Mechanics of dynamic needle insertion into a biological material

Haptic Feedback in Needle Insertion Modeling and Simulation

Needle insertion is the most basic skill in medical care, and training has to be imparted not only for physicians but also for nurses and paramedics. In most needle insertion procedures, haptic feedback from the needle is the main stimulus in which novices need training. For better patient safety, the classical methods of training the haptic skills have to be replaced with simulators based on new robotic and graphics technologies. This paper reviews the current advances in needle insertion modeling, classified into three sections: needle insertion models, tissue deformation models, and needle-tissue interaction models. Although understated in the literature, the classical and dynamic friction models, which are critical for needle insertion modeling, are also discussed. The experimental setup or the needle simulators that have been developed to validate the models are described. The need of psychophysics for needle simulators and psychophysical parameter analysis of human perception in needle insertion are discussed, which are completely ignored in the literature.

Adaptive Kinematic Control of a Robotic Venipuncture Device Based on Stereo Vision, Ultrasound, and Force Guidance

Robotic systems have slowly entered the realm of modern medicine; however, outside the operating room, medical robotics has yet to be translated to more routine interventions such as blood sampling or intravenous fluid delivery. In this paper, we present a medical robot that safely and rapidly cannulates peripheral blood vessels-a procedure commonly known as venipuncture. The device uses near-infrared and ultrasound imaging to scan and select suitable injection sites, and a 9-DOF robot to insert the needle into the center of the vessel based on image and force guidance. We first present the system design and visual servoing scheme of the latest generation robot, and then evaluate the performance of the device through workspace simulations and free-space positioning tests. Finally, we perform a series of motion tracking experiments using stereo vision, ultrasound, and force sensing to guide the position and orientation of the needle tip. Positioning experiments indicate sub-millimeter accuracy and repeatability over the operating workspace of the system, while tracking studies demonstrate real-time needle servoing in response to moving targets. Lastly, robotic phantom cannulations demonstrate the use of multiple system states to confirm that the needle has reached the center of the vessel.

The influence of tip shape on bending force during needle insertion

Steering of needles involves the planning and timely modifying of instrument-tissue force interactions to allow for controlled deflections during the insertion in tissue. In this work, the effect of tip shape on these forces was studied using 10 mm diameter needle tips. Six different tips were selected, including beveled and conical versions, with or without pre-bend or pre-curve. A six-degree-of-freedom force/torque sensor measured the loads during indentations in tissue simulants. The increased insertion (axial) and bending (radial) forces with insertion depth - the force-displacement slopes - were analyzed. Results showed that the ratio between radial and axial forces was not always proportional. This means that the tip load does not have a constant orientation, as is often assumed in mechanics-based steering models. For all tip types, the tip-load assumed a more radial orientation with increased axial load. This effect was larger for straight tips than for pre-bent or pre-curved tips. In addition, the force-displacement slopes were consistently higher for (1) increased tip angles, and for (2) beveled tips compared to conical tips. Needles with a bent or curved tip allow for an increased bending force and a decreased variability of the tip load vector orientation.

Detecting stages of needle penetration into tissues through force estimation at needle tip using fiber Bragg grating sensors

Several medical procedures involve the use of needles. The advent of robotic and robot assisted procedures requires dynamic estimation of the needle tip location during insertion for use in both assistive systems as well as for automatic control. Most prior studies have focused on the maneuvering of solid flexible needles using external force measurements at the base of the needle holder. However, hollow needles are used in several procedures and measurements of forces in proximity of such needles can eliminate the need for estimating frictional forces that have high variations. These measurements are also significant for endoscopic procedures in which measurement of forces at the needle holder base is difficult. Fiber Bragg grating sensors, due to their small size, inert nature, and multiplexing capability, provide a good option for this purpose. Force measurements have been undertaken during needle insertion into tissue mimicking phantoms made of polydimethylsiloxane as well as chicken tissue using an 18-G needle instrumented with FBG sensors. The results obtained show that it is possible to estimate the different stages of needle penetration including partial rupture, which is significant for procedures in which precise estimation of needle tip position inside the organ or tissue is required.

A combination of experimental and finite element analyses of needle-tissue interaction to compute the stresses and deformations during injection at different angles

One of the main clinical applications of the needles is its practical usage in the femoral vein catheterization. Annually more than two million peoples in the United States are exposed to femoral vein catheterization. How to use the input needles into the femoral vein has a key role in the sense of pain in post-injection and possible injuries, such as tissue damage and bleeding. It has been shown that there might be a correlation between the stresses and deformations due to femoral injection to the tissue and the sense of pain and, consequently, injuries caused by needles. In this study, the stresses and deformations induced by the needle to the femoral tissue were experimentally and numerically investigated in response to an input needle at four different angles, i.e., 30°, 45°, 60°, and 90°, via finite element method. In addition, a set of experimental injections at different angles were carried out to compare the numerical results with that of the experimental ones, namely pain score. The results revealed that by increasing the angle of injection up to 60°, the strain at the interaction site of the needle-tissue is increased accordingly while a significant falling is observed at the angle of 90°. In contrast, the stress due to injection was decreased at the region of needle-tissue interaction with showing the lowest one at the angle of 90°. Experimental results were also well confirmed the numerical observations since the lowest pain score was seen at the angle of 90°. The results suggest that the most effective angle of injection would be 90° due to a lower amount of stresses and deformations compared to the other angles of injection. These findings may have implications not only for understating the stresses and deformations induced during injection around the needle-tissue interaction, but also to give an outlook to the doctors to implement the most suitable angle of injection in order to reduce the pain as well as post injury of the patients.

Microneedle-based minimally-invasive measurement of puncture resistance and fracture toughness of sclera

The sclera provides the structural support of the eye and protects the intraocular contents. Since it covers a large portion of the eye surface and has relatively high permeability for most drugs, the sclera has been used as a major pathway for drug administration. Recently, microneedle (MN) technology has shown the possibility of highly local and minimally-invasive drug delivery to the eye by MN insertion through the sclera or the suprachoroidal space. Although ocular MN needs to be inserted through the sclera, there has been no systematic study to understand the mechanical properties of the sclera, which are important to design ocular MNs. In this study, we investigated a MN-based method to measure the puncture resistance and fracture toughness of the sclera. To reflect the conditions of MN insertion into the sclera, force-displacement curves obtained from MN-insertion tests were used to estimate the puncture resistance and fracture toughness of sclera tissue. To understand the effect of the insertion conditions, dependency of the mechanical properties on insertion speeds, pre-strain of the sclera, and MN sizes were analyzed and discussed.

STATEMENT OF SIGNIFICANCE

Measurement of mechanical property of soft biological tissue is challenging due to variations between tissue samples or lack of well-defined measurement techniques. Although non-invasive measurement techniques such as nano/micro indentation were employed to locally measure the elastic modulus of soft biological materials, mechanical properties such as puncture resistance or fracture toughness, which requires "invasive" measurement and is important for the application of "microneedles or hypodermic needles", has not been well studied. In this work, we report minimally-invasive measurement of puncture resistance and fracture toughness of sclera using a double MN insertion method. Parametric studies showed that use of MN proved to be advantageous because of minimally-invasive insertion into tissue as well as higher sensitivity to sub-tissue architecture during the measurement.

Micro/nano-particle decorated metal wire for cutting soft matter

To cut soft materials such as biological tissues with minimal damage and reduced positional error is highly desired in medical surgery and biomechanics. After years of natural selection and evolution, mosquitoes have acquired the ability to insert their proboscises into human skin with astonishingly tiny forces. This can be associated with the unique structure of their proboscises, with micro/nano sawteeth, and the distinctive insertion manner: high frequency reciprocating saw cutting. Inspired by these, this communication describes the successful implantation of metal oxide particles onto molybdenum wire surfaces through a sol-calcination process, to form a biomimetic sawblade with a high density of micro/nano saw teeth, where the acidification is essential in terms of generating active anchoring sites on the wire. When used as a sawblade in conjunction with reciprocating action to cut the viscoelastic gel, both the cut-in force and cut-in displacement could be decreased substantially. The cutting speed and frequency of reciprocating action are important operating parameters influencing cut-in force.

Multicenter, prospective, crossover trial comparing the door-knocking method with the conventional method for EUS-FNA of solid pancreatic masses (with videos)

BACKGROUND AND AIMS

There are currently no prospective, controlled trials of needle puncture speed in EUS-guided FNA (EUS-FNA). In this study, we prospectively evaluated the accuracy of histological diagnosis and the tissue acquisition rate of EUS-FNA by using the door-knocking method (DKM) with a standard 22-gauge needle.

METHODS

From November 2013 to August 2014, 82 patients who had solid pancreatic masses underwent EUS-FNA in which the conventional method (CM) and DKM with 2 respective passes in turn were used. The primary outcomes of this study were the accuracy of histological diagnosis and the rates of tissue acquisition in 2 FNA procedures by using these 2 methods.

RESULTS

Although the successful tissue acquisition rate for histology was not significantly different with the DKM and CM (91.5% vs 89.0%, P = .37), the high cellularity tissue acquisition rate for histology with the DKM was significantly superior to that with the CM (54.9% vs 41.5%, P = .03). However, adequate quality rate and accuracy were not different in the DKM and CM (78.0% vs 80.5%, P = .42 and 76.8% vs 78.0%, P = .50, respectively). In the transgastric puncture group, although the adequate quality rate and accuracy were similar in the DKM and CM (84.1% vs 79.4%, P = .30 and 84.1% vs 76.2%, P = .11, respectively), the tissue acquisition rate tended to be higher with the DKM than the CM (93.7% vs 85.7%, P = .06). Moreover, the high cellularity tissue acquisition rate was significantly better with the DKM than the CM (63.5% vs 39.7%, P = .002). On the other hand, in the transduodenal puncture group, although the tissue acquisition rate was similar with the DKM and CM (84.2% vs 100%, P = .13), the adequate quality rate and accuracy were significantly lower with the DKM than with the CM (57.9% vs 84.2%, P = .03 and 52.6% vs 84.2%, P = .02, respectively).

CONCLUSION

EUS-FNA by using a 22-gauge needle with the DKM did not improve the accuracy of histological diagnosis, but enabled acquisition of a larger amount of tissue specimen by using transgastric puncture. (

TRIAL REGISTRATION

http://www.umin.ac.jp/english/: UMIN000012127.).

Effects of Axial Vibration on Needle Insertion into the Tail Veins of Rats and Subsequent Serial Blood Corticosterone Levels

Blood collection is commonplace in biomedical research. Obtaining sufficient sample while minimizing animal stress requires significant skill and practice. Repeated needle punctures can cause discomfort and lead to variable release of stress hormones, potentially confounding analysis. We designed a handheld device to reduce the force necessary for needle insertion by using low-frequency, axial (forward and backward) micromotions (that is, vibration) delivered to the needle during venipuncture. Tests with cadaver rat-tail segments (n = 18) confirmed that peak insertion forces were reduced by 73% on average with needle vibration. A serial blood-sampling study was then conducted by using Sprague-Dawley rats divided into 2 groups based on needle condition used to cause bleeds: vibration on (n = 10) and vibration off (n = 9). On 3 days (1 wk apart), 3 tail-vein blood collections were performed in each subject at 1-h intervals. To evaluate associated stress levels, plasma corticosterone concentration was quantified by radioimmunoassay and behavior (that is, movement and vocalization) was scored by blinded review of blood-sampling videos. After the initial trial, average corticosterone was lower (46% difference), the mean intrasubject variance trended lower (72%), and behavioral indications of stress were rated lower for the vibration-on group compared with the vibration-off group. Adding controlled vibrations to needles during insertion may decrease the stress associated with blood sampling from rats--an important methodologic advance for investigators studying and assessing stress processes and a refinement over current blood sampling techniques.

Buckling prevention strategies in nature as inspiration for improving percutaneous instruments: a review

A typical mechanical failure mode observed in slender percutaneous instruments, such as needles and guidewires, is buckling. Buckling is observed when the axial compressive force that is required to penetrate certain tissue types exceeds the critical load of the instrument and manifests itself by sudden lateral deflection of the instrument. In nature, several organisms are able to penetrate substrates without buckling while using apparatuses with diameters smaller than those of off-the-shelf available percutaneous needles and guidewires. In this study we reviewed the apparatuses and buckling prevention strategies employed by biological organisms to penetrate substrates such as wood and skin. A subdivision is made between buckling prevention strategies that focus on increasing the critical load of the penetration tool and strategies that focus on decreasing the penetration load of the substrate. In total, 28 buckling prevention strategies were identified and categorized. Most organisms appear to be using a combination of buckling prevention strategies simultaneously. Integration and combination of these biological buckling prevention strategies in percutaneous instruments may contribute to increasing the success rate of percutaneous interventions.

Modelling needle forces during insertion into soft tissue

Robot-assisted needle-based surgeries are sought to improve many operations, from brain surgery to spine and urological procedures. Force feedback from a needle can provide important guidance during needle insertion. This paper presents a new modelling method of needle force during insertion into soft tissue based on finite element simulation. This is achieved by analysing the results of a series of needle inserting experiments with different insertion velocities. The forces acting on the needle are then modelled based on the experimental results. A simulation is implemented to verify the designed model.

Hybrid motion/force control of multi-backbone continuum robots

The recent growth of surgical applications exploiting continuum robots demands for new control paradigms that ensure safety by controlling interaction forces of tele-operated end-effectors. In this paper, we present the modeling, sensing and control of multi-backbone continuum robots in a unified framework for hybrid motion/force control. Multi-backbone continuum robots allow to estimate forces and torques at the operational point by monitoring loads along their actuation lines without the need for a dedicated transducer at the operational point. This capability is indeed crucial in emerging fields such as robotic surgery where cost and strict sterilization guidelines prevent the adoption of a dedicated sensor to provide force feedback from the sterile field. To advance further the force sensing capabilities of multi-backbone continuum robots, we present a new framework for hybrid motion and force control of continuum robots with intrinsic force sensing capabilities. The framework is based on a kinetostatic modeling of the multi-backbone continuum robot with, a simplified model for online estimate of the manipulator’s compliance, and a new strategy for merging force and motion control laws in the configuration space of the manipulator. Experimental results show the ability to sense and regulate forces at the operational point and evaluate the framework for shape exploration and stiffness imaging in flexible environments.

AAPM and GEC-ESTRO guidelines for image-guided robotic brachytherapy: report of Task Group 192

In the last decade, there have been significant developments into integration of robots and automation tools with brachytherapy delivery systems. These systems aim to improve the current paradigm by executing higher precision and accuracy in seed placement, improving calculation of optimal seed locations, minimizing surgical trauma, and reducing radiation exposure to medical staff. Most of the applications of this technology have been in the implantation of seeds in patients with early-stage prostate cancer. Nevertheless, the techniques apply to any clinical site where interstitial brachytherapy is appropriate. In consideration of the rapid developments in this area, the American Association of Physicists in Medicine (AAPM) commissioned Task Group 192 to review the state-of-the-art in the field of robotic interstitial brachytherapy. This is a joint Task Group with the Groupe Européen de Curiethérapie-European Society for Radiotherapy & Oncology (GEC-ESTRO). All developed and reported robotic brachytherapy systems were reviewed. Commissioning and quality assurance procedures for the safe and consistent use of these systems are also provided. Manual seed placement techniques with a rigid template have an estimated in vivo accuracy of 3-6 mm. In addition to the placement accuracy, factors such as tissue deformation, needle deviation, and edema may result in a delivered dose distribution that differs from the preimplant or intraoperative plan. However, real-time needle tracking and seed identification for dynamic updating of dosimetry may improve the quality of seed implantation. The AAPM and GEC-ESTRO recommend that robotic systems should demonstrate a spatial accuracy of seed placement ≤1.0 mm in a phantom. This recommendation is based on the current performance of existing robotic brachytherapy systems and propagation of uncertainties. During clinical commissioning, tests should be conducted to ensure that this level of accuracy is achieved. These tests should mimic the real operating procedure as closely as possible. Additional recommendations on robotic brachytherapy systems include display of the operational state; capability of manual override; documented policies for independent check and data verification; intuitive interface displaying the implantation plan and visualization of needle positions and seed locations relative to the target anatomy; needle insertion in a sequential order; robot-clinician and robot-patient interactions robustness, reliability, and safety while delivering the correct dose at the correct site for the correct patient; avoidance of excessive force on radioactive sources; delivery confirmation of the required number or position of seeds; incorporation of a collision avoidance system; system cleaning, decontamination, and sterilization procedures. These recommendations are applicable to end users and manufacturers of robotic brachytherapy systems.

Structures, properties, and functions of the stings of honey bees and paper wasps: a comparative study

Through natural selection, many animal organs with similar functions have evolved different macroscopic morphologies and microscopic structures. Here, we comparatively investigate the structures, properties and functions of honey bee stings and paper wasp stings. Their elegant structures were systematically observed. To examine their behaviors of penetrating into different materials, we performed penetration-extraction tests and slow motion analyses of their insertion process. In comparison, the barbed stings of honey bees are relatively difficult to be withdrawn from fibrous tissues (e.g. skin), while the removal of paper wasp stings is easier due to their different structures and insertion skills. The similarities and differences of the two kinds of stings are summarized on the basis of the experiments and observations.

In vivo evaluation of needle force and friction stress during insertion at varying insertion speed into the brain

BACKGROUND

Convection enhanced delivery (CED) infuses drugs directly into brain tissue. Needle insertion is required and results in tissue damage which can promote flowback along the needle track and improper targeting. The goal of this study was to evaluate friction stress (calculated from needle insertion force) as a measure of tissue contact and damage during needle insertion for varying insertion speeds.

NEW METHOD

Forces and surface dimpling during needle insertion were measured in rat brain in vivo. Needle retraction forces were used to calculate friction stresses. These measures were compared to track damage from a previous study. Differences between brain tissues and soft hydrogels were evaluated for varying insertion speeds: 0.2, 2, and 10mm/s.

RESULTS

In brain tissue, average insertion force and surface dimpling increased with increasing insertion speed. Average friction stress along the needle-tissue interface decreased with insertion speed (from 0.58 ± 0.27 to 0.16 ± 0.08 kPa). Friction stress varied between brain regions: cortex (0.227 ± 0.27 kPa), external capsule (0.222 ± 0.19 kPa), and CPu (0.383 ± 0.30 kPa). Hydrogels exhibited opposite trends for dimpling and friction stress with insertion speed.

COMPARISON WITH EXISTING METHODS

Previously, increasing needle damage with insertion speed has been measured with histological methods. Friction stress appears to decrease with increasing tissue damage and decreasing tissue contact, providing the potential for in vivo and real time evaluation along the needle track.

CONCLUSION

Force derived friction stress decreased with increasing insertion speed and was smaller within white matter regions. Hydrogels exhibited opposite trends to brain tissue.

Investigating recurrent neural networks for OCT A-scan based tissue analysis

OBJECTIVES

Optical Coherence Tomography (OCT) has been proposed as a high resolution image modality to guide transbronchial biopsies. In this study we address the question, whether individual A-scans obtained in needle direction can contribute to the identification of pulmonary nodules.

METHODS

OCT A-scans from freshly resected human lung tissue specimen were recorded through a customized needle with an embedded optical fiber. Bidirectional Long Short Term Memory networks (BLSTMs) were trained on randomly distributed training and test sets of the acquired A-scans. Patient specific training and different pre-processing steps were evaluated.

RESULTS

Classification rates from 67.5% up to 76% were archived for different training scenarios. Sensitivity and specificity were highest for a patient specific training with 0.87 and 0.85. Low pass filtering decreased the accuracy from 73.2% on a reference distribution to 62.2% for higher cutoff frequencies and to 56% for lower cutoff frequencies.

CONCLUSION

The results indicate that a grey value based classification is feasible and may provide additional information for diagnosis and navigation. Furthermore, the experiments show patient specific signal properties and indicate that the lower and upper parts of the frequency spectrum contribute to the classification.

Optimal needle design for minimal insertion force and bevel length

This research presents a methodology for optimal design of the needle geometry to minimize the insertion force and bevel length based on mathematical models of cutting edge inclination and rake angles and the insertion force. In brachytherapy, the needle with lower insertion force typically is easier for guidance and has less deflection. In this study, the needle with lancet point (denoted as lancet needle) is applied to demonstrate the model-based optimization for needle design. Mathematical models to calculate the bevel length and inclination and rake angles for lancet needle are presented. A needle insertion force model is developed to predict the insertion force for lancet needle. The genetic algorithm is utilized to optimize the needle geometry for two cases. One is to minimize the needle insertion force. Using the geometry of a commercial lancet needle as the baseline, the optimized needle has 11% lower insertion force with the same bevel length. The other case is to minimize the bevel length under the same needle insertion force. The optimized design can reduce the bevel length by 46%. Both optimized needle designs were validated experimentally in ex vivo porcine liver needle insertion tests and demonstrated the methodology of the model-based optimal needle design.

Histological observation for needle-tissue interactions

We histologically investigated tissue fractures and deformations caused by ex vivo needle insertions. The tissue was formalin-fixed while the needle remained in the tissue. Following removal of the needle, the tissue was microtomed, stained, and observed microscopically. This method enabled observations of cellular and tissular conditions where deformations caused by needle insertions were approximately preserved. For this study, our novel method presents preliminary findings related with tissue fractures and the orientation of needle blade relative to muscle fibers. When the needle blade was perpendicular to the muscle fiber, transfiber fractures and relatively large longitudinal deformations occurred. When the needle blade was parallel to the muscle fiber, interfiber fractures and relatively small longitudinal deformations occurred. This made a significant difference in the resistance force of the needle insertions.

Needle Insertion Force Modeling using Genetic Programming Polynomial Higher Order Neural Network

Precise insertion of a medical needle as an end-effecter of a robotic or computer-aided system into biological tissue is an important issue and should be considered in different operations, such as brain biopsy, prostate brachytherapy, and percutaneous therapies. Proper understanding of the whole procedure leads to a better performance by an operator or system. In this chapter, the authors use a 0.98 mm diameter needle with a real-time recording of force, displacement, and velocity of needle through biological tissue during in-vitro insertions. Using constant velocity experiments from 5 mm/min up to 300 mm/min, the data set for the force-displacement graph of insertion was gathered. Tissue deformation with a small puncture and a constant velocity penetration are the two first phases in the needle insertion process. Direct effects of different parameters and their correlations during the process is being modeled using a polynomial neural network. The authors develop different networks in 2nd and 3rd order to model the two first phases of insertion separately. Modeling accuracies were 98% and 86% in phase 1 and 2, respectively.

Macroscopic and microscopic observations of needle insertion into gels

Needle insertion into soft tissue is one of the most common medical interventions. This study provides macroscopic and microscopic observations of needle-gel interactions. A gelatin mixture is used as a soft-tissue simulant. For the macroscopic studies, system parameters, such as insertion velocity, needle diameter, gel elasticity, needle tip shape (including bevel angle) and insertion motion profile, are varied, while the maximum insertion force and maximum needle deflection are recorded. The needle tip and gel interactions are observed using confocal microscopic images. Observations indicate that increasing the insertion velocity and needle diameter results in larger insertion forces and smaller needle deflections. Varying the needle bevel angle from 8 degrees to 82 degrees results in the insertion force increasing monotonically, while the needle deflection does not. These variations are due to the coupling between gel rupture and tip compression interactions, which are observed during microscopic studies. Increasing the gel elasticity results in larger insertion forces and needle deflections. Varying the tip shapes demonstrates that bevel-tipped needles produce the largest deflection, but insertion force does not vary among the tested tip shapes. Insertion with different motion profiles are performed. Results show that adding I Hz rotational motion during linear insertion decreases the needle deflection. Increasing the rotational motion from I Hz to 5 Hz decreases the insertion force, while the needle deflection remains the same. A high-velocity (250 mm/s and 300 mm/s) tapping during insertion yields no significant decrease in needle deflection and a slight increase in insertion force.

Preliminary results on the design of a tool for inserting of transverse intrafascicular multichannel electrodes (TIME) into the peripheral nervous system

Transverse intrafascicular multichannel electrodes (TIMEs) are polyimide-based microelectrodes, which are potentially very interesting to restore sensorimotor functions in disabled people. By means of microstimulation of the nerve stump of an amputee, it can be possible to manipulate the phantom limb sensation, to provide sensory feedback to upper limb amputees, and to investigate methods of treatment of phantom limb pain. The current insertion procedure of TIMEs is completely done by hand. This makes the task difficult. This paper presents the preliminary results related to the development of a robotic tool to increase the accuracy in electrode placement and reduced size of the working area. The possibility to manage insertion parameters such as force, velocity, and positioning, could decrease the risk of damaging the nervous tissue, improving the coordination, and making placements repeatable. With the aim of solving the issues avbove, we developed a first prototype of a 4DoF multi-axis device. Additional strategies concerning system components and control are discussed. We performed characterization of implantation mechanics to derive mechanical design specifications for the robotic device. Force caracterization of the pig peripheral nerve during penetration of the needle at three velocities (1, 30, 40mm/sec) was executed. Results shown inverse relationship between maximal force and velocities values. The force values extracted varied between 0.081-0.174 N.

Needle-tissue interaction forces--a survey of experimental data

The development of needles, needle-insertion simulators, and needle-wielding robots for use in a clinical environment depends on a thorough understanding of the mechanics of needle-tissue interaction. It stands to reason that the forces arising from this interaction are influenced by numerous factors, such as needle type, insertion speed, and tissue characteristics. However, exactly how these factors influence the force is not clear. For this reason, the influence of various factors on needle insertion-force was investigated by searching literature for experimental data. This resulted in a comprehensive overview of experimental insertion-force data available in the literature, grouped by factor for quick reference. In total, 99 papers presenting such force data were found, with typical peak forces in the order of 1-10N. The data suggest, for example, that higher velocity tends to decrease puncture force and increase friction. Furthermore, increased needle diameter was found to increase peak forces, and conical needles were found to create higher peak forces than beveled needles. However, many questions remain open for investigation, especially those concerning the influence of tissue characteristics.

Microneedle delivery of plasmid DNA to living human skin: Formulation coating, skin insertion and gene expression

Microneedle delivery of nucleic acids, in particular plasmid DNA (pDNA), to the skin represents a potential new approach for the clinical management of genetic skin diseases and cutaneous cancers, and for intracutaneous genetic immunisation. In this study excised human skin explants were used to investigate and optimise key parameters that will determine stable and effective microneedle-facilitated pDNA delivery. These include (i) high dose-loading of pDNA onto microneedle surfaces, (ii) stability and functionality of the coated pDNA, (iii) skin penetration capability of pDNA-coated microneedles, and (iv) efficient gene expression in human skin. Optimisation of a dip-coating method enabled significant increases in the loading capacity, up to 100μg of pDNA per 5-microneedle array. Coated microneedles were able to reproducibly perforate human skin at low (<1N) insertion forces. The physical stability of the coated pDNA was partially compromised on storage, although this was improved through the addition of saccharide excipients without detriment to the biological functionality of pDNA. The pDNA-coated microneedles facilitated reporter gene expression in viable human skin. The efficiency of gene expression from coated microneedles will depend upon suitable DNA loading, efficient and reproducible skin puncture and rapid in situ dissolution of the plasmid at the site of delivery.

Positional calibration of an ultrasound image-guided robotic breast biopsy system

OBJECTIVES

Precision biopsy of small lesions is essential in providing high-quality patient diagnosis and management. Localization depends on high-quality imaging. We have developed a dedicated, fully automatic volume breast ultrasound (US) imaging system for early breast cancer detection. This work focuses on development of an image-guided robotic biopsy system that is integrated with the volume breast US system for performing minimally invasive breast biopsies. The objective of this work was to assess the positional accuracy of the robotic system for breast biopsy.

METHODS

We have adapted a compact robotic arm for performing breast biopsy. The arm incorporates a force torque sensor and is modified to accommodate breast biopsy sampling needles mounted on the robot end effector. Volume breast US images are used as input to a targeting algorithm that provides the physician with control of biopsy device guidance and trajectory optimization. In this work, the positional accuracy was evaluated using (1) a light-emitting diode (LED) mounted on the end effector and (2) a LED mounted on the end of a biopsy needle, each of which was imaged for each robot controller position as part of mapping the positional accuracy throughout a volume that would contain the breast. We measured the error in each location and the cumulative error.

RESULTS

Robotic device performance over the volume provided mean accuracy ± SD of 0.76 ± 0.13 mm (end effector) and 0.55 ± 0.13 mm (needle sample location), sufficient for a targeting accuracy within ±1 mm, which is suitable for clinical use. Depth positioning error also was small: 0.38 ± 0.03 mm. Reproducibility was excellent with less than 0.5% variation.

CONCLUSIONS

Overall accuracy and reproducibility of the compact robotic device were excellent, well within clinical biopsy performance requirements. Volume breast US data provide high-quality input to a biopsy sampling algorithm under physician control. Robotic devices may provide more precise device placement, assisting physicians with biopsy procedures.

Estimation of fracture toughness of liver tissue: experiments and validation

The mechanical interaction between the surgical tools and the target soft tissue is mainly dictated by the fracture toughness of the tissue in several medical procedures, such as catheter insertion, robotic-guided needle placement, suturing, cutting or tearing, and biopsy. Despite the numerous experimental works on the fracture toughness of hard biomaterials, such as bone and dentin, only a very limited number of studies have focused on soft tissues, where the results do not show any consistency mainly due to the negligence of the puncturing/cutting tool geometry. In order to address this issue, we performed needle insertion experiments on 3 bovine livers with 4 custom-made needles having different diameters. A unique value for fracture toughness (J=164±6 J/m(2)) was obtained for the bovine liver by fitting a line to the toughness values estimated from the set of insertion experiments. In order to validate the experimental results, a finite element model of the bovine liver was developed and its hyper-viscoelastic material properties were estimated through an inverse solution based on static indentation and ramp-and-hold experiments. Then, needle insertion into the model was simulated utilizing an energy-based fracture mechanics approach. The insertion forces estimated from the FE simulations show an excellent agreement with those acquired from the physical experiments for all needle geometries.

MRI-powered Actuators for Robotic Interventions

This paper presents a novel actuation technology for robotically assisted MRI-guided interventional procedures. Compact and wireless, the actuators are both powered and controlled by the MRI scanner. The design concept and performance limits are described and derived analytically. Simulation and experiments in a clinical MR scanner are used to validate the analysis and to demonstrate the capability of the approach for needle biopsies. The concepts of actuator locking mechanisms and multi-axis control are also introduced.