@article{DoblerMaierKnottetal., author = {Dobler, Barbara and Maier, Johannes and Knott, Bernadette and Maerz, Manuel and L{\"o}schel, Rainer and K{\"o}lbl, Oliver}, title = {Second Cancer Risk after simultaneous integrated boost radiation therapy of right sided breast cancer with and without flattening filter}, series = {Strahlentherapie und Onkologie}, volume = {192}, journal = {Strahlentherapie und Onkologie}, number = {10}, publisher = {Springer Nature}, address = {Heidelberg}, doi = {10.1007/s00066-016-1025-5}, pages = {687 -- 695}, abstract = {Background The aim of this study was to investigate if the flattening filter free mode (FFF) of a linear accelerator reduces the excess absolute risk (EAR) for second cancer as compared to the flat beam mode (FF) in simultaneous integrated boost (SIB) radiation therapy of right-sided breast cancer. Patients and methods Six plans were generated treating the whole breast to 50.4 Gy and a SIB volume to 63 Gy on CT data of 10 patients: intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), and a tangential arc VMAT (tVMAT), each with flattening filter and without. The EAR was calculated for the contralateral breast and the lungs from dose-volume histograms (DVH) based on the linear-exponential, the plateau, and the full mechanistic dose-response model. Peripheral low-dose measurements were performed to compare the EAR in more distant regions as the thyroids and the uterus. Results FFF reduces the EAR significantly in the contralateral and peripheral organs for tVMAT and in the peripheral organs for VMAT. No reduction was found for IMRT. The lowest EAR for the contralateral breast and lung was achieved with tVMAT FFF, reducing the EAR by 25 \% and 29 \% as compared to tVMAT FF, and by 44 \% to 58 \% as compared to VMAT and IMRT in both irradiation modes. tVMAT FFF showed also the lowest peripheral dose corresponding to the lowest EAR in the thyroids and the uterus. Conclusion The use of FFF mode allows reducing the EAR significantly when tVMAT is used as the treatment technique. When second cancer risk is a major concern, tVMAT FFF is considered the preferred treatment option in SIB irradiation of right-sided breast cancer.}, language = {en} } @article{MaierKnottMaerzetal., author = {Maier, Johannes and Knott, Bernadette and M{\"a}rz, Manuel and L{\"o}schel, Rainer and K{\"o}lbl, Oliver and Dobler, Barbara}, title = {Simultaneous integrated boost (SIB) radiation therapy of right sided breast cancer with and without flattening filter - A treatment planning study}, series = {Radiation oncology}, volume = {11}, journal = {Radiation oncology}, publisher = {BMC, Part of Springer Nature}, doi = {10.1186/s13014-016-0687-6}, abstract = {Background: The aim of the study was to compare the two irradiation modes with (FF) and without flattening filter (FFF) for three different treatment techniques for simultaneous integrated boost radiation therapy of patients with right sided breast cancer. Methods: An Elekta Synergy linac with Agility collimating device is used to simulate the treatment of 10 patients. Six plans were generated in Monaco 5.0 for each patient treating the whole breast and a simultaneous integrated boost (SIB) volume: intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT) and a tangential arc VMAT (tVMAT), each with and without flattening filter. Plan quality was assessed considering target coverage, sparing of the contralateral breast, the lungs, the heart and the normal tissue. All plans were verified by a 2D-ionisation-chamber-array and delivery times were measured and compared. The Wilcoxon test was used for statistical analysis with a significance level of 0.05. Results: Significantly best target coverage and homogeneity was achieved using VMAT FFF with V95\% = (98.7 +/- 0.8) \% and HI = (8.2 +/- 0.9) \% for the SIB and V95\% = (98.3 +/- 0.7) \% for the PTV, whereas tVMAT showed significantly lowest doses to the contralateral organs at risk with a D-mean of (0.7 +/- 0.1) Gy for the contralateral lung, (1.0 +/- 0.2) Gy for the contralateral breast and (1.4 +/- 0.2) Gy for the heart. All plans passed the gamma evaluation with a mean passing rate of (99.2 +/- 0.8) \%. Delivery times were significantly reduced for VMAT and tVMAT but increased for IMRT, when FFF was used. Lowest delivery times were observed for tVMAT FFF with (1:20 +/- 0:07) min. Conclusion: Balancing target coverage, OAR sparing and delivery time, VMAT FFF and tVMAT FFF are considered the preferable of the investigated treatment options in simultaneous integrated boost irradiation of right sided breast cancer for the combination of an Elekta Synergy linac with Agility and the treatment planning system Monaco 5.0.}, language = {en} } @misc{MauererRexhepajMonkmanetal., author = {Mauerer, Wolfgang and Rexhepaj, Tanja and Monkman, Gareth J. and Sindersberger, Dirk and Diermeier, Andreas and Neidhart, Thomas and Wolfrum, Dominik and Sterner, Michael and Heberl, Michael and Nusko, Robert and Maier, Georg and Nagl, Klaus and Reuter, Monika and Hofrichter, Andreas and Lex, Thomas and Lesch, Florian and Kieninger, B{\"a}rbel and Szalo, Alexander Eduard and Zehner, Alexander and Palm, Christoph and Joblin, Mitchell and Apel, Sven and Ramsauer, Ralf and Lohmann, Daniel and Westner, Markus and Strasser, Artur and Munndi, Maximilian and Ebner, Lena and Elsner, Michael and Weiß, Nils and Segerer, Matthias and Hackenberg, Rudolf and Steger, Sebastian and Schmailzl, Anton and Dostalek, Michael and Armbruster, Dominik and Koch, Fabian and Hierl, Stefan and Thumann, Philipp and Swidergal, Krzysztof and Wagner, Marcus and Briem, Ulrich and Diermeier, Andreas and Spreitzer, Stefan and Beiderbeck, Sabrina and Hook, Christian and Zobel, Martin and Weber, Tim and Groß, Simon and Penzkofer, Rainer and Dendorfer, Sebastian and Schillitz, Ingo and Bauer, Thomas and Rudolph, Clarissa and Schmidt, Katja and Liebetruth, Thomas and Hamer, Markus and Haug, Sonja and Vernim, Matthias and Weber, Karsten and Saßmannshausen, Sean Patrick and Books, Sebastian and Neuleitner, Nikolaus and Rechenauer, Christian and Steffens, Oliver and Kusterle, Wolfgang and G{\"o}mmel, Roland and Wellnitz, Felix and Stierstorfer, Johannes and Stadler, Dominik and Hofmann, Matthias J. and Motschmann, Hubert and Shamonin (Chamonine), Mikhail and Bleicher, Veronika and Fischer, Sebastian and Hackenberg, Rudolf and Horn, Anton and Kawasch, Raphael and Petzenhauser, Michael and Probst, Tobias and Udalzow, Anton and Dams, Florian and Schreiner, Rupert and Langer, Christoph and Prommesberger, Christian and Ławrowski, Robert Damian}, title = {Forschungsbericht 2016}, editor = {Baier, Wolfgang}, address = {Regensburg}, organization = {Ostbayerische Technische Hochschule Regensburg}, doi = {10.35096/othr/pub-1384}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:898-opus4-13840}, language = {de} } @misc{WeberDendorferSuessetal., author = {Weber, Karsten and Dendorfer, Sebastian and S{\"u}ß, Franz and Kubowitsch, Simone and Schratzenstaller, Thomas and Haug, Sonja and Mohr, Christa and Kiesl, Hans and Drechsler, J{\"o}rg and Westner, Markus and Kobus, J{\"o}rn and Schubert, Martin J. W. and Zenger, Stefan and Pietsch, Alexander and Weiß, Josef and Hinterseer, Sebastian and Schieck, Roland and Scherzinger, Stefanie and Klettke, Meike and Ringlstetter, Andreas and St{\"o}rl, Uta and Bissyand{\´e}, Tegawend{\´e} F. and Seeburger, Achim and Schindler, Timo and Ramsauer, Ralf and Kiszka, Jan and K{\"o}lbl, Andreas and Lohmann, Daniel and Mauerer, Wolfgang and Maier, Johannes and Scorna, Ulrike and Palm, Christoph and Soska, Alexander and Mottok, J{\"u}rgen and Ellermeier, Andreas and V{\"o}gele, Daniel and Hierl, Stefan and Briem, Ulrich and Buschmann, Knut and Ehrlich, Ingo and Pongratz, Christian and Pielmeier, Benjamin and Tyroller, Quirin and Monkman, Gareth J. and Gut, Franz and Roth, Carina and Hausler, Peter and Bierl, Rudolf and Prommesberger, Christian and Ławrowski, Robert Damian and Langer, Christoph and Schreiner, Rupert and Huang, Yifeng and She, Juncong and Ottl, Andreas and Rieger, Walter and Kraml, Agnes and Poxleitner, Thomas and Hofer, Simon and Heisterkamp, Benjamin and Lerch, Maximilian and Sammer, Nike and Golde, Olivia and Wellnitz, Felix and Schmid, Sandra and Muntschick, Claudia and Kusterle, Wolfgang and Paric, Ivan and Br{\"u}ckl, Oliver and Haslbeck, Matthias and Schmidt, Ottfried and Schwanzer, Peter and Rabl, Hans-Peter and Sterner, Michael and Bauer, Franz and Steinmann, Sven and Eckert, Fabian and Hofrichter, Andreas}, title = {Forschungsbericht 2017}, editor = {Baier, Wolfgang}, address = {Regensburg}, organization = {Ostbayerische Technische Hochschule Regensburg}, isbn = {978-3-9818209-3-5}, doi = {10.35096/othr/pub-1383}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:898-opus4-13835}, subject = {Forschung}, language = {de} } @article{MaierPerretSimonetal., author = {Maier, Johannes and Perret, Jerome and Simon, Martina and Schmitt-R{\"u}th, Stephanie and Wittenberg, Thomas and Palm, Christoph}, title = {Force-feedback assisted and virtual fixtures based K-wire drilling simulation}, series = {Computers in Biology and Medicine}, volume = {114}, journal = {Computers in Biology and Medicine}, publisher = {Elsevier}, doi = {10.1016/j.compbiomed.2019.103473}, pages = {1 -- 10}, abstract = {One common method to fix fractures of the human hand after an accident is an osteosynthesis with Kirschner wires (K-wires) to stabilize the bone fragments. The insertion of K-wires is a delicate minimally invasive surgery, because surgeons operate almost without a sight. Since realistic training methods are time consuming, costly and insufficient, a virtual-reality (VR) based training system for the placement of K-wires was developed. As part of this, the current work deals with the real-time bone drilling simulation using a haptic force-feedback device. To simulate the drilling, we introduce a virtual fixture based force-feedback drilling approach. By decomposition of the drilling task into individual phases, each phase can be handled individually to perfectly control the drilling procedure. We report about the related finite state machine (FSM), describe the haptic feedback of each state and explain, how to avoid jerking of the haptic force-feedback during state transition. The usage of the virtual fixture approach results in a good haptic performance and a stable drilling behavior. This was confirmed by 26 expert surgeons, who evaluated the virtual drilling on the simulator and rated it as very realistic. To make the system even more convincing, we determined real drilling feed rates through experimental pig bone drilling and transferred them to our system. Due to a constant simulation thread we can guarantee a precise drilling motion. Virtual fixtures based force-feedback calculation is able to simulate force-feedback assisted bone drilling with high quality and, thus, will have a great potential in developing medical applications.}, subject = {Handchirurgie}, language = {en} } @article{HuberSchlosserStenzeletal., author = {Huber, Michaela and Schlosser, Daniela and Stenzel, Susanne and Maier, Johannes and Pattappa, Girish and Kujat, Richard and Striegl, Birgit and Docheva, Denitsa}, title = {Quantitative Analysis of Surface Contouring with Pulsed Bipolar Radiofrequency on Thin Chondromalacic Cartilage}, series = {BioMed Research International}, journal = {BioMed Research International}, publisher = {HINDAWI}, doi = {10.1155/2020/1242086}, pages = {1 -- 8}, abstract = {The purpose of this study was to evaluate the quality of surface contouring of chondromalacic cartilage by bipolar radio frequency energy using different treatment patterns in an animal model, as well as examining the impact of the treatment onto chondrocyte viability by two different methods. Our experiments were conducted on 36 fresh osteochondral sections from the tibia plateau of slaughtered 6-month-old pigs, where the thickness of the cartilage is similar to that of human wrist cartilage. An area of 1 cm(2) was first treated with emery paper to simulate the chondromalacic cartilage. Then, the treatment with RFE followed in 6 different patterns. The osteochondral sections were assessed for cellular viability (live/dead assay, caspase (cell apoptosis marker) staining, and quantitative analysed images obtained by fluorescent microscopy). For a quantitative characterization of none or treated cartilage surfaces, various roughness parameters were measured using confocal laser scanning microscopy (Olympus LEXT OLS 4000 3D). To describe the roughness, the Root-Mean-Square parameter (Sq) was calculated. A smoothing effect of the cartilage surface was detectable upon each pattern of RFE treatment. The Sq for native cartilage was Sq=3.8 +/- 1.1 mu m. The best smoothing pattern was seen for two RFE passes and a 2-second pulsed mode (B2p2) with an Sq=27.3 +/- 4.9 mu m. However, with increased smoothing, an augmentation in chondrocyte death up to 95\% was detected. Using bipolar RFE treatment in arthroscopy for small joints like the wrist or MCP joints should be used with caution. In the case of chondroplasty, there is a high chance to destroy the joint cartilage.}, language = {en} } @misc{MaierWeihererHuberetal., author = {Maier, Johannes and Weiherer, Maximilian and Huber, Michaela and Palm, Christoph}, title = {Abstract: Imitating Human Soft Tissue with Dual-Material 3D Printing}, series = {Bildverarbeitung f{\"u}r die Medizin 2019, Algorithmen - Systeme - Anwendungen. Proceedings des Workshops vom 17. bis 19. M{\"a}rz 2019 in L{\"u}beck}, journal = {Bildverarbeitung f{\"u}r die Medizin 2019, Algorithmen - Systeme - Anwendungen. Proceedings des Workshops vom 17. bis 19. M{\"a}rz 2019 in L{\"u}beck}, editor = {Handels, Heinz and Deserno, Thomas M. and Maier, Andreas and Maier-Hein, Klaus H. and Palm, Christoph and Tolxdorff, Thomas}, publisher = {Springer Vieweg}, address = {Wiesbaden}, isbn = {978-3-658-25325-7}, doi = {10.1007/978-3-658-25326-4_48}, pages = {218}, abstract = {Currently, it is common practice to use three-dimensional (3D) printers not only for rapid prototyping in the industry, but also in the medical area to create medical applications for training inexperienced surgeons. In a clinical training simulator for minimally invasive bone drilling to fix hand fractures with Kirschner-wires (K-wires), a 3D printed hand phantom must not only be geometrically but also haptically correct. Due to a limited view during an operation, surgeons need to perfectly localize underlying risk structures only by feeling of specific bony protrusions of the human hand.}, subject = {Handchirurgie}, language = {en} } @article{MaierWeihererHuberetal., author = {Maier, Johannes and Weiherer, Maximilian and Huber, Michaela and Palm, Christoph}, title = {Imitating human soft tissue on basis of a dual-material 3D print using a support-filled metamaterial to provide bimanual haptic for a hand surgery training system}, series = {Quantitative Imaging in Medicine and Surgery}, volume = {9}, journal = {Quantitative Imaging in Medicine and Surgery}, number = {1}, publisher = {AME Publishing Company}, doi = {10.21037/qims.2018.09.17}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:898-opus4-979}, pages = {30 -- 42}, abstract = {Background: Currently, it is common practice to use three-dimensional (3D) printers not only for rapid prototyping in the industry, but also in the medical area to create medical applications for training inexperienced surgeons. In a clinical training simulator for minimally invasive bone drilling to fix hand fractures with Kirschner-wires (K-wires), a 3D-printed hand phantom must not only be geometrically but also haptically correct. Due to a limited view during an operation, surgeons need to perfectly localize underlying risk structures only by feeling of specific bony protrusions of the human hand. Methods: The goal of this experiment is to imitate human soft tissue with its haptic and elasticity for a realistic hand phantom fabrication, using only a dual-material 3D printer and support-material-filled metamaterial between skin and bone. We present our workflow to generate lattice structures between hard bone and soft skin with iterative cube edge (CE) or cube face (CF) unit cells. Cuboid and finger shaped sample prints with and without inner hard bone in different lattice thickness are constructed and 3D printed. Results: The most elastic available rubber-like material is too firm to imitate soft tissue. By reducing the amount of rubber in the inner volume through support material (SUP), objects become significantly softer. Without metamaterial, after disintegration, the SUP can be shifted through the volume and thus the body loses its original shape. Although the CE design increases the elasticity, it cannot restore the fabric form. In contrast to CE, the CF design increases not only the elasticity but also guarantees a local limitation of the SUP. Therefore, the body retains its shape and internal bones remain in its intended place. Various unit cell sizes, lattice thickening and skin thickness regulate the rubber material and SUP ratio. Test prints with higher SUP and lower rubber material percentage appear softer and vice versa. This was confirmed by an expert surgeon evaluation. Subjects adjudged pure rubber-like material as too firm and samples only filled with SUP or lattice structure in CE design as not suitable for imitating tissue. 3D-printed finger samples in CF design were rated as realistic compared to the haptic of human tissue with a good palpable bone structure. Conclusions: We developed a new dual-material 3D print technique to imitate soft tissue of the human hand with its haptic properties. Blowy SUP is trapped within a lattice structure to soften rubber-like 3D print material, which makes it possible to reproduce a realistic replica of human hand soft tissue.}, subject = {Handchirurgie}, language = {en} } @article{MaierWeihererHuberetal., author = {Maier, Johannes and Weiherer, Maximilian and Huber, Michaela and Palm, Christoph}, title = {Optically tracked and 3D printed haptic phantom hand for surgical training system}, series = {Quantitative Imaging in Medicine and Surgery}, volume = {10}, journal = {Quantitative Imaging in Medicine and Surgery}, number = {02}, publisher = {AME Publishing Company}, address = {Hong Kong, China}, doi = {10.21037/qims.2019.12.03}, pages = {340 -- 455}, abstract = {Background: For surgical fixation of bone fractures of the human hand, so-called Kirschner-wires (K-wires) are drilled through bone fragments. Due to the minimally invasive drilling procedures without a view of risk structures like vessels and nerves, a thorough training of young surgeons is necessary. For the development of a virtual reality (VR) based training system, a three-dimensional (3D) printed phantom hand is required. To ensure an intuitive operation, this phantom hand has to be realistic in both, its position relative to the driller as well as in its haptic features. The softest 3D printing material available on the market, however, is too hard to imitate human soft tissue. Therefore, a support-material (SUP) filled metamaterial is used to soften the raw material. Realistic haptic features are important to palpate protrusions of the bone to determine the drilling starting point and angle. An optical real-time tracking is used to transfer position and rotation to the training system. Methods: A metamaterial already developed in previous work is further improved by use of a new unit cell. Thus, the amount of SUP within the volume can be increased and the tissue is softened further. In addition, the human anatomy is transferred to the entire hand model. A subcutaneous fat layer and penetration of air through pores into the volume simulate shiftability of skin layers. For optical tracking, a rotationally symmetrical marker attached to the phantom hand with corresponding reference marker is developed. In order to ensure trouble-free position transmission, various types of marker point applications are tested. Results: Several cuboid and forearm sample prints lead to a final 30 centimeter long hand model. The whole haptic phantom could be printed faultless within about 17 hours. The metamaterial consisting of the new unit cell results in an increased SUP share of 4.32\%. Validated by an expert surgeon study, this allows in combination with a displacement of the uppermost skin layer a good palpability of the bones. Tracking of the hand marker in dodecahedron design works trouble-free in conjunction with a reference marker attached to the worktop of the training system. Conclusions: In this work, an optically tracked and haptically correct phantom hand was developed using dual-material 3D printing, which can be easily integrated into a surgical training system.}, subject = {Handchirurgie}, language = {en} } @inproceedings{MaierHuberKatzkyetal., author = {Maier, Johannes and Huber, Michaela and Katzky, Uwe and Perret, Jerome and Wittenberg, Thomas and Palm, Christoph}, title = {Force-Feedback-assisted Bone Drilling Simulation Based on CT Data}, series = {Bildverarbeitung f{\"u}r die Medizin 2018; Algorithmen - Systeme - Anwendungen; Proceedings des Workshops vom 11. bis 13. M{\"a}rz 2018 in Erlangen}, booktitle = {Bildverarbeitung f{\"u}r die Medizin 2018; Algorithmen - Systeme - Anwendungen; Proceedings des Workshops vom 11. bis 13. M{\"a}rz 2018 in Erlangen}, publisher = {Springer}, address = {Berlin}, doi = {10.1007/978-3-662-56537-7_78}, pages = {291 -- 296}, abstract = {In order to fix a fracture using minimally invasive surgery approaches, surgeons are drilling complex and tiny bones with a 2 dimensional X-ray as single imaging modality in the operating room. Our novel haptic force-feedback and visual assisted training system will potentially help hand surgeons to learn the drilling procedure in a realistic visual environment. Within the simulation, the collision detection as well as the interaction between virtual drill, bone voxels and surfaces are important. In this work, the chai3d collision detection and force calculation algorithms are combined with a physics engine to simulate the bone drilling process. The chosen Bullet-Physics-Engine provides a stable simulation of rigid bodies, if the collision model of the drill and the tool holder is generated as a compound shape. Three haptic points are added to the K-wire tip for removing single voxels from the bone. For the drilling process three modes are proposed to emulate the different phases of drilling in restricting the movement of a haptic device.}, subject = {Handchirurgie}, language = {en} }