Robotic-assisted percutaneous irreversible electroporation for the treatment of hepatocellular carcinoma

In Vivo Safety and Feasibility of a CT-Guided Robotic Device for Percutaneous Needle Placement in Bone

PURPOSE

To evaluate the feasibility and accuracy of a robotic device used clinically in soft tissues (abdomen and lung), modified in design and workflow, to perform needle insertions in percutaneous skeletal procedures.

MATERIALS AND METHODS

The primary objective was safety (severe adverse events) of robotic-assisted insertion in this new application. Secondary objectives were feasibility (placement technical success), performance (rate of acceptable insertions), accuracy (lateral deviation), number of intermediate computed tomography (CT) scans, and tolerability (mild/moderate adverse events). Robotic-assisted insertions were performed by 6 interventional radiologists on 3 male pigs under general anesthesia. Needle trajectory was planned on the device software, and then needles were inserted with robotic guidance to reach the cortical bone. Intermediate CT was then performed to verify needle direction; if needed, the trajectory was modified, and robotic-assisted modified insertion into the target was performed. As many intermediate CT scans and trajectory modifications as needed by the operator were allowed.

RESULTS

Twenty-eight needles were inserted (10 in the spine and 18 in the pelvis). No adverse event was reported. Technical success rate was 96.4% (27/28). One insertion was not feasible after several robotic attempts. The placement success rate was 100% (27/27). After the planned intermediate CT scan, 13 (48.1%) of 27 trajectories did not require any modification, and 11 (40.7%) of 27 trajectories required a single modification. One needle was removed and replaced to achieve correct placement. Placement accuracy was similar for spinal and pelvic insertions, with a mean lateral deviation of 2.1 mm (SD ± 1.3).

CONCLUSIONS

Preclinical robotic-assisted needle insertions in bone were safe and feasible, with satisfactory accuracy. A multicenter in-human study is ongoing to evaluate feasibility and safety for percutaneous bone ablation and consolidation procedures.

Imaging in France: 2024 Update

Radiology in France has made major advances in recent years through innovations in research and clinical practice. French institutions have developed innovative imaging techniques and artificial intelligence applications in the field of diagnostic imaging and interventional radiology. These include, but are not limited to, a more precise diagnosis of cancer and other diseases, research in dual-energy and photon-counting computed tomography, new applications of artificial intelligence, and advanced treatments in the field of interventional radiology. This article aims to explore the major research initiatives and technological advances that are shaping the landscape of radiology in France. By highlighting key contributions in diagnostic imaging, artificial intelligence, and interventional radiology, we provide a comprehensive overview of how these innovations are improving patient outcomes, enhancing diagnostic accuracy, and expanding the possibilities for minimally invasive therapies. As the field continues to evolve, France's position at the forefront of radiological research ensures that these innovations will play a central role in addressing current healthcare challenges and improving patient care on a global scale.

Paranoid About Androids: A Review of Robotics in Radiology

In tandem with the ever-increasing global population, the demand for diagnostic radiology service provision is on the rise and at a disproportionate rate compared to the number of radiologists available to practice. The current "revolution in robotics" promises to alleviate personnel shortages in many sectors of industry, including medicine. Despite negative depictions of robots in popular culture, their multiple potential benefits cannot be overlooked, in particular when it comes to health service provision. The type of robots used for interventional procedures are largely robotic-assistance devices, such as the Da Vinci surgical robot. Advances have also been made with regards to robots for image-guided percutaneous needle placement, which have demonstrated superior accuracy compared to manual methods. It is likely that artificial intelligence will come to play a key role in the field of robotics and will result in an increase in the levels of robotic autonomy attainable. However, this concept is not without ethical and legal considerations, most notably who is responsible should an error occur; the physician, the robot manufacturer, software engineers, or the robot itself? Efforts have been made to legislate in order to protect against the potentially harmful effects of unexplainable "black-box" decision outputs of artificial intelligence systems. In order to be accepted by patients, studies have shown that the perceived level of trustworthiness and predictability of robots is crucial. Ultimately, effective, widespread implementation of medical robotic systems will be contingent on developers remaining cognizant of factors that increase human acceptance, as well as ensuring compliance with regulations.

Evaluation of navigation and robotic systems for percutaneous image-guided interventions: A novel metric for advanced imaging and artificial intelligence integration

PURPOSE

Navigation and robotic systems aim to improve the accuracy and efficiency of percutaneous image-guided interventions, but the evaluation of their autonomy and integration of advanced imaging and artificial intelligence (AI) is lacking. The purpose of this study was to evaluate the level of automation and integration of advanced imaging and artificial intelligence in navigation and robotic systems for percutaneous image-guided interventions, using established and novel metrics to categorize and compare their capabilities.

MATERIALS AND METHODS

Following PRISMA guidelines, a systematic review was conducted to identify studies on clinically validated navigation and robotic systems published between 2000 and May 2024. The PubMed, Embase, Cochrane Library, and Web of Science databases were searched. Data on navigation devices were extracted and analyzed. The levels of autonomy in surgical robotics (LASR) classification system (from 1 to 5) was used to analyze automation. A novel taxonomy, the Levels of Integration of Advanced Imaging and AI (LIAI2) classification system, was created to categorize the integration of imaging technologies and AI (from 1 to 5). These two scores were combined into an aggregate score (from 1 to 10) to reflect the autonomy in percutaneous image-guided intervention.

RESULTS

The review included 20 studies assessing two navigation systems and eight robotic devices. The median LASR score was 1 (Q1, Q3: 1, 1), the median LIAI2 score was 2 (Q1, Q3: 2, 3), and the median aggregate score was 3 (Q1, Q3: 3, 4). Only one robotic system (10 % of those reviewed) achieved the highest LASR qualification in the literature, a level 2/5. Four systems (40 %) shared the highest rating for LIAI2, which was a score of 3/5. Four systems (40 %) achieved the highest aggregate scores of 4/10.

CONCLUSION

None of the navigation and robotic systems achieved full autonomy for percutaneous image-guided intervention. The LASR and LIAI2 scales can guide innovation by identifying areas for further development and integration.

Interstitial Dual-Mode Ultrasound With a 3-mm MR-Compatible Catheter for Image-Guided HIFU and Directional In Vitro Tissue Ablations

Current interstitial techniques of tumor ablation face challenges that ultrasound (US) technologies could meet. The ablation radius and directionality of the US beam could improve the efficiency and precision. Here, a nine-gauge magnetic resonance (MR)-compatible dual-mode US catheter prototype was experimentally evaluated for ultrasound image-guided high-intensity focused ultrasound (USgHIFU) conformal ablations. The prototype consisted of 64 piezocomposite linear-array elements and was driven by an open research programmable dual-mode US platform. After verifying the US image guidance capabilities of the prototype, the high-intensity focused US (HIFU) output performances (dynamic focusing and HIFU intensities) were quantitatively characterized, together with the associated 3-D HIFU-induced thermal heating in tissue phantoms [using MR thermometry (MRT)]. Finally, the ability to produce robustly HIFU-induced thermal ablations in in vitro liver was studied experimentally and compared to numerical modeling. Investigations of several HIFU dynamic focusing allowed overcoming the challenges of miniaturizing the device: monofocal focusing maximized deep energy deposition, while multifocal strategies eliminated grating lobes. The linear-array design of the prototype made it possible to produce interstitial US images of tissue and tumor mimics in situ. Multifocal pressure fields were generated without grating lobes and transducer surface intensities reached up to . Seventeen elementary thermal ablations were performed in vitro. Rotation of the catheter proved the directionality of ablation, sparing nontargeted tissue. This experimental proof of concept demonstrates the feasibility of treating volumes comparable to those of primary solid tumors with a miniaturized USgHIFU catheter whose dimensions are close to those of tools traditionally used in interventional radiology while offering new functionalities.

Robotic-assisted CT-guided percutaneous thermal ablation of abdominal tumors: An analysis of 41 patients

PURPOSE

Robotic assistance is rapidly evolving and may help physicians optimize needle guidance during percutaneous interventions. The purpose of the study was to report feasibility, safety, accuracy, immediate clinical success and short-term local tumor control after robotic-assisted computed tomography (CT)-guided thermal ablation of abdominal tumors.

MATERIALS AND METHODS

Forty-one patients who underwent percutaneous thermal ablation of abdominal tumors using robotic-assisted CT-guided were included. All ablations were performed with robotic assistance, using an optically-monitored robotic system with a needle guide sent to preplanned trajectories defined on three-dimensional-volumetric CT acquisitions with respiration monitoring. Endpoints were technical success, safety, distance from needle tip to planned trajectory and number of needle adjustments, and complete ablation rate.

RESULTS

Forty-one patients (31 men; mean age, 66.7 ± 9.9 [standard deviation (SD)] years [age range: 41-84 years]) were treated for 48 abdominal tumors, with 79 planned needles. Lesions treated were located in the liver (23/41; 56%), kidney (14/41;34%), adrenal gland (3/41; 7%) or retroperitoneum (1/41; 2%). Technical success was achieved in 39/41 (95%) patients, and 76/79 (96%) needle insertions. The mean lateral distance between the needle tip and planned trajectory was 3.2 ± 4.5 (SD) mm (range: 0-20 mm) before adjustments, and the mean three-dimensional distance was 1.6 ± 2.6 (SD) mm (range: 0-13 mm) after 29 manual depth adjustments (29/78; 37%) and 33 lateral adjustments (33/78; 42%). Two (2/79; 3%) needles required complete manual reinsertion. One grade 3 complication was reported in one patient (1/41; 2%). The overall clinical success rate was 100%. The 3-month local tumor control rate (progression free survival) was 95% (38/41).

CONCLUSION

These results provide further evidence on the use of robotic-assisted needle insertion regarding feasibility, safety, and accuracy, resulting in effective percutaneous thermal ablation of abdominal tumors.