A review of image guidance and localization methods for liver puncture robots

Liver puncture is an indispensable procedure in the diagnosis and treatment of liver diseases. However, traditional manual puncture typically relies on the extensive experience and judgment of physicians. Liver puncture robots, with their advantages of high stability, precision, and safety, can to some extent compensate for the shortcomings of traditional manual puncture. Based on the different imaging modalities, liver puncture robots are categorized into those guided by ultrasound, CT, and MRI, and the advantages and disadvantages of these three imaging guidance methods are analyzed. Spatial positioning methods play a crucial role in improving the accuracy of puncture during surgery. Therefore, the spatial positioning methods under image guidance are introduced. Finally, the current research status of image-guided liver puncture robots and positioning methods is summarized, and future research directions are discussed.

Robotics and optical coherence tomography: current works and future perspectives [Invited]

Optical coherence tomography (OCT) is an interferometric technique for micron-level imaging in biological and non-biological contexts. As a non-invasive, non-ionizing, and video-rate imaging modality, OCT is widely used in biomedical and clinical applications, especially ophthalmology, where it functions in many roles, including tissue mapping, disease diagnosis, and intrasurgical visualization. In recent years, the rapid growth of medical robotics has led to new applications for OCT, primarily for 3D free-space scanning, volumetric perception, and novel optical designs for specialized medical applications. This review paper surveys these recent developments at the intersection of OCT and robotics and organizes them by degree of integration and application, with a focus on biomedical and clinical topics. We conclude with perspectives on how these recent innovations may lead to further advances in imaging and medical technology.

Optimization of percutaneous intervention robotic system for skin insertion force

PURPOSE

Percutaneous puncture is a common interventional procedure, and its effectiveness is influenced by the insertion force of the needle. To optimize outcomes, we focus on reducing the peak force of the needle in the skin, aiming to apply this method to other tissue layers.

METHODS

We developed a clinical puncture system, setting and measuring various variables. We analyzed their effects, introduced admittance control, set thresholds, and adjusted parameters. Finally, we validated these methods to ensure their effectiveness.

RESULTS

Our system meets application requirements. We assessed the impact of various variables on peak force and validated the effectiveness of the new method. Results show a reduction of about 50% in peak force compared to the maximum force condition and about 13% compared to the minimum force condition. Finally, we summarized the factors to consider when applying this method.

CONCLUSION

To achieve peak force suppression, initial puncture variables should be set based on the trends in variable impact. Additionally, the factors of the new method should be introduced using these initial settings. When selecting these factors, the characteristics of the new method must also be considered. This process will help to better optimize peak puncture force.

Design and evaluation of a pneumatic actuation unit for a wasp-inspired self-propelled needle

Transperineal laser ablation is a minimally invasive thermo-ablative treatment for prostate cancer that requires the insertion of a needle for accurate optical fiber positioning. Needle insertion in soft tissues may cause tissue motion and deformation, resulting in tissue damage and needle positioning errors. In this study, we present a wasp-inspired self-propelled needle that uses pneumatic actuation to move forward with zero external push force, thus avoiding large tissue motion and deformation. The needle consists of six parallel 0.25-mm diameter Nitinol rods driven by a pneumatic actuation system. The pneumatic actuation system consists of Magnetic Resonance (MR) safe 3D-printed parts and off-the-shelf plastic screws. A self-propelled motion is achieved by advancing the needle segments one by one, followed by retracting them simultaneously. The advancing needle segment has to overcome a cutting and friction force, while the stationary needle segments experience a friction force in the opposite direction. The needle self-propels through the tissue when the friction force of the five stationary needle segments overcomes the sum of the friction and cutting forces of the advancing needle segment. We evaluated the prototype's performance in 10-wt% gelatin phantoms and ex vivo porcine liver tissue inside a preclinical Magnetic Resonance Imaging (MRI) scanner in terms of the slip ratio of the needle with respect to the phantom or liver tissue. Our results demonstrated that the needle was able to self-propel through the phantom and liver tissue with slip ratios of 0.912-0.955 and 0.88, respectively. The prototype is a promising step toward the development of self-propelled needles for MRI-guided transperineal laser ablation as a method to treat prostate cancer.

Robotic system for magnetic resonance imaging-guided high-intensity focus ultrasound application: Feasibility of breast fibroadenoma treatment

PURPOSE

This paper presents a high-intensity focus ultrasound (HIFU) robotic system for treating breast fibroadenoma under the guidance of magnetic resonance imaging (MRI). Based on the thermal and mechanical effects of ultrasound, the system aims to deliver ultrasound energy to a target precisely without damaging the normal tissue. The temperature elevation can be monitored in real time by MRI, and the treatment plan can be adjusted during the procedure. The requirements, design specifications, control system and registration of the robotic system are specified.

METHODS

The robotic system was designed with a 3 degrees of freedom manipulator with limit switches and encoders, a customised MRI-compatible breast coil, a water bladder with sets of breast-conforming brackets, and a probe capable of generating ultrasound. Twenty volunteers were recruited for this study, and their data were analysed to provide more precise data for the design. The accuracy of the robot was evaluated in free space using a coordinate measuring machine, phantom and ex vivo porcine tissue in MRI room. The study also verified the signal-to-noise ratio (SNR) of the MRI with the effect of the robotic system.

RESULTS

The research findings revealed that the manipulator exhibited a translational precision of 0.10 ± 0.14 mm, a rotational fidelity around the X direction of 0.11 ± 0.09°, and an oscillatory exactness around the Y direction of 0.10 ± 0.08°. The investigation of positioning accuracy demonstrated that the robot's error in free space was 0.26 ± 0.07 mm. When subjected to MRI room with agar-silica phantom and ex vivo porcine tissue, the positioning accuracy amounted to 1.11 ± 0.47 mm and 1.57 ± 0.52 mm. In the presence of the robotic system, the SNR of the MRI experienced a 4.2% reduction, which had a negligible impact on image quality.

CONCLUSIONS

The conducted experiments validate the efficacy of the proposed MRI-guided HIFU robotic system in executing agar-silica phantom and ex vivo porcine tissue investigations with adequate positioning accuracy. Consequently, this system exhibits certain feasibility for the treatment of breast fibroadenomas.

Lung nodule pre-diagnosis and insertion path planning for chest CT images

Medical image processing has proven to be effective and feasible for assisting oncologists in diagnosing lung, thyroid, and other cancers, especially at early stage. However, there is no reliable method for the recognition, screening, classification, and detection of nodules, and even deep learning-based methods have limitations. In this study, we mainly explored the automatic pre-diagnosis of lung nodules with the aim of accurately identifying nodules in chest CT images, regardless of the benign and malignant nodules, and the insertion path planning of suspected malignant nodules, used for further diagnosis by robotic-based biopsy puncture. The overall process included lung parenchyma segmentation, classification and pre-diagnosis, 3-D reconstruction and path planning, and experimental verification. First, accurate lung parenchyma segmentation in chest CT images was achieved using digital image processing technologies, such as adaptive gray threshold, connected area labeling, and mathematical morphological boundary repair. Multi-feature weight assignment was then adopted to establish a multi-level classification criterion to complete the classification and pre-diagnosis of pulmonary nodules. Next, 3-D reconstruction of lung regions was performed using voxelization, and on its basis, a feasible local optimal insertion path with an insertion point could be found by avoiding sternums and/or key tissues in terms of the needle-inserting path. Finally, CT images of 900 patients from Lung Image Database Consortium and Image Database Resource Initiative were chosen to verify the validity of pulmonary nodule diagnosis. Our previously designed surgical robotic system and a custom thoracic model were used to validate the effectiveness of the insertion path. This work can not only assist doctors in completing the pre-diagnosis of pulmonary nodules but also provide a reference for clinical biopsy puncture of suspected malignant nodules considered by doctors.

Design of a 6-DoF Parallel Robotic Platform for MRI Applications

In this work, the design, analysis, and characterization of a parallel robotic motion generation platform with 6-degrees of freedom (DoF) for magnetic resonance imaging (MRI) applications are presented. The motivation for the development of this robot is the need for a robotic platform able to produce accurate 6-DoF motion inside the MRI bore to serve as the ground truth for motion modeling; other applications include manipulation of interventional tools such as biopsy and ablation needles and ultrasound probes for therapy and neuromodulation under MRI guidance. The robot is comprised of six pneumatic cylinder actuators controlled via a robust sliding mode controller. Tracking experiments of the pneumatic actuator indicates that the system is able to achieve an average error of 0.69 ± 0.14 mm and 0.67 ± 0.40 mm for step signal tracking and sinusoidal signal tracking, respectively. To demonstrate the feasibility and potential of using the proposed robot for minimally invasive procedures, a phantom experiment was performed in the benchtop environment, which showed a mean positional error of 1.20 ± 0.43 mm and a mean orientational error of 1.09 ± 0.57°, respectively. Experiments conducted in a 3T whole body human MRI scanner indicate that the robot is MRI compatible and capable of achieving positional error of 1.68 ± 0.31 mm and orientational error of 1.51 ± 0.32° inside the scanner, respectively. This study demonstrates the potential of this device to enable accurate 6-DoF motions in the MRI environment.

A Dual-Armed Robotic Puncture System: Design, Implementation and Preliminary Tests

Traditional renal puncture surgery requires manual operation, which has a poor puncture effect, low surgical success rate, and high incidence of postoperative complications. Robot-assisted puncture surgery can effectively improve the accuracy of punctures, improve the success rate of surgery, and reduce the occurrence of postoperative complications. This paper provides a dual-armed robotic puncture scheme to assist surgeons. The system is divided into an ultrasound scanning arm and a puncture arm. Both robotic arms with a compliant positioning function and master–slave control function are designed, respectively, and the control system is achieved. The puncture arm’s position and posture are decoupled by the wrist RCM mechanism and the arm decoupling mechanism. According to the independent joint control principle, the compliant positioning function is realized based on the single-joint human–computer interactive admittance control. The simulation and tests verify its functions and performance. The differential motion incremental master–slave mapping strategy is used to realize the master–slave control function. The error feedback link is introduced to solve the cumulative error problem in the master–slave control. The dual-armed robotic puncture system prototype is established and animal tests verify the effectiveness.

Robot-Assisted Image-Guided Interventions

Image guidance is a common methodology of minimally invasive procedures. Depending on the type of intervention, various imaging modalities are available. Common imaging modalities are computed tomography, magnetic resonance tomography, and ultrasound. Robotic systems have been developed to enable and improve the procedures using these imaging techniques. Spatial and technological constraints limit the development of versatile robotic systems. This paper offers a brief overview of the developments of robotic systems for image-guided interventions since 2015 and includes samples of our current research in this field.

Body-Mounted Robotic System for MRI-Guided Shoulder Arthrography: Cadaver and Clinical Workflow Studies

This paper presents an intraoperative MRI-guided, patient-mounted robotic system for shoulder arthrography procedures in pediatric patients. The robot is designed to be compact and lightweight and is constructed with nonmagnetic materials for MRI safety. Our goal is to transform the current two-step arthrography procedure (CT/x-ray-guided needle insertion followed by diagnostic MRI) into a streamlined single-step ionizing radiation-free procedure under MRI guidance. The MR-conditional robot was evaluated in a Thiel embalmed cadaver study and healthy volunteer studies. The robot was attached to the shoulder using straps and ten locations in the shoulder joint space were selected as targets. For the first target, contrast agent (saline) was injected to complete the clinical workflow. After each targeting attempt, a confirmation scan was acquired to analyze the needle placement accuracy. During the volunteer studies, a more comfortable and ergonomic shoulder brace was used, and the complete clinical workflow was followed to measure the total procedure time. In the cadaver study, the needle was successfully placed in the shoulder joint space in all the targeting attempts with translational and rotational accuracy of 2.07 ± 1.22 mm and 1.46 ± 1.06 degrees, respectively. The total time for the entire procedure was 94 min and the average time for each targeting attempt was 20 min in the cadaver study, while the average time for the entire workflow for the volunteer studies was 36 min. No image quality degradation due to the presence of the robot was detected. This Thiel-embalmed cadaver study along with the clinical workflow studies on human volunteers demonstrated the feasibility of using an MR-conditional, patient-mounted robotic system for MRI-guided shoulder arthrography procedure. Future work will be focused on moving the technology to clinical practice.

Workflow-Based Design and Evaluation of a Device for CBCT-Guided Biopsy

Biopsies for personalized cancer care can be performed with cone beam computed tomography (CBCT) guidance, but manual needle manipulation remains an issue due to X-ray exposure to physicians. Modern CBCT scanners integrate today real-time imaging and software assistance for needle planning. In this paper, these available features are exploited to design a novel device offering an intermediate level of assistance between simple passive mechanical devices of limited efficiency, and advanced robotic devices requiring adapted procedure workflows. Our resulting system is built to limit its impact on the current manual practice. It is patient-mounted and provides remote control of needle orientation and insertion. A multilayer phantom is specifically developed to reproduce interactions between the needle and soft abdominal tissues. It is used to experimentally evaluate the device added value by comparing assisted versus manual needle insertions. The device is shown to help reducing X-ray exposure by a factor 4, without impacting the accuracy obtained manually.

Biopsy Needle System With a Steerable Concentric Tube and Online Monitoring of Electrical Resistivity and Insertion Forces

OBJECTIVE

Biopsies are the gold standard for clinical diagnosis. However, a discrepancy between the biopsy sample and target tissue because of misplacement of the biopsy spoon can lead to errors in the diagnosis and subsequent treatment. Thus, correctly determining whether the needle tip is in the tumor is crucial for accurate biopsy results.

METHODS

A biopsy needle system was designed with a steerable, flexible, and superelastic concentric tube; electrodes to monitor the electrical resistivity; and load cells to monitor the insertion force. The degrees of freedom were analyzed for two working modes: straight-line and deflection.

RESULTS

Experimental results showed that the system could perceive the tissue type in online based on the electrical resistivity. In addition, changes in the insertion force indicated transitions between the interfaces of adjacent tissue layers.

CONCLUSION

The two monitoring methods guarantee that the biopsy spoon is at the desired position inside the tumor during an operation.

SIGNIFICANCE

The proposed biopsy needle system can be integrated into an autonomous robotic biopsy system.

Review of Advanced Medical Telerobots

The advent of telerobotic systems has revolutionized various aspects of the industry and human life. This technology is designed to augment human sensorimotor capabilities to extend them beyond natural competence. Classic examples are space and underwater applications when distance and access are the two major physical barriers to be combated with this technology. In modern examples, telerobotic systems have been used in several clinical applications, including teleoperated surgery and telerehabilitation. In this regard, there has been a significant amount of research and development due to the major benefits in terms of medical outcomes. Recently telerobotic systems are combined with advanced artificial intelligence modules to better share the agency with the operator and open new doors of medical automation. In this review paper, we have provided a comprehensive analysis of the literature considering various topologies of telerobotic systems in the medical domain while shedding light on different levels of autonomy for this technology, starting from direct control, going up to command-tracking autonomous telerobots. Existing challenges, including instrumentation, transparency, autonomy, stochastic communication delays, and stability, in addition to the current direction of research related to benefit in telemedicine and medical automation, and future vision of this technology, are discussed in this review paper.

A Direct Drive Parallel Plane Piezoelectric Needle Positioning Robot for MRI Guided Intraspinal Injection

Recent developments in the field of cellular therapeutics have indicated the potential of stem cell injections directly to the spinal cord. Injections require either open surgery or a Magnetic Resonance Imaging (MRI) guided injection. Needle positioning during MRI imaging is a significant hurdle to direct spinal injection, as the small target region and interlaminar space require high positioning accuracy.

OBJECTIVE

To improve both the procedure time and positioning accuracy, an MRI guided robotic needle positioning system is developed.

METHODS

The robot uses linear piezoelectric motors to directly drive a parallel plane positioning mechanism. Feedback is provided through MRI during the orientation procedure. Both accuracy and repeatability of the robot are characterized.

RESULTS

This system is found to be capable of repeatability below 51 μm. Needle endpoint error is limited by imaging modality, but is validated to 156 μm.

CONCLUSION

The reported robot and MRI image feedback system is capable of repeatable and accurate needle guide positioning.

SIGNIFICANCE

This high accuracy will result in a significant improvement to the workflow of spinal injection procedures.

A Fully Actuated Body-Mounted Robotic Assistant for MRI-Guided Low Back Pain Injection

This paper reports the development of a fully actuated body-mounted robotic assistant for MRI-guided low back pain injection. The robot is designed with a 4-DOF needle alignment module and a 2-DOF remotely actuated needle driver module. The 6-DOF fully actuated robot can operate inside the scanner bore during imaging; hence, minimizing the need of moving the patient in or out of the scanner during the procedure, and thus potentially reducing the procedure time and streamlining the workflow. The robot is built with a lightweight and compact structure that can be attached directly to the patient's lower back using straps; therefore, attenuating the effect of patient motion by moving with the patient. The novel remote actuation design of the needle driver module with beaded chain transmission can reduce the weight and profile on the patient, as well as minimize the imaging degradation caused by the actuation electronics. The free space positioning accuracy of the system was evaluated with an optical tracking system, demonstrating the mean absolute errors (MAE) of the tip position to be 0.99±0.46 mm and orientation to be 0.99±0.65°. Qualitative imaging quality evaluation was performed on a human volunteer, revealing minimal visible image degradation that should not affect the procedure. The mounting stability of the system was assessed on a human volunteer, indicating the 3D position variation of target movement with respect to the robot frame to be less than 0.7 mm.

Shoulder-mounted Robot for MRI-Guided Arthrography: Clinically Optimized System

This paper introduces our compact and lightweight patient-mounted MRI-compatible 4 degree-of-freedom (DOF) robot with an improved transmission system for MRI-guided arthrography procedures. This robot could make the traditional two-stage arthrography procedure (fluoroscopy-guided needle insertion followed by a diagnostic MRI scan) simpler by converting it to a one-stage procedure but more accurate with an optimized system. The new transmission system is proposed, using different mechanical components, to result in higher accuracy of needle insertion. The results of a recent accuracy study are reported. Experimental results show that the new system has an error of 1.7 mm in positioning the needle tip at a depth of 50 mm, which indicates high accuracy.

Determination of a tactile feedback strategy for use in robotized percutaneous procedures

Remote manipulation in robotized percutaneous procedures can offer increased safety to radiologists as well as patients. Providing feedback to the radiologist on needle-tissue interactions is however mandatory in addition to the medical images. A tactile feedback strategy is developed in this paper. Two types of information are considered: tissue puncture and nature of tissues. A haptic device is developed for that purpose, using a tactile display to provide information. Adequate signals are identified experimentally, with analysis of reaction times and the ability to discriminate one information from the other.

Lesion positioning method of a CT-guided surgical robotic system for minimally invasive percutaneous lung

BACKGROUND

Robot-assisted puncture has gradually attracted more attention and practical clinical application. The lesion positioning and the needle positioning are the basis to ensure the accuracy of puncture and the key techniques in insertion operation.

METHODS

A lesion positioning method is established which is realized only by the robot-CT system without using external positioning system, and an omnidirectional needle positioning method is also developed and realized by using VRCM, in order to make the puncture needle always keep pointing to the lesion point. A CT-guided surgical robotic system used for minimally invasive percutaneous lung is designed and the physical prototype is manufactured, to perform in-vitro experiments, thereby to validate the effectiveness of the lesion positioning method and the feasibility of omnidirectional needle positioning method.

RESULTS

The accuracy of established lesion positioning method based on three non-collinear markers is within 3 mm, which is similar to that of the least squares method based on the five non-coplanar markers, but the positioning efficiency can be improved by about 40%, and the non-collinearity of markers is easier to be satisfied than non-coplanarity in practical applications. The average calculation error of the established positioning method is 0.997 mm. Moreover, the omnidirectional positioning of the puncture needle under the designed surgical robot is feasible.

CONCLUSIONS

The designed surgical robot has good control accuracy and it can satisfy the requirements for use. The established lesion positioning method can provide a good precision basis for robot-assisted puncture surgery. The suitable insertion point and insertion posture can be determined by the developed omnidirectional needle positioning method. This study can provide theoretical reference for further study of path planning or autonomous positioning.

Review of Robotic Needle Guide Systems for Percutaneous Intervention

Numerous research groups in the past have designed and developed robotic needle guide systems that improve the targeting accuracy and precision by either providing a physical guidance for manual insertion or enabling a complete automated intervention. Here we review systems that have been reported in the last 11 years and limited to straight line needle interventions. Most systems fall under the category of image guided systems as they either use magnetic resonance image, computed tomography, ultrasound or a combination of these modalities for real time image feedback of the intervention path being followed. Actuation and control technology along with materials used for construction are the main aspects that differentiate these systems from each other and have been reviewed here. Image compatibility test details and results are also reviewed as they are used to ensure proper functioning of these systems under the respective imaging environments. We have also reviewed needle guide systems which either don't use any image feedback or have not reported any but provide physical guidance. Throughout this paper, we provide a comprehensive review of the technological aspects and trends in the field of robotic, straight line, needle guide intervention systems.

System Integration and Preliminary Clinical Evaluation of a Robotic System for MRI-Guided Transperineal Prostate Biopsy

This paper presents the development, preclinical evaluation, and preliminary clinical study of a robotic system for targeted transperineal prostate biopsy under direct interventional magnetic resonance imaging (MRI) guidance. The clinically integrated robotic system is developed based on a modular design approach, comprised of surgical navigation application, robot control software, MRI robot controller hardware, and robotic needle placement manipulator. The system provides enabling technologies for MRI-guided procedures. It can be easily transported and setup for supporting the clinical workflow of interventional procedures, and the system is readily extensible and reconfigurable to other clinical applications. Preclinical evaluation of the system is performed with phantom studies in a 3 Tesla MRI scanner, rehearsing the proposed clinical workflow, and demonstrating an in-plane targeting error of 1.5mm. The robotic system has been approved by the institutional review board (IRB) for clinical trials. A preliminary clinical study is conducted with the patient consent, demonstrating the targeting errors at two biopsy target sites to be 4.0mm and 3.7mm, which is sufficient to target a clinically significant tumor foci. First-in-human trials to evaluate the system's effectiveness and accuracy for MR image-guide prostate biopsy are underway.

Preclinical evaluation of an integrated robotic system for magnetic resonance imaging guided shoulder arthrography

Shoulder arthrography is a diagnostic procedure which involves injecting a contrast agent into the joint space for enhanced visualization of anatomical structures. Typically, a contrast agent is injected under fluoroscopy or computed tomography (CT) guidance, resulting in exposure to ionizing radiation, which should be avoided especially in pediatric patients. The patient then waits for the next available magnetic resonance imaging (MRI) slot for obtaining high-resolution anatomical images for diagnosis, which can result in long procedure times. Performing the contrast agent injection under MRI guidance could overcome both these issues. However, it comes with the challenges of the MRI environment including high magnetic field strength, limited ergonomic patient access, and lack of real-time needle guidance. We present the development of an integrated robotic system to perform shoulder arthrography procedures under intraoperative MRI guidance, eliminating fluoroscopy/CT guidance and patient transportation from the fluoroscopy/CT room to the MRI suite. The average accuracy of the robotic manipulator in benchtop experiments is 0.90 mm and 1.04 deg, whereas the average accuracy of the integrated system in MRI phantom experiments is 1.92 mm and 1.28 deg at the needle tip. Based on the American Society for Testing and Materials (ASTM) tests performed, the system is classified as MR conditional.

A Real-Time Tracking and Visualization System for Robot-Assisted Template Location Method Applied to Lung Cancer Brachytherapy

Accurate location of the puncture-guiding template, including the position and orientation, is essential for surgeons to implant radioactive seeds into an internal tumor in lung cancer brachytherapy. The objective of this paper is to establish a real-time tracking and visualization system (RTVS) to monitor the robot-assisted location process distantly and confirm the ultimate location accuracy without redundant computed tomography (CT) scans. RTVS consists of tracking and visualization components. A quaternion-based iterative closest point (QICP) algorithm for higher accuracy was proposed for the premised module of spatial registration. Arithmetic accuracy of QICP and clinical performance of RTVS were both validated by a series of experiments in a CT room. Spatial registration experiment shows that QICP consistently presents a distinctly higher degree of accuracy of 0.87±0.11 mm compared with other two conventional algorithms. RTVS, evaluated by tracking and visualization experiments, achieves a tracking accuracy of 1.05±0.05 mm position and (0.29±0.14) deg orientation. In addition, the time cost for template location is greatly reduced, so are the CT scan times. RTVS has the potential on lessening the workload of surgeons, reducing the CT radiation injury to the patient, and accelerating the progress of a brachytherapy surgery. The system presented means a new contribution to the lung cancer brachytherapy.

Observations And Experiments For The Definition Of A New Robotic Device Dedicated To CT, CBCT And MRI-Guided Percutaneous Procedures

In this paper, we present the work achieved to define the robotic functionalities of interest for percutaneous procedures as performed in interventional radiology. Our contributions are twofold. First, a detailed task analysis is performed with workflow analysis of biopsies, one of the most frequent tasks, under three imaging modalities, namely CT, CBCT and MRI. Second, the functionalities of a robotic assistant are identified, and we analyze whether a single device can bring an added value during procedures in the three modalities while keeping the robotized workflow close to manual tasks, to minimize learning time and difficulty of use. Experimental analysis on CBCT is notably used to confirm the interest of the determined robotic functionalities.

Body-Mounted Robot for Image-Guided Percutaneous Interventions: Mechanical Design and Preliminary Accuracy Evaluation

This paper presents a body-mounted, four degree-of-freedom (4-DOF) parallel mechanism robot for image-guided percutaneous interventions. The design of the robot is optimized to be light weight and compact such that it could be mounted to the patient body. It has a modular design that can be adopted for assisting various image-guided, needle-based percutaneous interventions such as arthrography, biopsy and brachytherapy seed placement. The robot mechanism and the control system are designed and manufactured with components compatible with imaging modalities including Magnetic Resonance Imaging (MRI) and Computed Tomography (CT). The current version of the robot presented in this paper is optimized for shoulder arthrography under MRI guidance; a Z-shaped fiducial frame is attached to the robot, providing accurate and repeatable robot registration with the MR scanner coordinate system. Here we present the mechanical design of the manipulator, robot kinematics, robot calibration procedure, and preliminary bench-top accuracy assessment. The bench-top accuracy evaluation of the robotic manipulator shows average translational error of 1.01 mm and 0.96 mm in X and Z axes, respectively, and average rotational error of 3.06 degrees and 2.07 degrees about the X and Z axes, respectively.

Evaluation of the Needle Positioning Accuracy of a Light Puncture Robot Under MRI Guidance: Results of a Clinical Trial on Healthy Volunteers

PURPOSE

To assess the accuracy of Light Puncture Robot (LPR) as a patient-mounted robot, in positioning a sham needle under MRI guidance for abdominal percutaneous interventions.

MATERIALS AND METHODS

This monocentric, prospective and non-controlled study was approved by the ethics review board. The study evaluated the accuracy of LPR V3 to achieve a virtual puncture in 20 healthy volunteers. Three trajectories were tried on each volunteer, under 3-T MRI guidance.

RESULTS

Accuracy under 5 mm in attaining a 10 cm-deep target was reached in 72% of attempts after 2 robot motions with a median error of 4.1 mm [2.1; 5.1]. Median procedure time for one trajectory was 12.9 min [10.2; 18.0] and median installation time was 9.0 min [6.0; 13.0].

CONCLUSION

LPR accuracy in the deployment of a sham needle inside the MRI tunnel and its setup time are promising. Further studies need to be conducted to confirm these results before clinical trials.

[Ablative therapy in urology: Good practice and perspective]

INTRODUCTION

To expose the main point of discussion from present ablative therapies' guidelines and propose global perspectives.

MATERIALS AND METHODS

A review of the scientific literature was performed in Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com/) using different associations of keywords "ablative therapy" ; "prostate cancer"; "kidney cancer"; "guidelines"; "hybrid operating room". Publications obtained were selected based on methodology, language and relevance.

RESULTS

Present guidelines on ablative therapies in urology are, considering authors and organs, either particularly prudent (EAU guidelines for prostate and kidney) or relatively optimistic (CIRSE guidelines). This discrepancy is related to a low level of proof. So, a new approach is mandatory: more homogeneous in methodology, and especially more open to a new organization sparing economic efficiency. The objective will be to get multifunctional and multidisciplinaries platforms, in facts and in minds. It will induce, in the future, a deep reflection about training and boundaries' specialties.

CONCLUSION

Ablative therapies represent a crucial stake for urology and a clear example of medicosurgical evolution in future, based on new technologies (energy, robotic, imaging). A serious and deep reflection is necessary to prepare it and be deeply involved in.

Design and validation of a CT-guided robotic system for lung cancer brachytherapy

PURPOSE

Currently, lung brachytherapy in clinical setting is a complex procedure. Operation accuracy depends on accurate positioning of the template; however, it is difficult to guarantee the positioning accuracy manually. Application of robotic-assisted systems can simplify the procedure and improve the manual positioning accuracy. Therefore, a novel CT-guided robotic system was developed to assist the lung cancer brachytherapy.

METHODS

A four degree-of-freedom (DOF) robot, controlled by a lung brachytherapy treatment planning system (TPS) software, was designed and manufactured to assist the template positioning. Target position of the template can be obtained from the treatment plan, thus the robot is driven to the target position automatically. The robotic system was validated in both the laboratory and the CT environment. In laboratory environment, a 3D laser tracker and an inertial measurement unit (IMU) were used to measure the mechanical accuracy in air, which includes positioning accuracy and position repeatability. Working reliability was also validated in this procedure by observing the response reliability and calculating the position repeatability. Imaging artifacts and accuracy of the robot registration were validated in the CT environment by using an artificial phantom with fiducial markers. CT images were obtained and used to test the image artifact and calculate the registration accuracy. Phantom experiments were conducted to test the accuracy of needle insertion by using a transparent hydrogel phantom with a high imitation artificial phantom. Also, the efficiency was validated in this procedure by comparing time costs in manual positioning with robotic positioning under the same experimental conditions.

RESULTS

The robotic system achieved the positioning accuracy of 0.28 ± 0.25 mm and the position repeatability of 0.09 ± 0.11 mm. Experimental results showed that the robot was CT-compatible and responded reliably to the control commands. The mean registration accuracy of the robotic system was 0.49 ± 0.29 mm. Phantom experiments indicated that the accuracy of needle insertion was 1.5 ± 1.7 mm at a depth ranging from 30 to 80 mm. The time used to adjust the template to the target position was 12 min on average by robotic system automatically. An average of 30 min was saved compared with the manual positioning procedure in phantom experiments.

CONCLUSIONS

This paper describes the design and experimental validation of a novel CT-guided robotic system for lung cancer brachytherapy. The robotic system was validated in a number of aspects which prove that it was capable of locating the template with clinically acceptable accuracy in the CT environment. All experimental results indicated that the system is reliable and ready to be applied to further studies on animals.