courses:456:2022:projects:456-2022-26:project-26

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======Evaluation of Various Sensing Modalities for Accurate Measurement of Neck Flexion Angle during Ear Surgery======
**Last updated: 5/1/22 at 6:00pm**


======Summary======
Enter a short narrative description here

Increasing evidence demonstrates that a surgeon’s operating posture can contribute to chronic pain. Specifically, trapezius muscle fatigue has been shown to be highest when neck flexion exceeds 30°. This study sought to accurately measure the surgeon’s neck flexion angle while performing ear surgery, comparing the risks of traditional “heads down” surgery to that of “heads up” endoscopic surgery


  * **Students:** Zihao Lin, Millan Patel
  * **Mentor(s):** Dr. Russell Taylor, Dr. Deepa Galaiya


======Background, Specific Aims, and Significance======
A paragraph or so here.  Give background of the problem. Explicitly state specific aims (numbered list is good) and explain why they are important

Nowadays, there is more and more evidence suggesting that specific posture of surgeon while operating can contribute to discomfort, cervical musculoskeletal strain, and chronic pain. Postural neck pain can be caused by several factors. The persistent neck flexion, long periods of static posture, and the long time use of microscopes and magnifiers lead the microsurgeons in a particularly high risk to the pain mentioned above. 

In this project, we are focusing on the surgeon posture during ear surgery. There are two kinds of surgical sceneries: traditional case and endoscopic case. When surgeons do ear surgery in a traditional way, they have to look through microscopes. It is obvious that surgeons have to band their necks, and even sometimes they need to band over their bodies in order to finish specific operations. The persistent neck flexion is the main factor that causes the discomfort. However, as for endoscopic cases, surgeons can make full use of the monitors. It is easier for them to keep the correct upright posture for most of the time. 

Poor surgical ergonomics may lead to surgeon disability:
  - A recent survey of plastic surgeons in the United States, Canada, and Norway showed that nearly two-third of respondents reported four neck discomfort related to their occupation. (1)
  - Among surveyed laparoscopic, ophthalmic, and general surgeons, the reported prevalence of musculoskeletal symptoms in the neck and shoulders is as high as 87%. (2)

It is crucial and meaningful for us to investigate:
  - The region of the neck flexion angle which the surgeon feels comfortable while operating.
  - The neck flexion angle data used to correct the new surgeons’ posture, preventing them from chronic injury again. 
  - The data which may help to show whether the endoscopic surgery have more advantages than the traditional surgery by comparison.

 // Khansa I, Khansa L, Westvik TS, Ahmad J, Lista F, Janis JE. Work‐related musculoskeletal injuries in plastic surgeons in the United States, Canada, and Norway. Plast Reconstr Surg. 2018;141(1):165e‐175e.
  Capone AC, Parikh PM, Gatti ME, Davidson BJ, Davison SP. Occupational injury in plastic surgeons. Plast Reconstr Surg. 2010;125(5):1555‐1561.//

======Deliverables======
 
  * **Minimum:**
    - Evaluation of the Existing Calibration Steps & Physical Model (exp. 3/2/22, Complete)
    - Documentation of Software Setting, Calibration Steps, and Physical Model (exp. 3/2/22, Complete)
    - Data Analysis Report and Documentation of Mock OR Experiment (exp. 4/10/22, Complete)
    - Data Analysis Report of Surgical Data from Previous Semester (exp. 4/10/22, Delayed)
    

  * **Expected:**
    - Improvement to Signal Processing of Measurements Obtained from IMUs (exp. 3/11/22, Complete)
    - Data Analysis Report of Real Surgical Scenarios (exp. 4/24/22, Delayed)

  * **Maximum:** 
    - Clinical Paper (exp. 5/4/22)


======Technical Approach======
here describe the technical approach in sufficient detail so someone can understand what you are trying to do

We hypothesize that neck flexion angle is greater than 30 degrees for a higher proportion of time during traditional open surgery, such as microscopic ear surgery, than during minimally invasive endoscopic surgery, such as endoscopic ear surgery.

For this study, the software and the surgical simulation environments for data collection was arranged. In order to confirm the accuracy of neck flexion measurements, the IMUs’ pitch angle was calibrated against a known angle measured by an electromagnetic tracker (EM tracker), and a linear regression model is used to derive the calibration.

Next, the mathematical model for pitch angle calculation was derived using quaternion and rotation matrices. The quaternions of the IMUs were collected for both the reference posture (standing normally and neutrally for one minute) and in the operating posture. We converted the quaternions to Euler angles in order to calibrate the pitch component using the linear regression model mentioned above. Then, the calibrated Euler angles were converted into rotation matrices. For both IMUs, we calculated the difference rotation matrices between the reference position data and the surgical position data. Finally, the difference rotation matrix between the two IMUs was calculated and converted into Euler angles with X, Y, and Z components. The X component, or the pitch angle, was the neck flexion angle of our interest.

We collected data for seven head movements, including turning the head in the X, Y and Z planes periodically, rotating the head in all directions, and shaking the shoulders to confirm the rationality of our algorithm. We then performed mock surgical procedures in a simulated operating room setting. Two surgical scenarios were simulated in order to compare traditional surgery with endoscopic surgery.
======Dependencies======
describe dependencies and effect on milestones and deliverables if not met
  - Computer with Linux & ROS
    * Effect: Affects ability to analyze experimental data and run the calibration
    * How to Resolve: Use our own computers or another computer from CIIS lab for calibration
    * Alternative Plan: Use Backup files in another computer
    * Date Expected: 3/6/22
    * Date Solved: 2/22/22 
  - Two IMUs
    * Effect: Affects ability to collect data during Mock and real surgeries
    * How to Resolve: Provided by Dr. Deepa Galaiya
    * Alternative Plan: Purchase two new IMUs
    * Date Expected: 2/7/22
    * Date Solved: 2/7/22 
  - MATLAB for Data Analysis Dropbox for Data Saving
    * Effect: Affects ability to analyze experimental data and run the calibration
    * How to Resolve: Install MATLAB on all relevant computers
    * Alternative Plan: Use Python/Google Colab
    * Date Expected: 3/1/22
    * Date Solved: 3/1/22 
  - Actual Surgery Data
    * Effect: Real surgical data is needed for the analysis and clinical paper
    * How to Resolve: Get data from Hyonoo who is responsible for collecting actual surgery data in medical school
    * Alternative Plan: Do all the measurement in Mock OR. Decrease goal of 10 surgeries to 5.
    * Date Expected: 3/3/22
    * Date Needed: 3/21/22 (Unmet)
  - Eggshell Drilling Experiment Data
    * Effect: This data is needed to compare favorable and unfavorable ergonomics for the clinical paper
    * How to Resolve: Dr. Galaiya performs surgery in Mock OR
    * Alternative Plan: Use assistance by other graduate students
    * Date Expected: 3/12/22
    * Date Solved: 3/21/22 
======Milestones and Status ======
  - Linux and ROS Environment Configuration Finished
    * Planned Date: 2/22/22
    * Expected Date: 2/22/22
    * Status: Complete
  - Evaluation of IMU Calibration and Mathematical Model Finished
    * Planned Date: 3/2/22
    * Expected Date: 3/2/22
    * Status: Complete
  - First Measure in Mock OR and Analysis of the Data Finished
    * Planned Date: 3/11/22
    * Expected Date: 3/11/22
    * Status: Complete
  - Complete Documentation of Mock OR Data Analysis
    * Planned Date: 3/27/22
    * Expected Date: 3/27/22
    * Status: Complete
  - Data Analysis of Existing Surgical Measurement Finished
    * Planned Date: 3/27/22
    * Expected Date: 4/10/22
    * Status: Incomplete
  - Collect Mock OR Measurement from Eggshell Drilling Experiment Finished
    * Planned Date: 4/3/22
    * Expected Date: 4/3/22
    * Status: Incomplete
  - Data Analysis of Mock OR Measurement from Eggshell Drilling Experiment Finished
    * Planned Date: 4/10/22
    * Expected Date: 4/10/22
    * Status: Incomplete
  - Data Analysis of New Surgical Measurement Among Various Surgery Scenarios Finished
    * Planned Date: 4/17/22
    * Expected Date: 4/17/22
    * Status: Incomplete
  - Documentation of Data Collection and Data Analysis Finished
    * Planned Date: 4/24/22
    * Expected Date: 4/24/22
    * Status: Incomplete
  - Clinical Paper Finished
    * Planned Date: 5/4/22
    * Expected Date: 5/4/22
    * Status: Incomplete



======Reports and presentations======

  * Project Plan
    * {{ :courses:456:2022:projects:456-2022-26:ciis_presentation.pdf |Project Plan Presentation}}
    * {{ :courses:456:2022:projects:456-2022-26:plan_proposal.pdf |Project Plan Proposal}}
  * Project Background Reading 
    * See Bibliography below for links.
    * {{ :courses:456:2022:projects:456-2022-26:background_reading_report.pdf |Paper Seminar Report}}
    * {{ :courses:456:2022:projects:456-2022-26:1-s2.0-s0196070916305415-main.pdf |Seminar Paper}}
  * Project Checkpoint
    * {{ :courses:456:2022:projects:456-2022-26:ciis_checkpoint_presentation.pdf |Project checkpoint presentation}}
  * Paper Seminar Presentations
    * {{ :courses:456:2022:projects:456-2022-26:background_reading_presentation.pdf |Seminar Presentation}}
    * {{ :courses:456:2022:projects:456-2022-26:sem_paper.pdf |Seminar Paper 1}}
    * {{ :courses:456:2022:projects:456-2022-26:1-s2.0-s0196070916305415-main.pdf |Seminar Paper 2}}
  * Project Final Presentation
    * {{ :courses:456:2022:projects:456-2022-26:final_poster_final.pdf |PDF of Poster}}
  * Project Final Report
    * {{:courses:456:2022:projects:456-2022-26:final_report_group26.pdf |Final Report}}
    * links to any appendices or other material

======Project Bibliography=======

Du, Y., Shih, C., Fan, S. et al. An IMU-compensated skeletal tracking system using Kinect for the upper limb. Microsyst Technol 24, 4317–4327 (2018).

Islam, Tariqul, et al. "Comparison of complementary and Kalman filter based data fusion for attitude heading reference system." AIP Conference Proceedings. Vol. 1919. No. 1. AIP Publishing LLC, 2017.
 
Won, Seong-hoon, William Melek, and Farid Golnaraghi. "Position and orientation estimation using Kalman filtering and particle diltering with one IMU and one position sensor." 2008 34th Annual Conference of IEEE Industrial Electronics. IEEE, 2008. 

Lakhiani C, Fisher SM, Janhofer DE, Song DH. Ergonomics in microsurgery. J Surg Oncol. 2018;118(5):840–844. doi:10.1002/jso.25197

Vaisbuch Y, Aaron KA, Moore JM, et al. Ergonomic hazards in otolaryngology. Laryngoscope. 2019;129(2):370–376. doi:10.1002/lary.27496

Wong K, Grundfast KM, Levi JR. Assessing work-related musculoskeletal symptoms among otolaryngology residents. Am J Otolaryngol. 2017;38(2):213–217. doi:10.1016/j.amjoto.2017.01.013

Wang R, Liang Z, Zihni AM, Ray S, Awad MM. Which causes more ergonomic stress: Laparoscopic or open surgery?. Surg Endosc. 2017;31(8):3286–3290. doi:10.1007/s00464-016-5360-5

Zihni AM, Cavallo JA, Ray S, Ohu I, Cho S, Awad MM. Ergonomic analysis of primary and assistant surgical roles. J Surg Res. 2016;203(2):301–305. doi:10.1016/j.jss.2016.03.058

Nguyen NT, Ho HS, Smith WD, et al. An ergonomic evaluation of surgeons' axial skeletal and upper extremity movements during laparoscopic and open surgery. Am J Surg. 2001;182(6):720–724. doi:10.1016/s0002-9610(01)00801-7

======Other Resources and Project Files======
Here give list of other project files (e.g., source code) associated with the project.  If these are online give a link to an appropriate external repository or to uploaded media files under this name space (2022-01).

[[https://www.dropbox.com/home/Ergonomics/IMU%20Neck%20Angle%20Study
https://www.dropbox.com/home/Ergonomics/IMU%20Neck%20Angle%20Study|Code and Documentation Dropbox Link]]
courses/456/2022/projects/456-2022-26/project-26.txt · Last modified: 2022/05/17 19:05 by mpatel73