Augmented Reality and Surgery: helping surgeons achieve ever-greater accuracy

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Questions of health, well-being and personal independence are central preoccupations of all modern societies. Age-related illnesses, and our ageing populations, pose a number of social and economic challenges. Over the last two decades, information sciences and technologies have helped us rise to these challenges. Concepts such as distance health care and online treatment are now accepted as a part of everyday life. Among these new technologies, successive innovations in the field of medical imaging have been of particular significance. The Institut Mines-Télécom is a leading centre of research in this sector. Based at Télécom Bretagne, where she works with a multi-disciplinary team bringing together clinical scientists and researchers specialising in information processing, Chafiaâ Hamitouche has had a hand in numerous discoveries which have helped pave the way for the use of augmented reality technology in surgery.

 

Chafiaâ Hamitouche, a researcher at Télécom Bretagne, has long been interested in the potential of modelling technologies, starting from morphology modelling. “Form and function are interdependent. It’s thanks to the movement of the foetus inside the mother’s womb that joints are formed,” Dr. Hamitouche explains. Her work seeks to find  a new representation space forboth the morphology (form) and movement (function) of joints.

This research allows us to achieve a clearer understanding of certain joint and bone disorders, reflected in symptoms such as sprains and arthritis; treatment generally requires physiotherapy or surgery.

The rise of  Navigated Surgery

In 2001, Chafiaâ Hamitouche first began to take a particular interest in Computer Assisted  Orthopaedic Surgery. As she points out, “this is a sector where stakes are high: every year over 150,000 prostheses are implanted in France alone.” But decisions regarding the implant operation are still generally made on the basis of 2D X-rays, with no quantifiable control method. There is therefore always the risk that errors might arise, making the operation a failure.

The aim of  assisted surgery is to optimise the surgeon’s gesture, ensuring  its accuracy. This requires a change in the layout of operating room – introducing a 3D localizer and specially-adapted surgical instruments – and the use of guiding tools, some of which were developed at LaTIM[1]. These techniques allow surgeons to make their interventions less invasive, and sometimes shorter. They can also help avoid or limit X-ray exposure for patients and medical  staff.

And, as Dr. Hamitouche explains, “with 3D modelling and advanced imaging technology the surgeon can get a clear look at the bone structure of the patient before the operation, select the surgical instruments and plan the surgery accordingly.” During the operation, real-time fusion of multimodal (data from various sensors) information  is perfomed. This fusion of pre-operative and intra-operative data  allows the surgeon to see things which would otherwise be invisible or inaccessible due to the limited size of the incision or the presence of other tissues. Data  fusion can also help predict the consequences of a gesture (intervention) before it is made.

Mathematical modelling of biological forms, based on the morphogenesis process

Personalised treatment and surgery

Dr. Hamitouche continues to explore and expand the possibilities of guided surgery, and since 2010 has been working on radiofrequency ablation for bone tumours. “Augmented reality technology is the future of surgery,” she declares. Dr. Hamitouche and her team are currently working on an ambitious EU-backed project (ITEA2 programme), developing the interventional environment of next generation. The project is led by one of the world’s leading medical imaging specialists, Philips Healthcare, bringing together 27 partners from 4 different countries, including 6 French SMEs. Dr. Hamitouche is the coordinator of the French arm consortium, focusing on boosting the productivity and efficiency of surgical treatments and reducing patient risk and discomfort by helping doctors make the transition from invasive surgery towards minimally-invasive, image-guided techniques.

The operating room of tomorrow will be interactive and highly flexible, allowing professionals to tailor their procedures to the specific requirements of the patient. The techniques pioneered by Dr. Hamitouche and her team allow surgeons to plan their operations in great detail before they begin, and also to be more accurate and efficient in their use of radiation therapy to treat tumours.

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OSTESYS and IMASCAP, two companies born in our laboratories

High tibial osteotomy is a surgical technique for treating arthritis in the knees. It is a cheap, non-invasive and relatively quick surgical procedure performed on around 7,000 patients every year. But to achieve satisfactory long term results, the operation needs to be extremely accurate. OSTESYS was founded in March 2009, a spin-off from a project developed by Chafiaâ Hamitouche’s research team and focusing on osteotomy of the knee. The company produces intelligent medical equipment integrating augmented reality technology, with innovative surgical instruments and implants which allow surgeons to achieve maximum accuracy using minimally-invasive techniques.

IMASCAP is an innovative start-up launched in 2009 as part of an ANR project conducted in partnership with LaTIM and Nice University Hospital, specialising in Image Guided Shoulder Surgery. Total Shoulder Arthroplasty pose a number of problems: the soft tissue environment where the muscles are of utmost importance, and it can be difficult to visualise the structure of the shoulder. The new technology developed, provides a 3D reconstruction showing the different structures in the shoulder, which can be reliably connected to key points identified by palpation of the target area. This process makes the operation possible even in highly complex cases. This procedure is performed on around 25,000 patients every year in France alone. Find out more [/box]

From fundamental research to clinical application

Augmented reality technologies of this nature are now widely used in clinical contexts. These new solutions have been developed with substantial input from surgeons, helping to make their interventions more precise, cut costs and above all to protect patients’ well-being. This is certainly true of the work undertaken by the team since 2006 on the development of a new generation of predictive autonomous implants  . These prostheses incorporate electronic components and adjustable mechanical elements allowing for post-operative functional modifications.

The team’s researchers are currently working on four key technological challenges: achieving autonomous power by generating energy within the prosthesis, analysing ligament imbalance, installing telemetry system and  actuation. Further opportunities to launch new start-ups and create new jobs? Watch this space…

[author title=”” image=” https://imtech-test.imt.fr/wp-content/uploads/2017/10/Portrait_Chafiaa_réduit.jpg”]Chafiaâ Hamitouche would have been able to study medicine, but ultimately decided that her real passion was mathematics. She obtained her engineering degree in Algeria in 1987, winning an international doctoral scholarship in the process. More interested in signal processing than electronics, Dr. Hamitouche embarked upon a research career and was soon drawn to the medical sector. In 1988 she developed an interest in three-dimensional medical imaging, and in 1991 submitted her doctoral thesis, prepared at the Image and Signal Processing Laboratory of the University of Rennes 1 and focusing on a very promising subject: the analysis of three-dimensional medical images, applied to the extraction of anatomical structures.

Having always lived close to the sea, she chooses to continue her work in Brest, attracted by both the quality of research and the quality of life in Brittany. In 2005 she was officially accredited as a Research Director in the field of geometric and kinematics modelling in 3D medical imaging. She is now Professor of Image and Signal Processing at Télécom Bretagne, and deputy Director of LaTIM.

Dr. Hamitouche is involved with a number of projects in the field of augmented reality and its surgical applications, and has coordinated various national and European projects as well as supervising more than 12 doctoral theses. She is listed as co-inventor of 5 national and international patents and software innovations.

Nonetheless, Dr. Hamitouche is always keen to underline the importance of teamwork. When she first arrived at Télécom Bretagne, Christian Roux, now the school’s Scientific Director, was already working on bone and joint structures. Éric Stindel, an orthopaedic surgeon and the current Director of LaTIM, played a crucial role in the development of numerous innovations in orthopaedic surgery, innovations to which Dr. Hamitouche contributed. “I’ve also been lucky enough to work with some great doctoral researchers,” she hastens to add, describing their passion for Computer Assisted surgery which, in some cases, has resulted in business start-ups.[/author]

[1] LaTIM, is the Laboratoire de Traitement de l’Information Médicale (Laboratory of Medical Information Processing),  a combined research unit affiliated to INSERM (UMR1101) and including researchers from Brest University Hospital, the Université de Bretagne Occidentale and Télécom Bretagne.

Télécom SudParis, Maryline Laurent, Cybersécurité, Sécurité, Security, CVPIP

The security challenges of open IT systems

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In today’s society, IT security systems are seriously put to the test: cloud data storage, the omnipresence of micro chips, social networking… Not only does constant communication via networks expose cryptographic systems to multitudes of threatening connections, but security mechanisms must also now function on devices with weak computing capacity, such as mobile phones. The older algorithms are under strain, and increasingly vulnerable to identity fraud and other violations of privacy. Institut Mines-Télécom, and specifically, the Télécom SudParis R3S (Réseaux, systèmes, services et sécurité – Networks, systems, services and security) team led by Maryline Laurent, is facing up the challenge of making these systems secure. The work of this team, conducted in collaboration with other research laboratories and industrial partners, focuses on developing new architecture and advanced cryptographic technology.

 

One of the most significant contemporary security problems is data storage in clouds: “Nowadays, a system fitted with a single entry point is relatively easy to secure,” explains Maryline Laurent, “but when a cloud is distributed on any hardware featuring (disc) storage resources, the protection of confidential data against potential criminals becomes a real problem.” This is an issue for private users just as much as it is for professionals, given that routers (Internet provider boxes) connect our domestic devices to a worldwide system.

The R3S team is working in partnership with telephone service providers such as Orange to come up with solutions capable of improving the security of content. Their goal: to ensure that content remains confidential and anonymous. Maryline Laurent explains: “Each user on a network is provided with a unique identifier in order to be recognised. We adopted a two-stage approach, the first stage enabling the encryption of data using a symmetric key and the second stage enabling the symmetric key to be secured within the cloud using the ID-based method; the symmetric key, which enables encryption and decryption, is generated by the users based on their identifier.” Consequently, not only would hackers be unable to read the data if stolen, but they would not even be able to tell who the data belongs to.

Furthermore, the standard ID-based method now appears to be insufficient for open systems such as cloud computing. More often than not it is not just a single user, but entire groups of users who share and access the same data. A further refinement has therefore been implemented: “To increase security, we decided that our ID-based encryption would generate its key not just from the unique user identifier, but also from the data itself.” This provides a unique cloud, where each piece of data has its own unique identifier providing a summary of its content. To find data in such a system, you need to know what you are looking for.

 

The challenge of securing a passive system

However this method requires a high level of processing power on the part of the user, while today’s systems are increasingly portable and scaled down. “A further challenge,” says Maryline Laurent “is being able to quickly authenticate devices such as smart phones, which are limited to carrying out simple processing operations.” Whether by use of a password or some other means, this authentication should provide evidence that the network user is who they say they are.

Maryline Laurent has carried out research on an extreme case of lack of power, in relation to RFID (Radio Frequency Identification) chips, which are tiny and yet play an important role in identifying remote devices. The security drawbacks of RFID chips explain why Europe is so reluctant to use them. A new European regulation should also enable general regulations on data protection to be updated. In the United States, industrial groups have already established uses for RFID chips, which are, for example, now replacing labels and barcodes at Walmart. Incorporated within daily objects, they could even allow a handbag to be scanned instantly to see if it contains the cigarette lighter you’re looking for, or a stolen ring. However, this quickly poses a threat to privacy: without strong authentification, anyone could potentially search your bag without permission! Success in blocking access could be the key to opening the European market to RFID chips.

Resolving the issue of lack of power required an innovative solution. “We took the NTRU (N-th degree truncated polynomial ring) method, a highly promising public key method, and adapted it. It is now possible to divide up the cryptographic processes: the entire workload is given to the server and the RFID chip only has a few binary operations to perform.”

Technically, what has been developed is a light system of two-way authentification where the processing principle consists of converting the NTRU into a binary polynomial and proposing a new method of generating/multiplying polynomials. “We can now carry out multiplication using simple shift operations.”

RFID chips will also benefit from strong authentification. “Our RFID chips project is highly advanced and has enabled us to register two patents. And if this encryption functions on passive chips, it will of course function on any machine.”

 

Taking back control of identity

These two developments allow data to be secured, but there is another element to take into account in order for users to put their trust into the systems: the security of data flows. Maryline Laurent explains: “The classic example is Facebook; if you return to Facebook a year after you have unsubscribed, you will find that all the data in your profile has been retained. This does not comply with the right to erasure of data outlined by European regulations. In social networks as they are today, users are losing control of the information they transmit and produce, and are unaware of the location of their data, of whether it has been duplicated and who has access to it.”

Maryline Laurent’s team are working on this issue alongside the W3C (World Wide Web Consortium), the organisation which works to standardize web technologies. The concept works by testing solutions which enable the user to manage access and distribution of their data on a social network, using a resource named MyProfile. Amongst other things, the user is able to physically control their data, as if it appeared on a home computer. It is not the data of the user which is transmitted, but solely its location on the hard disk. This is made possible using semantic web technology, meaning the network is required to connect to the disk in order to access the data. Using this approach, if users wish to erase their data there is no way for anyone to gain access to it.

Unfortunately, it will be difficult to get social networks to adopt these privacy-respecting technologies, which are clearly a disadvantage to them. The solution is therefore to establish new rival networks. The general public is becoming increasingly aware of the risks and will, in theory, eventually migrate towards networks which will respect their privacy, giving them greater control over their personal data.

 

Maintaining security

Despite all these measures, is it possible for data to ever be truly secure? We are increasingly entrusting our secrets to a growing number of people. Ultimately, vulnerability does not occur as a result of the system but of the user: “Users do not really understand the consequences of decisions they make in relation to data and system security,” explains Maryline Laurent. “Our role as researchers is to come up with solutions to protect users from the risks connected with new technologies, to guide their decision making, and to give them the confidence to know that their efforts are not in vain.”

 

Maryline Laurent, Chaire VPIP, SécuritéThe Personal Information Values and Policies Chair

With a PhD in Information Science, Maryline Laurent now specialises in IPv4 and IPv6 (Internet Protocol) network security. As a professor at Telecom SudParis, for several years she has led research into the issues of security and data protection in cloud computing, under strain systems, social networks and identity management. As a result of this research, she now co-hosts the multidisciplinary Institut Mines-Télécom Chair launched in 2013, entitled Personal Information Values and Policies.

The aim of the Chair is to promote discussion around legal, ethical, economical and technical regulation of personal information and online identities. This team’s key strength is its multi-disciplinary approach: Maryline Laurent is responsible for the technological side of things, but she works alongside a legal practitioner, a philosopher and an economist! Their boundary-breaking work is yielding new solutions to a one of modern society’s most delicate problems.

 

René Garello, Vigisat, Océan, Télécom Bretagne, Ocean

An ocean of environmental data to be processed

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If nowadays we can detect icebergs along the route of the Vendée Globe, track and identify ships causing pollution from space, and define ecological corridors and reserves for the protection of animal species, it is largely thanks to stations which receive and process satellite images in real time, and the progress made in the last twenty years in the field of signal processing.

The creation of resources for environmental surveillance, sustainable management of marine resources and maritime safety is a key research priority of the Institut Mines-Télécom, and a field to which René Garello – a signal processing researcher at Télécom Bretagne, Director of GIS BreTel, and the recently elected president of the IEEE[1] OES (Oceanic Engineering Society) international academic association – has made major contributions.

 

Mapping, climate change, the battle against pollution, oceanography… a number of organizations working in these fields can be found in the city of Brest, with many of them collaborating at the Pôle Mer Bretagne competitiveness cluster, working together for a safe and sustainable maritime world. An expert at Pôle Mer and representative of the Brittany region for NEREUS (the Network of European Regions Using Space Technologies), René Garello is a key figure in this research community, covering both remote sensing and marine science.

 

Remote sensing and environmental observation

René Garello joined Télécom Bretagne in 1984, after three years at the NOAA (National Oceanic and Atmospheric Administration), the American agency responsible for the study of the ocean and the atmosphere. His thesis on radars for observation of the ocean surface led him to explore further practical applications, bringing valuable specialist skills to the agency.

Upon returning to France he continued to plough his own unique furrow, finding practical applications for scientific breakthroughs. While pursuing his research at Télécom Bretagne, the young researcher was also setting up European projects with German, British and Italian partners on marine surface observation and remote sensing. The first links were made with IFREMER (Institut Français de Recherche pour l’Exploitation de la Mer – French Research Institute for Exploitation of the Sea), which was commissioned by the IEEE OES with the organization of its flagship conference, OCEANS, in 1994. In 2005, René Garello chaired the second edition of the event in Brest.

The strength of his work lies in its two-dimensional approach to methods which were previously only used for one-dimension signal processing. “The starting point was signal processing, something which immediately interested me during my graduate studies, when I developed a particular interest in mathematics and its applications,” explains René Garello. Despite often relating to image-type data, this particular case was a question of two-dimensional signal processing as opposed to image processing.

Remote sensing is now carried out in ocean, coastal and inshore areas as well as both rural and urban areas for environmental purposes. VIGISAT (see text box) is a ground station for direct reception and analysis of satellite images, located in Brest and operated by CLS[2]. It provides ocean observation and surveillance services to a variety of organizations, including those responsible for government action at sea, defense, offshore construction, researchers and environmental associations…

 

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Vigisat, René Garello, BreTel, Télécom Bretagne

The station for direct reception in Brest

VIGISAT, a station for direct reception and analysis of satellite images operated in Brest.

This cutting-edge facility was created by a Télécom Bretagne start-up called Boost Technologies, set up in 2001 by Professor Vincent Kerbaol, in which René Garello was a founding partner. A technology transfer partnership (for data processing software) was set up between Télécom Bretagne and Boost. The goal of this venture was to create a satellite radar receiving ground station in Brest, but such an infrastructure raised complex management issues (cost, maintenance, contracts with the European Space Agency) and the VIGISAT platform eventually came to fruition at the end of 2009, once Boost received backing from CLS. VIGISAT receives, processes, analyzes and distributes high-resolution radar images from European and Canadian satellites, 24 hours a day and in real time. Learn more [/box]

 

A constant interplay between theory and practice

René Garello’s main interest is still finding new applications for signal processing in the maritime context. “The marine surface is of great interest to a signal processing specialist, and it’s a useful subject to study: the sea provides a statistic that is non-Gaussian, non-stationary and non-linear. None of the models given to students are still applicable. For example, the noise model is not additive but multiplicative, there is nothing we can find in text books”, explains the professor.

The marine surface constitutes a film of water otherwise known as “surface roughness”. Waves, swells, eddies, wind and boats are visible through variation in roughness. The difficulty in processing these images arises when a sea is in motion which results in a Doppler effect (the shift in frequency of a wave between the levels recorded at emission and reception, when the distance between these two points changes over a period of time) before interpretation using signal processing statistical tools takes place: speed of wave movement, currents, boats. These speeds need to be taken into consideration in order to produce accurate images.

“The scientific advances we have made have been linked to the fact that we were looking for spatially distributed information, and wanted to work towards an extremely high-resolution,” explains René Garello. “We managed to get around the problem of non-stationary data using small, linear pieces.” But, bypassing the standard scientific approach, René did not just try out a few signal processing methods to see which one would work the most effectively. He began by looking closer at the physical nature of the phenomenon, and called in some specialist assistance.

“We rely on our knowledge of the geo-physical data, and of the instrument, the radar, which gives us a model which takes into consideration the physical nature of the phenomenon and sensor interaction.” This back and forth relationship between upstream research in signal processing and downstream research in marine science has led to progress in both fields.

One recent example arose from a simple question: how can we detect internal waves from space? Internal waves are a marine phenomenon, remaining beneath the surface and, through the vertical displacement of a mass of water, causing modifications to the surface roughness. These waves exert an influence on the water column: their energy can affect moored structures and they act as barriers to underwater communications. A European project (MORSE) driven by René Garello focused on analyzing radar images from periods of known internal wave activity, in order to be able to quantify: “We measured the wavelength and height of the internal wave on the radar image, and with the in situ measurements, we were able to validate the model which enabled us to experience the phenomenon in three-dimension.”

This desire to continuously compare research with the field of application is central in the the scientist activities for the IEEE. With the issues of climate change and energy-saving (oil, deep-sea exploration, offshore wind power) becoming ever more important, René Garello is steering the association towards further research on renewable marine energy, one of the key themes of the Pôle Mer Bretagne cluster and the IEED (Institut d’Excellence dans le domaine des Énergies Décarbonées – Institute of Excellence in the field of Decarbonated Energies) based in Brest.

 

René Garello, Télécom BretagneBorn in 1953 in the South of France, René Garello has spent his whole career in academia. Following a Master’s degree in Telecommunications in Toulon in 1977, he completed his Master of Advanced Studies and PhD at the INP Grenoble (Institut Polytechnique de Grenoble – Grenoble Polytechnic Institute of Technology). After joining Télécom Bretagne in 1984, he was appointed professor in 1988 and earned the Habilitation to Supervise Research in 1994. He was elected Fellow of the IEEE for his scientific research in 2006.

René Garello explains his commitment to the IEEE professional association: “The IEEE pushes us to prove that what we are doing is useful for humankind: it has a political commitment too, working with policy-makers, at a global level. Each researcher networks with contacts in their own country, so we have representative groups with an interest in maritime activities in most countries worldwide.” René was elected president of the IEEE OES (Oceanic Engineering Society) at the end of 2012, a responsibility which is rarely given to a non-American.

The researcher now divides his time between the IEEE and the research he is carrying out at TOMS (Traitements, Observation et Méthodes Statistiques – Processing, Observation and Statistical Methods) team at the Brittany-based Lab-STICC. Now a multi-administrative team (UBO, UBS, Télécom Bretagne, ENIB, ENSTA Bretagne), it has been rated A+ by the Agence d’Évaluation de la Recherche et de l’Enseignement Supérieur (AERES –Agency for the Assessment of Research and Higher Education) and brings together 20 professors and 25 PhD students.

 

[1] The Institute of Electrical and Electronics Engineers is a large organization which brings together over 400,000 members from more than 40 academic associations. The IEEE organizes 850 conferences each year, with 2 million documents, almost 150 journals and over 1,300 projects and standards under development. Now present in 160 countries, the institute is primarily led and managed by American nationals.

[2] A subsidiary of the CNES (Centre National d’Études Spatiales – National Centre for Space Studies) and IFREMER, CLS operates and processes data from over 80 instruments embedded in some forty satellites.