions. New World Health, Sterling Publications Ltd., London, 1997, pp. 51-54
  • Anton, M, Zimolong, A, Brandt, G., Radermacher, K.: Medical Specifications and Clinical Boundary Conditions. Contract Deliverable CD1, EU-BIOMED 2 Projekt CT 97 2427 "CRIGOS" EC-DGXII, 1998
  • Radermacher, K., Brandt, G.: Annual Progress Report. Contract Deliverable CD3, EUBIOMED 2 Projekt CT 97 2427 „CRIGOS" EC-DGXII, 1998
  • Zimolong, A., Radermacher, K., Rau, G., Staudte, H.-W.: Benutzerschnittstelle und Eingabemedien für den CRIGOS Chirurgieroboter. Zeitschrift für Biomedizinische Technik, Band 45, Ergänzungsband 1, 2000, S. 224-225
  • Zimolong, A., Brandt, G., Radermacher, K., Rau, G., Staudte, H.-W.: Der CRIGOS Chirurgieroboter – Risikoanalyse und Sicherheitskonzept. Zeitschrift für Biomedizinische Technik, Band 45, Ergänzungsband 1, 2000, S. 229-230
  • Radermacher K., G. Brandt, L. Carrat, A. Zimolong: CRIGOS Mid Term Project Report. Projektbericht CD4, CRIGOS-Projekt EC-BIOMED 2 BMH4-CT97-2427, 1999
  • Radermacher K., G. Brandt, L. Carrat, A. Zimolong, J. Troccaz: CRIGOS 2nd Annual Project Report. Projektbericht CD5, CRIGOS-Projekt EC-BIOMED 2 BMH4-CT97-2427, 1999
  • Brandt, G., Zimolong, A., Carrat, L., Merloz, P. Staudte, H.-W., Lavallee, S., Radermacher, K., Rau, G.: CRIGOS: A Compact Robot for Image Guided Orthopaedic Interventions. IEEE Transactions on Information Technology in Biomedicine, Vol.3, No.4 December 1999, pp. 252-260
  • Brandt, G., Radermacher, K., Zimolong, A., Rau, G., Merloz, P., Klos, T.V.S., Robb, J., Staudte, H.-W.: CRIGOS – Entwicklung eines Kompaktrobotersystems für die bildgeführte orthopädische Chirurgie. Der Orthopäde 2000 – 29:645-649
  • Zimolong, A., Radermacher, K., Rau, G.: Bewertung der benutzer- und aufgabenorientierten Gestaltung bildgeführter Chirurgiesysteme. K.-P. Timpe, H.-P. Willumeit, H. Kolrep (Hrsg.): Bewertung von Mensch-Maschine-Systemen. 3. Berliner Werkstatt Mensch-Maschine-Systeme, 1999. Fortschr.-Ber. VDI Reihe 22 Nr. 1, VDI Verlag 2000: 46-63
  • Zimolong, A., Radermacher, K., Wirtz, D.C.: Benutzerorientierte Sicherheitskonzepte für Chirurgierobotersysteme. Orthopädische Praxis, 12/2000, 36. Jahrgang, S.746-750
  • Portheine, F., Radermacher, K., Staudte, H.-W.: Potentiale der CT-basierten Planung und schablonengestützten Ausführung in der Hüft- und Kniechirurgie. Orthopädische Praxis, 12/2000, 36. Jahrgang, S.786-791
  • Radermacher, K., Rau, G.: Computerassistierte Planung und Operation in der Orthopädie. Orthopädische Praxis, 12/2000, 36. Jahrgang, S.731-737
  • Schkommodau, E., Kaspers, G., Klapper, U., Radermacher, K., Staudte, H.-W.: Klinische Erfahrung mit der Individualschablonentechnik. Orthopädische Praxis, 1/2001, 37. Jahrgang, S.19-22 (2001)
  • Birnbaum, K., Schkommodau, E., Decker, N., Prescher, A., Klapper, U., Radermacher, K.: Computer assisted orthopedic surgery with individual templates and comparison to conventional methods. Spine, Vol. 26, No. 4, February 15 (2001), pp. 365-369
  • Zimolong, A., Friedrichs, D., Portheine, F., Radermacher, K., Traub, F., Staudte, H.-W.: Fluoroscopic Image Based Planning for Femoral Neck Surgery. Proc. 6th CAOS Symposium 2001, Davos, p.85
  • Schkommodau, E., Portheine, F., Radermacher, K.: Geometric Co-Relation Between Topogram-Tomogram for Computer Assisted Surgical Planning of Total Knee Replacement. Proc. 6th CAOS Symposium 2001, Davos, p.115
  • Radermacher, K., E. Schkommodau, St. Erbse, A. Zimolong, F. Portheine, S. Heger, W. Lauer, T. Wu, M. de la Fuente, N. Schiffers, St. Jetzki, D. Westrich, P. Bast, G. Brandt: Planung, Chirurgierobotik, Automation und Navigation in der orthopädischen Chirurgie. in: Weck, M. et al. (Hrsg.): 3. Symposium: Neue Technologien für die Medizin: – Forschung – Praxis – Innovation. Shaker-Verlag Aachen (2001), S.23-62
  • Zimolong, A., Radermacher, K., Zimolong, B., Rau, G.: Clinical Usability Engineering for Computer Assisted Surgery. in: Stephanides, C. et al. (eds.): Universal Access in HCI – Towards an Information Society for All. Lawrence Erlbaum Ass. Publ., 2001 (in press)
  • Frömel, M., Portheine, F., Ebner, M., Radermacher, K.: Computer Assisted Template Based Navigation for Total Knee Replacement. Fourth Annual North American CAOS/USA 2001 Conference, June 20-23, 2001, Pittsburgh, Pennsylvania USA
  • Portheine, F., Frömel, M., Radermacher, K.: Computerunterstützte Knie- Totalendoprothetik mit planungsspezifischen Bearbeitungsschablonen. Zeitschrift f. Biomedizinische Technik, Ergänzungsband, S. 370-371
  • Radermacher, K., Schkommodau, E., Brandt, G., Zimolong, A., Carrat, L., Merloz, Ph., Klos, T.V.S., Robb, J., Wirtz, D.C., Staudte, H.-W., Rau, G.: CRIGOS – Ein Kompaktrobotersystem für die bildgeführte Orthopädische Chirurgie. Zeitschrift f. Biomedizinische Technik, Ergänzungsband, S. 368-369
  • Radermacher, K., Westrich, D., Heilige, M., Brandt, G., Jungk, A., Rau, G.: PAROMIS – Ein Parallelrobotersystem für die sprachgesteuerte Kameraführung in der MIC. Zeitschrift f. Biomedizinische Technik, Ergänzungsband, S. 366-367

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