Augmented reality technology used for the first time to guide breast-cancer surgery with personalised breast models


In the future, surgeons specialised in breast and other cancers may routinely come to wear digital headsets in the operating room to guide their hands as they excise malignant tumours.

In the future, surgeons specialised in breast and other cancers may routinely come to wear digital headsets in the operating room to guide their hands as they excise malignant tumours.

Breast 4.0

Last January, a team at the Champalimaud Clinical Centre, in Lisbon, successfully tested the precision of a novel, non-invasive, 100% digital method for locating cancerous breast tumours “on the fly” during surgery. For the first time in operating room settings, a surgeon fitted with an “augmented reality” headset was able to visualise, in real-time, a virtual image of the tumour to be extracted from inside the patient’s body. 

Pedro Gouveia – the surgeon from the Breast Unit of the Champalimaud Clinical Centre who performed the surgery – is pioneering digital technology that could usher in a new era for breast cancer surgery, which he calls Breast 4.0. “Today, the technology and the computing power are available to do it”, he says. His ultimate goal is to develop a system that can be integrated into operating rooms. “We are just at the beginning of this transformation”, he adds. 

Recognising its potential, today (November 18th), the “Best and Greatest in Portuguese Technology” award in the Innovation category was attributed to the Breast 4.0 project. These awards, which this year also included other categories such as Sustainability, Brands, Computers, and Applications, are an initiative of the Portuguese technology magazine Exame Informática.

But going back to the project itself, what is the current situation in terms of conservative breast cancer surgery?  For one, since many breast malignancies are caught in their early stages, they are not palpable. So breast surgeons have to completely rely on images – mammograms, ultrasounds, magnetic resonance (MRI) – to locate the tumours. 

This is not simple, because according to the type of image, patients can be either standing or lying down in different positions – and the breast may even have to be compressed (as in mammograms) or will simply be stretched by gravity. It is time-consuming and takes an expert surgeon to interpret the images and to infer, as precisely as possible, the actual location of the tumour from these non-overlapping, deformed views.

Also, prior to surgery, the location of the tumour inferred from the images needs to be printed directly onto the patient to mark the spot where the tumour actually is and to programme the intervention. Various methods, all of them invasive, are used for this, which can cause pain and anxiety to the patients. The method used at the Champalimaud consists of a series of injections of liquid carbon into the breast, with a needle, resulting in a small circular “tattoo” on the skin and on the tumour pointing to the target. 

But what if real images of the tumour could be fused together, in spite of the deformations caused on the breast by the way they were obtained, with a personalised 3D model of the surface of the patient’s torso, and then overlaid on the real environment through special transparent goggles? There would be no more need for painstakingly figuring out where the tumour is or for painfully producing markings – which, moreover, are prone to errors. 

That’s exactly what augmented reality is about. Remember how, in 2016, the mobile game Pokémon GO sent hundreds of millions of players all over the world hunting for virtual monsters in their surroundings? The game was based on… augmented reality (AR) technology, which overlays computer-generated imagery on real-world environments. “In fact, it all started with Pokémon”, says Gouveia.

The idea of venturing into this technological approach initially came from Maria João Cardoso, who leads the surgical team of the Breast Unit and who is, at the same time, Pedro Gouveia’s PhD supervisor. “Using new artificial intelligence technologies for surgery was always something our group believed in, and Dr. Pedro Gouveia was able to exploit this window of opportunity, always with the maximum potential benefits for the patients in mind”, says Maria João Cardoso.

For more than two years, Gouveia has been studying, in collaboration with colleagues at the Champalimaud Centre for the Unknown as well as computer scientists and engineers from INESC TEC and the Portuguese company AI4medimaging, how to fuse MRI images of a patient’s tumour with a 3D surface scan of the patient’s own torso (lying supine) by using special “fusion” algorithms developed by Sílvia Bessa (from INESC TEC) and Pedro Gouveia. “This has been a team effort through and through on the part of the whole Breast Unit, which has also relied on the support of Celeste Alves, head of the Breast Radiology service, and Nickolas Papanikolaou, group leader of the Computational Clinical Imaging Group”, Gouveia points out.

To produce the final fusion image, the scientists start by drawing a set of meaningful dots on the patient’s torso with a permanent marker, outlining the breast. This poses a problem, however: although these dots will appear on the 3D surface scan of the torso, they will not be visible on the MRI images. To solve it, the team has come up with a pretty clever, simple and cheap solution: once the 3D scan is completed, they fix cod liver oil pills over the black marker dots – and since the oil is a liquid, it will be visible on the MRI! 

The final image, when uploaded to the augmented reality headset, will superimpose itself on the visible real environment. And when the surgeon looks at the torso of the patient, lying supine on the operating table, the surgeon will see the tumour where it actually is. It was the Portuguese company NextReality that gave support to the team in terms of augmented reality and lending them its Hololens headset.

A similar approach has already been used in neurosurgery, Gouveia points out, but making it work on soft, deformable tissue such as the breast is another matter. Also, the team is set on automating the process so that the 3D body scan of the patient lying on the operating table can be acquired “on the fly”, something that has never been attempted. “In the January surgery, we did everything manually”, says Gouveia. “The digital 3D breast model of the patient took more than seven hours to be produced after registration with a handheld scanner and breast MRI!” Gouveia’s idea for the future is to install various 3D scanners on the operating room ceiling so that the system can work quickly and autonomously. 

Before testing their approach during an actual surgery, the team had already performed, between 2017 and 2019, tests of the precision of their experimental method on 16 patients scheduled for surgery by simply comparing the virtual images of their tumours to the corresponding invasive skin markings (which had already been made in preparation for the surgery). The team described this “proof of concept” study – that is, concluded that the approach was feasible – in a paper published in January 2020 in a special issue on Artificial Intelligence in Breast Cancer Care in the journal The Breast.

As far as the real-life test is concerned, “the test during surgery was a success”, says Gouveia. “The position of the virtual image [seen through the headset] matched that of the carbon tattoo on the patient’s skin”. This suggests that the surgeon would have been able to perform the surgery based solely on the digital data – and with the added advantages of having more information about the shape and the boundaries of the tumour.

“But of course, this is still just a prototype”, says Gouveia. There is still a long way to go before the team can turn it into a reliable, fully automated commercial medical device that could be used in hospitals around the world. And, who knows, for other types of cancer.

Metaverse: Augmented reality pioneer warns it could be far worse than social media


If used improperly, the metaverse could be more divisive than social media and an insidious threat to society and even reality itself.

KEY TAKEAWAYS

  • Social media manipulates our reality by filtering what we are allowed (or not allowed) to see. 
  • We live in dangerous times because too many people use social media to disseminate untruths and promote division. 
  • Augmented reality and the metaverse have the potential to amplify these dangers to incomprehensible levels. 

At its core, augmented reality (AR) and the metaverse are media technologies that aim to present content in the most natural form possible — by seamlessly integrating simulated sights, sounds, and even feelings into our perception of the real world around us. This means AR, more than any form of media to date, has the potential to alter our sense of reality, distorting how we interpret our direct daily experiences. In an augmented world, simply walking down the street will become a wild amalgamation of the physical and the virtual, merged so convincingly that the boundaries will disappear in our minds. Our surroundings will become filled with persons, places, objects, and activities that don’t actually exist, and yet they will seem deeply authentic to us.

Early augmented reality (AR)

Personally, I find this terrifying. That is because augmented reality will fundamentally change all aspects of society and not necessarily in a good way. I say this as someone who has been a champion of AR for a long time. In fact, my enthusiasm began 30 years ago, before the phrase “augmented reality” had even been coined. Back then, I was the principal investigator on a pioneering effort conducted at Air Force Research Laboratory (AFRL) with support from Stanford University and NASA. Known as the Virtual Fixtures project, for the very first time, it enabled users to reach out and interact with a mixed reality of both real and virtual objects.

This early system employed a million dollars’ worth of equipment, requiring users to climb into a large motor-driven exoskeleton and peer into a makeshift vision system that hung from the ceiling, all while they performed manual tasks in the real world, such as inserting pegs into holes of different sizes. At the same time, virtual objects were merged into their perception of the real workspace, the goal being to assist users as they perform the complex task. The research was a successshowing that we could boost human performance by over 100 percent when combining the real and the virtual into a single reality.

But even more exciting was the reaction of the human subjects after they tried that very first version of AR. Everyone climbed out of the system with big smiles and told me without prompting how remarkable the experience was — not because it boosted their performance but because it was magical to interact with virtual objects that felt like genuine additions to the physical world. I was convinced that this technology would eventually be everywhere, splashing techno-magic onto the world around us, impacting every domain from business and commerce to gaming and entertainment.

Now, 30 years later, I am more convinced than ever that augmented reality will become central to all aspects of life, touching everything from how we work and play to how we communicate with each other. In fact, I am convinced that it will happen this decade — and yes, it will be magical. But at the same time, I am very concerned about the negative consequences, and it is not because I worry about bad actors hacking the technology or otherwise hijacking our good intentions. No, I am concerned about the legitimate uses of AR by the powerful platform providers that will control the infrastructure.

A dystopian walk in the neighborhood

Let’s face it: We find ourselves in a society where countless layers of technology exist between each of us and our daily lives, moderating our access to news and information, mediating our relationships with friends and family, filtering our impressions of products and services, and even influencing our acceptance of basic facts. We now live mediated lives, all of us depending more and more on the corporations that provide and maintain the intervening layers. And when those layers are used to manipulate us, the industry does not view it as misuse but as “marketing.” And this is not just being used to peddle products but to disseminate untruths and promote social division. The fact is, we now live in dangerous times, and AR has the potential to amplify the dangers to levels we have never seen.

Imagine walking down the street in your hometown, casually glancing at people you pass on the sidewalk. It is much like today, except floating over the heads of every person you see are big glowing bubbles of information. Maybe the intention is innocent, allowing people to share their hobbies and interests with everyone around them. Now imagine that third parties can inject their own content, possibly as a paid filter layer that only certain people can see. And they use that layer to tag individuals with bold flashing words like “Alcoholic” or “Immigrant” or “Atheist” or “Racist” or even less charged words like “Democrat” or “Republican.” Those who are tagged may not even know that others can see them that way. The virtual overlays could easily be designed to amplify political division, ostracize certain groups, even drive hatred and mistrust. Will this really make the world a better place? Or will it take the polarized and confrontational culture that has emerged online and spray it across the real world?

Now imagine you work behind a retail counter. AR will change how you size up your customers. That is because personal data will float all around them, showing you their tastes and interests, their spending habits, the type of car they drive, the size of their house, even their gross annual income. It would have been unthinkable decades ago to imagine corporations having access to such information, but these days, we accept it as the price of being consumers in a digital world. With AR, personal information will follow us everywhere, exposing our behaviors and reducing our privacy. Will this make the world a better place? I don’t think so, and yet this is where we are headed. 

The metaverse could make reality disappear

Over the last decade, the abuse of media technologies has made us all vulnerable to distortions and misinformation, from fake news and deepfakes to botnets and troll farms. These dangers are insidious, but at least we can turn off our phones or step away from our screens and have authentic real-world experiences, face-to-face, that aren’t filtered through corporate databases or manipulated by intelligent algorithms. With the rise of AR, this last bastion of reliable reality could completely disappear. And when that happens, it will only exacerbate the social divisions that threaten us.   

After all, the shared experience we call “civilized society” is quickly eroding, largely because we each live in our own data bubble, everyone being fed custom news and information (and even lies) tailored to their own personal beliefs. This reinforces our biases and entrenches our opinions. But today, we can at least enter a public space and have some level of shared experience in a common reality. With AR, that too will be lost. When you walk down a street in an augmented world, you will see a city filled with content that reinforces your personal views, deceiving you into believing that everyone thinks the way you do. When I walk down that same street, I could see vastly different content, promoting inverse views that make me believe opposite things about the very same citizens of the very same town. 

Consider the tragedy of homelessness. There will be those who choose not to see this problem for political reasons, their AR headsets generating virtual blinders, hiding soup kitchens and homeless shelters behind virtual walls, much like construction sites are hidden in today’s world. There will be others who choose not to see fertility clinics or gun stores or whatever else the prevailing political forces encourage them to “reality block.” At the same time, consider the impact on the poorest members of society. If a family cannot afford AR hardware, they will live in a world where critical content is completely invisible to them. Talk about disenfranchisement.

You can’t ever leave the metaverse

And no, you won’t just take off your AR glasses or pop out your contacts to avoid these problems. Why not? Because faster than any of us can imagine, we will become thoroughly dependent on the virtual layers of information projected all around us. It will feel no more optional than internet access feels optional today. You won’t unplug your AR system because doing so will make important aspects of your surroundings inaccessible to you, putting you at a disadvantage socially, economically, and intellectually.  The fact is, the technologies we adopt in the name of convenience rarely remain optional — not when they are integrated into our lives as broadly as AR will be.

Don’t get me wrong. AR has the power to enrich our lives in wonderful ways. I am confident that AR will enable surgeons to perform faster and better. Construction workers, engineers, scientists — everybody, young and old, will benefit. I am also confident that AR will revolutionize entertainment and education, unleashing experiences that are not just engaging and informative but thrilling and inspiring.

But AR also will make us even more dependent on the insidious layers of technology that mediate our lives and the powerbrokers that control those layers. This will leave us increasingly susceptible to manipulations and distortions by those who can afford to pull the strings. If we are not careful now, AR could easily be used to fracture society, pushing us from our own information bubbles into our own custom realities, further entrenching our views and cementing our divisions, even when we are standing face-to-face with others in what feels like the public sphere. 

Being an optimist, I still believe AR can be a force for good, making the world a magical place and expanding what it means to be human. But to protect against the potential dangers, we need to proceed carefully and thoughtfully, anticipating the problems that could corrupt what should be an uplifting technology. If we have learned anything from the unexpected evils of social media, it is that good intentions are not enough to prevent systems from being deployed with serious structural problems.  And once those structural problems are in place, it is extremely difficult to undo the damage. This means the proponents of AR need to get things right the first time.

A New Apple Patent Offers a Radically New Vision for Future Smartphones


Apple will likely stick with its signature smartphone notch for the foreseeable future, but the company is looking to shake up the display design in years to come. With Samsung and a few upstarts hard at work developing an ecosystem around “foldable” multiple-display handsets, a new patent suggests that Apple’s looking in a slightly different direction.

It’s actually series of new Apple patents, and together they suggest the iPhone’s successors will be more of an all-in-one gaming platform that can make better use of the augmented reality and gaming features the company touted this year.

The bevy of 37 new patents the U.S. Patent and Trademark Office approved and released Tuesday detail the designs for an iPhone with a screen that wraps all the way around it, almost like a smartphone crepe. Its internals would be completely encased in a flexible display, making it completely bezel-less and giving users access to screen real-estate on the rear and sides of the phone. The patents were first reported by Patently Apple.

The filings also explain how the device could use an accelerometer to detect tilt motions, as well as how users could use the rear screen to interact with the front screen. This design would make it an ideal gaming phone. Tilt controls could be used for racing or dogfighting games and the rear touch interface could serve as bumpers like the ones found on all gaming console controllers. In short, the findings suggest that a gaming-focused iPhone could be in Apple’s future.

apple iphone patent
A flexible screen would wrap around the phone’s internals, creating a sort of smartphone crepe.

Sections of the documentation obtained by Patently Apple describe the theoretical device:

“A transparent display cover structure that wraps around an axis of the electronic device…The control circuitry comprises an accelerometer that gathers tilt data…The electronic device has a front face and a rear face and wherein the flexible display layer is configured to display content on the front face based on touch input gathered using the touch sensor on the rear face.”

This design corresponds with Apple’s push towards AR and gaming applications with the 2018 releases of the iPhone XS, XS Max, and iPad Pro. A wraparound display could convert iPhones into gaming controllers for iPad Pros or standalone mobile gaming platforms.

iphone patent concept gaming apple
View of a user interacting with the back of the device to control the front display.

While this design could make Apple’s push into gaming more viable, the documentation doesn’t address where it would put its cameras. That much display would also take a big toll on battery life.

Patents, while they are a good way to see what concepts companies are spitballing, are not dependable gauges of product launches. If Apple does choose to move forward with this idea it probably wouldn’t be for at least a few more years.

But who knows, maybe the iPhone and iPad will be bundled together as a gaming console within the next decade.

Mark Zuckerberg wants to eliminate all screens from your life with special glasses.


If Facebook CEO Mark Zuckerberg has his way, you’ll never have to buy a gadget with a screen again.

Instead, you’ll be using a pair of augmented reality (AR) glasses or even contacts in the future in order to place digital content on top of any surface.

facebook glasses

At a keynote speech at Facebook’s annual F8 developers conference Tuesday, Zuckerberg said that while the company is kicking off its AR efforts with the smartphone camera and screen, the ultimate goal is to just have one gadget that rules them all.

“We all know where we want this to get eventually,” Zuckerberg said during the keynote. “We all want glasses or eventually contact lenses that look and feel normal but let us overlay all kinds of information and digital objects on top of the real world.”

To be clear, Zuckerberg didn’t come out and say Facebook is building a glasses or contacts right away since the technology is so far off. Facebook isn’t the only company exploring AR glasses either. Apple, Google, Microsoft, Snap and the startup Magic Leap are all focused on developing similar types of products.

But the all have the same goal: to eliminate screens from your life and give you that one gadget to trump the rest.

Source:http://www.businessinsider.in