MRI Conditional Actively Tracked Metallic Electrophysiology Catheters and Guidewires With Miniature Tethered Radio-Frequency Traps: Theory, Design, and Validation

Optimized radiofrequency shimming using low-heating B1+-mapping in the presence of deep brain stimulation implants: Proof of concept

MRI of patients with Deep Brain Stimulation (DBS) implants is constrained due to radiofrequency (RF) heating of the implant lead. However, "RF-shimming" parallel transmission (PTX) has the potential to reduce DBS heating during MRI. As part of using PTX in such a "safe mode", maps of the RF transmission field (B1+) are typically acquired for calibration purposes, with each transmit coil excited individually. These maps often have large zones of low signal intensity distant from the specific coil that is being excited, raising concerns that low signal-to-noise ratio (SNR) in these zones might negatively impact the ability of the optimized RF shim settings to suppress heating in safe mode. One way to improve SNR would be to increase RF transmission power during B1+ mapping, but this also raises heating concerns especially for coil elements proximal to the implant. Acting with an abundance of caution, it would be useful to investigate methods that permit B1+ mapping with low localized heating while producing high SNR measurements that lead to safe PTX RF shim settings. The present work addresses this issue in proof of concept using electromagnetic simulations and experimental PTX MRI. A two-step optimization algorithm is proposed and examined for a cylindrical phantom with an implanted wire to enable 1) robust B1+ mapping with low localized heating; and 2) robust RF shimming PTX with low localized heating and good B1+ homogeneity over a large imaging volume. Simulation and experimental outcomes were compared with those obtained using an existing simulation-driven workflow for obtaining safe mode RF shim settings, and for quadrature RF transmission using a circularly polarized (CP) birdcage head coil. Experimental results showed that although both existing and proposed safe-mode workflows effectively suppressed localized heating at the wire tip in comparison to the CP coil results, the proposed workflow produced much smaller temperature elevations and much improved signal uniformity. These promising results support continued investigation and refinement of the proposed workflow, involving more realistic scenarios toward ultimate implementations in DBS patients.

Modeling and Control of an MR-Safe Pneumatic Radial Inflow Motor and Encoder (PRIME)

Magnetic resonance (MR) conditional actuators and encoders are the key components for MR-guided robotic systems. In this article, we present the modeling and control of our MR-safe pneumatic radial inflow motor and encoder. A comprehensive model is developed that considers the primary dynamic elements of the system, including: 1) motor dynamics, 2) pneumatic transmission line dynamics, and 3) valve dynamics. After model validation, we present a simplified third order model that facilitates design of a first order sliding mode controller (TO-SMC). Finally, the motor hardware is tested in a 7T MRI. No image distortion or artifacts were observed. We posit the MR-safe motor and dynamic model will lower the entry barriers for researchers interested in MR-guided robots and promote wider adoption of MR-guided robotic systems.

Quasi-static Path Planning for Continuum Robots By Sampling on Implicit Manifold

Continuum robots (CR) offer excellent dexterity and compliance in contrast to rigid-link robots, making them suitable for navigating through, and interacting with, confined environments. However, the study of path planning for CRs while considering external elastic contact is limited. The challenge lies in the fact that CRs can have multiple possible configurations when in contact, rendering the forward kinematics not well-defined, and characterizing the set of feasible robot configurations is non-trivial. In this paper, we propose to perform quasi-static path planning on an implicit manifold. We model elastic obstacles as external potential fields and formulate the robot statics in the potential field as the extremal trajectory of an optimal control problem. We show that the set of stable robot configurations is a smooth manifold diffeomorphic to a submanifold embedded in the product space of the CR actuation and base internal wrench. We then propose to perform path planning on this manifold using AtlasRRT*, a sampling-based planner dedicated to planning on implicit manifolds. Simulations in different operation scenarios were conducted and the results show that the proposed planner outperforms Euclidean space planners in terms of success rate and computational efficiency.

Evaluation of 12-lead electrocardiogram at 0.55T for improved cardiac monitoring in magnetic resonance imaging

BACKGROUND

The 12-lead electrocardiogram (ECG) is a standard diagnostic tool for monitoring cardiac ischemia and heart rhythm during cardiac interventional procedures and stress testing. These procedures can benefit from magnetic resonance imaging (MRI) information; however, the MRI scanner magnetic field leads to ECG distortion that limits ECG interpretation. This study evaluated the potential for improved ECG interpretation in a "low field" 0.55T MRI scanner.

METHODS

The 12-lead ECGs were recorded inside 0.55T, 1.5T, and 3T MRI scanners, as well as at scanner table "home" position in the fringe field and outside the scanner room (seven pigs). To assess interpretation of ischemic ECG changes in a 0.55T MRI scanner, ECGs were recorded before and after coronary artery occlusion (seven pigs). ECGs was also recorded for five healthy human volunteers in the 0.55T scanner. ECG error and variation were assessed over 2-minute recordings for ECG features relevant to clinical interpretation: the PR interval, QRS interval, J point, and ST segment.

RESULTS

ECG error was lower at 0.55T compared to higher field scanners. Only at 0.55T table home position, did the error approach the guideline recommended 0.025 mV ceiling for ECG distortion (median 0.03 mV). At scanner isocenter, only in the 0.55T scanner did J point error fall within the 0.1 mV threshold for detecting myocardial ischemia (median 0.03 mV in pigs and 0.06 mV in healthy volunteers). Correlation of J point deviation inside versus outside the 0.55T scanner following coronary artery occlusion was excellent at scanner table home position (r2 = 0.97), and strong at scanner isocenter (r2 = 0.92).

CONCLUSION

ECG distortion is improved in 0.55T compared to 1.5T and 3T MRI scanners. At scanner home position, ECG distortion at 0.55T is low enough that clinical interpretation appears feasible without need for more cumbersome patient repositioning. At 0.55T scanner isocenter, ST segment changes during coronary artery occlusion appear detectable but distortion is enough to obscure subtle ST segment changes that could be clinically relevant. Reduced ECG distortion in 0.55T scanners may simplify the problem of suppressing residual distortion by ECG cable positioning, averaging, and filtering and could reduce current restrictions on ECG monitoring during interventional MRI procedures.

Concentric Tube Robot Redundancy Resolution via Velocity/Compliance Manipulability Optimization

Concentric Tube Robots (CTR) have the potential to enable effective minimally invasive surgeries. While extensive modeling and control work have been proposed in the past decade, limited efforts have been made to improve the path tracking performance from the perspective of manipulability, which can be critical to generate safe motion and feasible actuator commands. In this paper, we propose a gradient-based redundancy resolution framework that optimizes velocity/compliance manipulability-based performance indices during path tracking for a kinematically redundant CTR. We efficiently calculate the gradients of manipulabilities by propagating the first- and second-order derivatives of state variables of the Cosserat rod model along the CTR arc length, reducing the gradient computation time by 68% compared to the finite difference method. Task-specific performance indices are optimized by projecting the gradient into the null-space of path tracking. Simulation results show that the proposed method is able to accomplish the required tasks while commonly used redundancy resolution approaches underperform or even fail.

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.

Interventional cardiovascular magnetic resonance: state-of-the-art

Transcatheter cardiovascular interventions increasingly rely on advanced imaging. X-ray fluoroscopy provides excellent visualization of catheters and devices, but poor visualization of anatomy. In contrast, magnetic resonance imaging (MRI) provides excellent visualization of anatomy and can generate real-time imaging with frame rates similar to X-ray fluoroscopy. Realization of MRI as a primary imaging modality for cardiovascular interventions has been slow, largely because existing guidewires, catheters and other devices create imaging artifacts and can heat dangerously. Nonetheless, numerous clinical centers have started interventional cardiovascular magnetic resonance (iCMR) programs for invasive hemodynamic studies or electrophysiology procedures to leverage the clear advantages of MRI tissue characterization, to quantify cardiac chamber function and flow, and to avoid ionizing radiation exposure. Clinical implementation of more complex cardiovascular interventions has been challenging because catheters and other tools require re-engineering for safety and conspicuity in the iCMR environment. However, recent innovations in scanner and interventional device technology, in particular availability of high performance low-field MRI scanners could be the inflection point, enabling a new generation of iCMR procedures. In this review we review these technical considerations, summarize contemporary clinical iCMR experience, and consider potential future applications.

MRI-Conditional Eccentric-Tube Injection Needle: Design, Fabrication, and Animal Trial

Effective radiation therapy aims to maximize the radiation dose delivered to the tumor while minimizing damage to the surrounding healthy tissues, which can be a challenging task when the tissue-tumor space is small. To eliminate the damage to healthy tissue, it is now possible to inject biocompatible hydrogels between cancerous targets and surrounding tissues to create a spacer pocket. Conventional methods have limitations in poor target visualization and device tracking. In this paper, we leverage our MR-tracking technique to develop a novel injection needle for hydrogel spacer deployment. Herein, we present the working principle and fabrication method, followed by benchtop validation in an agar phantom, and MRI-guided validation in tissue-mimic prostate phantom and sexually mature female swine. Animal trials indicated that the spacer pockets in the rectovaginal septum can be accurately visualized on T2-weighted MRI. The experimental results showed that the vaginal-rectal spacing was successfully increased by 12 ± 2 mm anterior-posterior.

Review of Robot-Assisted HIFU Therapy

This paper provides an overview of current robot-assisted high-intensity focused ultrasound (HIFU) systems for image-guided therapies. HIFU is a minimally invasive technique that relies on the thermo-mechanical effects of focused ultrasound waves to perform clinical treatments, such as tumor ablation, mild hyperthermia adjuvant to radiation or chemotherapy, vein occlusion, and many others. HIFU is typically performed under ultrasound (USgHIFU) or magnetic resonance imaging guidance (MRgHIFU), which provide intra-operative monitoring of treatment outcomes. Robot-assisted HIFU probe manipulation provides precise HIFU focal control to avoid damage to surrounding sensitive anatomy, such as blood vessels, nerve bundles, or adjacent organs. These clinical and technical benefits have promoted the rapid adoption of robot-assisted HIFU in the past several decades. This paper aims to present the recent developments of robot-assisted HIFU by summarizing the key features and clinical applications of each system. The paper concludes with a comparison and discussion of future perspectives on robot-assisted HIFU.

Curvature-based force estimation for an elastic tube

Contact force is one of the most significant feedback for robots to achieve accurate control and safe interaction with environment. For continuum robots, it is possible to estimate the contact force based on the feedback of robot shapes, which can address the difficulty of mounting dedicated force sensors on the continuum robot body with strict dimension constraints. In this paper, we use local curvatures to estimate the magnitude and location of single or multiple contact forces based on Cosserat rod theory. We validate the proposed method in a thin elastic tube and calculate the curvatures via Fiber Bragg Grating (FBG) sensors or image feedback. For the curvature feedback obtained from multicore FBG sensors, the overall force magnitude estimation error is $0.062 \pm 0.068$ N and the overall location estimation error is $3.51 \pm 2.60$ mm. For the curvature feedback obtained from image, the overall force magnitude estimation error is $0.049 \pm 0.048$ N and the overall location estimation error is $2.75 \pm 1.71$ mm. The results demonstrate that the curvature-based force estimation method is able to accurately estimate the contact force.

An interventional MRI guidewire combining profile and tip conspicuity for catheterization at 0.55T

PURPOSE

We describe a clinical grade, "active", monopole antenna-based metallic guidewire that has a continuous shaft-to-tip image profile, a pre-shaped tip-curve, standard 0.89 mm (0.035″) outer diameter, and a detachable connector for catheter exchange during cardiovascular catheterization at 0.55T.

METHODS

Electromagnetic simulations were performed to characterize the magnetic field around the antenna whip for continuous tip visibility. The active guidewire was manufactured using medical grade materials in an ISO Class 7 cleanroom. RF-induced heating of the active guidewire prototype was tested in one gel phantom per ASTM 2182-19a, alone and in tandem with clinical metal-braided catheters. Real-time MRI visibility was tested in one gel phantom and in-vivo in two swine. Mechanical performance was compared with commercial equivalents.

RESULTS

The active guidewire provided continuous "profile" shaft and tip visibility in-vitro and in-vivo, analogous to guidewire shaft-and-tip profiles under X-ray. The MRI signal signature matched simulation results. Maximum unscaled RF-induced temperature rise was 5.2°C and 6.5°C (3.47 W/kg local background specific absorption rate), alone and in tandem with a steel-braided catheter, respectively. Mechanical characteristics matched commercial comparator guidewires.

CONCLUSION

The active guidewire was clearly visible via real-time MRI at 0.55T and exhibits a favorable geometric sensitivity profile depicting the guidewire continuously from shaft-to-tip including a unique curved-tip signature. RF-induced heating is clinically acceptable. This design allows safe device navigation through luminal structures and heart chambers. The detachable connector allows delivery and exchange of cardiovascular catheters while maintaining guidewire position. This enhanced guidewire design affords the expected performance of X-ray guidewires during human MRI catheterization.

Magic of 5G Technology and Optimization Methods Applied to Biomedical Devices: A Survey

Wireless networks have gained significant attention and importance in healthcare as various medical devices such as mobile devices, sensors, and remote monitoring equipment must be connected to communication networks. In order to provide advanced medical treatments to patients, high-performance technologies such as the emerging fifth generation/sixth generation (5G/6G) are required for transferring data to and from medical devices and in addition to their major components developed with improved optimization methods which are substantially needed and embedded in them. Providing intelligent system design is a challenging task in medical applications, as it affects the whole behaviors of medical devices. A critical review of the medical devices and the various optimization methods employed are presented in this paper, to pave the way for designers to develop an apparatus that is applicable in the healthcare industry under 5G technology and future 6G wireless networks.

Intracardiac MR imaging (ICMRI) guiding-sheath with amplified expandable-tip imaging and MR-tracking for navigation and arrythmia ablation monitoring: Swine testing at 1.5 and 3T

PURPOSE

Develop a deflectable intracardiac MR imaging (ICMRI) guiding-sheath to accelerate imaging during MR-guided electrophysiological (EP) interventions for radiofrequency (500 kHz) ablation (RFA) of arrythmia. Requirements include imaging at three to five times surface-coil SNR in cardiac chambers, vascular insertion, steerable-active-navigation into cardiac chambers, operation with ablation catheters, and safe levels of MR-induced heating.

METHODS

ICMRI's 6 mm outer-diameter (OD) metallic-braided shaft had a 2.6 mm OD internal lumen for ablation-catheter insertion. Miniature-Baluns (MBaluns) on ICMRI's 1 m shaft reduced body-coil-induced heating. Distal section was a folded "star"-shaped imaging-coil mounted on an expandable frame, with an integrated miniature low-noise-amplifier overcoming cable losses. A handle-activated movable-shaft expanded imaging-coil to 35 mm OD for imaging within cardiac-chambers. Four MR-tracking micro-coils enabled navigation and motion-compensation, assuming a tetrahedron-shape when expanded. A second handle-lever enabled distal-tip deflection. ICMRI with a protruding deflectable EP catheter were used for MR-tracked navigation and RFA using a dedicated 3D-slicer user-interface. ICMRI was tested at 3T and 1.5T in swine to evaluate (a) heating, (b) cardiac-chamber access, (c) imaging field-of-view and SNR, and (d) intraprocedural RFA lesion monitoring.

RESULTS

The 3T and 1.5T imaging SNR demonstrated >400% SNR boost over a 4 × 4 × 4 cm3 FOV in the heart, relative to body and spine arrays. ICMRI with MBaluns met ASTM/IEC heating limits during navigation. Tip-deflection allowed navigating ICMRI and EP catheter into atria and ventricles. Acute-lesion long-inversion-time-T1-weighted 3D-imaging (TWILITE) ablation-monitoring using ICMRI required 5:30 min, half the time needed with surface arrays alone.

CONCLUSION

ICMRI assisted EP-catheter navigation to difficult targets and accelerated RFA monitoring.

MR-Tracked Deflectable Stylet for Gynecologic Brachytherapy

Brachytherapy is a radiation based treatment that is implemented by precisely placing focused radiation sources into tumors. In advanced interstitial cervical cancer bracytherapy treatment, this is performed by placing a metallic rod ("stylet") inside a hollow cylindrical tube ("catheter") and advancing the pair to the desired target. The stylet is removed once the target is reached, followed by the insertion of radiation sources into the catheter. However, manually advancing an initially straight stylet into the tumor with millimeter spatial accuracy has been a long-standing challenge, which requires multiple insertions and retractions, due to the unforeseen stylet deflection caused by the stiff muscle tissue that is traversed. In this paper, we develop a novel tendon-actuated deflectable stylet equipped with MR active-tracking coils that may enhance brachytherapy treatment outcomes by allowing accurate stylet trajectory control. Herein we present the design concept and fabrication method, followed by the kinematic and mechanics models of the deflectable stylet. The hardware and theoretical models are extensively validated via benchtop and MRI-guided characterization. At insertion depths of 60 mm, benchtop phantom targeting tests provided a targeting error of 1. 23 ± 0. 47 mm, and porcine tissue targeting tests provided a targeting error of 1. 65 ± 0. 64 mm, after only a single insertion. MR-guided experiments indicate that the stylet can be safely and accurately located within the MRI environment.

A 20-gauge active needle design with thin-film printed circuitry for interventional MRI at 0.55T

PURPOSE

This work aims to fabricate RF antenna components on metallic needle surfaces using biocompatible polyester tubing and conductive ink to develop an active interventional MRI needle for clinical use at 0.55 Tesla.

METHODS

A custom computer numeric control-based conductive ink printing method was developed. Based on electromagnetic simulation results, thin-film RF antennas were printed with conductive ink and used to fabricate a medical grade, 20-gauge (0.87 mm outer diameter), 90-mm long active interventional MRI needle. The MRI visibility performance of the active needle prototype was tested in vitro in 1 gel phantom and in vivo in 1 swine. A nearly identical active needle constructed using a 44 American Wire Gauge insulated copper wire-wound RF receiver antenna was a comparator. The RF-induced heating risk was evaluated in a gel phantom per American Society for Testing and Materials (ASTM) 2182-19.

RESULTS

The active needle prototype with printed RF antenna was clearly visible both in vitro and in vivo under MRI. The maximum RF-induced temperature rise of prototypes with printed RF antenna and insulated copper wire antenna after a 3.96 W/kg, 15 min. long scan were 1.64°C and 8.21°C, respectively. The increase in needle diameter was 98 µm and 264 µm for prototypes with printed RF antenna and copper wire-wound antenna, respectively.

CONCLUSION

The active needle prototype with conductive ink printed antenna provides distinct device visibility under MRI. Variations on the needle surface are mitigated compared to use of a 44 American Wire Gauge copper wire. RF-induced heating tests support device RF safety under MRI. The proposed method enables fabrication of small diameter active interventional MRI devices having complex geometries, something previously difficult using conventional methods.