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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_605_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Biomedical Engineering in Gastrointestinal Surgery
- •Copyright
- •Contents
- •Foreword
- •Acknowledgments
- •2.1.3 Attrition and Erosion
- •2.2 Esophagus
- •2.2.1 Anatomical Description
- •2.2.2 Functional Task
- •2.2.3 Disorders and Diseases
- •2.2.4 Cancer
- •2.2.5 Biomedical Engineering Aspects
- •2.2.5.1 Internal (Endoscopic) Reinforcement
- •Reference
- •2.1 The Gastrointestinal Tract: an Overview
- •2.1.1 Structural Defects
- •2.1.2 Functional Defects
- •2.2.5.2 Implants
- •2.2.5.3 Electrical Stimulation
- •2.3 Stomach
- •2.3.1 Anatomical Description
- •2.3.2 Functional Task
- •2.3.3 Disorders and Diseases
- •2.3.4 Biomedical Engineering Aspects
- •2.4 Duodenum and Small Intestine
- •2.4.1 Anatomical Description
- •2.4.2 Functional Task
- •2.4.3 Disorders and Diseases
- •2.4.4 Biomedical Engineering Aspects
- •2.5 Colon and Rectum
- •2.5.1 Anatomical Description
- •2.5.2 Functional Task
- •2.5.3 Disorders and Diseases
- •2.5.4 Biomedical Engineering Aspects
- •2.6 Liver/Gallbladder
- •2.6.1 Anatomical Description
- •2.6.2 Functional Task
- •2.6.3 Disorders and Diseases
- •2.6.4 Biomedical Engineering Aspects
- •2.7 Pancreas
- •2.7.1 Anatomical Description
- •2.7.2 Functional Task
- •2.7.3 Disorders and Diseases
- •2.7.4 Biomedical Engineering Aspects
- •References
- •3.1 Definition
- •3.2 Basic Surgical Principles
- •3.2.1 Wound Healing, Wound Treatment
- •3.2.2 Indications for Surgery
- •3.2.2.1 Emergency Surgery
- •3.2.2.2 Urgent Surgery
- •3.2.2.3 Semielective Surgery
- •3.2.2.4 Elective Surgery
- •3.2.3 Steps of the Operation
- •3.2.3.1 Positioning on the OR Table
- •3.2.3.2 Incision
- •3.2.3.3 Exposure
- •3.2.3.4 Dissection
- •3.2.3.5 Resection
- •3.2.3.6 Specimen Retrieval
- •3.2.3.7 Viscerosynthesis/Reconstruction
- •3.2.3.8 Wound Closure
- •3.3 Structure and Organization of Surgical Care
- •3.3.1 Outpatient Surgical Care
- •3.3.2 In-Hospital Surgical Care
- •3.3.2.1 Emergencies in Visceral Surgery
- •3.3.2.2 Elective Surgery
- •3.3.2.3 Hospital Beds
- •4.1 Asepsis
- •4.1.1 The Detection of Antisepsis
- •4.1.2 Reprocessing of Surgical Instruments
- •4.1.3 Sterilization
- •4.2 Anesthesia
- •4.2.1 Sedation
- •4.3 Dedicated Workplace: The Operating Room
- •4.3.1 The Surgical Workplace
- •4.3.2 Core Elements of the Surgical Site
- •4.3.3 Stationary Systems
- •4.3.4 Typical Surgical Positions in Visceral Surgery
- •4.3.5 Maximum Load
- •4.3.6 Cleaning and Disinfection
- •4.3.7 Operating Lights
- •4.3.8 Peripheral Devices
- •4.3.9 Structural Preconditions
- •References
- •5.1 Conventional Radiology
- •5.1.1 Technical Aspects
- •5.1.2 Generation and Detection of X-Rays
- •5.1.3 Projection Radiography
- •5.1.4 Real-Time Radiography
- •5.2 Computed Tomography
- •5.2.1 Principle of Computed Tomography
- •5.2.2 Multislice Computed Tomography
- •5.2.3 Cone Beam Computed Tomography
- •5.2.4 Dual-Energy Computed Tomography
- •5.3 Magnetic Resonance Imaging
- •5.3.1 General Considerations
- •5.3.2 Technical Insights
- •5.3.3 Contrast Agents for Magnetic Resonance Imaging
- •5.3.4 Magnets
- •5.3.5 Real-Time Magnetic Resonance Imaging
- •5.3.6 Magnetic Particle Imaging
- •5.2.5 Dual-Source Computed Tomography
- •5.2.6 Phase-Contrast Computed Tomography
- •5.2.7 X-Ray Microtomography
- •5.2.8 Electron-Beam Computed Tomography
- •5.4 Diagnostic Ultrasound
- •5.4.1 History
- •5.4.2 Transducer Arrays
- •5.4.3 US Application in Visceral Medicine
- •5.4.4 Doppler Imaging
- •5.4.5 US Elastography
- •5.4.5.1 Acoustic Radiation Force Impulse Imaging
- •5.4.5.2 Shear Wave Elastography
- •5.4.5.3 Shear Wave Dispersion Ultrasound Vibrometry
- •5.4.6 3D/4D Ultrasound
- •5.4.7 Ultrasound Computed Tomography
- •5.5 Nuclear Imaging Systems
- •5.5.1 Gamma Camera
- •5.5.2 Positron Emission Tomography
- •5.5.3 Single-Photon Emission Computed Tomography
- •5.5.4 Conclusion
- •5.6 Advanced Optical Systems
- •5.6.1 Photodetectors
- •5.6.2 Optical Coherence Tomography
- •5.6.2.1 Time-Domain Optical Coherence Tomography
- •5.6.2.2 Fourier-Domain Optical Coherence Tomography
- •5.6.2.3 Fourier-Domain Doppler Optical Coherence Tomography
- •5.6.3 Optical Fluorescence Imaging
- •5.6.4 Hyperspectral Imaging
- •5.6.5 Diffuse Optical Imaging (Near-Infrared Optical Tomography)
- •5.6.6 Confocal Laser Scanning
- •5.6.7 Photoacoustic Imaging
- •5.6.8 Conclusion
- •5.7 Endoscopy
- •5.7.1 Rigid Endoscopes
- •5.7.2 Flexible Diagnostic Endoscopy
- •5.7.2.1 Flexible Scopes
- •5.7.2.1.1 The Handle
- •5.7.2.1.2 Connection to the Control/Supply Unit
- •5.7.2.2 Control/Support Unit
- •5.7.2.2.1 Imaging/Illumination
- •5.7.2.2.2 Suction/Irrigation/Insufflation
- •5.7.2.3 Instruments
- •5.7.2.4 The Endoscopic Trolley
- •5.7.2.5 Instrument Reprocessing
- •5.7.2.6 Clinical Applications
- •5.7.2.6.1 Colonoscopy
- •5.7.2.6.2 Enteroscopy, “Deep Endoscopy”
- •5.7.3 Autofluorescence Imaging Endoscopy
- •5.7.4 Computed Virtual Chromoendoscopy/Narrow Band Imaging (NBI)
- •5.7.5 Confocal Endomicroscopy
- •5.7.6 Endoscopic Optical Coherence Tomography
- •5.7.7 Endoscopic Ultrasound
- •5.7.8 Wireless Capsule Endoscopy
- •5.7.9 Conclusion
- •5.8 Hybrid Systems
- •5.8.1 Real-Time Virtual Sonography
- •5.8.2 Positron Emission Tomography/Computed Tomography
- •5.8.3 Single-Photon Emission Computed Tomography/Computed Tomography
- •5.8.4 Positron Emission Tomography/Magnetic Resonance Imaging
- •5.8.5 Single-Photon Emission Computed Tomography/Magnetic Resonance Imaging
- •5.8.6 X-Ray/MRI
- •5.8.7 Integrated Optical Coherence Tomography Ultrasound Imaging System
- •5.8.8 Integrated Optical Coherence Tomography and Positron Detection
- •5.8.9 Microscope Integrated Optical Coherence Tomography and Optical Coherence Microscope
- •5.9 Intraoperative Diagnostic Procedures
- •5.9.1 Ultrasound
- •5.9.2 Conventional Radiography (C-Arm)
- •5.9.3 Isocentric Radiography
- •5.9.4 Intraoperative Volume Data Acquisition
- •5.9.5 Intraoperative Computed Tomography/Magnetic Resonance Imaging
- •References
- •6.1 “Classical” Surgical Instruments for Conventional Surgery
- •6.1.1 Surgical Knives/Scalpels
- •6.1.2 Forceps/Tweezers
- •6.1.2.1 Basic Forceps Designs
- •6.1.3 Scissors
- •6.1.4 Fixation Instruments/Locking Forceps
- •6.1.4.1 Hemostats
- •6.1.4.2 Vascular Clamps
- •6.1.5 Retractors
- •6.1.6 Self-Retaining Retractors
- •6.1.7 Needle Holders
- •6.1.8 Others
- •6.2 Electrosurgery
- •6.2.1 Thermal Low-Temperature Effects
- •6.2.2 Hyperthermia and Devitalization
- •6.2.3 Thermal Coagulation
- •6.2.4 Thermal Desiccation
- •6.2.5 Thermal High-Temperature Effects
- •6.2.6 Carbonization
- •6.2.7 Vaporization
- •6.2.8 Principles of Electrosurgery
- •6.2.9 Physical Theories of Electrosurgery
- •6.2.10 Electrosurgical Techniques
- •6.2.11 Monopolar Technique
- •6.2.12 Electrosurgical Coagulation and Desiccation (Hemostasis)
- •6.2.12.1 Impedance-Controlled Electrocoagulation
- •6.2.12.2 Argon Plasma Coagulation
- •6.2.13 Electrosurgical Cutting
- •6.2.14 Electrosurgical Unit
- •6.2.15 Clinical Aspects of Electrosurgery
- •6.3 Ultrasound Dissection
- •6.4 Water Jet
- •6.5 Stapling Devices
- •6.5.1 Linear staplers
- •6.5.2 Linear Cutting Devices
- •6.5.3 Circular Staplers
- •6.6 Biomaterials
- •6.6.1 Surgical Suture Materials
- •6.6.1.1 Absorbability
- •6.6.1.2 Internal Structure
- •6.6.2 Surgical Mesh
- •References
- •7.1 Basics
- •7.1.1 Pneumoperitoneum
- •7.1.1.1 Creation of the Necessary Space
- •7.1.2 The Veress Needle
- •7.1.2.1 Insertion of the Veress Needle
- •7.1.3 Gas Insufflators
- •7.1.3.1 Insufflation Device
- •7.1.3.2 Creation of the Pneumoperitoneum
- •7.1.4 Trocars
- •7.1.4.1 Reusable Trocars
- •7.1.4.2 Disposable Trocars
- •7.1.4.3 Hybrid Systems
- •7.1.5 Visualization
- •7.1.5.1 Laparoscopes (Laparoscopic Telescopes)
- •7.1.5.1.1 Advanced Laparoscopes
- •7.1.5.1.2 Future Developments
- •7.1.5.2 Laparoscopic Cameras
- •7.1.5.3 Laparoscopic Image Processors (Camera Control Unit)
- •7.1.5.4 Monitors
- •7.1.5.5 3D Endoscopy
- •7.1.6 Light Source and Transmission
- •7.1.6.1 Halogen Lamps
- •7.1.6.2 Xenon
- •7.1.6.3 Halide Lamps
- •7.1.6.4 Condensing Lens
- •7.1.6.5 Illumination Control
- •7.1.6.6 Light Cables
- •7.1.7 Suction/Irrigation Device
- •7.1.8 Documentation
- •7.1.9 Equipment Cart
- •7.2 Hand Instruments
- •7.2.1 Forceps/Graspers
- •7.2.2 Dissectors
- •7.2.3 Scissors
- •7.2.4 Needle Drivers
- •7.2.5 Retractors
- •7.2.6 Laparoscopic Electrosurgery
- •7.2.7 Clips and Clip Appliers
- •7.2.8 Laparoscopic Stapling Devices
- •7.2.9 Laparoscopic Ultrasound Dissection
- •7.2.10 Impedance-Guided Dissection
- •7.3 Minilaparoscopic Procedures
- •7.4 Mono-Port (Single Port) Surgery
- •7.4.1 Trocars
- •7.4.2 Hand Instruments
- •7.4.2.1 The SPIDER Surgical System
- •7.4.2.2 Critical Comments and Outlook
- •References
- •8.1 “Operative” Endoscopes
- •8.1.1 Upper Gastrointestinal Scopes, Colonoscopes
- •8.1.2 Side-Viewing Duodenoscopes
- •8.2 Instruments
- •8.2.1 Knives
- •8.2.2 Hooks
- •8.2.3 Snares
- •8.2.4 Injection Needles
- •8.2.5 Forceps/Graspers
- •8.3 Clips
- •8.3.1 Standard endoscopic clips
- •8.3.2 Over-the-Scope-Clip
- •8.4 Clinical Applications
- •8.4.1 Gastrointestinal Bleeding
- •8.4.1.1 Injection Therapy
- •8.4.1.2 Thermal Hemostasis
- •8.4.1.2.1 Contact Methods
- •8.4.1.2.2 Noncontact Methods
- •8.4.1.3 Mechanical Methods
- •8.4.2 Percutaneous Endoscopic Gastrostomy
- •8.4.3 Endoscopic Resection of Neoplastic Tissue
- •8.4.3.1 Snare Polypectomy
- •8.4.3.2 Endoscopic Mucosal Resection
- •8.4.3.3 Endoscopic Submucosal Dissection
- •8.4.4 Endoscopic Interventions on the Bile Duct (ERCP)
- •8.4.5 Gastrointestinal Stenting
- •8.4.5.1 Bougienage and Balloon Dilatation
- •8.4.6 Outlook
- •References
- •9.1 Combined Laparoscopic-Endoscopic Procedures (CLEP)
- •9.1.1 Indications
- •9.1.2 Esophagus
- •9.1.3 Stomach
- •9.1.4 Duodenum
- •9.1.5 Colon
- •9.1.6 Contraindications
- •9.1.7 Tumor Localization
- •9.1.8 Defining the Line of Section (Margin)
- •9.1.9 Selection of the Appropriate Technique for Tumor Resection
- •9.1.10 Specimen Retrieval
- •9.1.11 Leak Test
- •9.1.12 Technical Considerations
- •9.2 Natural Orifice Transluminal Endoscopic Surgery—Surgery Without Visible Scars
- •9.2.1 Access into the Abdominal Cavity
- •9.2.1.1 Transgastric Approach
- •9.2.1.2 Transurethral Approach
- •9.2.1.3 Transvaginal Approach
- •9.2.1.4 Transcolonic Approach
- •9.2.2 Intestinal Closure
- •9.2.2.1 Clips
- •9.2.2.2 Suturing Devices
- •9.2.3 Flexible Staplers
- •9.2.4 Plicator-Like Devices
- •9.2.5 Rivets
- •9.3 Spatial Orientation
- •9.4 Illumination
- •9.5 Fog/Mist Elimination
- •9.6 Stabilization of the Horizon
- •9.7 View Extension
- •9.8 Three-Dimensional Stereoscopy
- •9.9 Multifunctional Endoscopes and Mechanical Platforms
- •9.9.1 Endosamurai
- •9.9.2 Anubis
- •9.9.3 SPOT (Single Port Overtube System), Technische Universität München
- •9.10 Outlook
- •References
- •10.1 Computerized Systems
- •10.1.1 Active Camera Holders
- •10.1.1.1 Automated Endoscope System for Optimal Positioning
- •10.1.1.2 Currently Available Active Camera Holders
- •10.1.1.3 Conclusion and Further Development
- •10.1.2.1 Zeus
- •10.1.2.2 DaVinci
- •10.1.2.3 New Developments
- •10.1.2.3.1 Titan SPORT
- •10.1.2.3.2 Senhance Surgical Robot System
- •10.1.2.3.3 MiroSurge
- •10.1.3 Computerized Platforms for NOTES
- •10.1.3.1 Electromechanically Controlled Conventional Endoscopes
- •10.1.3.2 Systems With Elements of Autonomous Locomotion
- •10.1.3.2.1 Endotic
- •10.1.3.2.2 Aer-O-Scope
- •10.1.3.3 Robotically Driven Instrumentation
- •10.1.3.3.1 Single Access and Transluminal Robotic Assistant for Surgeons (ISIS-STRAS)
- •10.1.3.3.2 C-SPOT
- •10.1.3.3.3 MASTER (Master and Slave Transluminal Endoscopic Robot)
- •10.1.3.3.4 Endomina
- •10.2 Nontethered (Cable-Less) Systems/Modular Assembling Reconfigurable Miniature Robots
- •10.2.1 ARES
- •10.2.2 ARAKNES
- •10.3 Special Aspects of Roboterized Surgery
- •10.3.1 Haptic Feedback
- •References
- •11.1 Optical Tracking Systems
- •11.2 Electromagnetic Tracking Systems
- •11.3 Fiber Bragg Grating Sensors
- •11.4 Radio-Based Tracking Systems
- •11.4.1 Radio-Frequency Identification Devices
- •11.4.2 RFID Applications in Health Care
- •11.4.3 Bluetooth
- •11.4.4 Wi-Fi
- •11.4.5 ZigBee
- •11.4.6 Ultra-Wide Band
- •11.4.7 RuBee
- •11.5 Acoustic Tracking Systems
- •11.6 Inertial Tracking Systems
- •11.7 Others
- •11.7.1 Depth Maps, 3D Surface Reconstruction
- •11.7.2 Passive Methods
- •11.7.2.1 Stereoscopy
- •11.7.3 Monocular Shape-From-x
- •11.7.4 Simultaneous Localization and Mapping
- •11.7.5 Active Methods
- •11.7.5.1 Time-of-Flight (ToF)
- •11.7.5.2 Structured Light (Color-Coded Triangulation)
- •11.8 Strengths and Weaknesses of Real-Time 3D Surface Reconstruction Methods
- •References
- •12.1 Hospital Information Systems
- •12.1.1 Specialty-Specific Extensions
- •12.1.1.1 Picture Archiving and Communication System
- •12.1.1.2 Others
- •12.1.2 Health Informatics On-Site
- •12.1.2.1 HIS in the Outpatients (Preadmission) Department
- •12.1.2.2 HIS in the Surgical Floor
- •12.1.2.3 HIS for Multidisciplinary Conferences
- •12.1.2.4 HIS in the OR
- •12.1.2.5 HIS and Quality of Care
- •12.1.2.6 Data Mining
- •12.2 Surgical Telematics/”Telesurgery”
- •12.2.1 Teleconsultation
- •12.2.2 Telepresence
- •12.2.3 Telesurgery
- •References
- •13.2 Cadaver Studies
- •13.3 Live Animal Training

Tracking and Navigation Systems
455
example, the intraoperative matching of the actual anatomy with the preoperatively gained 3D dataset could be significantly enhanced by intracanalicular
FBGs. Likewise , the configuration of an endoscope could easily be described
in real-time (which is currently done by EM tracking) (see
Section 11.2:
Electromagnetic Tracking Systems).
11.4 RADIO-BASED TRACKING SYSTEMS
Wireless indoor positioning systems have also become very popular in
recent years in medicine, partly even in the surgical OR.
As compared to optical, EM, and fiber bragg tracking, the spatial resolution is lower which makes them suitable for the tracking of persons or
larger devices, but not for, e.g., surgical instruments or smaller items.
Fig. 11.10 gives an overview.
Figure 11.10 The most common radio-based positioning technologies suitable for
biomedical use classified by resolution and scale in comparison to optical and electromagnetical tracking technologies. UWB: Ultrawide band, transmitting in microwave wavelength from 3.1 to 10.6 GHz; RuBee: transmitting in long wave at about
131 kHz; RF systems: working in four frequency bands: LF (125 kHz), HF (13.56 MHz),
UHF (433, 868-915 MHz) and Microwave (2.45, 5.8 GHz); Wi-Fi, Bluetooth and ZigBee
are already implemented techniques in many devices working in frequencies of 868
and 915 MHz, 2.4 and 5 GHz. Modified according to Liu H, Darabi H, Banerjee P, Liu J.
Survey of wireless indoor positioning techniques and systems. IEEE Trans SystMan
Cybern Appl Rev 2007;37(6):106780
[17].

456
Biomedical Engineering in Gastrointestinal Surgery
Radio-based real-time location systems (Radio RTLS) application can
be categorized into asset tracking, workflow improvement, and patient/
staff location
[18].
A major issue in surgery are Radio Identification Devices (RFID).
11.4.1 Radio-Frequency Identification Devices
RFID use electromagnetic fields to localize specific markers (tags)
attached to an object.
Currently, four different types of RFID exist.
• Low-Frequency RFID (LF RFID) with frequencies from 30 to
500 kHz (typically 125 kHz)
• High-Frequency RFID (HF RFID) with frequencies from 3 to
30 MHz (typically 13.56 MHz)
• Ultrahigh Frequency RFID (UHF RFID) with frequencies from 433/
850 to 950 MHz
• Microwave/Super Ultrahigh Frequency (S-UHF) with frequencies
from 2.4 to 2.5 and 5.8 GHz.
The higher the frequency, the better the range and data transfer rate.
On the downside, the modules become more prone to interference
caused by metallic objects or liquid in the area
ways to operate RFID tags: active or passive (
powered by batteries and send out information to the anchors whereas in
passive systems, the antenna coil of the RFID reader generates a high frequent electromagnetic field. This induces a voltage in the antenna coil of
the transponder tag. Additionally, there are semiactive tags available,
which operate similarly to the passive tag. Semiactive tags can power
[19]. There are two main
Fig. 11.11). Active tags are
Figure 11.11 Structure of a passive (A) and an active (B) RFID tag. It becomes clearly
visible that the design of the active tag is much more complex compared to the passive one. Miniaturization is challenging since a battery is necessary. All from MITI.

Tracking and Navigation Systems
Figure 11.12 Different types of passive RFID tags which can only hold a limited
amout of data. Reading range is mainly dependent on antenna size and design.
From MITI.
457
electronics used in conjunction with off-board sensors like thermal sensors or accelerometers and can store information in a volatile memory.
The range in active systems is specified as around 100 m with an achievable maximum of 500 m and in passive systems as under 10 m.
Simple transponders consist only of the antenna and the chip and can
hold a 96-bit long Electronic Product Code, while more sophisticated
tags are equipped with a EEPROM which can also be filled with data by
special RFID readers (
Fig. 11.12).
RFID readers
The RFID reader is a crucial hardware device which is establishing
the connection over one or more antennas to the transponder. The
RFID reader initiates and controls the communication with one or more
transponders.
A microcontroller or an ASIC (Application Specific Integrated
Circuit) communicates with the application software on one side with an
integrated interface (LAN, Wi-Fi, USB, RS232/485, etc.) and controls
the execution of software commands. In addition, the integrated controller is responsible for modulation of the signal for transmission and
demodulation of received signals, while the high-frequency module generates, after receiving the corresponding command, the electromagnetic
field (
Fig. 11.13).
There are a variety of different RFID readers available. Main differences are the working frequencies and transmission protocols which must
fit to the used tags, transmitting power, and communication interfaces.
Further more, more sophisticated readers can prevent interferences by

458
Biomedical Engineering in Gastrointestinal Surgery
Figure 11.13 Principle of an RFID reader: The ASIC communicates with the host
computer and controls the data stream in both directions with the HF-Interface connected to the internal or external antenna(s). From MITI.
different anticollision mechanisms. Depending on the application, three
major interferences can occur:
1. Tag-to-tag interferences (collision), when multiple tags are simultaneously energized by the reader and reflect the respective signals back.
Because of the scattered waves, then the reader cannot differentiate
the individual IDs of the tags. This can be overcome by integrated
anticollision algorithms
[20].
2. Reader-to-tag interferences, where a tag is located at the intersection
of two or more reader interrogation ranges and the readers attempt to
communicate with the tag simultaneously. This interference can be
eliminated by separating the interrogation range of the reader s
[21].
3. Reader-to-reader interference is induced when a signal from one
reader reaches other readers which can be overcome by integrated
RFID dense reader modes
[22].
In addition to powerful readers with connectors for one or more
antennas, RFID readers with already integrated antennas as mobile
devices or for less demanding applications are available.
RFID Antennas
There are several different designs of antennas available, which strongly
influence reading distance by the specific gain and beamwidth (
Fig. 11.14).
Higher beamwidth creates a broader area of coverage, but the beam will travel

Tracking and Navigation Systems
Figure 11.14 Comparison of RFID antennas for passive HF (13.56 MHz) RFID tags
(A) and for active (2.5 GHz) RFID tags (B). Because of the required energy transmission and technology, antennas for passive RFID tags are much larger than for active
technology. All from MITI.
459
a shorter distance. In addition, the maximal allowed energy for generating the
electromagnetic field depends on the antenna design. Also installation of several antennas with an overlapping field influences the data transmission—null
zones may occur where waves with the same circular motion overlap .
11.4.2 RFID Applications in Health Care
In recent years RFID technology has found its way into health care.
Applications to reduce the potential occurrence of adverse events in the
process of administration of drugs
patient flow
instruments were developed
[24], or even systems to count and track consumables and
[25] (Fig. 11.15).
[23], tracking systems to measure
11.4.3 Bluetooth
Bluetooth is part of the 802.15.1 standard and its recent iteration consists
of two types of operation modes:
• Classic
Bluetooth works in the 2.4 GHz frequency band just as ZigBee or
Wi-Fi but uses channels which do not overlap with the existing ones
from the two other technologies. An integrated frequency-hopping
tries to send messages automatically on free Bluetooth channels.

460
Biomedical Engineering in Gastrointestinal Surgery
Figure 11.15 (A) Prototype of a surgical RFID application: Counting and localizing of
abdominal sponges. In total nine towels are prepared, five are on the Mayo stand,
two in the patient, one is used in the bin and one is missing. (B) Surgical sponge
with integrated passive RFID tag
[25]. All from MITI.
• Low Energy
In recent years, the 4.0 standard for Bluetooth was introduced. The
new specification included “Low Energy” which, compared to the classic
version, offered a compelling price-performance ratio for modules with
predefined services, excellent battery performance but a slow update-rate.
According to
[26], Bluetooth modules consume 80% less power and
are, in general, less expensive compared to similar modules using Wi-Fi,
but the data throughput as well as the possible range with these modules
is less than that of other comparable technologies
[27]. Bluetooth Classic
uses 79 channels with a bandwidth of 1 MHz for communication while
Bluetooth Low Energy uses just 37 with a bandwidth of 2 MHz and three
additional channels for advertising. Both operation modes come with
“Adaptive Frequency-Hopping” which allows the modules to jump on
frequencies with less interference. In general, Bluetooth Classic requires
more channels for inquiry or connection pur poses which is why coexisting radio-based technologies in the same 2.4 GHz frequency band (such
as Wi-Fi) can interfere. Bluetooth Low Energy, on the other hand, uses
frequencies to avoid any interference problems (particularly with Wi-Fi).
Bluetooth trackers are relatively new and became fashionable
with the introduction of Bluetooth Low Eenergy. Bluetooth tracking
systems estimate the proximity to an anchor (beacon), but cannot calculate the exact location. Use of more than one beacon, however, generates overlapping areas resulting in sectors where something or someone
is located.

461Tracking and Navigation Systems
11.4.4 Wi-Fi
• Advantages: based on standards; networks can be used for other things
beside location tracking; high range; already deployed infrastructure
can be used.
• Disadvantage: problems with influences/interferences coming from
other networks or technologies in the same frequency band.
Access points of routers are used as anchors and small battery-powered
Wi-Fi modules are used as tags. These can either work in the 2.4 or
5 GHz frequency band. Infor mation is sent between the anchors and tags
to calculate/estimate a position for the user, based on measuring the
intensity of the received signal (received signal strength). A big disadvantage is the possibility of interference problems when using Wi-Fi on the
same channels/frequencies as other devices that create huge amounts of
data traffic. Also, metallic objects or liquid can cause signal fluctuations
and subsequently result in inaccurately calculated positions. But on the
other hand, existing Wi-Fi infrastructure can be used for location tracking
purposes and the possible detection range as well as data throughput rates
are high
[28].
11.4.5 ZigBee
• Advantages: b ased on standards; good performance even in difficult
environments; long battery lif e; cheap; tags communicating with
each other which can lead to building a bigger network consisting of
tags.
• Disadvantage: problems with interference still exist.
ZigBee is based on the IEEE 802.15.4 standard and extends it with a
specification regarding radio-based networks with a maximum range of
100 m. One of the features of ZigBee is the ability to link modules to a
network of tags (also called “Wireless Sensor Networks”) where each
device can communicate directly or through neighboring devices with
other devices in the network. The connections between the nodes are
dynamically updated and optimized in difficult conditions which leads to
accuracies of 1 m and a good battery life. ZigBee works in the 2.4 GHz
frequency band and is often used in the home automation as well as in
the location tracking sector. Problems with ZigBee arise through interference when it is used in coexistence with other technologies in the same
frequency band
[29].

462 Biomedical Engineering in Gastrointestinal Surgery
11.4.6 Ultra-Wide Band
• Advantages: high accuracy; no problems with interferences or difficult
environments; high range.
• Disadvantage: high costs.
Ultra-wide band (UWB) uses the frequency spectrum of 3.1 to
10.6 GHz and features a high-frequency bandwidth of more than
500 MHz and very short pulse signals (, 1 ns) which lead to very high
data rates
overlapping signals
[17]. These help to reduce reflections, multipath fading, and
[30]. UWB is being used more frequently in the last
years for accurate location tracking in research but has the big disadvantage of being too expensive. Due to its limited signal power, the maximum range of UWB is usually specified as 50 m
[31].
11.4.7 RuBee
RuBee is a radio-based technology designed for military and medical asset
tracking. It was developed by the company Visible Assets (Stratham, NH,
United States) and is represented by the IEEE standard 1902.1. The technology serves as an alternative to RFID and tries to overcome the
problems of this technology.
According to
the batteries of RuBee tags can last between 5 and 15 years. Low frequencies (131 kHz) lead to less power consumption and with a long
wavelength of 2289 m, it is less prone to interferences than other comparable technologies, such as RFID, even penetrating steel and water
Another advantage of RuBee is the high scalability with an anchor
being capable of managing up to 1000 tags. The tags come in a really
slim form factor (usually credit card size). On the downside, the data
throughput is worse than with Wi-Fi or ZigBee.
Although the technology comes with many advantages, such as being
classified as a “Non-Significant Risk” class 1 device in medical visibility
applications by the FDA or having no electromagnetical interference
(EMI) or electromagnetical compatibility (EMC) issues in the operating
room, we omitted it from the comparison in
that there was hardly any literature or empirical data available on RuBee.
In addition, we could not get any development kits from providers in
order to test and analyze the technology for ourselves.
[32], the detection range can be up to 100 feet and
[33].
Table 11.4. The reason is

463Tracking and Navigation Systems
Table 11.4 Comparison between radio-based technologies
Update-
Technology Scalability Price Accuracy
RFID / o 1 oo1
Wi-Fi 1 oo 11o
Bluetooth o 1 oo o11
ZigBee 11 o 1 o 11 1
UWB 1 2 11 11 1 1
rate Range Durability
11.5 ACOUSTIC TRACKING SYSTEMS
The efficiency and effectiveness of acoustic tracking and navigation
is impressively demonstrated by nature: Bats rely entirely—and
very successfully—on this sense. It is amazing how modifications
of frequency, loudness, etc., are harnessed to gain maximal information. In medicine, the first applications were in ambient assisted
living.
Acoustic sensors receive signals which are emitted by ultrasonic
emitters with frequencies above the audible range of the human ear, at
approximately 20 kHz, and determine their location via time-of-flight.
A si mple emitterreceiver pair delivers the distance obtained from the
simple beat timing. For estimation of a position in a three-dimensional
space at least one emitter and three receivers are required. An incre ase
in resolution can be achieved by three emitters and three receivers tune d
at different frequencies. Similar to infrared, the signals are distributed
and mostly stay in a room, which is why the technology is commonly
used to achieve room level o r subroom level accuracy. Its low propagation speed of about 340 m/s returns results with a l ow time resolution.
In addi tion, precision is affected by environmental variables like me dia
density, reflections of the signal wave, temperature, and humidity. The
limited accu racy and working volume limits the use of an acoustic
tracking system to applicat ions where low resolution is required.
However, with improvements of the tracking algorithm and within a
short tracking range, acoustic trackers are used to realize nonelectromagnetic tracking, achieving submillimeter accuracy, and h ave been
found u seful in cardiology studies where minimum electrical signal is
expected
[34].

464
Biomedical Engineering in Gastrointestinal Surgery
11.6 INERTIAL TRACKING SYSTEMS
In general, an inertial navigation system (INS) is used with the method
“Dead Reckoning” and requires two components: inertial sensors and a
starting position. Inertial sensors can include accelerometers, gyroscopes, or
magnetometers. They measure the (non)gravitational acceleration, the orientation, or the strength/direction of a magnetic field. With measurements
like these, distances, angles, or the cardinal position can be calculated and
used for further computation. Since the sensors can only detect changes
from one state to another (the difference between state s
position has to be set and known to the INS. From the state s
ing position, all changes/measurements are added up to determine the current state. Extremely precise laser-based inertial tracking systems are large,
expensive, and mainly developed for military use. However, in recent years
small and cheap microelectromechanical systems (MEMS), with sufficient
precision for most applications have become available. In contrast to laserbased systems, these have a sensor drift dur ing long-term use. Typically,
MEMS-based inertial tracking systems are used for control of robots, axes,
acceleration measurements, body tracking, and stabilizations. On the basis
of an inertial measurement unit, recently a system to determine the center
and s2), a starting
1
at the start-
0
Figure 11.16 A tiny triaxial MEMS is placed on the tip of an endoscope. The impact
of gravity on each of the three axes is determined. If the measuring frequency of the
sensor is sufficiently higher than the usual endoscopic video frame rate of about
25 Hz, angle rectification of each single image is feasible
EIT Health e.V., Erlangen, Germany.
[36]. Courtesy: Dr. K. Höller,
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