A coordinate positioning puncture method under robot-assisted CT-guidance: phantom and animal experiments

Experimental validation of the accuracy of robotic-assisted radioactive seed implantation for tumor treatment

An experimental validation of a robotic system for radioactive iodine-125 seed implantation (RISI) in tumor treatment was conducted using customized phantom models and animal models simulating liver and lung lesions. The robotic system, consisting of planning, navigation, and implantation modules, was employed to implant dummy radioactive seeds into the models. Fiducial markers were used for target localization. In phantom experiments across 40 cases, the mean errors between planned and actual seed positions were 0.98 ± 1.05 mm, 1.14 ± 0.62 mm, and 0.90 ± 1.05 mm in the x, y, and z directions, respectively. The x, y, and z directions correspond to the left-right, anterior-posterior, and superior-inferior anatomical planes. Silicone phantoms exhibiting significantly smaller x-axis errors compared to liver and lung phantoms (p < 0.05). Template assistance significantly reduced errors in all axes (p < 0.05). No significant dosimetric deviations were observed in parameters such as D90, V100, and V150 between plans and post-implant doses (p > 0.05). In animal experiments across 23 liver and lung cases, the mean implantation errors were 1.28 ± 0.77 mm, 1.66 ± 0.69 mm, and 1.86 ± 0.93 mm in the x, y, and z directions, slightly higher than in phantoms (p < 0.05), with no significant differences between liver and lung models. The dosimetric results closely matched planned values, confirming the accuracy of the robotic system for RISI, offering new possibilities in clinical tumor treatment.

Application of Medical Image Navigation Technology in Minimally Invasive Puncture Robot

Microneedle puncture is a standard minimally invasive treatment and surgical method, which is widely used in extracting blood, tissues, and their secretions for pathological examination, needle-puncture-directed drug therapy, local anaesthesia, microwave ablation needle therapy, radiotherapy, and other procedures. The use of robots for microneedle puncture has become a worldwide research hotspot, and medical imaging navigation technology plays an essential role in preoperative robotic puncture path planning, intraoperative assisted puncture, and surgical efficacy detection. This paper introduces medical imaging technology and minimally invasive puncture robots, reviews the current status of research on the application of medical imaging navigation technology in minimally invasive puncture robots, and points out its future development trends and challenges.

Evaluation of the performance of robot assisted CT-guided percutaneous needle insertion: Comparison with freehand insertion in a phantom

PURPOSE

To evaluate the performance of a novel robot for CT-guided needle positioning procedures and compare it to the freehand technique in an abdominal phantom.

METHODS

One interventional radiology fellow and one experienced interventional radiologist (IR) performed twelve robot-assisted and twelve freehand needle positionings in a phantom over predetermined trajectories. The robot automatically aimed a needle-guide according to the planned trajectories, after which the clinician manually inserted the needle. Using repeated CT scans, the needle position was assessed and adjusted if the clinician deemed it necessary. Technical success, accuracy, number of position adjustments, and procedure time were measured. All outcomes were analyzed using descriptive statistics and were compared between the robot-assisted and freehand procedures using the paired t-test and Wilcoxon signed rank test.

RESULTS

Compared with the freehand technique, the robot system improved the number of technically successfully needle targeting (20/24 vs 14/24), with higher accuracy (mean Euclidean deviation from target center: 3.5 ± 1.8 mm vs 4.6 ± 2.1 mm, p = 0.02) and required fewer needle position adjustments (0.0 ± 0.2 steps vs 1.7 ± 0.9 steps, p < 0.001), respectively. The robot improved the needle positioning for both, the fellow and the expert IR, compared to their freehand performances, with more improvement for the fellow than for the expert IR. The procedure time was similar for the robot-assisted and freehand procedures (19.5 ± 9.2 min. vs 21.0 ± 6.9 min., p = 0.777).

CONCLUSIONS

CT-guided needle positioning with the robot was more successful and accurate than freehand needle positioning and required fewer needle position adjustments without prolonging the procedure.

Spiral Computed Tomography Imaging Analysis of Positioning of Lumbar Spinal Nerve Anesthesia under the Concept of Enhanced Recovery after Surgery

The objective of this research was to explore the effect of perioperative anesthesia management for patients based on the concept of enhanced recovery after surgery (ERAS) and the application value of the computed tomography (CT) localization method in lumbar spinal nerve anesthesia, reducing the damage caused by anesthesia. One hundred and twenty patients who underwent the lumbar spinal anesthesia in lower limb surgery were selected as the research subjects. According to puncture positioning and nursing intention, the patients were classified into the control group with 30 patients (method of anatomical landmarks), CT group with 50 patients (the CT localization), and ERAS group with 40 patients (the CT localization and the ERAS management). The effects of the anesthesia positioning method and the ERAS management were compared and analyzed. The results showed that d (0.32) and r (0.27) of exponential filtering function were notably smaller than those of R-L filtering function (d = 0.40, r = 0.39) and of S-R filtering function (d = 0.37, r = 0.36) (P < 0.05). Puncture time ((9.23 ± 0.32) min vs. (13.11 ± 0.45) min), puncture direction change (20% vs. 33.33%), abnormal puncture sensation (22% vs. 40%), and nerve root touch (4% vs. 23.33%) in the CT group were all lower than those in the control group. The proportion of Degree I anesthesia effect (94%) of the CT group was greatly higher than that of the control group (76.67%) (P < 0.05). The VAS score, time of activity and gastrointestinal function recovery, and the incidence of adverse reactions (2.5% vs. 28%) in the ERAS group were lower than those in the CT group (P < 0.05). All in all, the CT localization method can improve the difficulty of anesthesia puncture and improve the anesthetic effect; the ERAS nursing concept can improve the postoperative pain of patients and contribute to the prognosis of patients and have a good clinical value.

Study of CT-Guided Localization in Pulmonary Nodule Resection

Objective

In recent years, with the attention of the general people to health, the surgical treatment of small nodules has become necessary. However, some nodules are too small, too deep, or difficult to reach, and it is difficult to accurately locate small nodules in the process of routine resection. In order to solve this problem and increase the success rate of puncture surgery, this study analyzed the application value of zoning localization method guided by CT in patients with pulmonary nodules.

Methods

The clinical history of patients with pulmonary nodules treated in Anhui Third Affiliated Hospital was retrospectively studied and analyzed. 97 patients with solitary pulmonary nodules treated in Anhui Third Affiliated Hospital from June 2021 to August 2021 were divided into observation group and reference group according to whether CT-guided localization method was used during operation. The operation rate, 1-year survival rate, recurrence rate, and pulmonary nodule metastasis rate of the two groups were compared; the results showed that the CT-guided zonal localization method was long and short, accurate, safe, and reliable. Comprehensive comparison through market survey on postoperative recovery compares the variability of patient data by using the statistical bivariatet-calibration method and using sensitivity specificity to analyze whether the CT-guided positioning method has advantages.

Results

The data underlying the results presented in the study are available within the manuscript. The results showed that there were 37 cases of pulmonary nodules, accounting for 38.14%; there were 8 patients with lung cancer, accounting for 8.24%; the proportion of diagnosis and analysis results of pulmonary nodules in hospitalized patients was significant; the medical history and clinical diagnosis information of 37 patients with pulmonary nodules were tracked and analyzed in detail. The diagnostic results were as follows: 8 patients (21.62%) with stage I, 11 patients (29.72%) with stage II, and 18 patients (48.64%) with stage III. The proportion of severe patients in the third stage was significantly higher than that in the first two stages; the results of CT-guided localization and conventional surgical resection were T < 10.000 and P < 0.05; the observation of prognosis and quality of life in the later stage of resection treatment showed that the observation group had obvious advantages over the reference group in terms of postoperative survival rate, recurrence rate, and nodule deterioration rate. The results show that the CT-guided zoning positioning operation is accurate, safe, and reliable.

Conclusion

The application of the CT-guided localization in the surgical treatment of pulmonary nodules is more safe and reliable. It can not only reduce the trauma but also improve the success rate of operation and reduce postoperative complications. It has the value of clinical promotion.