Abstracts Case 2: 6th july, 2012

Mastertrack Reconstructive Medicine

Title: Endovascular treatment of aortic arch aneurysms: ‘universal’ versus ‘custom made’ endograft design.
Maaike Braham, Koen Dijkstra, Esmée van Geffen, Jovita Schoffelmeer

Aneurysms of the aorta have become a common problem, however abdominal aneurysm treatments are more advanced compared to thoracic aneurysm treatments. This can be ascribed to the higher numbers of abdominal aneurysms, however also other factors are of influence. The thoracic site is more complex because of the aortas vital side branches and its curvature. Overall, the vessel properties of the aorta are different comparing both sites. Therefore, it is of importance to develop an endograft specifically for the aortic arch. The usage of an abdominal endograft in the aortic arch can lead to major complications. Thus, there is a demand for an endovascular procedure that can be used to repair aneurysms of the aortic arch, without the need for open surgery. The possibilities of a universal and a custom made endograft that covers the aortic arch and its side branches was explored. A universal endograft can be available in a few different sizes that together fit in all patients. This design is made in such a way that it can be molded in vivo, so that the fenestrations or side branches can be placed directly in front of the openings of the branches. A custom made endograft is especially designed for one patient, based on CT-angiography of the aortic arch. It takes more time before this endograft is fabricated and thus is less usable in acute cases. However, this tailor-made endograft fits perfectly and thus decreases the chance of complications.

Both designs will be explained and compared in our presentation.

Mastertrack Medical Signaling

An objective measurement of dyskinesia in Parkinson’s Disease using the Centre of Mass and the Centre of Pressure
Groep 1: Corine Janssen, Jos Thannhauser, Michelle Vos

Dyskinesia, the presence of involuntary movements, is a side effect of Parkinson’s Disease (PD) medication . Nowadays, diagnosticians use the UPDRS score to determine the severity of the dyskinesia. The goal of this study was to determine an objective measurement to measure the severity of dyskinesia. Two measurements were performed in the VICON Lab, a static measurement where the subject, a patient with Huntington’s disease, was aimed to stand still and another, also standing measurement whereas the subject performed a mental task. The results are analyzed by using the Centre of Mass and the Centre of Pressure and are compared to the results of a healthy person. The results show differences between the patient and the healthy person, which indicates that an objective measurements for dyskinesia in PD is possible.

Measurements of postural balance control in Parkinson's Disease: A comparison between methods.

Groep 2: Gert Jan Snel, Peter Somhorst en Lisanne Jansen Holleboom.

Parkinson’s disease is a progressive neurological disorder caused by necrosis of dopamine producing cells in the substantia nigra. Parkinson’s disease is characterized by several symptoms, e.g postural instability. This impaired postural balance is in clinical practice often measured with subjective tests like the pull test and the Berg Balance Scale. In clinical setting, accurate and quantifying tests should be available to measure the postural balance. This study will compare quantifying measurement techniques for balance control in a distorted and a non-distorted situation. The distorted situation requires advanced methods of data acquisition and analysis, which may lead to highly interpretable results. The study of the undistorted situation can be performed with simpler methods resulting in less-depth data, but can be implemented in clinical settings more easily. Both measurements will be compared for sensitivity, specificity, and the feasibility.

Quantitative assessment of motor fluctuations in Parkinson's disease patients using wearable sensors

Groep 3: Robert Helling, Marjolein Admiraal, Marjanne Piena

As Parkinson’s disease (PD) progresses, levadopa appears to become less effective in eliminating motor symptoms. Eventually some PD patients start to fluctuate between the ‘on’ and ‘off’ state. Currently the unified Parkinson’s disease rating scale (UPDRS) score in combination with a diary is often used to determine if the ‘on-off’ fluctuations form a pattern, which can be prevented with a change in the time schedule for levadopa administration. However this method is subjective and time consuming for the physician. This paper was aimed at finding a way to monitor and quantify the ‘on-off’ fluctuations with acceleration sensors over a time period of several days. Several analysis techniques for this data are compared in order to determine their feasibility. 


Incorporating rotational motion into an innovative novel colonoscopy controller

Groep 1: Jorn Beukinga, Roos Blankena, Ilse Kant, Bram Schermers, Jordy van Zandwijk

Colonoscopy is a medical procedure in which interior surfaces of the large intestine from rectum to caecum can be assessed. Despite the fact that this technique has been used widely as a screening method for various pathologies, the steering technique to control the scope is far from optimal. A novel steering design consisting of an add-on module provides joystick or one-handed control of the colonoscope, with intended benefits including more intuitive and user-friendly control. A short survey to investigate whether and how much rotation is required in colonoscopy was performed. Furthermore, this paper describes the design of a basic suspension system with a dispensable click-on docking station in order to allow two freedom degrees of rotation, thus facilitating the ease of operation.

Design of a loop-free endoscope system

Groep 2: Anke Christenhusz , Bart Cornelissen, Stefan Hummelink, Mirjam Peek, and Sygriet Rinsma.

Introduction: The purpose of this report is to find a solution to work efficient and stable with the scopes that are currently functioning in hospitals. There are two problems which this research focuses on. The first one is to eliminate looping in the patient. Secondly to reduce the rotation that takes place between the physician and the patient.
Methodology: Based on a design model and literature study, a new design is developed that complies with the requirements of the contemporary work environment and has a problem-free adaptation in the field
Results: To find a solution mainly literature research was performed. This information was used to make our design more realistic, especially literature of materials which are used in the medical field. Our choice therefore fell on a high-quality plastic in combination with a sliding frelon bearing. The great advantage of the design is its simplicity. By the choice of simple design, inexpensive yet strong materials and the probability to place the design on contemporary equipment, makes the design for many hospitals accessible.
Keywords: Endoscope, rotation, looping

Rotation mechanism for Scoopsupport

Groep 3: Colien Hazelaar, Marije Kamphuis, Danielle Koopman, Marit Lucas, Marleen Vonder

In the Netherlands 180.000 colonoscopies are performed each year and with the introduction of the colorectal cancer screening in 2013, it is expected that this will lead to 80.000 additional endoscopy procedures each year. However, the bi-manual steering of the endoscope isn’t very intuitive and the learn curve is quite long. Therefore, a system called Scoopsupport is designed that makes electromechanical remote control of the tip possible. The current steering mechanism of the endoscope will be replaced by a joystick. However, the current design doesn’t support rotation of the scoop and the goal of this project is to make a design of Scoopsupport that makes rotation possible while fulfilling other requirements. Different concepts (passive and active rotation) are described based on a problem analysis, function analysis and requirements. Some experiments are performed to choose the best concept. Finally one concept is chosen and is described in detail.

Supporting Scopesupport: solution design for rotation and looping

Groep 4: Jorit Boersen, Roelant Eigelaar, Richte Schuurman, Thomas van Steenbergen, Harm Weekenstroo

Recently, the Dutch department of health decided to set up a national screening program for colon cancer, scheduled for January 2013. This will led to an additional amount of 80.000 colonoscopies a year. Although colonoscopy has shown to be effective in screening for colon cancer, it still has its limitations including steep learning curve, difficult to control and looping. In order to address these problems, University of Twente and Olympus Netherlands developed Scopesupport, a more intuitive way of scope control using a controller. However, looping, which causes several other problems and rotation of the scope, which was found to be necessary in colonoscopy, are not addressed by this solution. This report focus primary on the amount of rotation needed to perform a colonoscopy and design of a solution to provide rotation of the scope using Scopesupport. Subsequent steps in a design process were followed and in hospital sessions were planned to discuss demands with primary users and to examine the amount of rotation needed. Secondary, this report focus on real time 3D tracking of the colonoscope, in order to provide a solution for looping

Go as a rocket on the socket!

Groep 5: Lex van Rossum, Erwin Krikken, Lidy Kuster, Maaike Koenrades, Frank Vos

By providing new insights into the world of endoscopy a new steering system for advanced interventions is being developed. This system is secured onto the conventional steering wheels making the body too heavy to handle. To stay ahead on the upcoming shortcomings our task was to develop a suspension system that meets the new requirements and does not anticipate any disruption to the physician. The design includes a ball and socket joint attached to the vertically placed endoscopic body. All desired rotation and translation movements of the shaft can still be carried out passively. The suspension system, at eye level, is attached to the endoscopic tower by a multipart arm which moves freely to any desired position and the intervention channel is still easily accessible. 


Stay focused on the procedure; don 0t worry about the devices and wires

Groep 6: Laura van Deden, Feike de Graaff, Michiel Klitsie, Laura Peeters, Dhabia Al Samarrai, Juliette Velu

Background: An endoscopic procedure is di_cult, the anatomy is complex and the steering is not intuitive. Therefore there are a lot of researches to improve the endoscopic procedure. One of the subjects of research is more intuitive steering, such as the Scoopsupport. In the Scoopsupport a connector is around the control body and with motors the steering wheels are driven. The

physician controls the motors with a joystick in the steering handle or with a single hand controller. However, the physician moves the control body during the procedure to steer the endoscope. Therefore the suspending system should be able to make the movements that are needed to steer the scoop well. Two major issues are the following from the control body from the movements of the physician and the z-rotation of the control body. Design Process: During the design process, solutions to these problems are found. The design holds the control body and follows the movements of the physician, without disturbing the procedure. The rotation of the control body is made with an actuator, that reacts on a rotation sensor in the steering handle. Solution: Curious? Friday the 6th of July we will present the whole design.