Introduction – Why AI in Medicine ? - Department of Computer ...

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14 Νοε 2013 (πριν από 3 χρόνια και 11 μήνες)

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+

MEDICAL ROBOTICS

CAUTION: The images displayed may be disturbing

-
Anvit Tawar

-
Alankar

Saxena

-
Pierre
Gennetay

-
Gaurav

Choudhary

+

Contents


Introduction


Why

AI

in

Medicine

?


History


Role

of

AI

in

Medicine


Surgical

Robotics


Benefits

of

Robots


Design

Challenges


Surgical

Assistance


Clinical

Application


ROBODOC


Da

Vinci



Nanomedicine


Desired

Properties


Design

Issues


Today

&

Tomorrow


Future

&

Ethical

Impact


Extraordinary

Applications


Genetic

Modification


Ethical

Issues


Possible

Risks


Further

Reading

&

References

2

+

Introduction

+

Introduction


Why AI in Medicine ?


Medicine

is

a

field

in

which

such

help

is

critically

needed
.



We

see

increase

in

expectations

of

the

highest

quality

health

care

and

the

rapid

growth

of

ever

more

detailed

medical

knowledge
.



This

leaves

the

physician

with

inadequate

time

to

devote

to

each

case

and

struggling

to

keep

up

with

the

newest

developments

in

his

field
.


Continued

training

and

recertification

procedures

encourage

the

physician

to

keep

more

of

the

relevant

information

constantly

in

mind
.


4

+

Introduction


Why AI in Medicine ?


But

fundamental

limitations

of

human

memory

and

recall

coupled

with

the

growth

of

knowledge

assure

that

most

of

what

is

known

cannot

be

known

by

most

individuals
.



This

is

the

opportunity

for

new

computer

tools
:

to

help

organize,

store,

and

retrieve

appropriate

medical

knowledge

needed

by

the

practitioner

in

dealing

with

each

difficult

case
.


T
o

suggest

appropriate

diagnostic,

prognostic

and

therapeutic

decisions

and

decision

making

techniques
.


5

+

History



With

intelligent

computers

able

to

store

and

process

vast

stores

of

knowledge,

the

hope

was

that

they

would

become

perfect

'doctors

in

a

box',

assisting

or

surpassing

clinicians

with

tasks

like

diagnosis
.







With

such

motivations,

a

small

but

talented

community

of

computer

scientists

and

healthcare

professionals

set

about

shaping

a

research

program

for

a

new

discipline

called

Artificial

Intelligence

in

Medicine

(AIM)
.


6

+

History



These

researchers

had

a

bold

vision

of

the

way

AIM

would

revolutionize

medicine,

and

push

forward

the

frontiers

of

technology
.


After

the

first

euphoria

surrounding

the

promise

of

artificially

intelligent

diagnostic

programs,

the

last

decade

has

seen

increasing

disillusion

amongst

many

with

the

potential

for

such

systems
.



Much

of

the

difficulty

has

been

the

poor

way

in

which

they

have

fitted

into

clinical

practice,

either

solving

problems

that

were

not

perceived

to

be

an

issue,

or

imposing

changes

in

the

way

clinicians

worked
.





7

+

Role of AI in Medicine


Medical

artificial

intelligence

is

primarily

concerned

with

the

construction

of

AI

programs

that

perform

diagnosis

and

make

therapy

recommendations

8

+

Role of AI in Medicine



AI

can

support

both

the

creation

and

the

use

of

medical

knowledge

:



Proponents

of

so
-
called

'strong'

AI

are

interested

in

creating

computer

systems

whose

behavior

is

at

some

level

indistinguishable

from

humans


An

AI

system

could

be

running

within

an

electronic

medical

record

system,

for

example,

and

alert

a

clinician

when

it

detects

a

contraindication

to

a

planned

treatment
.



AI

systems

also

have

a

very

different

role

to

play

in

the

process

of

scientific

research
.

In

particular,

AI

systems

have

the

capacity

to

learn,

leading

to

the

discovery

of

new

phenomena

and

the

creation

of

medical

knowledge
.



9

+

Role of AI in Medicine







Reasoning

with

medical

knowledge
:


Expert

or

knowledge
-
based

systems

contain

medical

knowledge,

usually

about

a

very

specifically

defined

task,

and

are

able

to

reason

with

data

from

individual

patients

to

come

up

with

reasoned

conclusions
.


10

+

Surgical Robotics

+

Benefits of Surgical Robots


Robots

can

perform

tasks

very

accurately

and

precisely
.

Hence

very

effective

for

Minimally

Invasive

Surgery

(MIS)



Less

Cutting,

Less

Complications

&

F
aster

Recovery
.


Can

work

in

inaccessible

or

non
-
human
-
friendly

zones,

such

as

inside

of

the

patient,

or

amidst

X
-
rays
.



Allow

for

Tele
-
Surgery

or

Remote

Surgery,

and

even

Unmanned

surgery,

where

no

human

is

directly

involved
.

12

+

Design Challenges


Surgical

Robots

present

a

unique

set

of

challenges

due

to

requirements

of

size,

sterility,

safety

and

dynamic

nature

of

patient’s

body
.


MANIPULATION
:

Require

ability

to

make

highly

dexterous

movements

in

small

spaces
.


STERILITY
:

Mainly

ensured

by

using

disposable

parts

and

sterile

drape

coverings
.

Leads

to

expensive

maintenance
.

13

+

Design Challenges (continued)


SENSING
:

Real
-
time

Force

and

Vision/Imaging

sensors

are

required

for

medical

purposes
.


INTERFERENCE
:


MRI

generates

high

magnetic

field

(
1
.
5
-
3

Tesla)

and

RF

pulses,

in

which

traditional

robotic

components

fail
.


Non
-
metallic

links

and

Piezo
-
Electric

or

Hydraulic

motors

are

hence

required
.


REGISTRATION
:


Transformation

between

coordinate

systems

of

the

body,

images,

robots

and

sensors
.


Parts

of

the

anatomy

change

shape,

and

thus

Dynamic

and

Non
-
rigid

transformations

are

required
.

14

+

Surgical Assistance


Medical

Interventions

are

highly

interactive

processes,

and

require

many

critical

decisions

to

be

made

on

the

spot
.

No

computational

system,

to

date,

possesses

the

judgment

&

intelligence

required
.


Goal

of

Surgical

Assistance
:

Not

to

replace

humans,

but

to

provide

with

intelligent

&

versatile

tools

to

augment

the

physician’s

ability
.


There

are

2

Basic

Augmentation

Strategies
:


Improve

the

physician’s

existing

ability,

for

example

by

providing

X
-
ray

vision

to

supplement

direct

vision


Increase

the

number

of

available

sensors

and

actuators
.

These

perform

tasks

such

as

endoscope

handling

or

limb

positioning

15

+

Surgical Assistance Paradigms


Control

Methods
:

Steady
-
hand

operation,

Motion

Scaling
.

Can

be

cooperative

or

teleoperative
.


Haptic

Feedback
:

Provides

force/tactile

feedback

to

the

surgeon,

thus

eliminating

the

awkwardness

due

to

lack

of

direct

contact
.


Information
-
enhanced

Assistance
:

Software
-
generated

force/position

signals

applied

to

the

human,

to

guide

his

movement

and

improve

accuracy

&

safety
.

16

+


Percutaneous

Needle
-
based

Surgery


Minimally

Invasive

Surgery



Less

cutting

through

the

skin
.












Exceedingly

Complex,

with

translation

and

rotation

along

different

axes

in

3
D,

and

bending

and

insertion

forces

of

varying

magnitude

making

it

a

delicate

procedure
.


Best

served

by

robots

that

provide

dexterous

movements

with

high

precision

&

accuracy
.

Clinical Application Examples

Image Courtesy:

Johns Hopkins

University

17

+

Clinical Application (continued…)


Neurosurgery


It

is

one

of

the

first

applications

of

surgical

CAD/CAM

(Computer
-
Aided

Design/Manufacturing)

systems
.











Initially,

robots

were

limited

to

passive

tool

positioning

devices,

but

they

are

now

used

as

active

robots,

carrying

out

various

manipulations

on

the

body
.


The

entry

and

target

points

are

planned

on

CT/MR

images
.

After

coordinate

transformations,

the

robot

places

a

needle

or

drill

guide,

and

executes

the

intervention
.

Image Courtesy:

Integrated Surgical Systems

18

+

ROBODOC


Developed

for

Total

Hip

Replacement

&

Total

Knee

Replacement
.







It

uses

CT

for

3
D

planning

and

modeling

of

the

prosthesis

with

the

body
.

A

robot

for

automatic

bone

milling

performs

the

surgery
.

Image Courtesy: Robotics & Automation Magazine, IEEE

19

+

Da Vinci Tele
-
Surgery System


The

system

improves

the

surgeon’s

skills

by

enabling

him

to

remotely

manipulate

tissue

through

incisions

which

are

too

small

for

direct

intervention
.

It

also

provides

arms

to

handle

endoscope,

scissors,

etc
.

at

the

patient
-
side

slave

robot
.

Image Courtesy: boston.com

20

+

Nanomedicine

+

22

+

Desired Properties


Small

and

A
gile

-

to

navigate

through

complex

network

of

veins

and

arteries
.




Capacity

to

carry

medication

or

miniature

tools
.



Assuming

the

nanorobot

isn't

meant

to

stay

in

the

patient

forever,

it

should

be

able

to

make

its

way

out

of

the

host
.

23

+

Design Issues

Three

main

considerations

that

need

focus
:


Navigation


Power


Locomotion


Most

options

can

be

divided

into

one

of

two

categories
:

external

systems

and

onboard

systems
.

24

+

External navigation systems


Using

ultrasonic

signals
.


Using

a

MRI

device


Doctors

at

Ecole

Polytechnique

have

successfully

maneuvered

a

small

magnetic

particle

through

a

pig's

arteries

using

MRI
.


25


Injecting

a

radioactive

dye


We

use

a

fluoroscope

to

detect

the

radioactive

dye

as

it

moves

through

the

circulatory

system
.



Complex

3
-
D

images

indicate

where

the

nanorobot

is

located
.


Image Courtesy: Google

+

Onboard navigation systems


Chemical

sensors



Detect

the

trail

of

specific

chemicals

to

reach

the

right

location
.



A

spectroscopic

sensor

would

allow

the

nanorobot

to

take

samples

of

surrounding

tissue,

analyze

them

and

follow

a

path

of

the

right

combination

of

chemicals
.


Miniature

television

camera


An

operator

at

a

console

will

be

able

to

steer

the

device

while

watching

a

live

video

feed
.

26

+

Powering the Nanorobot

3

kinds

of

powering

systems
:


U
sing

the

patient's

own

body

as

a

way

of

generating

power
.



P
ower

source

on

board

the

robot

itself
.


U
sing

forces

outside

the

patient's

body

to

power

the

robot
.

27

+

Internal Systems


Using

patient’s

body


Electrolytes

found

in

blood

:

A

nanorobot

with

mounted

electrodes

could

form

a

battery

using

the

electrolytes
.


Chemical

reactions

with

blood

:

The

nanorobot

would

hold

a

small

supply

of

chemicals

that

would

become

a

fuel

source
.


Onboard

Power

systems


Batteries



Nuclear

power


28

+

External Power Systems


Tethered

systems


These

need

a

strong

wire

between

the

nanorobot

and

the

power

source

which

should

move

effortlessly

through

the

human

body

without

causing

damage
.



A

physical

tether

can

supply

power

electrically

or

optically
.


Use

of

ultrasonic

signals


A

nanorobot

with

a

piezoelectric

membrane

could

pick

up

ultrasonic

signals

and

convert

them

into

electricity
.

29

+

Nanorobot Locomotion


Propulsion

of

the

bot

to

the

damaged

cell

is

essential
.




Because

it

may

have

to

travel

against

the

flow

of

blood,

the

propulsion

system

has

to

be

relatively

strong

for

its

size
.




Another

important

consideration

is

safety

of

the

patient

.

The

system

must

be

able

to

move

the

nanorobot

around

without

causing

damage

to

the

host
.


30

+

Nanorobot
Locomotion(Continued
…)


Using

Magnetic

Fields


Scientists

in

Israel

created

a

microrobot

with

small

appendages

to

grip

and

crawl

through

blood

vessels
.



Magnetic

fields

outside

the

patient's

body

cause

the

robot's

arms

to

vibrate,

pushing

it

further

through

the

blood

vessels
.


Capacitors


Use

capacitors

to

generate

magnetic

fields

that

would

pull

conductive

fluids

through

an

electromagnetic

pump

and

shoot

it

out

the

back

end
.



Miniaturized

jet

pumps

could

even

use

blood

plasma

to

push

the

nanorobot

forward
.

31

+

Nanorobots: Today and Tomorrow


Teams

around

the

world

are

working

on

creating

the

first

practical

medical

nanorobot
.



Robots,

a

millimeter

in

diameter

already

exist,

though

they

are

all

still

in

the

testing

phase

of

development
.



Today's

microrobots

are

just

prototypes

that

lack

the

ability

to

perform

medical

tasks
.


32

+

Nanorobots: Today and Tomorrow


In

the

future,

nanorobots

could

revolutionize

medicine
.



Doctors

could

treat

everything

from

heart

disease

to

cancer

using

tiny

robots

the

size

of

bacteria
.


Also

nanorobot

technology

could

be

used

to

re
-
engineer

our

bodies

to

become

resistant

to

disease,

increase

our

strength

or

even

improve

our

intelligence

making

us

super
-
humans
.

33

+

Nanorobots: Today and Tomorrow

Will

we

one

day

have

thousands

of

microscopic

robots

rushing

around

in

our

veins

healing

our

cuts,

bruises

and

illnesses?

With

the

growing

technology,

it

seems

like

anything

is

possible
.

34

+

Future & Ethical
Impact

+

Extraordinary possible
applications


Nanobots

in

bloodstream

displaying

type

of

present

bacteria

could

help

quicken

diagnosis
.


Artificial

red

cells

will

provide

a

mean

to

perform

blood

substitution,

treatment

for

anemia

and

lung

disorders


Artificial

phagocytes

will

help

in

destroying

microbiological

pathogens

36


Artificial

neurotransmitters

will

remedy

to

low

level

of

neurotransmitters

or

deficient

transport

of

neurotransmitters


Image Courtesy: nanobotmodels.com

+

Interest of genetic modification


Some

human

disease

involve

cellular

malfunction,

often

caused

by

defective

chromosomes

or

gene

expression



Solution

:

replace

genetic

material

in

cell

nucleus


Different

techniques

already

used
:


Viral,

bacterial,

chemical

carriers


Electrical,

UV

or

near

IR

pulses


DNA

microinjection

37

+

Chromosome replacement therapy


Hypothetical

cell

repairing

nanorobots

:

chromallocytes


They

travel

to

a

cell,

enter

its

nucleus

remove

existing

set

of

chromosomes,

replace

it

by

a

new

one

and

exit

the

body


Robert

Freitas

Jr
.

already

made

a

very

detailed

description

of

the

nano

devices,

their

structure,

energy

supply

mechanism,

functioning

,

as

well

as

the

medical

process

and

the

emergency

procedures

in

case

of

failure
.

38


The

treatment

of

an

entire

large

human

organ

would

require

1

trillion

devices

and

last

7

hours

Image Courtesy: nanobotmodels.com

+

Ethical issues


The

most

important

consequence

of

the

success

of

this

chromosome

replacement

therapy

would

be

the

possibility

to

repair

cell

damage

due

to

aging,

which

means

very

extended

lives


It

raises

some

ethical

issues

related

to

the

transhumanist

claim

:

it

is

possible

and

desirable

to

improve

the

human

condition

especially

by

developing

technologies

to

eliminate

aging

and

enhance

human

intellectual

physical

and

psychological

capacities


Transhumanists

study

potential

benefits

and

dangers,

and

ethical

matters

related

to

the

new

technologies

used


Even

if

technologies

are

new,

issues

have

already

been

discussed

during

the

genetic

therapy

debate

39

+

Possible risks


To

produce

the

nanobots

we

need

to

be

able

to

build

complex

structure

atom

by

atom

and

this

technology

could

be

misused


In

the

scenario

known

as

“grey
-
goo”

nano
-
robots

disassemble

everything

on

earth

to

produce

copies

of

themselves


Extended

life

span

could

cause

an

overpopulation

problem

with

too

many

birth

not

being

balanced

by

as

many

deaths
.

A

simple

solution

could

be

to

establish

a

control

of

the

bitrh

rate

40

+

Ethical decisions


Considering

the

possible

risks,

should

we

apply

the

precautionary

principle

and

b
an

research?


In

that

case

we

would

lose

enormous

potential

benefits
.



If

research

is

banned,

no

protection

will

be

there

against

misusage

of

nano

technology



The

best

solution

would

be

controlled

research

41

+

Further Reading & References


A

Practical

NanoRobot

for

Treatment

of

Various

Medical

Problems,

Leslie

Rubinstein,

Eighth

Foresight

Conference

on

Molecular

Nanotechnology,

November

2000
,

Foresight

Institute


Medical

Robotics,

Giancarlo

Ferrigno,

Guido

Baroni,

Federico

Casolo,

Elena

De

Momi,

Giuseppina

Gini,

Matteo

Matteucci,

and

Alessandra

Pedrocchi
,

IEEE

Pulse,

May/June

2011


Surgical

and

Interventional

Systems,

Peter

Kazanzides
,

Gabor

Fichtinger
,

Gregory

D
.

Hager,

Allison

M
.

Okamura,

Louis

L
.

Whitcomb,

and

Russell

H
.

Taylor
,

Robotics

and

Automation

Magazine

2008
,

IEEE


Medical

Nanobots
,

Kirk

L

Kroeker
,

Communications

of

the

ACM
,

September

2009


Surgical

Robots,

Ron

Alterovitz

&

Jaydev

P

Desai,

Robotics

and

Automation

Magazine

June

2009
,

IEEE


Robotic

Surgery,

Riccardo

Muradore
,

Davide

Bresolin
,

Luca

Geretti
,

Paolo

Fiorini
,

and

Tiziano

Villa,

Robotics

and

Automation

Magazine

September

2011
,

IEEE

42

+

Further Reading & References


http
:
//io
9
.
com/
5066893
/where
-
are
-
my
-
medical
-
nanobots


http
:
//robotzeitgeist
.
com/tag/medical
-
robot


http
:
//www
.
lasvegastribune
.
com/index
.
php?option=com_content&view=article&id=
88
7
:
medical
-
nanobots
-
could
-
end
-
disease
-
aging
-
in
-
2
-
decades&catid=
61
:
future
-
talk&Itemid=
128


http
:
//www
.
informationweek
.
com/news/galleries/healthcare/patient/
229100383
?pgno
=
1


http
:
//blog
.
speculist
.
com/biotechnology/the
-
age
-
of
-
medi
.
html


http
:
//www
.
cbc
.
ca/news/technology/story/
2007
/
12
/
27
/sperm
-
power
.
html


http
:
//scienceray
.
com/technology/medical
-
nanobots
-
tiny
-
robots
-
performing
-
miracles/



http
:
//en
.
wikipedia
.
org/wiki/Nanomedicine


http
:
//en
.
wikipedia
.
org/wiki/Molecular_nanotechnology


http
:
//
www
.
openclinical
.
org/aiinmedicine
.
html

43

+

Further Reading & References


http
:
//
edition
.
cnn
.
com/
2007
/TECH/science/
02
/
08
/ft
.
nanobots/index
.
html


http
:
//
www
.
dailytech
.
com/Scientists+Ready+New+Nanobots+to+Swim+in+Human+Bl
ood+Stream/article
14018
.
htm


http
:
//
findarticles
.
com/p/articles/mi_m
1594
/is_
4
_
20
/ai_n
32144798
/


http
:
//
news
.
bbc
.
co
.
uk/
2
/hi/science/nature/
7288426
.
stm


http
:
//nanogloss
.
com/nanobots/how
-
nanobots
-
can
-
repair
-
damaged
-
tissue/#
axzz
1
rDFKSinQ


http
:
//
www
.
nanobotmodels
.
com


http
:
//
jetpress
.
org/v
16
/freitas
.
pdf


http
:
//
www
.
foresight
.
org/Nanomedicine/Respirocytes
.
html


http
:
//
www
.
jetpress
.
org/volume
14
/freitas
.
html


http
:
//
www
.
transhumanism
.
org/resources/FAQv
21
.
pdf


http
:
//www
.
crnano
.
org/dangers
.
htm

44

The End

45