Robotic Revolution

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As robots play an increasing role in modern medicine, the current and future generations of doctors have to get wired in.

The Zeno robot can initiate certain behaviors such as: look at me, follow me, imitate my facial gestures, imitate my head-eye motion, hand extension and grasping, hand waving, verbal dialogue, emotion recognition and head, face and hand coordination.
The Zeno robot has been used in therapy for children with autism who have trouble interacting with other people. It stands about 2 feet tall and looks similar to a small boy with an expressive face that has cameras for eyes so it can monitor what the child is doing.
Research being done with the Biomask at the Univeristy of Texas at Arlington Research Institute is meant to provide accelerated and higher-quality wound healing by providing capabilities to apply negative pressure wound therapy, deliver therapeutics and hold skin grafts in place while constantly monitoring the healing process.
The work being done at the University of Texas at Arlington Research Institute to develop the neuro-electrical interface consists of a set of electrodes that connect to the peripheral nerves in an effort to allow communication between the body and prosthetic devices.
Texas Health Harris Methodist Hospital Southwest utilizes Xenex disinfecting robots for advanced environmental cleaning of its healthcare facility.
The da Vinci System features a magnified 3D high-definition vision system and tiny wristed instruments that bend and rotate far greater than the human wrist. As a result, da Vinci enables your surgeon to operate with enhanced vision, precision, dexterity and control.
Below: Sophisticated patient simulators are being used in a new multidisciplinary educational facility in the Marion Emergency Care Center at Texas Health Harris Methodist Hospital Fort Worth.  The simulators respond to anesthesia gases, have heart sounds, lung sounds, real blood pressure and can sweat, bleed, vomit, urinate and speak.
Above: Texas Health Heart & Vascular Hospital Arlington on the campus of Texas Health Arlington Memorial Hospital has been using the Sensei X Robotic Catheter System since 2010. It allows the surgeon to manipulate a catheter inside the heart while seated at a computer console. It’s the only system of its kind in North Texas. For the patient, it means less anesthesia and less radiation exposure.
Below: Baylor All Saints Medical Center at Fort Worth recently introduced a robot they are calling S.A.R.A., which stands for Stroke Assessment Robotic Assistant. The remote presence robot will be utilized in the hospital’s stroke center. S.A.R.A. will allow doctors to provide life-saving care from miles away.
The Laboratory of Molecular Identification at UNT Health Science Center uses robots that allow the number of DNA analyses to skyrocket. One robot, for example, can analyze nearly 18,000 DNA samples per year.

| photography by Alex Lepe |
From medical mechanisms that can perform surgery while the doctor controls them nearby at a console to lifelike patient simulators being used in medical training that can sweat, breathe and bleed, usage of robots in the medical field is borderline science-fiction.
    Proven to reduce hospital stays and the effects of surgery and exposure to radiation, robotic surgical systems are oftentimes taking the place of traditional surgery. Some institutions are utilizing robots for therapy benefiting autistic children, DNA analysis in forensic laboratories or incorporating disinfecting robots for advanced environmental cleaning in patients’ hospital rooms and operating rooms.
    On the horizon, expect to see breakthroughs in research being done locally to help burn victims regenerate tissue or allow those who have lost a limb to use their peripheral nerves to communicate between the body and the robotic prosthetic device.
    Whether you’re ready for it or not, medical robotics is the wave of the future.
    Zeno Hanson Robotics creates robots that founder and chief scientist Dr. David Hanson calls Genius Machines. The Zeno robot tracks faces and sound, perceives facial expressions and mimics the user’s facial expressions. It is his belief that understanding human expressions can help to model human empathy and enable machine empathy. Hanson hopes to create robots with the same level of intelligence as people. The robots that he creates possess masterful facial expressions, conversational personalities, walking robot bodies and adaptive intelligence.
    “We seek to understand the fundamental nature of creativity, compassion and consciousness and the human perception of robots. We also creatively explore robots as works of art. Manufactured for real uses, our robots currently serve health, safety, and education, and scientific research at universities around the world. Although we have a ways to go before we achieve true Genius Machines, we’ve made real progress,” Hanson says in a statement on the Hanson website.
    The Zeno robot has been used in therapy for children with autism who have trouble interacting with other people. It stands about 2 feet tall and looks similar to a small boy with an expressive face that has cameras for eyes so it can monitor what the child is doing. Zeno can interact with children from different distances and can initiate certain behaviors such as: look at me, follow me, imitate my facial gestures, imitate my head-eye motion, hand extension and grasping, hand waving, verbal dialogue, emotion recognition and head, face and hand coordination.
    Dr. Nicoleta Bugnariu, associate professor of physical therapy at the UNT Health Science Center, has used the Zeno robot in her therapy. In an interview a few years ago, she spoke about its benefits. “We had this robot taken to the Dallas treatment center, and children that had previously had no interest in toys interacted with the robot,” Bugnariu said. “They had a very good reaction to it. We think that this [Zeno] can serve as a transition from non-human to human interaction.”
Biomask
An advanced therapeutic system for real-time monitoring and treatment of facial burns is being developed at the University of Texas at Arlington Research Institute (UTARI).

    UTARI works to bridge the gap between academic research and product development in the areas of Advanced Manufacturing, Biomedical Technologies and Robotics. They collaborate directly with UT Arlington faculty to promote undergraduate and graduate education by providing opportunities for research and development. Collaboration with government, industry and university partners to facilitate early stage product development in their disciplines is imperative. Their focus is to continue enabling product development to help humanity, providing unique, affordable solutions to complex problems.
    The Biomask is meant to provide accelerated and higher-quality wound healing by providing capabilities to apply negative pressure wound therapy, deliver therapeutics and hold skin grafts in place while constantly monitoring the healing process.
    Eileen Clements, director of research for UTARI, says, “We are developing a system to come into contact with a burn on the face. We can monitor but also deliver the necessary therapeutics that are needed in real time. Typically people with severe burns must go through several surgeries with skin grafts. The results leave a lot to be desired.”
    Researchers at UTARI are collaborating with surgeons at the Institute of Surgical Research at the U.S. Army Dental and Trauma Research Detachment and the Feinberg School of Medicine at Northwestern University.
    Clements says that the Biomask could be beneficial to those who have received burns during military missions. “In most military instances, there is a lot of body armor, but the areas at risk are the limbs and the face.”
    Current research is focused on devices and systems being applied to animal wounds so that they can better understand the wound-healing process. With its hard outer shell, flexible inner lining and 3D scanning technology, the Biomask would be used on patients who are immobilized in a hospital environment.
    “The idea behind the Biomask is to have a solution where the body can regenerate tissue,” Clements says.
Robotic Prosthetic Devices and Interfaces
The researchers at UTARI are also working on prosthetic devices and interfaces under their Biomedical Technologies discipline.

    Research focus is on two distinct areas of prosthetics. The first focus is to enhance long-term socket performance/fit of prosthetics. Smart-Fit Dynamic Interface will partner pressure sensors with pressure actuators and will provide a consistent comfort level at all times.
    The second area of focus is investigating the control of robotic prosthesis using signals from peripheral nerves. The work being done to develop the neuro-electrical interface consists of a set of electrodes that connect to the peripheral nerves in an effort to allow communication between the body and the device.
    “If you have someone who has lost part of their limb and want to fit them with a prosthetic, you could control it if you have the right input. You would be able to interface with the nerves to control that prosthetic device,” Clements says. “There are multiple ways that robotic prosthetics can be controlled. Our research shows a lot of promise.”
Xenex Disinfecting Robot
The Center for Disease Control estimates that more than 2 million people in the United States get an infection while in the hospital annually. More than 100,000 people die each year in the U.S. because of healthcare associated infections.

    Texas Health Harris Methodist Hospital Southwest utilizes Xenex disinfecting robots for advanced environmental cleaning of its healthcare facility. Resembling R2-D2, the Xenex is an ultraviolet portable unit on wheels that uses a Xenon bulb (a powerful, non-mercury form of UV light) combined with technology that generates high-intensity pulses. The robot can disinfect a room in five to 10 minutes.
    The Infection Prevention Coordinator at Harris Southwest, Dr. Kathy Rhodes, says the Xenex has decreased healthcare associated infections. “We know because of human error, it may be possible to miss an area. It’s almost impossible to make sure you get every single surface. We take healthcare-associated infections very seriously. It gives us the opportunity to guarantee that the rooms are clean.” Rhodes says the unit is well worth its $82,000 price tag.
    The Xenex has not replaced the disinfection process at the hospital but is used as an additional precautionary step to ensure the room is sanitary. While the Xenex is becoming more prevalent in the local hospital community, Harris Southwest was the first hospital in North Texas to get this ultraviolet technology.
Patient Simulators
Sophisticated patient simulators are being used in a new multidisciplinary educational facility in the Marion Emergency Care Center at Texas Health Harris Methodist Hospital Fort Worth.

    The director of the Fort Worth Emergency Collaborative at Texas Health Harris Methodist Hospital Fort Worth, Debbie Krauser, says, “When I first started, it was see one, do one, teach one. There were a lot of mistakes. One of the greatest benefits [of patient simulators] is that we don’t have to make mistakes on people anymore. We can create challenging situations during training and make sure these future doctors are equipped in handling these difficult scenarios.”
    These patient “robots” can talk, bleed, sweat, breathe and respond to medical procedures. Krauser says, “We can create just about any clinical scenario from a heart attack to stroke. You name it, and we can recreate it. The simulators respond to anesthesia gases, have heart sounds, lung sounds, real blood pressure and can sweat, bleed, vomit, urinate and speak. The entire clinical scenario can be recreated all the way through recovery in each acute-care setting. The possibilities for simulation are endless.”
    Through a computer monitor, students receive immediate feedback as to whether they are helping or hurting the patient. A camera also monitors their actions, so teachers can go through the scenario with the student after it ends. 
    Using an automatic feature on the simulator, teachers can either slow down or speed up the process of life-threatening illnesses. For students who are either newly out of school or uncertain about specific procedures, the simulator can exhibit scenarios for all levels and abilities. Additional scenarios can also be purchased.
    Currently the hospital has four simulators. They have personalized each one by naming them and creating identification for each. As a very important part of patient care, the training process includes simulations of the documentation process. The simulators vary in price depending on the fidelity they provide, but the average cost is $300,000.
Telemedicine
Robot Baylor All Saints Medical Center at Fort Worth recently introduced a robot they are calling S.A.R.A., which stands for Stroke Assessment Robotic Assistant. The remote presence robot will be utilized in the hospital’s stroke center. S.A.R.A. will allow doctors to provide life-saving care from miles away. When time is of the essence, this telemedicine technology allows for two-way video/two-way communications for health care providers who need access to neuro-stroke specialists at their facility’s emergency department. The neuro-stroke specialist can participate in consultation with emergency physicians to give timely and accurate clinical decision-making.

    Neuro-hospitalists based at Baylor University Medical Center in Dallas use iPads or laptops to connect with other Baylor medical centers whenever a call comes from their emergency departments.
    Dr. Timothy Jones, medical director of the emergency department at Baylor, says that telemedicine is the wave of the future. “When it comes to stroke, time is of the essence. Medicine that allows us to treat a stroke from a blood clot must be administered shortly after the stroke has taken place. By bringing the specialist bedside without any delay enhances the bedside experience and overall outcome.”
    The specific model that Baylor purchased is the RP Lite, which costs in the range of $80,000. Currently only one robot is required to handle the patient stroke load at any given time.
da Vinci Surgical System
With the da Vinci Surgical System, surgeons operate through just a few small incisions. The da Vinci System features a magnified 3D high-definition vision system and tiny wristed instruments that bend and rotate far greater than the human wrist. As a result, da Vinci enables your surgeon to operate with enhanced vision, precision, dexterity and control.
     The da Vinci Surgical System consists of several key components, including an ergonomically designed console where the surgeon sits while operating, a patient-side cart where the patient lies during surgery, four interactive robotic arms, a high-definition 3D vision system and proprietary EndoWrist  instruments.
     Russell Dickey is a USMD surgeon who has been specializing in robot-assisted, single site hysterectomy surgery since 2006. The main advantages for him include the high-definition, 3D view and the enhanced control and precision of the robotic instruments.
“The daVinci system has helped me improve outcomes for my patients in many ways. Complex operations that formerly required a large incision and a three-four day hospital stay can now be performed through small incisions on an outpatient basis.  I have seen that patients undergoing robotic surgery appear to have less pain and quicker recoveries compared to traditional surgery," Dickey says.
     USMD Surgeon Steven Schierling has been using the robot in single-site gallbladder surgery for about two years. He says, “My patients notice the definite difference in visible scarring. They are spared the scars in their upper abdomen, and the one main scar they do have is well hidden in their belly button and oftentimes cannot be seen at all. Additionally, my patients have enjoyed very good pain control and return to activity with this approach for surgery.”

Robotic Catheter System
Since 2010, Texas Health Heart & Vascular Hospital Arlington on the campus of Texas Health Arlington Memorial Hospital has been using the Sensei X Robotic Catheter System. It’s a state-of-the-art EP robotic navigation system that allows the surgeon to manipulate a catheter inside the heart while seated at a computer console. It’s the only system of its kind in North Texas. For the patient, it means less anesthesia and less radiation exposure.

    The benefits of the robotic catheter system exceeded the hospital’s expectations the first year. It had anticipated an additional 24 patients in 2010, but they instead saw an increase of 65 patients (a 76 percent year-over-year change). In 2014, it remains a successful program.
    Dr. William Nesbitt, cardiac electro physiologist at Texas Health Arlington Memorial Hospital, says, “In my experience, the robotic catheter procedure provides more stability for placement of ablation lesions. It provides for shorter procedure times and decreases the amount of radiation exposure. Better patient outcome is the ultimate goal.”
    Another major benefit of this system is that it decreases the amount of fatigue for the surgeon. “Typically I will do two or three in a day. You are seated and things are calm. Instead of standing in 20 pounds of lead for four hours, I am now sitting for three of those hours,” Nesbitt says.
DNA Analysis Robotics
The University of North Texas Center for Human Identification (UNTCHI) assists law enforcement officials across the country in missing persons’ cases. Law enforcement agencies and medical examiners can submit samples to UNTCHI to be processed for DNA free of charge. The DNA results are entered into the multi-tiered Combined DNA Index System (CODIS) and searched against other unidentified cases and the families of missing persons.

    UNTCHI has assisted with more than 180 identifications from Hawaii to New York, and experts there are dedicated to providing valuable genetic information to agencies for the identification of the loved ones whose lives have been cut short.
    UNTCHI consists of the Laboratory of Molecular Identification, located in Fort Worth, and the Laboratory of Forensic Anthropology in Denton. The Laboratory of Forensic Anthropology examines unidentified human remains to provide information regarding useful forensic details and the cause of death. Additionally, the Laboratory of Forensic Anthropology can assist in making identifications using medical records. The Laboratory of Molecular Identification develops genetic profiles from unidentified human remains and family references using cutting-edge DNA techniques and analysis.
    The database at UNTCHI was established in 2001. Texas was the first state with a Missing Persons laboratory capable of analyzing both mitochondrial and nuclear DNA, and it was the first to participate in the federal CODIS database for missing persons.
    Dr. Rhonda Roby, associate professor at UNT Health Science Center, says, “As a forensic scientist, one of my main interests is finding better, faster and more efficient methods of processing samples in a forensic DNA laboratory, especially in mitochondrial DNA. These methods include both liquid handling and data analysis systems. I have received two grants from the National Institute of Justice for high-throughput processing of mitochondrial DNA and developing software data for analysis.”
    The lab uses robots, which allow the number of DNA analyses to skyrocket. One robot, for example, can analyze nearly 18,000 DNA samples per year.
    There was a shift in the way robotics was used in the lab following the tragedy on Sept. 11, 2001. “The progression has been more apparent in the forensic laboratory. The entities working on 9/11 embraced robotics and expert system software in order to process all the samples in a timely manner. A lot of this technology already was there before the attacks, but the forensic laboratories are slow to change. We really had to adapt the technology because it was more efficient and offered higher throughput capabilities. After 9/11, it simply became more commonplace,” Roby says.

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