Toward effective needle steering in brain tissue

A Survey of Needle Steering Approaches in Minimally Invasive Surgery

In virtue of a curved insertion path inside tissues, needle steering techniques have revealed the potential with the assistance of medical robots and images. The superiority of this technique has been preliminarily verified with several maneuvers: target realignment, obstacle circumvention, and multi-target access. However, the momentum of needle steering approaches in the past decade leads to an open question-"How to choose an applicable needle steering approach for a specific clinical application?" This survey discusses this question in terms of design choices and clinical considerations, respectively. In view of design choices, this survey proposes a hierarchical taxonomy of current needle steering approaches. Needle steering approaches of different manipulations and designs are classified to systematically review the design choices and their influences on clinical treatments. In view of clinical consideration, this survey discusses the steerability and acceptability of the current needle steering approaches. On this basis, the pros and cons of the current needle steering approaches are weighed and their suitable applications are summarized. At last, this survey concluded with an outlook of the needle steering techniques, including the potential clinical applications and future developments in mechanical design.

A survey on puncture models and path planning algorithms of bevel-tipped flexible needles

Percutaneous needle insertion is a minimally invasive surgery with broad medical application prospects, such as biopsy and brachytherapy. However, the currently adopted rigid needles have limitations, as they cannot bypass obstacles or correct puncture deviations and can only travel along a straight path. Bevel-tip flexible needles are increasingly being adopted to address these issues, owing to their needle body's ease of deformation and bending. Successful puncture of flexible needles relies on accurate models and path planning, ensuring the needle reaches the target while avoiding vital tissues. This review investigates puncture models and path-planning algorithms by reviewing recent literature, focusing on the path-planning part. According to the literature, puncture models can be divided into three types: mechanical, finite element method (FEM), and kinematic models, while path-planning algorithms are categorized and discussed following the division used for mobile robots, which differs from the conventional approach for flexible needles-an innovation in this review. This review systematically summarizes the following categories: graph theory search, sampling-based, intelligent search, local obstacle avoidance, and other algorithms, including their implementation, advantages, and disadvantages, to further explore the potential to overcome obstacles in path planning for minimally invasive puncture needles. Finally, this study proposes future development trends in path-planning algorithms, providing possible directions for subsequent research for bevel-tipped flexible needles. This research aims to provide a resource for researchers to quickly learn about common path-planning algorithms, their backgrounds, and puncture models.

Non-Metallic MR-Guided Concentric Tube Robot for Intracerebral Hemorrhage Evacuation

OBJECTIVE

We aim to develop and evaluate an MR-conditional concentric tube robot for intracerebral hemorrhage (ICH) evacuation.

METHODS

We fabricated the concentric tube robot hardware with plastic tubes and customized pneumatic motors. The robot kinematic model was developed using a discretized piece-wise constant curvature (D-PCC) approach to account for variable curvature along the tube shape, and tube mechanics model was used to compensate torsional deflection of the inner tube. The MR-safe pneumatic motors were controlled using a variable gain PID algorithm. The robot hardware was validated in a series of bench-top and MRI experiments, and the robot's evacuation efficacy was tested in MR-guided phantom trials.

RESULTS

The pneumatic motor was able to achieve a rotational accuracy of 0.32°±0.30° with the proposed variable gain PID control algorithm. The kinematic model provided a positional accuracy of the tube tip of 1.39 ± 0.54 mm. The robot was able to evacuate an initial 38.36 mL clot, leaving a residual hematoma of 8.14 mL after 5 minutes, well below the 15 mL guideline suggesting good post-ICH evacuation clinical outcomes.

CONCLUSION

This robotic platform provides an effective method for MR-guided ICH evacuation.

SIGNIFICANCE

ICH evacuation is feasible under MRI guidance using a plastic concentric tube, indicating potential feasibility in future live animal studies.

Basis for error in stereotactic and computer-assisted surgery in neurosurgical applications: literature review

Technological advancements in optoelectronic motion capture systems have allowed for the development of high-precision computer-assisted surgery (CAS) used in cranial and spinal surgical procedures. Errors generated sequentially throughout the chain of components of CAS may have cumulative effect on the accuracy of implant and instrumentation placement - potentially affecting patient outcomes. Navigational integrity and maintenance of fidelity of optoelectronic data is the cornerstone of CAS. Error reporting measures vary between studies. Understanding error generation, mechanisms of propagation, and how they relate to workflow can assist clinicians in error mitigation and improve accuracy during navigation in neurosurgical procedures. Diligence in planning, fiducial positioning, system registration, and intra-operative workflow have the potential to improve accuracy and decrease disparity between planned and final instrumentation and implant position. This study reviews the potential errors associated with each step in computer-assisted surgery and provides a basis for disparity in intrinsic accuracy versus achieved accuracy in the clinical operative environment.

Axially rigid steerable needle with compliant active tip control

Steerable instruments allow for precise access to deeply-seated targets while sparing sensitive tissues and avoiding anatomical structures. In this study we present a novel omnidirectional steerable instrument for prostate high-dose-rate (HDR) brachytherapy (BT). The instrument utilizes a needle with internal compliant mechanism, which enables distal tip steering through proximal instrument bending while retaining high axial and flexural rigidity. Finite element analysis evaluated the design and the prototype was validated in experiments involving tissue simulants and ex-vivo bovine tissue. Ultrasound (US) images were used to provide visualization and shape-reconstruction of the instrument during the insertions. In the experiments lateral tip steering up to 20 mm was found. Manually controlled active needle tip steering in inhomogeneous tissue simulants and ex-vivo tissue resulted in mean targeting errors of 1.4 mm and 2 mm in 3D position, respectively. The experiments show that steering response of the instrument is history-independent. The results indicate that the endpoint accuracy of the steerable instrument is similar to that of the conventional rigid HDR BT needle while adding the ability to steer along curved paths. Due to the design of the steerable needle sufficient axial and flexural rigidity is preserved to enable puncturing and path control within various heterogeneous tissues. The developed instrument has the potential to overcome problems currently unavoidable with conventional instruments, such as pubic arch interference in HDR BT, without major changes to the clinical workflow.

Biologically Inspired Surgical Needle Steering: Technology and Application of the Programmable Bevel-Tip Needle

Percutaneous interventions via minimally invasive surgical systems can provide patients with better outcomes and faster recovery times than open surgeries. Accurate needle insertions are vital for successful procedures, and actively steered needles can increase system precision. Here, we describe how biology inspired the design of a novel Programmable Bevel-Tip Needle (PBN), mimicking the mechanics and control methods of certain insects ovipositors. Following an overview of our unique research and development journey, this paper explores our latest, biomimetic control of PBNs and its application to neurosurgery, which we validate within a simulated environment. Three modalities are presented, namely a Direct Push Controller, a Cyclic Actuation Controller, and a newly developed Hybrid Controller, which have been integrated into a surgical visual interface. The results of open loop, expert human-in-the-loop and a non-expert user study show that the Hybrid Controller is the best choice when considering system performance and the ability to lesson strain on the surrounding tissue which we hypothesis will result in less damage along the insertion tract. Over representative trajectories for neurosurgery using a Hybrid Controller, an expert user could reach a target along a 3D path with an accuracy of 0.70±0.69 mm, and non-expert users 0.97±0.72 mm, both clinically viable results and equivalent or better than the state-of-the-art actively steered needles over 3D paths. This paper showcases a successful example of a biologically inspired, actively steered needle, which has been integrated within a clinical interface and designed for seamless integration into the neurosurgical workflow.

Decoupling Steerability from Diameter: Helical Dovetail Laser Patterning for Steerable Needles

The maximum curvature of a steerable needle in soft tissue is highly sensitive to needle shaft stiffness, which has motivated use of small diameter needles in the past. However, desired needle payloads constrain minimum shaft diameters, and shearing along the needle shaft can occur at small diameters and high curvatures. We provide a new way to adjust needle shaft stiffness (thereby enhancing maximum curvature, i.e. "steerability") at diameters selected based on needle payload requirements. We propose helical dovetail laser patterning to increase needle steerability without reducing shaft diameter. Experiments in phantoms and ex vivo animal muscle, brain, liver, and inflated lung tissues demonstrate high steerability in soft tissues. These experiments use needle diameters suitable for various clinical scenarios, and which have been previously limited by steering challenges without helical dovetail patterning. We show that steerable needle targeting remains accurate with established controllers and demonstrate interventional payload delivery (brachytherapy seeds and radiofrequency ablation) through the needle. Helical dovetail patterning decouples steerability from diameter in needle design. It enables diameter to be selected based on clinical requirements rather than being carefully tuned to tissue properties. These results pave the way for new sensors and interventional tools to be integrated into high-curvature steerable needles.

Method and Apparatus for the Automated Delivery of Continuous Neural Stem Cell Trails Into the Spinal Cord of Small and Large Animals

BACKGROUND

Immature neurons can extend processes after transplantation in adult animals. Neuronal relays can form between injected neural stem cells (NSCs) and surviving neurons, possibly improving recovery after spinal cord injury (SCI). Cell delivery methods of single or multiple bolus injections of concentrated cell suspensions thus far tested in preclinical and clinical experiments are suboptimal for new tract formation. Nonuniform injectate dispersal is often seen due to gravitational cell settling and clumping. Multiple injections have additive risks of hemorrhage, parenchymal damage, and cellular reflux and require additional surgical exposure. The deposition of multiply delivered cells boluses may be uneven and discontinuous.

OBJECTIVE

To develop an injection apparatus and methodology to deliver continuous cellular trails bridging spinal cord lesions.

METHODS

We improved the uniformity of cellular trails by formulating NSCs in hyaluronic acid. The TrailmakerTM stereotaxic injection device was automatized to extend a shape memory needle from a single-entry point in the spinal cord longitudinal axis to "pioneer" a new trail space and then retract while depositing an hyaluronic acid-NSC suspension. We conducted testing in a collagen spinal models, and animal testing using human NSCs (hNSCs) in rats and minipigs.

RESULTS

Continuous surviving trails of hNSCs within rat and minipig naive spinal cords were 12 and 40 mm in length. hNSC trails were delivered across semi-acute contusion injuries in rats. Transplanted hNSCs survived and were able to differentiate into neural lineage cells and astrocytes.

CONCLUSION

The TrailmakerTM creates longitudinal cellular trails spanning multiple levels from a single-entry point. This may enhance the ability of therapeutics to promote functional relays after SCI.

Toward the Development of a Flexible Mesoscale MRI-compatible Neurosurgical Continuum Robot

Brain tumor, be it primary or metastatic, is usually life threatening for a person of any age. Primary surgical resection which is one of the most effective ways of treating brain tumors can have tremendously increased success rate if the appropriate imaging modality is used for complete tumor resection. Magnetic resonance imaging (MRI) is the imaging modality of choice for brain tumor imaging because of its excellent soft-tissue contrast. MRI combined with continuum soft robotics has immense potential to be the next major technological breakthrough in the field of brain cancer diagnosis and therapy. In this work, we present the design, kinematic, and force analysis of a flexible spring-based minimally invasive neurosurgical intracranial robot (MINIR-II). It is comprised of an inter-connected inner spring and an outer spring and is connected to actively cooled shape memory alloy spring actuators via tendon driven mechanism. Our robot has three serially connected 2-DoF segments which can be independently controlled due to the central tendon routing configuration. The kinematic and force analysis of the robot and the independent segment control were verified by experiments. Robot motion under forced cooling of SMA springs was evaluated as well as the MRI compatibility of the robot and its motion capability in brainlike gelatin environment.

Highly Articulated Robotic Needle Achieves Distributed Ablation of Liver Tissue

Robotic needle steering will improve percutaneous radio-frequency ablation (RFA) in the liver by performing distributed ablations without requiring multiple punctures of the liver capsule, thus enabling the treatment of large or multifocal tumors. However, state-of-the-art asymmetric-tip robotic needle steering systems do not yet achieve clinically relevant curvature. This work presents the design and development of a highly articulated needle that enables distributed RFA in liver tissue under ultrasound (US) image guidance. Our new needle design attains the target curvature required for liver procedures while meeting important clinical requirements, such as the use of fixed diameter needle introducers, presence of a free needle working channel, robustness for repeated insertions, and conductivity for the delivery of RF current for tissue ablation. The new needle tip includes two important design features: A tendon-actuated Nitinol asymmetric flexure joint, which allows for an active amplification of the needle steering force, and a steel back-bevel tip profile, which decreases the risk of needle jamming. The needle's resulting curvature was evaluated in both phantom and ex vivo liver tissues using segmented US images. The average radius of minimum curvature in ex vivo liver tissue was found to be 33.6 mm, the smallest reported to date. Furthermore, RFA in ex vivo porcine liver tissue tests were performed to demonstrate that distributedablation with a single puncture of the liver capsule is possible via robotic needle steering.

Towards human-controlled, real-time shape sensing based flexible needle steering for MRI-guided percutaneous therapies

BACKGROUND

Accurate needle placement into soft tissue is essential to percutaneous prostate cancer diagnosis and treatment procedures.

METHODS

This paper discusses the steering of a 20 gauge (G) FBG-integrated needle with three sets of Fiber Bragg Grating (FBG) sensors. A fourth-order polynomial shape reconstruction method is introduced and compared with previous approaches. To control the needle, a bicycle model based navigation method is developed to provide visual guidance lines for clinicians. A real-time model updating method is proposed for needle steering inside inhomogeneous tissue. A series of experiments were performed to evaluate the proposed needle shape reconstruction, visual guidance and real-time model updating methods.

RESULTS

Targeting experiments were performed in soft plastic phantoms and in vitro tissues with insertion depths ranging between 90 and 120 mm. Average targeting errors calculated based upon the acquired camera images were 0.40 ± 0.35 mm in homogeneous plastic phantoms, 0.61 ± 0.45 mm in multilayer plastic phantoms and 0.69 ± 0.25 mm in ex vivo tissue.

CONCLUSIONS

Results endorse the feasibility and accuracy of the needle shape reconstruction and visual guidance methods developed in this work. The approach implemented for the multilayer phantom study could facilitate accurate needle placement efforts in real inhomogeneous tissues. Copyright © 2016 John Wiley & Sons, Ltd.

Simulation and experimental studies in needle-tissue interactions

This work aims to introduce a new needle insertion simulation to predict the deflection of a bevel-tip needle inside soft tissue. The development of such a model, which predicts the steering behavior of the needle during needle-tissue interactions, could improve the performance of many percutaneous needle-based procedures such as brachytherapy and thermal ablation, by means of the virtual path planning and training systems of the needle toward the target and thus reducing possible incidents of complications in clinical practices. The Arbitrary-Lagrangian-Eulerian (ALE) formulation in LS-DYNA software was used to model the solid-fluid interactions between the needle and tissue. Since both large deformation and fracture of the continuum need to be considered in this model, applying ALE method for fluid analysis was considered a suitable approach. A 150 mm long needle was used to bend within the tissue due to the interacting forces on its asymmetric bevel tip. Three experimental cases of needle steering in a soft phantom were performed to validate the simulation. An error measurement of less than 10 % was found between the predicted deflection by the simulations and the one observed in experiments, validating our approach with reasonable accuracy. The effect of the needle diameter and its bevel tip angle on the final shape of the needle was investigated using this model. To maneuver around the anatomical obstacles of the human body and reach the target location, thin sharp needles are recommended, as they would create a smaller radius of curvature. The insertion model presented in this work is intended to be used as a base structure for path planning and training purposes for future studies.

Manually controlled steerable needle for MRI-guided percutaneous interventions

This study aims to develop and evaluate a manually controlled steerable needle that is compatible with and visible on MRI to facilitate full intra-procedural control and accurate navigation in percutaneous interventions. The steerable needle has a working channel that provides a lumen to a cutting stylet or a therapeutic instrument. A steering mechanism based on cable-operated compliant elements is integrated in the working channel. The needle can be steered by adjusting the orientation of the needle tip through manipulation of the handle. The steering mechanism is evaluated by recording needle deflection at constant steering angles. A steering angle of 20.3° results in a deflection of 9.1–13.3 mm in gelatin and 4.6–18.9 mm in porcine liver tissue at an insertion depth of 60 mm. Additionally, the possibility to control the needle path under MRI guidance is evaluated in a gelatin phantom. The needle can be steered to targets at different locations while starting from the same initial position and orientation under MRI guidance with generally available sequences. The steerable needle offers flexibility to the physician in control and choice of the needle path when navigating the needle toward the target position, which allows for optimization of individual treatment and may increase target accuracy.

On the use of discrete steps in robot-aided flexible needle insertion

Needle steering devices present great potential for improving the safety and accuracy of medical interventions with percutaneous access. Despite significant advances in the field, needle steerability remains an issue to be solved by the scientific community. In this paper, we propose the use of discrete steps in flexible needle insertion, inspired by the manual procedure performed by physicians. Conceptually, the method relies in alternating between two motions: grasp-push and release-retreat. For experimental evaluation, a modified gripper is used along with a 6DOF robotic manipulator to control needle insertion velocity, rotation and grasping. Preliminary results indicate that the use of discrete steps minimizes some negative effects, such as slippage and needle buckling, observed on alternative methods, while preserving their functional advantages.

Automatic Steering of Manually Inserted Needles

Bevel-tipped flexible needles can be robotically steered to reach clinical targets along curvilinear paths in 3D. Manual needle insertion allows the clinician to control the insertion speed, ensuring patient safety. This paper presents a control law for automatic 3D steering of manually inserted flexible needles, enabling path-following control. A look-ahead proportional controller for position and orientation is presented. The look-ahead distance is a linear function of insertion speed. Simulations in a 3D brain-like environment demonstrate the performance of the proposed controller. Experimental results also show the feasibility of this technique in 2D and 3D environments.

A flexure-based steerable needle: high curvature with reduced tissue damage

In the quest to design higher curvature bevel-steered needles, kinked bevel-tips have been one of the most successful approaches yet proposed. However, the price to be paid for enhancing steerability in this way has been increased tissue damage, since the prebent tip cuts a local helical path into tissue when axially rotated. This is problematic when closed-loop control is desired, because the controller will typically require the needle to rotate rapidly, and it is particularly problematic when duty cycling (i.e., continual needle spinning) is used to adjust curvature. In this paper, we propose a new flexure-based needle tip design that provides the enhanced steerability of kinked bevel-tip needles, while simultaneously minimizing tissue damage.

Towards a Meso-Scale SMA-Actuated MRI-Compatible Neurosurgical Robot

Brain tumors are the most feared complications of cancer. Their treatment is challenging due to the lack of good imaging modality and the inability to remove the complete tumor. Facilitating tumor removal by accessing regions outside the "line-of-sight" will require a highly dexterous and MRI compatible robot. We present our work towards the development of a MRI-compatible neurosurgical robot. We used two antagonistic shape memory alloy (SMA) wires as actuators for each joint. Due to the size limitation of the device, we rely on temperature feedback to control the joint motion of the robot. We have developed a theoretical model based on Tanaka's model to characterize the joint motion with the change in SMA wire temperature. The results demonstrated that the SMA wire temperature can be used reliably to predict the motion of the robot. We then used a PWM scheme and switching circuit to control the temperature of multiple SMA wires. Experimental results showed that we can actuate the robot reliably and observe joint motion in a gelatin medium. MR images also showed that the robot is fully MRI-compatible and creates no significant image distortion.

Percutaneous Intracerebral Navigation by Duty-Cycled Spinning of Flexible Bevel-Tipped Needles

BACKGROUND:

Intracerebral drug delivery using surgically placed microcatheters is a growing area of interest for potential treatment of a wide variety of neurological diseases, including tumors, neurodegenerative disorders, trauma, epilepsy, and stroke. Current catheter placement techniques are limited to straight trajectories. The development of an inexpensive system for flexible percutaneous intracranial navigation may be of significant clinical benefit.

OBJECTIVE:

Utilizing duty-cycled spinning of a flexible bevel-tipped needle, the authors devised and tested a means of achieving nonlinear trajectories for the navigation of catheters in the brain, which may be applicable to a wide variety of neurological diseases.

METHODS:

Exploiting the bending tendency of bevel-tipped needles due to their asymmetry, the authors devised and tested a means of generating curvilinear trajectories by spinning a needle with a variable duty cycle (ie, in on-off fashion). The technique can be performed using image guidance, and trajectories can be adjusted intraoperatively via joystick. Fifty-eight navigation trials were performed during cadaver testing to demonstrate the efficacy of the needle-steering system and to test its precision.

RESULTS:

The needle-steering system achieved a target acquisition error of 2 ± 1 mm, while demonstrating the ability to reach multiple targets from one burr hole using trajectories of varying curvature.

CONCLUSION:

The accuracy of the needle-steering system was demonstrated in a cadaveric model. Future studies will determine the safety of the device in vivo.

Interactive Motion Planning for Steerable Needles in 3D Environments with Obstacles

Bevel-tip steerable needles for minimally invasive medical procedures can be used to reach clinical targets that are behind sensitive or impenetrable areas and are inaccessible to straight, rigid needles. We present a fast algorithm that can compute motion plans for steerable needles to reach targets in complex, 3D environments with obstacles at interactive rates. The fast computation makes this method suitable for online control of the steerable needle based on 3D imaging feedback and allows physicians to interactively edit the planning environment in real-time by adding obstacle definitions as they are discovered or become relevant. We achieve this fast performance by using a Rapidly Exploring Random Tree (RRT) combined with a reachability-guided sampling heuristic to alleviate the sensitivity of the RRT planner to the choice of the distance metric. We also relax the constraint of constant-curvature needle trajectories by relying on duty-cycling to realize bounded-curvature needle trajectories. These characteristics enable us to achieve orders of magnitude speed-up compared to previous approaches; we compute steerable needle motion plans in under 1 second for challenging environments containing complex, polyhedral obstacles and narrow passages.

Testing of neurosurgical needle steering via duty-cycled spinning in brain tissue in vitro

A technique for steering of flexible bevel-tipped needles through tissue, providing proportional control of trajectory curvature by means of duty-cycled rotation or spinning during insertion, has been presented previously, and tested in vitro in gelatin samples. The present paper presents the results of testing under more authentic conditions. Thirty-two needle insertions were performed in cadaver brain tissue. Needle insertion was controlled interactively by the surgeon, adjusting parameters intraoperatively as needed based on fluoroscope images acquired at intervals of 1-2 cm of insertion depth. The average target acquisition error was 1.80 +/- 1.33 mm.

Estimation of Model Parameters for Steerable Needles

Flexible needles with bevel tips are being developed as useful tools for minimally invasive surgery and percutaneous therapy. When such a needle is inserted into soft tissue, it bends due to the asymmetric geometry of the bevel tip. This insertion with bending is not completely repeatable. We characterize the deviations in needle tip pose (position and orientation) by performing repeated needle insertions into artificial tissue. The base of the needle is pushed at a constant speed without rotating, and the covariance of the distribution of the needle tip pose is computed from experimental data. We develop the closed-form equations to describe how the covariance varies with different model parameters. We estimate the model parameters by matching the closed-form covariance and the experimentally obtained covariance. In this work, we use a needle model modified from a previously developed model with two noise parameters. The modified needle model uses three noise parameters to better capture the stochastic behavior of the needle insertion. The modified needle model provides an improvement of the covariance error from 26.1% to 6.55%.

Biologically inspired microtexturing: investigation into the surface topography of next-generation neurosurgical probes

Minimally Invasive (MI) surgery represents the future of many types of medical intervention (keyhole neurosurgery, natural orifice trans-luminal endoscopic surgery, etc.). However, the shortcomings of today's surgical tools fuel the need for the development of next-generation 'smart instrumentation', which will be more accurate and safer for the patient. This paper presents the preliminary results of a biologically inspired microtexturing method, based on UV-lithography, and its application to MI neurosurgery. These results suggest that the size and geometry of the texture 'printed' on the outer surface of a neurosurgical probe clearly affect the insertion and extraction forces generated at the brain-probe interface. Thus, by carefully choosing an appropriate microtexture, unique insertion characteristics can be obtained, which can improve the performance of existing instruments (e.g. reducing slippage in permanent electrodes such as those used in deep brain stimulation) or enable the development of novel designs altogether.

Image Guidance of Flexible Tip-Steerable Needles

Image guidance promises to improve targeting accuracy and broaden the scope of medical procedures performed with needles. This paper takes a step toward automating the guidance of a flexible tip-steerable needle as it is inserted into human tissue. We build upon a previously proposed nonholonomic model of needles that derive steering from asymmetric bevel forces at the tip. The bevel-tip needle is inserted and rotated at its base in order to steer it in six degrees of freedom. As a first step for control, we show that the needle tip can be automatically guided to a planar slice of tissue as it is inserted. Our approach keeps the physician in the loop to control insertion speed. The distance of the needle tip position from the plane of interest is used to drive an observer-based feedback controller which we prove is locally asymptotically stable. Numerical simulations demonstrate a large domain of attraction and robustness of the controller in the face of parametric uncertainty and measurement noise. Physical experiments with tip-steerable Nitinol needles inserted into a transparent plastisol tissue phantom under stereo image guidance validate the effectiveness of our approach.

Soft-tissue modeling and image-guided control of steerable needles

In this paper, we exploit a fuzzy controller on a flexible bevel-tip needle to manipulate the needle's base in order to steer its tip in a preset obstacle-free and target-tracking path. Although the needle tends to follow a curvature path, spinning the needle with an extremely high rotational velocity makes it symmetric with respect to the tissue to follow a straight path. The fuzzy controller determines an appropriate spinning to generate the planned trajectory and, the closed-loop system tries to match the needle body with that trajectory. The swine's brain tissue model, extracted from an in-vitro experimental setup, is a non-homogenous, uncertain and fast-updatable network to model real tissues, needle and their interactions providing the essential visual feedback for the control system. The simulation results illustrate a precise path tracking of the bevel-tip needle based on the fuzzy controller's commands with two degrees of freedom.

3D Motion Planning Algorithms for Steerable Needles Using Inverse Kinematics

Steerable needles can be used in medical applications to reach targets behind sensitive or impenetrable areas. The kinematics of a steerable needle are nonholonomic and, in 2D, equivalent to a Dubins car with constant radius of curvature. In 3D, the needle can be interpreted as an airplane with constant speed and pitch rate, zero yaw, and controllable roll angle.We present a constant-time motion planning algorithm for steerable needles based on explicit geometric inverse kinematics similar to the classic Paden-Kahan subproblems. Reachability and path competitivity are analyzed using analytic comparisons with shortest path solutions for the Dubins car (for 2D) and numerical simulations (for 3D). We also present an algorithm for local path adaptation using null-space results from redundant manipulator theory. Finally, we discuss several ways to use and extend the inverse kinematics solution to generate needle paths that avoid obstacles.

Integrated Planning and Image-Guided Control for Planar Needle Steering

Flexible, tip-steerable needles promise to enhance physicians' abilities to accurately reach targets and maneuver inside the human body while minimizing patient trauma. Here, we present a functional needle steering system that integrates two components: (1) a patient-specific 2D pre- and intra-operative planner that finds an achievable route to a target within a planar slice of tissue (Stochastic Motion Roadmap), and (2) a low-level image-guided feedback controller that keeps the needle tip within that slice. The planner generates a sequence of circular arcs that can be realized by interleaving pure insertions with 180° rotations of the needle shaft. This preplanned sequence is updated in realtime at regular intervals. Concurrently, the low-level image-based controller servos the needle to remain close to the desired plane between plan updates. Both planner and controller are predicated on a previously developed kinematic nonholonomic model of bevel-tip needle steering. We use slighly different needles here that have a small bend near the tip, so we extend the model to account for discontinuities of the tip position caused by 180° rotations. Further, during large rotations of the needle base, we maintain the desired tip angle by compensating for torsional compliance in the needle shaft, neglected in previous needle steering work. By integrating planning, control, and torsion compensation, we demonstrate both accurate targeting and obstacle avoidance.

Modeling of needle steering via duty-cycled spinning

As flexible bevel tip needles are inserted into tissue, a deflection force causes the needle to bend with a curvature dependent on relative stiffness and bevel angle. By constantly spinning the needle during insertion, the bevel angle is essentially negated and a straight trajectory can be achieved. Incorporating duty-cycled spinning during needle insertion provides proportional control of the curvature of the needle trajectory through tissue. This paper proposes a kinematic model for needle steering via duty-cycled spinning. Validation using experimental results is also presented.

Image-guided Control of Flexible Bevel-Tip Needles

Physicians perform percutaneous therapies in many diagnostic and therapeutic procedures. Image guidance promises to improve targeting accuracy and broaden the scope of needle interventions. In this paper, we consider the possibility of automating the guidance of a flexible bevel-tip needle as it is inserted into human tissue. We build upon a previously proposed nonholonomic kinematic model to develop a nonlinear observer-based controller. As a first step for control, we show that flexible needles can be automatically controlled to remain within a planar slice of tissue as they are inserted by a physician; our approach keeps the physician in the loop to control insertion speed. In the proposed controller, the distance of the needle tip position from the plane of interest is used as a feedback signal. Numerical simulations demonstrate the stability and robustness of the controller in the face of parametric uncertainty. We also present results from pilot physical experiments with phantom tissue under stereo image guidance.