| Autor: |
Nau-Hermes, Maria |
| Přispěvatelé: |
Schmitt, Robert |
| Jazyk: |
němčina |
| Rok vydání: |
2014 |
| Předmět: |
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| Zdroj: |
Aachen : Apprimus-Verl., Ergebnisse aus der Produktionstechnik 2014,39 IX, 121 S. : Ill., graph. Darst. (2014). = Zugl.: Aachen, Techn. Hochsch., Diss., 2014 |
| Popis: |
In this thesis the Therapeutical Risk Index (TRI) is proposed as an approach to the risk assessment of image-guided minimally invasive surgery. The risk is defined as the probability of damaging sensitive structures. Such an assessment of the patient’s risk is inevitable if minimally invasive surgery is expanded to the medical fields e.g. otolaryngology, in which it causes a need for new highly innovative surgical techniques. These innovative techniques imply that several manipulation canals must be drilled into the otobasis in order to reach structures at the inner ear (Figure 1). One challenge connected with this are closely spaced collision structures (e.g. the facial nerve and carotid artery) in this area. Even small deviations of the manipulation canals from the image-based presurgical planning can damage relevant collision structures. It is only ethically justifiable if this knowledge can be used in the decision making process for or against such a surgical intervention. The proposed approach to risk assessment is based on principles from metrology and production engineering which has several advantages: One aspect is that there is a common understanding in metrology regarding terms like accuracy, uncertainty and precision as they are defined in the international vocabulary of metrology. Another aspect is the existence of several standardized approaches to the estimation of uncertainty and to the proof of capability in the field of metrology. The approaches to the estimation of uncertainties and process capabilities are transferred to the medical domain and form the basis for the definition of the TRI. First relevant factors that influence the process chain are identified: imaging with image processing and the navigation of the surgical instrument. Both factors are uncertain (uimag and unav) to some degree which can cause the unintentional damage of sensitive structures. These uncertainties are quantified for one example. To estimate the individual patient’s risk and to validate the proposed risk index TRI the CT data from 10 real patients are used and the index TRI is calculated individually for each patient. It is evident that the TRI is a suitable index for the risk assessment of image-guided minimally invasive surgery through the comparison of this index with the calculated risk of damaging sensitive structures with a mathematical model. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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