Minimization of needle deflection in robot-assisted percutaneous therapy

Research on Prostate Brachytherapy Robot Design and Puncture Control Strategy

BACKGROUND

In prostate brachytherapy, oblique-tip needles are frequently used to deliver radioactive seeds to the target area. These needles often experience deflection during insertion, leading to deviations from the planned trajectory and compromising treatment accuracy.

METHOD

This study did not involve human participants or animals, and therefore, ethics review and approval were not required. The proposed method combines preoperative needle trajectory planning with real-time intraoperative corrections, using an adaptive PID controller enhanced by reinforcement learning to adjust corrective forces during needle insertion.

RESULTS

Experimental results demonstrated that the proposed method reduced the average seed implantation error to 1.92 mm, with a standard error of 0.56 mm. These findings indicate that the method minimises needle deflection and improves precision in seed implantation.

CONCLUSION

The proposed modular robotic system and puncture control method enhance the precision of seed implantation and show promise for improving treatment outcomes in prostate cancer therapy.

Design and evaluation of a ball spline wasp-inspired needle

In percutaneous interventions, needles are used to reach target locations inside the body. However, when the needle is pushed through the tissue, forces arise at the needle tip and along the needle body, making the needle prone to buckling. Recently, needles that prevent buckling inspired by the ovipositor of female parasitic wasps have been developed. Building on these needle designs, this study proposes a manual actuation unit that allows the operator to drive the wasp-inspired needle through stationary tissue. The needle consists of six 0.3-mm spring steel wires, of which one is advanced while the others are retracted. The advancing needle segment has to overcome a cutting and friction force while the retracting ones experience a friction force in the opposite direction. The actuation unit moves the needle segments in the required sequence using a low-friction ball spline mechanism. The moving components of the needle have low inertia, and its connection to the actuation unit using a ball spline introduces a small friction force, generating a small push force on the needle that facilitates the needle's propulsion into tissue while preventing needle buckling. Experimental testing evaluated the needle's ability to move through stationary 15-wt% gelatin tissue phantoms for different actuation velocities. It was found that the needle moved through the tissue phantoms with mean slip ratios of 0.35, 0.31, and 0.29 for actuation velocities of π, 2π, and 3π rad/s, respectively. Furthermore, evaluation in 15-wt%, 10-wt%, and 5-wt% gelatin tissue phantoms showed that decreasing the gelatin concentration decreased the mean slip ratios from 0.35 to 0.19 and 0.18, respectively. The needle actuation system design is a step forward in developing a wasp-inspired needle for percutaneous procedures that prevents buckling.

Comparison of curved and straight tip radiofrequency cannula deflection in a ballistic model

Background

Percutaneous pain and spine procedures play an important diagnostic and therapeutic role in the treatment of various pain diagnoses. Accurate placement of needles or cannulae during these procedures is paramount to the success of these procedures.

Objective

The purpose of this study is to examine and quantify the amount of deflection of radiofrequency cannulae based on curved tip versus no curved tip, using a ballistic gel tissue simulant.

Materials and methods

Six different types of cannulae commonly used for spinal and peripheral nerve ablations were selected, including 18, 20, and 22 gauge curved and straight radiofrequency cannulae. Ballistic gel samples were made in molds of 40 mm and 80 mm. Each cannula was mounted in a drill press to ensure accurate trajectory.

Results

Curved RFA cannula had increased deflection when compared to straight cannula for 18-, 20-, and 22-gauge cannulae at a depth of 40 mm. Curved RFA cannula had increased deflection when compared to straight cannula for 20- and 22-gauge cannulae at a depth of 80 mm. Overall, the mean deflection for a curved cannula increased 1.9x for 20-gauge cannulae and 2.5x for 22-gauge cannulae when compared to a straight cannula.

Conclusions

For interventionalists, understanding the effects of needle or cannula shape is crucial for accurate placement. When a procedure requires additional steerability, additional deflection up to 2.5x obtained by placing a bend in the needle or cannula tip should be considered.

Design and evaluation of a pneumatic actuation unit for a wasp-inspired self-propelled needle

Transperineal laser ablation is a minimally invasive thermo-ablative treatment for prostate cancer that requires the insertion of a needle for accurate optical fiber positioning. Needle insertion in soft tissues may cause tissue motion and deformation, resulting in tissue damage and needle positioning errors. In this study, we present a wasp-inspired self-propelled needle that uses pneumatic actuation to move forward with zero external push force, thus avoiding large tissue motion and deformation. The needle consists of six parallel 0.25-mm diameter Nitinol rods driven by a pneumatic actuation system. The pneumatic actuation system consists of Magnetic Resonance (MR) safe 3D-printed parts and off-the-shelf plastic screws. A self-propelled motion is achieved by advancing the needle segments one by one, followed by retracting them simultaneously. The advancing needle segment has to overcome a cutting and friction force, while the stationary needle segments experience a friction force in the opposite direction. The needle self-propels through the tissue when the friction force of the five stationary needle segments overcomes the sum of the friction and cutting forces of the advancing needle segment. We evaluated the prototype's performance in 10-wt% gelatin phantoms and ex vivo porcine liver tissue inside a preclinical Magnetic Resonance Imaging (MRI) scanner in terms of the slip ratio of the needle with respect to the phantom or liver tissue. Our results demonstrated that the needle was able to self-propel through the phantom and liver tissue with slip ratios of 0.912-0.955 and 0.88, respectively. The prototype is a promising step toward the development of self-propelled needles for MRI-guided transperineal laser ablation as a method to treat prostate cancer.

Effect of twisting of intravitreal injections on ocular bio-mechanics: a novel insight to ocular surgery

Although intravitreal (IVT) injections provide several advantages in treating posterior segment eye diseases, several associated challenges remain. The current study uses the finite element method (FEM) to highlight the effect of IVT needle rotation along the insertion axis on the reaction forces and deformation inside the eye. A comparison of the reaction forces at the eye's key locations has been made with and without rotation. In addition, a sensitivity analysis of various parameters, such as the needle's angular speed, insertion location, angle, gauge, shape, and intraocular pressure (IOP), has been carried out to delineate the individual parameter's effect on reaction forces during rotation. Results demonstrate that twisting the needle significantly reduces the reaction forces at the penetration location and throughout the needle travel length, resulting in quicker penetration. Moreover, ocular biomechanics are influenced by needle insertion location, angle, shape, size, and IOP. The reaction forces incurred by the patient may be reduced by using a bevel needle of the higher gauge when inserted close to the normal of the local scleral surface toward the orra serrata within the Pars Plana region. Results obtained from the current study can deepen the understanding of the twisting needle's interaction with the ocular tissue.

A Review of Recent Advancements in Sensor-Integrated Medical Tools

A medical tool is a general instrument intended for use in the prevention, diagnosis, and treatment of diseases in humans or other animals. Nowadays, sensors are widely employed in medical tools to analyze or quantify disease-related parameters for the diagnosis and monitoring of patients' diseases. Recent explosive advancements in sensor technologies have extended the integration and application of sensors in medical tools by providing more versatile in vivo sensing capabilities. These unique sensing capabilities, especially for medical tools for surgery or medical treatment, are getting more attention owing to the rapid growth of minimally invasive surgery. In this review, recent advancements in sensor-integrated medical tools are presented, and their necessity, use, and examples are comprehensively introduced. Specifically, medical tools often utilized for medical surgery or treatment, for example, medical needles, catheters, robotic surgery, sutures, endoscopes, and tubes, are covered, and in-depth discussions about the working mechanism used for each sensor-integrated medical tool are provided.

Honeybee stinger-based biopsy needle and influence of the barbs on needle forces during insertion/extraction into the iliac crest: A multilayer finite element approach

Bone marrow biopsy (BMB) needles are frequently used in medical procedures, including extracting biological tissue to identify specific lesions or abnormalities discovered during a medical examination or a radiological scan. The forces applied by the needle during the cutting operation significantly impact the sample quality. Excessive needle insertion force and possible deflection might cause tissue damage, compromising the integrity of the biopsy specimen. The present study aims at proposing a revolutionary bioinspired needle design that will be utilized during the BMB procedure. A non-linear finite element method (FEM) has been used to analyze the insertion/extraction mechanisms of the honeybee-inspired biopsy needle with barbs into/from the human skin-bone domain (i.e., iliac crest model). It can be seen from the results of the FEM analysis that stresses are concentrated around the bioinspired biopsy needle tip and barbs during the needle insertion process. Also, these needles reduce the insertion force and reduce the tip deflection. The insertion force in the current study has been reduced by 8.6% for bone tissue and 22.66% for skin tissue layers. Similarly, the extraction force has been reduced by an average of 57.54%. Additionally, it has been observed that the needle-tip deflection got reduced from 10.44 mm for a plain bevel needle to 6.3 mm for a barbed biopsy bevel needle. According to the research findings, the proposed bioinspired barbed biopsy needle design could be utilized to create and produce novel biopsy needles for successful and minimally invasive piercing operations.

Robot and ultrasound assisted needle insertion to the transverse carpal ligament

BACKGROUND

A potential alternative treatment to surgery for carpal tunnel syndrome is to inject enzymes into the transverse carpal ligament to decrease its stiffness and alleviate pressure off the median nerve. An accurate injection is needed for delivery to achieve the effects of tissue degradation. The purposes of this study were to 1) determine injection sites using 3D reconstructed anatomy, and 2) insert the needle to the middle of the transverse carpal ligament thickness in situ.

METHODS

Six fresh-frozen cadaveric hands were used in this study. Five injection sites were determined in the sagittal plane along the center of the transverse carpal ligament thickness ulnar to the thenar muscle attachment using 3D ultrasonographic reconstruction. Each injection was delivered by rigidly fixing a 27-gauge needle to a six degrees of freedom robot arm programmed to insert the needle tip to the intended target. Ultrasound images were taken of the needle after insertion to measure accuracy and precision of the needle placement.

FINDINGS

The needle tip was successfully delivered to the middle region of the transverse carpal ligament thickness and visualized using ultrasound imaging. The accuracy and precision of the needle insertion were 0.83 and 0.31 mm, respectively.

INTERPRETATION

Methodology was established for robot-assisted needle insertion to the transverse carpal ligament using 3D ultrasonographic reconstructed anatomy. This methodology can be used in the future to deliver enzymatic injections to the transverse carpal ligament as a potential treatment for carpal tunnel syndrome.

Design and evaluation of an MRI-ready, self-propelled needle for prostate interventions

Prostate cancer diagnosis and focal laser ablation treatment both require the insertion of a needle for biopsy and optical fibre positioning. Needle insertion in soft tissues may cause tissue motion and deformation, which can, in turn, result in tissue damage and needle positioning errors. In this study, we present a prototype system making use of a wasp-inspired (bioinspired) self-propelled needle, which is able to move forward with zero external push force, thereby avoiding large tissue motion and deformation. Additionally, the actuation system solely consists of 3D printed parts and is therefore safe to use inside a magnetic resonance imaging (MRI) system. The needle consists of six parallel 0.25-mm diameter Nitinol rods driven by the actuation system. In the prototype, the self-propelled motion is achieved by advancing one needle segment while retracting the others. The advancing needle segment has to overcome a cutting and friction force while the retracting needle segments experience a friction force in the opposite direction. The needle self-propels through the tissue when the friction force of the five retracting needle segments overcomes the sum of the friction and cutting forces of the advancing needle segment. We tested the performance of the prototype in ex vivo human prostate tissue inside a preclinical MRI system in terms of the slip ratio of the needle with respect to the prostate tissue. The results showed that the needle was visible in MR images and that the needle was able to self-propel through the tissue with a slip ratio in the range of 0.78-0.95. The prototype is a step toward self-propelled needles for MRI-guided transperineal laser ablation as a method to treat prostate cancer.

Angular needle tracker and stabilizer for image-guided interventions

INTRODUCTION

Minimally invasive image-guided interventions have changed the face of procedural medicine. For these procedures, safety and efficacy depend on precise needle placement. Needle targeting devices help improve the accuracy of needle placement, but their use has not seen broad penetration. Some of these devices are costly and require major modifications to the clinical workflow. In this article, we developed a low-cost, disposable, and easy-to-use angulation tracking device, which was based on a redesigned commercial passive needle holder.

MATERIAL AND METHODS

The new design provided real-time angulation information for needle tracking. In this design, two potentiometers were used as angulation sensors, and they were connected to two axes of the passive needle holder's arch structure through a 3 D-printed bridge structure. A control unit included an Arduino Pro Mini, a Bluetooth module, and two rechargeable batteries. The angulation was calculated and communicated in real time to a novel developed smartphone app, where real-time angulation information was displayed for guiding the operator to position the needle to the planned angles.

RESULTS

The open-air test results showed that the average errors are 1.03° and 1.08° for left-right angulation and head-foot angulation, respectively. The animal cadaver tests revealed that the novel system had an average angular error of 3.2° and a radial distance error of 3.1 mm.

CONCLUSIONS

The accuracy was comparable with some commercially available solutions. The novel and low-cost needle tracking device may find a role as part of a real-time precision approach to both planning and implementation of image-guided therapies.

Multi-Bevel Needle Design Enabling Accurate Insertion in Biopsy for Cancer Diagnosis

OBJECTIVE

To obtain definitive cancer diagnosis for suspicious lesions, accurate needle deployment and adequate tissue sampling in needle biopsy are essential. However, the single-bevel needles in current biopsy devices often induce deflection during insertion, potentially causing lesion missampling/undersampling and cancer misdiagnosis. This study aims to reveal the biopsy needle design criteria enabling both low deflection and adequate tissue sampling.

METHODS

A novel model capable of predicting needle deflection and tissue deformation was first established to understand needle-tissue interaction with different needle tip geometries. Experiments of needle deflection and ex-vivo tissue biopsy were conducted for model validation.

RESULTS

The developed model showed a reasonably good prediction on the correlation of needle tip type vs. the resultant needle deflection and tissue sampling length. A new multi-bevel needle with the tissue separation point below the needle groove face has demonstrated to be an effective design with an 87% reduction in deflection magnitude and equivalently long tissue sampling length compared to the current single-bevel needle.

CONCLUSION

This study has revealed two critical design criteria for biopsy needles: 1) multiple bevel faces at the needle tip can generate forces to balance bending moments during insertion to enable a low needle deflection and 2) the tissue separation point should be below the needle groove face to ensure long tissue sampling length.

SIGNIFICANCE

The developed methodologies and findings in this study serve as proof-of-concept and can be utilized to investigate various biopsy procedures to improve cancer diagnostic accuracy as well as other procedures requiring accurate needle insertion.

Fine needle insertion method for minimising deflection in lower abdomen: In vivo evaluation

BACKGROUND

Fine needle insertion in the lower abdomen is difficult because of complex deflections and few image feedbacks. We aim to develop an approach for generating a straight insertion path by minimizing the needle deflection robustly based on a preoperative computer tomography (CT) image.

METHOD

This study presents two approaches: an insertion control strategy that performs both vibration and rotation-assisted needle insertions and a preoperative insertion path planning for determining an optimal insertion path based on insertion angles at each tissue boundary. Those proposed approaches were evaluated through an in vivo experiment with a Landrace mini-pig. We compered the following: (1) the deflection with and without the insertion control strategy in different 10 insertion paths and (2) the score calculated by the path planning and the actual deflection in the 10 insertion paths.

RESULTS

The result shows that the deflection can be reduced significantly by applying the insertion control strategy in the optimal insertion path calculated by the path planning.

CONCLUSION

The proposed method can decrease fine needle deflections in the lower abdomen, which has the potential for accurate and safety procedures without real-time CT imaging.

Transjugular Intrahepatic Portosystemic Shunt Creation Using a Radiofrequency Wire: Prospective Clinical Safety and Feasibility Trial in Cirrhosis

PURPOSE

To assess the safety and feasibility of using a radiofrequency (RF) wire for portosystemic shunt creation.

MATERIALS AND METHODS

Ten patients undergoing elective creation of a transjugular intrahepatic portosystemic shunt (TIPS) or a direct intrahepatic portosystemic shunt (DIPS) were prospectively enrolled. Primary outcomes were the safety and feasibility of RF wire used for the creation of TIPS and DIPS. Median age was 66.5 ± 6.1 years. Causes of liver disease included alcohol (n = 5), nonalcoholic steatohepatitis (n = 2), hepatitis C virus (n = 1), primary biliary cirrhosis (n = 1), autoimmune hepatitis (n = 1). The median score for model for end-stage liver disease was 11 ± 4.3. The Rosch-Uchida TIPS set was used with intravascular ultrasonography guidance in all cases. A 0.035-inch RF wire was used in lieu of the trocar needle through the 5-F TIPS set catheter to create a track between the hepatic vein and the portal vein. All shunts were created using stent grafts.

RESULTS

Technical success rate was 100%. In 7 of 10 patients, portal vein access was achieved with a single pass. A DIPS was created in 2 patients based on anatomic favorability. Median fluoroscopy time was 13.3 ± 3.8 min, and median total procedure time was 102 ± 19 min. The wire passed through parenchyma without subjective deflection. There was 1 case of extracapsular puncture with no clinical consequence. The RF wire was too stiff to curve into the main portal vein, requiring wire exchange in all but 1 case. Mean portosystemic gradient decreased from 13.9 ± 3.3 to 5.9 ± 2.1 mm Hg. No immediate complications were encountered. Shunt patency was 100% at 30 days.

CONCLUSIONS

Creation of TIPS and DIPS using an RF wire was safe and feasible, enabling creation of an intrahepatic track without subjective deflection in cirrhotic patients.

Effect of vibration on insertion force and deflection of bioinspired needle in tissues

The design of surgical needles used in biopsy procedures have remained fairly standard despite the increase in complexity of surgeries. Higher needle insertion forces and deflection can increase tissue damage and decrease biopsy sample integrity. To overcome these drawbacks, we present a novel bioinspired approach to reduce insertion forces and minimize needle-tip deflection. It is well known from the literature, design of bioinspired surgical needles results in decreasing insertion forces and needle-tip deflection from the needle insertion path. This technical note studies the influence of vibration on bioinspired needle to further reduce insertion forces and needle-tip deflection. Bioinspired needle geometrical parameters such as barb shapes and geometries were analyzed to determine the best design parameters. Static and dynamic (vibration) needle insertion tests were performed to determine the maximum insertion forces and to estimate needle-tip deflection. Our results show that introducing vibration on the bioinspired needle insertion can reduce the maximum insertion force by up to 50%. It was also found that the needle-tip deflection is decreased by 47%.

Robotically Steered Needles: A Survey of Neurosurgical Applications and Technical Innovations

This paper surveys both the clinical applications and main technical innovations related to steered needles, with an emphasis on neurosurgery. Technical innovations generally center on curvilinear robots that can adopt a complex path that circumvents critical structures and eloquent brain tissue. These advances include several needle-steering approaches, which consist of tip-based, lengthwise, base motion-driven, and tissue-centered steering strategies. This paper also describes foundational mathematical models for steering, where potential fields, nonholonomic bicycle-like models, spring models, and stochastic approaches are cited. In addition, practical path planning systems are also addressed, where we cite uncertainty modeling in path planning, intraoperative soft tissue shift estimation through imaging scans acquired during the procedure, and simulation-based prediction. Neurosurgical scenarios tend to emphasize straight needles so far, and span deep-brain stimulation (DBS), stereoelectroencephalography (SEEG), intracerebral drug delivery (IDD), stereotactic brain biopsy (SBB), stereotactic needle aspiration for hematoma, cysts and abscesses, and brachytherapy as well as thermal ablation of brain tumors and seizure-generating regions. We emphasize therapeutic considerations and complications that have been documented in conjunction with these applications.

Design Optimization of Nonrotational and Rotational Needle Insertion for Minimal Cutting Forces

The needle insertion is widely used in many medical procedures, particularly in the needle biopsy. The cutting force occurred during the insertion process has a significant effect on the cutting outcome. This paper focuses on minimizing the cutting force for two conventional needle insertion methods, the nonrotational and rotational needle insertion. For the nonrotational needle insertion, the secondary bevel angle and angle of rotation, which are two used for grinding the back-bevel and lancet needles, are considered. For the rotational needles, the effects of the insertion speed and the slice-push ratio on the cutting force are investigated. Levels of these design variables are defined using practical needle design configurations found in the literature. A clear trend of the cutting force decreases as the increase of the inclination angle was observed. The optimal cutting force of nonrotational needles was found as 0.242 N with inclination angle of 69.25 deg for the lancet needle and 0.254 N with inclination angle of 66.24 deg for the back-bevel needle. The optimization of rotational needles yielded a configuration of slice-push ratio as 4.66 and insertion speed as 2.01, which resulted in a minimal cutting force of 0.22 N. Besides, the main effects of and the interaction between the design variables on the cutting force are obtained and discussed. These results provide essential information for selecting geometric and cutting speed parameters for the design of nonrotational and rotational needles.

Needle deflection and tissue sampling length in needle biopsy

This study investigates the effect of needle tip geometry on the needle deflection and tissue sampling length in biopsy. Advances in medical imaging have allowed the identification of suspicious cancerous lesions which then require needle biopsy for tissue sampling and subsequent confirmatory pathological analysis. Precise needle insertion and adequate tissue sampling are essential for accurate cancer diagnosis and individualized treatment decisions. However, the single-bevel needles in current hand-held biopsy devices often deflect significantly during needle insertion, causing variance in the targeted and actual locations of the sampled tissue. This variance can lead to inaccurate sampling and false-negative results. There is also a limited understanding of factors affecting the tissue sampling length which is a critical component of accurate cancer diagnosis. This study compares the needle deflection and tissue sampling length between the existing single-bevel and exploratory multi-bevel needle tip geometries. A coupled Eulerian-Lagrangian finite element analysis was applied to understand the needle-tissue interaction during needle insertion. The needle deflection and tissue sampling length were experimentally studied using tissue-mimicking phantoms and ex-vivo tissue, respectively. This study reveals that the tissue separation location at the needle tip affects both needle deflection and tissue sampling length. By varying the tissue separation location and creating a multi-bevel needle tip geometry, the bending moments induced by the insertion forces can be altered to reduce the needle deflection. However, the tissue separation location also affects the tissue contact inside the needle groove, potentially reducing the tissue sampling length. A multi-bevel needle tip geometry with the tissue separation point below the needle groove face may reduce the needle deflection while maintaining a long tissue sampling length. Results from this study can guide needle tip design to enable the precise needle deployment and adequate tissue sampling for the needle biopsy procedures.

An electromagnetic tracking needle clip: an enabling design for low-cost image-guided therapy

INTRODUCTION

In this study, we hypothesized a disposable low-cost needle clip with a specially designed electromagnetic (EM) tracking sensor. It could be mounted onto 16- to 22-gauge needles, allowing the tip of the needle to be tracked in CT or US image-guided procedures using the Aurora EM tracking system.

MATERIAL AND METHODS

A 3 D printed EM needle clip case contains a pair of specially designed electromagnetic solenoids, positioned perpendicularly to each other in order to achieve six degrees of freedom for tracking the tip of the needle. The performance of the EM tracking needle clip was evaluated.

RESULTS

A low-cost 3D-printed disposable needle clip with specially designed EM tracking sensors that can be mounted on 16- to 22-gauge needles was designed. This needle clip has a 570 mm ×600 mm ×600 mm (L × W × H) working volume, an error <0.7 mm in the axial direction and 0.8 mm in the radial direction. The targeting accuracy results are on par with the commercially available EM tracking needles.

CONCLUSION

The designed EM needle clip provided successful needle tracking, with acceptable accuracy, and competitive performance compared to existing products. This proposed design may increase the clinical adoption of EM tracking needles because of its user-friendly design and low cost.

Tissue Deformation and Insertion Force of Bee-Stinger Inspired Surgical Needles

Surgical needles are commonly used to reach target locations inside of the body for percutaneous procedures. The major issues in needle steering in tissues are the insertion force which causes tissue damage and tissue deformation that causes the needle path deviation (i.e., tip deflection) resulting in the needle missing the intended target. In this study, honeybee-inspired needle prototypes were proposed and studied to decrease the insertion force and to reduce the tissue deformation. Three-dimensional (3D) printing technology was used to manufacture scaled-up needle prototypes. Needle insertion tests on tissue-mimicking polyvinyl chloride (PVC) gel were performed to measure the insertion force and the tip deflection. Digital image correlation (DIC) study was conducted to determine the tissue deformation during the insertion. It was demonstrated that the bioinspired needles can be utilized to decrease the insertion force by 24% and to minimize the tip deflection. It was also observed that the bioinspired needles decrease the tissue deformation by 17%. From this study, it can be concluded that the proposed bee-inspired needle design can be used to develop and manufacture innovative surgical needles for more effective and less invasive percutaneous procedures.

Novel design of honeybee-inspired needles for percutaneous procedure

The focus of this paper is to present new designs of innovative bioinspired needles to be used during percutaneous procedures. Insect stingers have been known to easily penetrate soft tissues. Bioinspired needles mimicking the barbs in a honeybee stinger were developed for a smaller insertion force, which can provide a less invasive procedure. Decreasing the insertion force will decrease the tissue deformation, which is essential for more accurate targeting. In this study, some design parameters, in particular, barb shape and geometry (i.e. front angle, back angle, and height) were defined, and their effects on the insertion force were investigated. Three-dimensional printing technology was used to manufacture bioinspired needles. A specially-designed insertion test setup using tissue mimicking polyvinyl chloride (PVC) gels was developed to measure the insertion and extraction forces. The barb design parameters were then experimentally modified through detailed experimental procedures to further reduce the insertion force. Different scales of the barbed needles were designed and used to explore the size-scale effect on the insertion force. To further investigate the efficacy of the proposed needle design in real surgeries, preliminary ex vivo insertion tests into bovine liver tissue were performed. Our results show that the insertion force of the needles in different scales decreased by 21-35% in PVC gel insertion tests, and by 46% in bovine liver tissue insertion tests.

Preoperative Needle Insertion Path Planning for Minimizing Deflection in Multilayered Tissues

Fine needle deflection is a problem encountered during insertion into a soft tissue. Although an axial rotational insertion is an effective approach for minimizing this problem, needle deflection still depends on the insertion angle with respect to the tissue boundary. Since the human body consists of multi-layered tissues of various shapes and mechanical properties, preoperative planning of an optimal path is a key factor for achieving a successful insertion. In this paper, we propose an optimization-based preoperative path planning model that minimizes needle deflection during multi-layered tissue insertion. This model can determine the optimal path based on the sum of insertion angles with respect to each tissue boundary that the needle passes through. To increase the accuracy of the model, we incorporated the effect of distances from tissue boundaries and the probability that the deflection is acceptable by incorporating weighting factors into the model. To validate the model, we performed experiments involving four scenarios of two- and three-layered tissues. The results showed that the proposed model is capable of determining the optimal insertion path in all scenarios.

AngleNav: MEMS Tracker to Facilitate CT-Guided Puncture

As a low-cost needle navigation system, AngleNav may be used to improve the accuracy, speed, and ease of CT-guided needle punctures. The AngleNav hardware includes a wireless device with a microelectromechanical (MEMS) tracker that can be attached to any standard needle. The physician defines the target, desired needle path and skin entry point on a CT slice image. The accuracy of AngleNav was first tested in a 3D-printed calibration platform in a benchtop setting. An abdominal phantom study was then performed in a CT scanner to validate the accuracy of the device's angular measurement. Finally, an in vivo swine study was performed to guide the needle towards liver targets (n = 8). CT scans of the targets were used to quantify the angular errors and needle tip-to-targeting distance errors between the planned needle path and the final needle position. The MEMS tracker showed a mean angular error of 0.01° with a standard deviation (SD) of 0.62° in the benchtop setting. The abdominal phantom test showed a mean angular error of 0.87° with an SD of 1.19° and a mean tip-to-target distance error of 4.89 mm with an SD of 1.57 mm. The animal experiment resulted in a mean angular error of 6.6° with an SD of 1.9° and a mean tip-to-target distance error of 8.7 mm with an SD of 3.1 mm. These results demonstrated the feasibility of AngleNav for CT-guided interventional workflow. The angular and distance errors were reduced by 64.4 and 54.8% respectively if using AngleNav instead of freehand insertion, with a limited number of operators. AngleNav assisted the physicians to deliver accurate needle insertion during CT-guided intervention. The device could potentially reduce the learning curve for physicians to perform CT-guided needle targeting.

Ovipositor-inspired steerable needle: design and preliminary experimental evaluation

Flexible steerable needles have the potential to allow surgeons to reach deep targets inside the human body with higher accuracy than rigid needles do. Furthermore, by maneuvering around critical anatomical structures, steerable needles could limit the risk of tissue damage. However, the design of a thin needle (e.g. diameter under 2 mm) with a multi-direction steering mechanism is challenging. The goal of this paper is to outline the design and experimental evaluation of a biologically inspired needle with a diameter under 2 mm that advances through straight and curved trajectories in a soft substrate without being pushed, without buckling, and without the need of axial rotation. The needle design, inspired by the ovipositor of parasitoid wasps, consisted of seven nickel titanium wires and had a total diameter of 1.2 mm. The motion of the needle was tested in gelatin phantoms. Forward motion of the needle was evaluated based on the lag between the actual and the desired insertion depth of the needle. Steering was evaluated based on the radius of curvature of a circle fitted to the needle centerline and on the ratio of the needle deflection from the straight path to the insertion depth. The needle moved forward inside the gelatin with a lag of 0.21 (single wire actuation) and 0.34 (double wire actuation) and achieved a maximum curvature of 0.0184 cm^-1and a deflection-to-insertion ratio of 0.0778. The proposed biologically inspired needle design is a relevant step towards the development of thin needles for percutaneous interventions.

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.

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.

Enabling freehand lateral scanning of optical coherence tomography needle probes with a magnetic tracking system

We present a high-resolution three-dimensional position tracking method that allows an optical coherence tomography (OCT) needle probe to be scanned laterally by hand, providing the high degree of flexibility and freedom required in clinical usage. The method is based on a magnetic tracking system, which is augmented by cross-correlation-based resampling and a two-stage moving window average algorithm to improve upon the tracker's limited intrinsic spatial resolution, achieving 18 µm RMS position accuracy. A proof-of-principle system was developed, with successful image reconstruction demonstrated on phantoms and on ex vivo human breast tissue validated against histology. This freehand scanning method could contribute toward clinical implementation of OCT needle imaging.

Target motion predictions for pre-operative planning during needle-based interventions

During biopsies, breast tissue is subjected to displacement upon needle indentation, puncture, and penetration. Thus, accurate needle placement requires pre-operative predictions of the target motions. In this paper, we used ultrasound elastography measurements to non-invasively predict elastic properties of breast tissue phantoms. These properties were used in finite element (FE) models of indentation of breast soft tissue phantoms. To validate the model predictions of target motion, experimental measurements were carried out. Breast tissue phantoms with cubic and hemispherical geometries were manufactured and included materials with different elastic properties to represent skin, adipose tissue, and lesions. Ultrasound was used to track the displacement of the target (i.e., the simulated lesion) during indentation. The FE model predictions were compared with ultrasound measurements for cases with different boundary conditions and phantom geometry. Maximum errors between measured and predicted target motions were 12% and 3% for the fully supported and partially supported cubic phantoms at 6.0 mm indentation, respectively. Further, FE-based parameter sensitivity analysis indicated that increasing skin elastic modulus and reducing the target depth location increased the target motion. Our results indicate that with a priori knowledge about the geometry, boundary conditions, and linear elastic properties, indentation of breast tissue phantoms can be accurately predicted with FE models. FE models for pre-operative planning in combination with robotic needle insertions, could play a key role in improving lesion targeting for breast biopsies.

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.

Needle deflection estimation using fusion of electromagnetic trackers

We present a needle deflection estimation method to compensate for needle bending during insertion into deformable tissue. We combine a kinematic needle deflection estimation model, electromagnetic (EM) trackers, and a Kalman filter (KF). We reduce the impact of error from the needle deflection estimation model by using the fusion of two EM trackers to report the approximate needle tip position in real-time. One reliable EM tracker is installed on the needle base, and estimates the needle tip position using the kinematic needle deflection model. A smaller but much less reliable EM tracker is installed on the needle tip, and estimates the needle tip position through direct noisy measurements. Using a KF, the sensory information from both EM trackers is fused to provide a reliable estimate of the needle tip position with much reduced variance in the estimation error. We then implement this method to compensate for needle deflection during simulated prostate cancer brachytherapy needle insertion. At a typical maximum insertion depth of 15 cm, needle tip mean estimation error was reduced from 2.39 mm to 0.31 mm, which demonstrates the effectiveness of our method, offering a clinically practical solution.

Transperineal prostate biopsy: analysis of a uniform core sampling pattern that yields data on tumor volume limits in negative biopsies

Background

Analyze an approach to distributing transperineal prostate biopsy cores that yields data on the volume of a tumor that might be present when the biopsy is negative, and also increases detection efficiency.

Methods

Basic principles of sampling and probability theory are employed to analyze a transperineal biopsy pattern that uses evenly-spaced parallel cores in order to extract quantitative data on the volume of a small spherical tumor that could potentially be present, even though the biopsy did not detect it, i.e., negative biopsy.

Results

This approach to distributing biopsy cores provides data for the upper limit on the volume of a small, spherical tumor that might be present, and the probability of smaller volumes, when biopsies are negative and provides a quantitative basis for evaluating the effectiveness of different core spacing distances.

Conclusions

Distributing transperineal biopsy cores so they are evenly spaced provides a means to calculate the probability that a tumor of given volume could be present when the biopsy is negative, and can improve detection efficiency.

Photoacoustic imaging of clinical metal needles in tissue

The ability to visualize and track temporarily or permanently implanted metal devices is important in many applications ranging from diagnosis to therapy. Specifically, reliable imaging of metal needles is required in today's clinical settings. Currently, ultrasound is utilized to image a needle inserted into tissue in real time. However, the diagnostic value and tracking ability of these images depends highly on the orientation of the needle, and also its proximity to regions of interest in the tissue. We examine the use of photoacoustic imaging combined with current ultrasound imaging methods to obtain high-contrast images of commonly used needles in the body. Experiments were performed using 21 G and 30 G needles inserted into ex vivo porcine tissue and tissue-mimicking phantoms. The needles and surrounding tissue were imaged using an ultrasound imaging system interfaced with the pulsed laser source necessary for photoacoustic imaging. The results suggest that photoacoustic imaging, combined with ultrasound imaging, is capable of real-time, high-contrast, and high-spatial-resolution visualization of metal implants within anatomical landmarks of the background tissue.

Teleoperated master-slave needle insertion

BACKGROUND

Accuracy of needle tip placement and needle tracking in soft tissue are of particular importance in many medical procedures. In recent years, developing autonomous and teleoperated systems for needle insertion has become an active area of research.

METHODS

In this study, needle insertion was performed using a master-slave set-up with multi-degrees of freedom. The effect of force feedback on the accuracy of needle insertion was investigated. In addition, this study compared autonomous, teleoperated and semi-autonomous needle insertion.

RESULTS

The results of this study show that incorporation of force feedback can improve teleoperated needle insertion. However, autonomous and semi-autonomous needle insertions, which use feedback from a deflection model, provide significantly better performance.

CONCLUSIONS

Development of a haptic master-slave needle insertion system, which is capable of performing some autonomous tasks based on feedback from tissue deformation and needle deflection models, can improve the performance of autonomous robotics-based insertions as well as non-autonomous teleoperated manual insertions.

Modelling and characterization of an instrumented medical needle in sight of new microsensor design for its insertion guidance

A needle used in in-vivo medical percutaneous procedures is subject to auto-deflection coming from its interactions with inhomogeneous and anisotropic tissues and organs in human body. In this paper we present the modelling and the characterization of microsensors glued on a medical needle in order to detect its real-time deflection by measuring strain variations on the needle. A first prototype has been developed by gluing metal foil strain gauges to the surface of a biopsy needle. The characterization of this prototype is carried out in comparison with theoretical analysis and finite element method (FEM) modelling. Results acquired through these different methods show an excellent conformity and confirm the feasibility of an instrumented medical device.

On the controllability of dynamic model-based needle insertion in soft tissue

Soft tissue needle guidance and steering for clinical applications has been an active topic of research in the past decade. Although dynamic feedback control of needle insertion systems is expected to provide more accurate target tracking, it has received little attention due to the fact that most available models for needle-tissue interaction do not incorporate the dynamics of motions. In this paper, we study the controllability of rigid or flexible needles inside soft tissues using mechanical-based dynamic models. The results have significant implications on the design of suitable feedback controllers for different types of needle insertion systems.

Modeling and control of needles with torsional friction

A flexible needle can be accurately steered by robotically controlling the bevel tip orientation as the needle is inserted into tissue. Friction between the long, flexible needle shaft and the tissue can cause a significant discrepancy between the orientation of the needle tip and the orientation of the base where the needle angle is controlled. Our experiments show that several common phantom tissues used in needle steering experiments impart substantial friction forces to the needle shaft, resulting in a lag of more than 45 ( degrees ) for a 10 cm insertion depth in some phantoms; clinical studies report torques large enough to cause similar errors during needle insertions. Such angle discrepancies will result in poor performance or failure of path planners and image-guided controllers, since the needles used in percutaneous procedures are too small for state-of-the-art imaging to accurately measure the tip angle. To compensate for the angle discrepancy, we develop an estimator using a mechanics-based model of the rotational dynamics of a needle being inserted into tissue. Compared to controllers that assume a rigid needle in a frictionless environment, our estimator-based controller improves the tip angle convergence time by nearly 50% and reduces the path deviation of the needle by 70%.

Modeling and simulation of flexible needles

Needle insertion is performed in many clinical and therapeutic procedures. Tissue displacement and needle bending which result from needle-tissue interaction make accurate targeting difficult. For performing physicians to gain essential needle targeting skills, needle insertion simulators can be used for training. An accurate needle bending model is essential for such simulators. These bending models are also needed for needle path planning. In this paper, three different models are presented to simulate the deformations of a needle. The first two models use the finite element method and take the geometric nonlinearity into account. The third model is a series of rigid bars connected by angular springs. The models were compared to recorded deformations during experiments of applying lateral tip forces on a brachytherapy needle. The model parameters were identified and the simulation results were compared to the experimental data. The results show that the angular spring model, which is computationally the most efficient model, is also the most accurate in modeling the bending of the brachytherapy needle.

Controlling a Robotically Steered Needle in the Presence of Torsional Friction

A flexible needle can be accurately steered by robotically controlling the orientation of the bevel tip as the needle is inserted into tissue. Here, we demonstrate the significant effect of friction between the long, flexible needle shaft and the tissue, which can cause a significant discrepancy between the orientation of the needle tip and the orientation of the base where the needle is controlled. Our experiments show that several common phantom tissues used in needle steering experiments impart substantial frictional forces to the needle shaft, resulting in a lag of over 45° for a 10 cm insertion depth in some phantoms; clinical studies have reported torques large enough to could cause similar errors during needle insertions. Such angle discrepancies will result in poor performance or failure of path planners and image-guided controllers, since the needles used in percutaneous procedures are too small for state-of-the-art imaging to accurately measure the tip angle. To compensate for the angle discrepancy, we develop a model for the rotational dynamics of a needle being continuously inserted into tissue and show how a PD controller is sufficient to compensate for the rotational dynamics.