Fiber Optic Force Sensors for MRI-Guided Interventions and Rehabilitation: A Review

Review of robotic systems for thoracoabdominal puncture interventional surgery

Cancer, with high morbidity and high mortality, is one of the major burdens threatening human health globally. Intervention procedures via percutaneous puncture have been widely used by physicians due to its minimally invasive surgical approach. However, traditional manual puncture intervention depends on personal experience and faces challenges in terms of precisely puncture, learning-curve, safety and efficacy. The development of puncture interventional surgery robotic (PISR) systems could alleviate the aforementioned problems to a certain extent. This paper attempts to review the current status and prospective of PISR systems for thoracic and abdominal application. In this review, the key technologies related to the robotics, including spatial registration, positioning navigation, puncture guidance feedback, respiratory motion compensation, and motion control, are discussed in detail.

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.

Biophysiologic Monitoring for the Neurosurgical Patient

Biophysiologic monitoring exists as a method of collecting objective information about the neurosurgical patient throughout their treatment and recovery process. Such data is crucial for an improved understanding of the disease processes while providing the surgeon additional clarity as they decipher the next best steps in decision-making and medical recommendations. In the current review article, the authors discuss the commonly used wearable and placeable monitoring devices and the biophysiological data that can be collected to monitor, as well as, assess the neurosurgical patient. Special focus is placed on invasive and non-invasive neurologic monitoring devices, but important and commonly used monitors for the rest of the body are also discussed as they relate to the neurosurgical patient. Last, the authors review new, as well as, upcoming devices and measurements to better analyze the neurosurgical patient's bodily function and physiologic status as needed. The synthesis of methods contained herein may provide meaningful guidance for neurosurgeons in effectively monitoring and treating their patients while also helping to guide their future efforts in patient biophysiologic monitoring developments within neurosurgery.

Robotic Instruments Inside the MRI Bore: Key Concepts and Evolving Paradigms in Imaging-enhanced Cranial Neurosurgery

Intraoperative MRI has been increasingly used to robotically deliver electrodes and catheters into the human brain using a linear trajectory with great clinical success. Current cranial MR guided robotics do not allow for continuous real-time imaging during the procedure because most surgical instruments are not MR-conditional. MRI guided robotic cranial surgery can achieve its full potential if all the traditional advantages of robotics (such as tremor-filtering, precision motion scaling, etc.) can be incorporated with the neurosurgeon physically present in the MRI bore or working remotely through controlled robotic arms. The technological limitations of design optimization, choice of sensing, kinematic modeling, physical constraints, and real-time control had hampered early developments in this emerging field, but continued research and development in these areas over time has granted neurosurgeons far greater confidence in using cranial robotic techniques. This article elucidates the role of MR-guided robotic procedures using clinical devices like NeuroBlate and Clearpoint that have several thousands of cases operated in a "linear cranial trajectory" and planned clinical trials, such as LAANTERN for MR guided robotics in cranial neurosurgery using LITT and MR-guided putaminal delivery of AAV2 GDNF in Parkinson's disease. The next logical improvisation would be a steerable curvilinear trajectory in cranial robotics with added DOFs and distal tip dexterity to the neurosurgical tools. Similarly, the novel concept of robotic actuators that are powered, imaged, and controlled by the MRI itself is discussed in this article, with its potential for seamless cranial neurosurgery.

Three-dimensional catheter tip force sensing using multi-core fiber Bragg gratings

Awareness of catheter tip interaction forces is a crucial aspect during cardiac ablation procedures. The most important contact forces are the ones that originate between the catheter tip and the beating cardiac tissue. Clinical studies have shown that effective ablation occurs when contact forces are in the proximity of 0.2 N. Lower contact forces lead to ineffective ablation, while higher contact forces may result in complications such as cardiac perforation. Accurate and high resolution force sensing is therefore indispensable in such critical situations. Accordingly, this work presents the development of a unique and novel catheter tip force sensor utilizing a multi-core fiber with inscribed fiber Bragg gratings. A customizable helical compression spring is designed to serve as the flexural component relaying external forces to the multi-core fiber. The limited number of components, simple construction, and compact nature of the sensor makes it an appealing solution towards clinical translation. An elaborated approach is proposed for the design and dimensioning of the necessary sensor components. The approach also presents a unique method to decouple longitudinal and lateral force measurements. A force sensor prototype and a dedicated calibration setup are developed to experimentally validate the theoretical performance. Results show that the proposed force sensor exhibits 7.4 mN longitudinal resolution, 0.8 mN lateral resolution, 0.72 mN mean longitudinal error, 0.96 mN mean lateral error, a high repeatability, and excellent decoupling between longitudinal and lateral forces.

A Novel Catheter Distal Contact Force Sensing for Cardiac Ablation Based on Fiber Bragg Grating with Temperature Compensation

OBJECTIVE

To accurately achieve distal contact force, a novel temperature-compensated sensor is developed and integrated into an atrial fibrillation (AF) ablation catheter.

METHODS

A dual elastomer-based dual FBGs structure is used to differentiate the strain on the two FBGs to achieve temperature compensation, and the design is optimized and validated by finite element simulation.

RESULTS

The designed sensor has a sensitivity of 90.5 pm/N, resolution of 0.01 N, and root-mean-square error (RMSE) of 0.02 N and 0.04 N for dynamic force loading and temperature compensation, respectively, and can stably measure distal contact forces with temperature disturbances.

CONCLUSION

Due to the advantages, i.e., simple structure, easy assembly, low cost, and good robustness, the proposed sensor is suitable for industrial mass production.

State of the Art and Future Opportunities in MRI-Guided Robot-Assisted Surgery and Interventions

Magnetic resonance imaging (MRI) can provide high-quality 3-D visualization of target anatomy, surrounding tissue, and instrumentation, but there are significant challenges in harnessing it for effectively guiding interventional procedures. Challenges include the strong static magnetic field, rapidly switching magnetic field gradients, high-power radio frequency pulses, sensitivity to electrical noise, and constrained space to operate within the bore of the scanner. MRI has a number of advantages over other medical imaging modalities, including no ionizing radiation, excellent soft-tissue contrast that allows for visualization of tumors and other features that are not readily visible by other modalities, true 3-D imaging capabilities, including the ability to image arbitrary scan plane geometry or perform volumetric imaging, and capability for multimodality sensing, including diffusion, dynamic contrast, blood flow, blood oxygenation, temperature, and tracking of biomarkers. The use of robotic assistants within the MRI bore, alongside the patient during imaging, enables intraoperative MR imaging (iMRI) to guide a surgical intervention in a closed-loop fashion that can include tracking of tissue deformation and target motion, localization of instrumentation, and monitoring of therapy delivery. With the ever-expanding clinical use of MRI, MRI-compatible robotic systems have been heralded as a new approach to assist interventional procedures to allow physicians to treat patients more accurately and effectively. Deploying robotic systems inside the bore synergizes the visual capability of MRI and the manipulation capability of robotic assistance, resulting in a closed-loop surgery architecture. This article details the challenges and history of robotic systems intended to operate in an MRI environment and outlines promising clinical applications and associated state-of-the-art MRI-compatible robotic systems and technology for making this possible.

Temperature Sensors Based on Polymer Fiber Optic Interferometer

Temperature measurements are of great importance in many fields of human activities, including industry, technology, and science. For example, obtaining a certain temperature value or a sudden change in it can be the primary control marker of a chemical process. Fiber optic sensors have remarkable properties giving a broad range of applications. They enable continuous real-time temperature control in difficult-to-reach areas, in hazardous working environments (air pollution, chemical or ionizing contamination), and in the presence of electromagnetic disturbances. The use of fiber optic temperature sensors in polymer technology can significantly reduce the cost of their production. Moreover, the installation process and usage would be simplified. As a result, these types of sensors would become increasingly popular in industrial solutions. This review provides a critical overview of the latest development of fiber optic temperature sensors based on Fabry–Pérot interferometer made with polymer technology.

Development of Force Sensor System Based on Tri-Axial Fiber Bragg Grating with Flexure Structure

Fiber Bragg grating (FBG) sensors have an advantage over optical sensors in that they are lightweight, easy to terminate, and have a high flexibility and a low cost. Additionally, FBG is highly sensitive to strain and temperature, which is why it has been used in FBG force sensor systems for cardiac catheterization. When manually inserting the catheter, the physician should sense the force at the catheter tip under the limitation of power (<0.5 N). The FBG force sensor can be optimal for a catheter as it can be small, low-cost, easy to manufacture, free of electromagnetic interference, and is materially biocompatible with humans. In this study, FBG fibers mounted on two different flexure structures were designed and simulated using ANSYS simulation software to verify their sensitivity and durability for use in a catheter tip. The selected flexure was combined with three FBGs and an interrogator to obtain the wavelength signals. To obtain a calibration curve, the FBG sensor obtained data on the change in wavelength with force at a high resolution of 0.01 N within the 0.1-0.5 N range. The calibration curve was used in the force sensor system by the LabVIEW program to measure the unknown force values in real time.

Magnetically Guided Catheters, Micro- and Nanorobots for Spinal Cord Stimulation

Spinal cord stimulation (SCS) is an established treatment for refractory pain syndromes and has recently been applied to improve locomotion. Several technical challenges are faced by surgeons during SCS lead implantation, particularly in the confined dorsal epidural spaces in patients with spinal degenerative disease, scarring and while targeting challenging structures such as the dorsal root ganglion. Magnetic navigation systems (MNS) represent a novel technology that uses externally placed magnets to precisely steer tethered and untethered devices. This innovation offers several benefits for SCS electrode placement, including enhanced navigation control during tip placement, and the ability to position and reposition the lead in an outpatient setting. Here, we describe the challenges of SCS implant surgery and how MNS can be used to overcome these hurdles. In addition to tethered electrode steering, we discuss the navigation of untethered micro- and nanorobots for wireless and remote neuromodulation. The use of these small-scale devices can potentially change the current standard of practice by omitting the need for electrode and pulse generator implantation or replacement. Open questions include whether small-scale robots can generate an electrical field sufficient to activate neuronal tissue, as well as testing precise navigation, placement, anchoring, and biodegradation of micro- and nanorobots in the in vivo environment.

Recent Advances in Biomedical Photonic Sensors: A Focus on Optical-Fibre-Based Sensing

In this invited review, we provide an overview of the recent advances in biomedical photonic sensors within the last five years. This review is focused on works using optical-fibre technology, employing diverse optical fibres, sensing techniques, and configurations applied in several medical fields. We identified technical innovations and advancements with increased implementations of optical-fibre sensors, multiparameter sensors, and control systems in real applications. Examples of outstanding optical-fibre sensor performances for physical and biochemical parameters are covered, including diverse sensing strategies and fibre-optical probes for integration into medical instruments such as catheters, needles, or endoscopes.

Interferometric optical fiber sensor for optoacoustic endomicroscopy

Optical fiber sensors can offer robust and miniaturized detection of wideband ultrasound, yielding high sensitivity and immunity to electromagnetic interference. However, the lack of cost-effective manufacturing methods prevents the disseminated use of these sensors in biomedical applications. In this study, we developed and optimized a simple method to create optical cavities with high-quality mirrors for acoustic sensing based on micro-manipulation of UV-curable optical adhesives and electroless chemical silver deposition. This approach enables the manufacturing of ultrasound sensors based on Fabry-Pérot interferometers on optical fiber tips with minimal production costs. Characterization and high-resolution optoacoustic imaging experiments show that the manufacturing process yielded a fiber sensor with a small NEP ( 11mPa/Hz ) over a broad detection bandwidth (25 MHz), generally outperforming conventional piezoelectric based transducers. We discuss how the new manufacturing process leads to a high-performance acoustic detector that, due to low cost, can be used as a disposable sensor.

In Vivo Optogenetic Modulation with Simultaneous Neural Detection Using Microelectrode Array Integrated with Optical Fiber

The detection of neuroelectrophysiology while performing optogenetic modulation can provide more reliable and useful information for neural research. In this study, an optical fiber and a microelectrode array were integrated through hot-melt adhesive bonding, which combined optogenetics and electrophysiological detection technology to achieve neuromodulation and neuronal activity recording. We carried out the experiments on the activation and electrophysiological detection of infected neurons at the depth range of 900-1250 μm in the brain which covers hippocampal CA1 and a part of the upper cortical area, analyzed a possible local inhibition circuit by combining opotogenetic modulation and electrophysiological characteristics and explored the effects of different optical patterns and light powers on the neuromodulation. It was found that optogenetics, combined with neural recording technology, could provide more information and ideas for neural circuit recognition. In this study, the optical stimulation with low frequency and large duty cycle induces more intense neuronal activity and larger light power induced more action potentials of neurons within a certain power range (1.032 mW-1.584 mW). The present study provided an efficient method for the detection and modulation of neurons in vivo and an effective tool to study neural circuit in the brain.

Force calibration for an endovascular robotic system with proximal force measurement

Surgeons, while performing manual endovascular procedures with conventional surgical tools (catheters and guidewires), experience forces on the tool outside the patient's body that are proximal to the point of actuation. Currently, most of the robotic systems for endovascular procedures use active catheters to navigate vasculature and to measure the contact forces at the distal end (tool tip). These tools are more expensive than the conventional surgical tools used in endovascular procedures. To avoid dependence on specialized devices like active catheters, we have developed a novel endovascular robotic system (ERS) that uses conventional surgical tools. Our robot can indirectly measure proximal forces and provide haptic feedback to surgeons. This paper discusses the theory, methodology, and calibration of indirect proximal force measurement. This new calibration technique is presented as a nested optimization problem that is solved using bi-level optimization. The results of experimental validation of the new force calibration methodology are also discussed. The results show that unbiasing of the indirect force measurement by means of force calibration will allow the use of conventional tools in robotic endovascular procedures.

Haptic Telerobotic Cardiovascular Intervention: A Review of Approaches, Methods, and Future Perspectives

Cardiac diseases are recognized as the leading cause of mortality, hospitalization, and medical prescription globally. The gold standard for the treatment of coronary artery stenosis is the percutaneous cardiac intervention that is performed under live X-ray imaging. Substantial clinical evidence shows that the surgeon and staff are prone to serious health problems due to X-ray exposure and occupational hazards. Telerobotic vascular intervention systems with a master-slave architecture reduced the X-ray exposure and enhanced the clinical outcomes; however, the loss of haptic feedback during surgery has been the main limitation of such systems. This paper is a review of the state of the art for haptic telerobotic cardiovascular interventions. A survey on the literature published between 2000 and 2019 was performed. Results of the survey were screened based on their relevance to this paper. Also, the leading research disciplines were identified based on the results of the survey. Furthermore, different approaches for sensor-based and model-based haptic telerobotic cardiovascular intervention, haptic rendering and actuation, and the pertinent methods were critically reviewed and compared. In the end, the current limitations of the state of the art, unexplored research areas as well as the future perspective of the research on this technology were laid out.

Phantom study of a fiber optic force sensor design for biopsy needles under MRI

Biopsy needles with embedded force sensors can eliminate the needle deflection and the needle targeting failure risks during MRI guided biopsy procedures. Fabry-Pérot interferometry (FPI) based sensors are small, compact and immune to electromagnetic and RF interferences, and therefore they are suitable for needle guidance under MRI. In this work, an FPI based fiber optic force sensor design and its integration to an 18-gauge MRI compatible biopsy needle are presented. The custom designed FPI sensor provides a force measurement range up to 13 N with a resolution of 0.1 N through benchtop experiments. The MRI compatibility of the sensor was evaluated using a commercially available prostate phantom under MRI.

Stereotactic Systems for MRI-Guided Neurosurgeries: A State-of-the-Art Review

Recent technological developments in magnetic resonance imaging (MRI) and stereotactic techniques have significantly improved surgical outcomes. Despite the advantages offered by the conventional MRI-guided stereotactic neurosurgery, the robotic-assisted stereotactic approach has potential to further improve the safety and accuracy of neurosurgeries. This review aims to provide an update on the potential and continued growth of the MRI-guided stereotactic neurosurgical techniques by describing the state of the art in MR conditional stereotactic devices including manual and robotic-assisted. The paper also presents a detailed overview of MRI-guided stereotactic devices, MR conditional actuators and encoders used in MR conditional robotic-assisted stereotactic devices. The review concludes with several research challenges and future perspectives, including actuator and sensor technique, MR image guidance, and robot design issues.

MRI Robots for Needle-Based Interventions: Systems and Technology

Magnetic resonance imaging (MRI) provides high-quality soft-tissue images of anatomical structures and radiation free imaging. The research community has focused on establishing new workflows, developing new technology, and creating robotic devices to change an MRI room from a solely diagnostic room to an interventional suite, where diagnosis and intervention can both be done in the same room. Closed bore MRI scanners provide limited access for interventional procedures using intraoperative imaging. MRI robots could improve access and procedure accuracy. Different research groups have focused on different technology aspects and anatomical structures. This paper presents the results of a systematic search of MRI robots for needle-based interventions. We report the most recent advances in the field, present relevant technologies, and discuss possible future advances. This survey shows that robotic-assisted MRI-guided prostate biopsy has received the most interest from the research community to date. Multiple successful clinical experiments have been reported in recent years that show great promise. However, in general the field of MRI robotic systems is still in the early stage. The continued development of these systems, along with partnerships with commercial vendors to bring this technology to market, is encouraged to create new and improved treatment opportunities for future patients.

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.