1
|
Jiang W, Gao Y, Wen M, Ye Z, Liang H, Wu D, Dong W. Preliminary evaluation for ultrasound-guided targeted prostate biopsy using a portable surgical robot: Ex vivo results. Int J Med Robot 2023:e2597. [PMID: 37984069 DOI: 10.1002/rcs.2597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Robotic systems are increasingly used to enhance clinical outcomes in prostate intervention. To evaluate the clinical value of the proposed portable robot, the robot-assisted and robot-targeted punctures were validated experimentally. METHOD The robot registration utilising the electromagnetic tracker achieves coordinate transformation from the ultrasound (US) image to the robot. Subsequently, Transrectal ultrasound (TRUS)-guided phantom trials were conducted for robot-assisted, free-hand, and robot-targeted punctures. RESULTS The accuracy of robot registration was 0.95 mm, and the accuracy of robot-assisted, free-hand, and robot-targeted punctures was 2.38 ± 0.64 mm, 3.11 ± 0.72 mm, and 3.29 ± 0.83 mm sequentially. CONCLUSION The registration method has been successfully applied to robot-targeted puncture. Current results indicate that the accuracy of robot-targeted puncture is slightly inferior to that of manual operations. Moreover, in manual operation, robot-assisted puncture improves the accuracy of free-hand puncture. Accuracy superior to 3.5 mm demonstrates the clinical applicability of both robot-assisted and robot-targeted punctures.
Collapse
Affiliation(s)
- Wenhe Jiang
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, China
| | - Yongzhuo Gao
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, China
| | - Mingwei Wen
- Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Zhichao Ye
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huageng Liang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongmei Wu
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, China
| | - Wei Dong
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, China
| |
Collapse
|
2
|
Manjila S, Rosa B, Price K, Manjila R, Mencattelli M, Dupont PE. Robotic Instruments Inside the MRI Bore: Key Concepts and Evolving Paradigms in Imaging-enhanced Cranial Neurosurgery. World Neurosurg 2023; 176:127-139. [PMID: 36639101 DOI: 10.1016/j.wneu.2023.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/08/2023] [Indexed: 01/12/2023]
Abstract
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.
Collapse
Affiliation(s)
- Sunil Manjila
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Benoit Rosa
- ICube Laboratory, UMR 7357 CNRS-University of Strasbourg, Strasbourg, France
| | - Karl Price
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rehan Manjila
- Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Margherita Mencattelli
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pierre E Dupont
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Zhang Y, Yuan Q, Muzzammil HM, Gao G, Xu Y. Image-guided prostate biopsy robots: A review. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:15135-15166. [PMID: 37679175 DOI: 10.3934/mbe.2023678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
At present, the incidence of prostate cancer (PCa) in men is increasing year by year. So, the early diagnosis of PCa is of great significance. Transrectal ultrasonography (TRUS)-guided biopsy is a common method for diagnosing PCa. The biopsy process is performed manually by urologists but the diagnostic rate is only 20%-30% and its reliability and accuracy can no longer meet clinical needs. The image-guided prostate biopsy robot has the advantages of a high degree of automation, does not rely on the skills and experience of operators, reduces the work intensity and operation time of urologists and so on. Capable of delivering biopsy needles to pre-defined biopsy locations with minimal needle placement errors, it makes up for the shortcomings of traditional free-hand biopsy and improves the reliability and accuracy of biopsy. The integration of medical imaging technology and the robotic system is an important means for accurate tumor location, biopsy puncture path planning and visualization. This paper mainly reviews image-guided prostate biopsy robots. According to the existing literature, guidance modalities are divided into magnetic resonance imaging (MRI), ultrasound (US) and fusion image. First, the robot structure research by different guided methods is the main line and the actuators and material research of these guided modalities is the auxiliary line to introduce and compare. Second, the robot image-guided localization technology is discussed. Finally, the image-guided prostate biopsy robot is summarized and suggestions for future development are provided.
Collapse
Affiliation(s)
- Yongde Zhang
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin 150080, China
- Foshan Baikang Robot Technology Co., Ltd, Nanhai District, Foshan City, Guangdong Province 528225, China
| | - Qihang Yuan
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin 150080, China
| | - Hafiz Muhammad Muzzammil
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin 150080, China
| | - Guoqiang Gao
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin 150080, China
| | - Yong Xu
- Department of Urology, the Third Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing 100039, China
| |
Collapse
|
4
|
Bernardes MC, Moreira P, Mareschal L, Tempany C, Tuncali K, Hata N, Tokuda J. Data-driven adaptive needle insertion assist for transperineal prostate interventions. Phys Med Biol 2023; 68:10.1088/1361-6560/accefa. [PMID: 37080237 PMCID: PMC10249778 DOI: 10.1088/1361-6560/accefa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/20/2023] [Indexed: 04/22/2023]
Abstract
Objective.Clinical outcomes of transperineal prostate interventions, such as biopsy, thermal ablations, and brachytherapy, depend on accurate needle placement for effectiveness. However, the accurate placement of a long needle, typically 150-200 mm in length, is challenging due to needle deviation induced by needle-tissue interaction. While several approaches for needle trajectory correction have been studied, many of them do not translate well to practical applications due to the use of specialized needles not yet approved for clinical use, or to relying on needle-tissue models that need to be tailored to individual patients.Approach.In this paper, we present a robot-assisted collaborative needle insertion method that only requires an actuated passive needle guide and a conventional needle. The method is designed to assist a physician inserting a needle manually through a needle guide. If the needle is deviated from the intended path, actuators shifts the needle radially in order to steer the needle trajectory and compensate for needle deviation adaptively. The needle guide is controlled by a new data-driven algorithm which does not requirea prioriinformation about needle or tissue properties. The method was evaluated in experiments with bothin vitroandex vivophantoms.Main results.The experiments inex vivotissue reported a mean final placement error of 0.36 mm with a reduction of 96.25% of placement error when compared to insertions without the use of assistive correction.Significance.Presented results show that the proposed closed-loop formulation can be successfully used to correct needle deflection during collaborative manual insertion with potential to be easily translated into clinical application.
Collapse
Affiliation(s)
- Mariana C Bernardes
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Pedro Moreira
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Lisa Mareschal
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Clare Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Nobuhiko Hata
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Junichi Tokuda
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| |
Collapse
|
5
|
Anvari M, Chapman T, Barlow K, Cookson T, Van Toen C, Fielding T. Clinical safety and efficacy of a fully automated robot for magnetic resonance imaging-guided breast biopsy. Int J Med Robot 2023; 19:e2472. [PMID: 36250521 DOI: 10.1002/rcs.2472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/05/2022] [Accepted: 10/16/2022] [Indexed: 03/03/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI)-guided biopsies are an accurate, but technically challenging, method for screening and diagnosis of breast lesions. This study assesses the safety and efficacy of an Image Guided Automated Robot (IGAR) in performing breast biopsies compared to manual procedures. METHODS Safety was determined from adverse events (AEs) and device deficiencies. Efficacy was assessed using targeting accuracy, number of successful biopsies, pain and scar scores, patient discomfort, and radiologist-determined ease-of-use. RESULTS All seven procedures in phase I were successfully and safely completed with no AEs and one device deficiency. The 23 IGAR biopsies in phase II outperformed the 18 manual biopsies in 1-week pain scores (p = 0.027), scarring at 1-week (p = 0.035), 1-month (p = 0.004), and components of comfort and ease-of-use. Phase II had seven and three AEs in the IGAR and manual groups, respectively (p = 0.317), with no serious AEs and nine device deficiencies. CONCLUSIONS The IGAR system is safe and effective for breast biopsy procedures. The results from these trials indicate the IGAR system as a potentially viable alternative to manual breast biopsy procedures.
Collapse
Affiliation(s)
- Mehran Anvari
- Centre for Surgical Invention and Innovation (CSii), McMaster University, Hamilton, Ontario, Canada
| | - Trevor Chapman
- Centre for Surgical Invention and Innovation (CSii), McMaster University, Hamilton, Ontario, Canada
| | - Karen Barlow
- Centre for Surgical Invention and Innovation (CSii), McMaster University, Hamilton, Ontario, Canada
| | - Tyler Cookson
- Centre for Surgical Invention and Innovation (CSii), McMaster University, Hamilton, Ontario, Canada
| | - Carolyn Van Toen
- MCDonald Detwiller & Associates (MDA), Brampton, Ontario, Canada
| | - Tim Fielding
- MCDonald Detwiller & Associates (MDA), Brampton, Ontario, Canada
| |
Collapse
|
6
|
Cheng K, Li L, Du Y, Wang J, Chen Z, Liu J, Zhang X, Dong L, Shen Y, Yang Z. A systematic review of image-guided, surgical robot-assisted percutaneous puncture: Challenges and benefits. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:8375-8399. [PMID: 37161203 DOI: 10.3934/mbe.2023367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Percutaneous puncture is a common medical procedure that involves accessing an internal organ or tissue through the skin. Image guidance and surgical robots have been increasingly used to assist with percutaneous procedures, but the challenges and benefits of these technologies have not been thoroughly explored. The aims of this systematic review are to furnish an overview of the challenges and benefits of image-guided, surgical robot-assisted percutaneous puncture and to provide evidence on this approach. We searched several electronic databases for studies on image-guided, surgical robot-assisted percutaneous punctures published between January 2018 and December 2022. The final analysis refers to 53 studies in total. The results of this review suggest that image guidance and surgical robots can improve the accuracy and precision of percutaneous procedures, decrease radiation exposure to patients and medical personnel and lower the risk of complications. However, there are many challenges related to the use of these technologies, such as the integration of the robot and operating room, immature robotic perception, and deviation of needle insertion. In conclusion, image-guided, surgical robot-assisted percutaneous puncture offers many potential benefits, but further research is needed to fully understand the challenges and optimize the utilization of these technologies in clinical practice.
Collapse
Affiliation(s)
- Kai Cheng
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Lixia Li
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Yanmin Du
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Jiangtao Wang
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Zhenghua Chen
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Jian Liu
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Xiangsheng Zhang
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Lin Dong
- Center on Frontiers of Computing Studies, Peking University, Beijing 100089, China
| | - Yuanyuan Shen
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Zhenlin Yang
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| |
Collapse
|
7
|
Su H, Kwok KW, Cleary K, Iordachita I, Cavusoglu MC, Desai JP, Fischer GS. State of the Art and Future Opportunities in MRI-Guided Robot-Assisted Surgery and Interventions. PROCEEDINGS OF THE IEEE. INSTITUTE OF ELECTRICAL AND ELECTRONICS ENGINEERS 2022; 110:968-992. [PMID: 35756185 PMCID: PMC9231642 DOI: 10.1109/jproc.2022.3169146] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
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.
Collapse
Affiliation(s)
- Hao Su
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695 USA
| | - Ka-Wai Kwok
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong
| | - Kevin Cleary
- Children's National Health System, Washington, DC 20010 USA
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD 21218 USA
| | - M Cenk Cavusoglu
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH 44106 USA
| | - Jaydev P Desai
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332 USA
| | - Gregory S Fischer
- Department of Robotics Engineering, Worcester Polytechnic Institute, Worcester, MA 01609 USA
| |
Collapse
|
8
|
Matsumae M, Nishiyama J, Kuroda K. Intraoperative MR Imaging during Glioma Resection. Magn Reson Med Sci 2022; 21:148-167. [PMID: 34880193 PMCID: PMC9199972 DOI: 10.2463/mrms.rev.2021-0116] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/11/2021] [Indexed: 11/09/2022] Open
Abstract
One of the major issues in the surgical treatment of gliomas is the concern about maximizing the extent of resection while minimizing neurological impairment. Thus, surgical planning by carefully observing the relationship between the glioma infiltration area and eloquent area of the connecting fibers is crucial. Neurosurgeons usually detect an eloquent area by functional MRI and identify a connecting fiber by diffusion tensor imaging. However, during surgery, the accuracy of neuronavigation can be decreased due to brain shift, but the positional information may be updated by intraoperative MRI and the next steps can be planned accordingly. In addition, various intraoperative modalities may be used to guide surgery, including neurophysiological monitoring that provides real-time information (e.g., awake surgery, motor-evoked potentials, and sensory evoked potential); photodynamic diagnosis, which can identify high-grade glioma cells; and other imaging techniques that provide anatomical information during the surgery. In this review, we present the historical and current context of the intraoperative MRI and some related approaches for an audience active in the technical, clinical, and research areas of radiology, as well as mention important aspects regarding safety and types of devices.
Collapse
Affiliation(s)
- Mitsunori Matsumae
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Jun Nishiyama
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Kagayaki Kuroda
- Department of Human and Information Sciences, School of Information Science and Technology, Tokai University, Hiratsuka, Kanagawa, Japan
| |
Collapse
|
9
|
Li G, Patel NA, Melzer A, Sharma K, Iordachita I, Cleary K. MRI-guided lumbar spinal injections with body-mounted robotic system: cadaver studies. MINIM INVASIV THER 2022; 31:297-305. [PMID: 32729771 PMCID: PMC7855543 DOI: 10.1080/13645706.2020.1799017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION This paper reports the system integration and cadaveric assessment of a body-mounted robotic system for MRI-guided lumbar spine injections. The system is developed to enable MR-guided interventions in closed bore magnet and avoid problems due to patient movement during cannula guidance. MATERIAL AND METHODS The robot is comprised by a lightweight and compact structure so that it can be mounted directly onto the lower back of a patient using straps. Therefore, it can minimize the influence of patient movement by moving with the patient. The MR-Conditional robot is integrated with an image-guided surgical planning workstation. A dedicated clinical workflow is created for the robot-assisted procedure to improve the conventional freehand MRI-guided procedure. RESULTS Cadaver studies were performed with both freehand and robot-assisted approaches to validate the feasibility of the clinical workflow and to assess the positioning accuracy of the robotic system. The experiment results demonstrate that the root mean square (RMS) error of the target position to be 2.57 ± 1.09 mm and of the insertion angle to be 2.17 ± 0.89°. CONCLUSION The robot-assisted approach is able to provide more accurate and reproducible cannula placements than the freehand procedure, as well as to reduce the number of insertion attempts.
Collapse
Affiliation(s)
- Gang Li
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, USA;,Gang Li, , 3400 N. Charles St., Baltimore, MD 21218, USA
| | - Niravkumar A. Patel
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, USA
| | - Andreas Melzer
- Institute of Medical Science and Technology, University of Dundee, Dundee, UK
| | - Karun Sharma
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington, DC, USA
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, USA
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington, DC, USA
| |
Collapse
|
10
|
Franson D, Dupuis A, Gulani V, Griswold M, Seiberlich N. A System for Real-Time, Online Mixed-Reality Visualization of Cardiac Magnetic Resonance Images. J Imaging 2021; 7:jimaging7120274. [PMID: 34940741 PMCID: PMC8709155 DOI: 10.3390/jimaging7120274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022] Open
Abstract
Image-guided cardiovascular interventions are rapidly evolving procedures that necessitate imaging systems capable of rapid data acquisition and low-latency image reconstruction and visualization. Compared to alternative modalities, Magnetic Resonance Imaging (MRI) is attractive for guidance in complex interventional settings thanks to excellent soft tissue contrast and large fields-of-view without exposure to ionizing radiation. However, most clinically deployed MRI sequences and visualization pipelines exhibit poor latency characteristics, and spatial integration of complex anatomy and device orientation can be challenging on conventional 2D displays. This work demonstrates a proof-of-concept system linking real-time cardiac MR image acquisition, online low-latency reconstruction, and a stereoscopic display to support further development in real-time MR-guided intervention. Data are acquired using an undersampled, radial trajectory and reconstructed via parallelized through-time radial generalized autocalibrating partially parallel acquisition (GRAPPA) implemented on graphics processing units. Images are rendered for display in a stereoscopic mixed-reality head-mounted display. The system is successfully tested by imaging standard cardiac views in healthy volunteers. Datasets comprised of one slice (46 ms), two slices (92 ms), and three slices (138 ms) are collected, with the acquisition time of each listed in parentheses. Images are displayed with latencies of 42 ms/frame or less for all three conditions. Volumetric data are acquired at one volume per heartbeat with acquisition times of 467 ms and 588 ms when 8 and 12 partitions are acquired, respectively. Volumes are displayed with a latency of 286 ms or less. The faster-than-acquisition latencies for both planar and volumetric display enable real-time 3D visualization of the heart.
Collapse
Affiliation(s)
- Dominique Franson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA;
- Correspondence: (D.F.); (A.D.)
| | - Andrew Dupuis
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA;
- Correspondence: (D.F.); (A.D.)
| | - Vikas Gulani
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (V.G.); (N.S.)
| | - Mark Griswold
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA;
- Department of Radiology, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Nicole Seiberlich
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (V.G.); (N.S.)
| |
Collapse
|
11
|
Mahcicek DI, Yildirim KD, Kasaci G, Kocaturk O. Preliminary Evaluation of Hydraulic Needle Delivery System for Magnetic Resonance Imaging-Guided Prostate Biopsy Procedures. J Med Device 2021. [DOI: 10.1115/1.4051610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
In clinical routine, the prostate biopsy procedure is performed with the guidance of transrectal ultrasound (TRUS) imaging to diagnose prostate cancer. However, the TRUS-guided prostate biopsy brings reliability concerns due to the lack of contrast difference between prostate tissue and lesions. In this study, a novel hydraulic needle delivery system that is designed for performing magnetic resonance imaging (MRI)-guided prostate biopsy procedure with transperineal approach is introduced. The feasibility of the overall system was evaluated through in vitro phantom experiments under an MRI guidance. The in vitro experiments performed using a certified prostate phantom (incorporating MRI visible lesions). MRI experiments showed that overall hydraulic biopsy needle delivery system has excellent MRI compatibility (signal to noise ratio (SNR) loss < 3%), provides acceptable targeting accuracy (average 2.05±0.46 mm) and procedure time (average 40 min).
Collapse
Affiliation(s)
- Davut Ibrahim Mahcicek
- Biomedical Engineering Department, Institute of Biomedical Engineering, Bogazici University, Kandilli Kampus, Istanbul, Cengelkoy 34684, Turkey
| | - Korel D. Yildirim
- National Institutes of Health Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, Bethesda, MD 20892-1538; Biomedical Engineering Department, Institute of Biomedical Engineering, Bogazici University, Kandilli Kampus, Istanbul, Cengelkoy 34684, Turkey
| | - Gokce Kasaci
- Biomedical Engineering Department, Institute of Biomedical Engineering, Bogazici University, Kandilli Kampus, Istanbul, Cengelkoy 34684, Turkey
| | - Ozgur Kocaturk
- National Institutes of Health Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, Bethesda, MD 20892-1538; Biomedical Engineering Department, Institute of Biomedical Engineering, Bogazici University, Kandilli Kampus, Istanbul, Cengelkoy 34684, Turkey
| |
Collapse
|
12
|
Patel N, Yan J, Li G, Monfaredi R, Priba L, Donald-Simpson H, Joy J, Dennison A, Melzer A, Sharma K, Iordachita I, Cleary K. Body-Mounted Robotic System for MRI-Guided Shoulder Arthrography: Cadaver and Clinical Workflow Studies. Front Robot AI 2021; 8:667121. [PMID: 34041276 PMCID: PMC8141739 DOI: 10.3389/frobt.2021.667121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/20/2021] [Indexed: 12/13/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Jiawen Yan
- LCSR, Johns Hopkins University, Baltimore, MD, United States
| | - Gang Li
- LCSR, Johns Hopkins University, Baltimore, MD, United States
| | - Reza Monfaredi
- Children's National Health System, Washington, DC, United States
| | - Lukasz Priba
- Institute for Medical Science and Technology, University of Dundee, Dundee, United Kingdom
| | - Helen Donald-Simpson
- Institute for Medical Science and Technology, University of Dundee, Dundee, United Kingdom
| | - Joyce Joy
- Institute for Medical Science and Technology, University of Dundee, Dundee, United Kingdom
| | - Andrew Dennison
- Institute for Medical Science and Technology, University of Dundee, Dundee, United Kingdom
| | - Andreas Melzer
- Institute for Medical Science and Technology, University of Dundee, Dundee, United Kingdom.,Institute for Computer Aided Surgery, University Leipzig, Leipzig, Germany
| | - Karun Sharma
- Children's National Health System, Washington, DC, United States
| | | | - Kevin Cleary
- Children's National Health System, Washington, DC, United States
| |
Collapse
|
13
|
Wang W, Pan B, Fu Y, Liu Y. Development of a transperineal prostate biopsy robot guided by MRI-TRUS image. Int J Med Robot 2021; 17:e2266. [PMID: 33887097 DOI: 10.1002/rcs.2266] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/08/2021] [Accepted: 04/19/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND In the transrectal ultrasound (TRUS)-guided transperineal prostate biopsy, doctors determine the biopsy target by observing the prostate region in TRUS images. However, ultrasound images with low imaging quality make doctors easy to be interfered when determining the biopsy route, which reduces the biopsy success rate. METHODS This paper introduces the guidance method of magnetic resonance image (MRI) registration to ultrasound image and develops a 5-degrees of freedom robot for prostate biopsy guided by MRI-TRUS image. The robot uses a structure attached to the ultrasound probe to reduce the space occupied. By registering the posture relationship between MRI, TRUS image, ultrasonic probe and the robot base, the accurate localization of the suspected lesion area can be achieved with the preoperative MRIs. RESULTS The prostate phantom biopsy based on the robotic biopsy system in this paper, the average biopsy error is 1.44 mm, and the maximum biopsy error is 2.23 mm. CONCLUSIONS We build a robotic biopsy platform with prostate phantom, and evaluate the biopsy accuracy of MRI-TRUS guided prostate biopsy robot, the results meet clinical prostate biopsy requirements.
Collapse
Affiliation(s)
- Weirong Wang
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, Heilongjiang, China
| | - Bo Pan
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, Heilongjiang, China
| | - Yili Fu
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, Heilongjiang, China
| | - Yanjie Liu
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, Heilongjiang, China
| |
Collapse
|
14
|
Initial phantom studies for an office-based low-field MR system for prostate biopsy. Int J Comput Assist Radiol Surg 2021; 16:741-748. [PMID: 33891253 PMCID: PMC8134310 DOI: 10.1007/s11548-021-02364-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/01/2021] [Indexed: 11/25/2022]
Abstract
Purpose Prostate cancer is the second most prevalent cancer in US men, with about 192,000 new cases and 33,000 deaths predicted for 2020. With only a 31% 5-year survival rate for patients with an initial diagnosis of stage-four prostate cancer, the necessity for early screening and diagnosis is clear. In this paper, we present navigation accuracy results for Promaxo’s MR system intended to be used in a physician’s office for image-guided transperineal prostate biopsy. Methods The office-based low-field MR system was used to acquire images of prostate phantoms with needles inserted through a transperineal template. Coordinates of the estimated sample core locations in the office-based MR system were compared to ground truth needle coordinates identified in a 1.5T external reference scan. The error was measured as the distance between the planned target and the ground truth core center and as the shortest perpendicular distance between the planned target and the ground truth trajectory of the whole core. Results The average error between the planned target and the ground truth core center was 2.57 ± 1.02 mm, [1.93–3.21] 95% CI. The average error between the planned target to the actual core segment was 2.05 ± 1.24 mm, [1.53–2.56] 95% CI. Conclusion The average navigation errors were below the clinically significant threshold of 5 mm. The initial phantom results demonstrate the feasibility of the office-based system for prostate biopsy.
Collapse
|
15
|
Li G, Patel NA, Sharma K, Monfaredi R, Dumoulin C, Fritz J, Iordachita I, Cleary K. Body-Mounted Robotics for Interventional MRI Procedures. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2020; 2:557-560. [PMID: 33778433 PMCID: PMC7996400 DOI: 10.1109/tmrb.2020.3030532] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
This paper reports the development and initial cadaveric evaluation of a robotic framework for MRI-guided interventions using a body-mounted approach. The framework is developed based on modular design principles. The framework consists of a body-mounted needle placement manipulator, robot control software, robot controller, interventional planning workstation, and MRI scanner. The framework is modular in the sense that all components are connected independently, making it readily extensible and reconfigurable for supporting the clinical workflow of various interventional MRI procedures. Based on this framework we developed two body-mounted robots for musculoskeletal procedures. The first robot is a four-degree of freedom system called ArthroBot for shoulder arthrography in pediatric patients. The second robot is a six-degree of freedom system called PainBot for perineural injections used to treat pain in adult and pediatric patients. Body-mounted robots are designed with compact and lightweight structure so that they can be attached directly to the patient, which minimizes the effect of patient motion by allowing the robot to move with the patient. A dedicated clinical workflow is proposed for the MRI-guided musculoskeletal procedures using body-mounted robots. Initial cadaveric evaluations of both systems were performed to verify the feasibility of the systems and validate the clinical workflow.
Collapse
Affiliation(s)
- Gang Li
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, USA
| | - Niravkumar A Patel
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, USA
| | - Karun Sharma
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Childrens National Hospital, Washington, DC, USA
| | - Reza Monfaredi
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Childrens National Hospital, Washington, DC, USA
| | - Charles Dumoulin
- Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, USA
| | - Jan Fritz
- New York University, New York, NY, USA
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, USA
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Childrens National Hospital, Washington, DC, USA
| |
Collapse
|
16
|
Patel NA, Nycz CJ, Carvalho PA, Gandomi KY, Gondokaryono R, Li G, Heffter T, Burdette EC, Pilitsis JG, Fischer GS. An Integrated Robotic System for MRI-Guided Neuroablation: Preclinical Evaluation. IEEE Trans Biomed Eng 2020; 67:2990-2999. [PMID: 32078530 PMCID: PMC7529397 DOI: 10.1109/tbme.2020.2974583] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Treatment of brain tumors requires high precision in order to ensure sufficient treatment while minimizing damage to surrounding healthy tissue. Ablation of such tumors using needle-based therapeutic ultrasound (NBTU) under real-time magnetic resonance imaging (MRI) can fulfill this need. However, the constrained space and strong magnetic field in the MRI bore restricts patient access limiting precise placement of the NBTU ablation tool. A surgical robot compatible with use inside the bore of an MRI scanner can alleviate these challenges. METHODS We present preclinical trials of a robotic system for NBTU ablation of brain tumors under real-time MRI guidance. The system comprises of an updated robotic manipulator and corresponding control electronics, the NBTU ablation system and applications for planning, navigation and monitoring of the system. RESULTS The robotic system had a mean translational and rotational accuracy of 1.39 ± 0.64 mm and 1.27 [Formula: see text] in gelatin phantoms and 3.13 ± 1.41 mm and 5.58 [Formula: see text] in 10 porcine trials while causing a maximum reduction in signal to noise ratio (SNR) of 10.3%. CONCLUSION The integrated robotic system can place NBTU ablator at a desired target location in porcine brain and monitor the ablation in realtime via magnetic resonance thermal imaging (MRTI). SIGNIFICANCE Further optimization of this system could result in a clinically viable system for use in human trials for various diagnostic or therapeutic neurosurgical interventions.
Collapse
|
17
|
Li G, Patel NA, Wang Y, Dumoulin C, Loew W, Loparo O, Schneider K, Sharma K, Cleary K, Fritz J, Iordachita I. Fully Actuated Body-Mounted Robotic System for MRI-Guided Lower Back Pain Injections: Initial Phantom and Cadaver Studies. IEEE Robot Autom Lett 2020; 5:5245-5251. [PMID: 33748414 PMCID: PMC7971162 DOI: 10.1109/lra.2020.3007459] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper reports the improved design, system integration, and initial experimental evaluation of a fully actuated body-mounted robotic system for real-time MRI-guided lower back pain injections. The 6-DOF robot is composed of a 4-DOF needle alignment module and a 2-DOF remotely actuated needle driver module, which together provide a fully actuated manipulator that can operate inside the scanner bore during imaging. The system minimizes the need to move the patient in and out of the scanner during a procedure, and thus may shorten the procedure time and streamline the clinical workflow. The robot is devised with a compact and lightweight structure that can be attached directly to the patient's lower back via straps. This approach minimizes the effect of patient motion by allowing the robot to move with the patient. The robot is integrated with an image-based surgical planning module. A dedicated clinical workflow is proposed for robot-assisted lower back pain injections under real-time MRI guidance. Targeting accuracy of the system was evaluated with a real-time MRI-guided phantom study, demonstrating the mean absolute errors (MAE) of the tip position to be 1.50±0.68mm and of the needle angle to be 1.56±0.93°. An initial cadaver study was performed to validate the feasibility of the clinical workflow, indicating the maximum error of the position to be less than 1.90mm and of the angle to be less than 3.14°.
Collapse
Affiliation(s)
- Gang Li
- Gang Li, Niravkumar A. Patel, Yanzhou Wang, and Iulian Iordachita are with Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, USA
| | - Niravkumar A Patel
- Gang Li, Niravkumar A. Patel, Yanzhou Wang, and Iulian Iordachita are with Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, USA
| | - Yanzhou Wang
- Gang Li, Niravkumar A. Patel, Yanzhou Wang, and Iulian Iordachita are with Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, USA
| | - Charles Dumoulin
- Charles Dumoulin, Wolfgang Loew, Olivia Loparo, and Katherine Schneider are with Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, USA
| | - Wolfgang Loew
- Charles Dumoulin, Wolfgang Loew, Olivia Loparo, and Katherine Schneider are with Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, USA
| | - Olivia Loparo
- Charles Dumoulin, Wolfgang Loew, Olivia Loparo, and Katherine Schneider are with Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, USA
| | - Katherine Schneider
- Charles Dumoulin, Wolfgang Loew, Olivia Loparo, and Katherine Schneider are with Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, USA
| | - Karun Sharma
- Karun Sharma and Kevin Cleary are with the Sheikh Zayed Institute for Pediatric Surgical Innovation, Childrens National Hospital, Washington, DC, USA
| | - Kevin Cleary
- Karun Sharma and Kevin Cleary are with the Sheikh Zayed Institute for Pediatric Surgical Innovation, Childrens National Hospital, Washington, DC, USA
| | - Jan Fritz
- Jan Fritz is with Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Iulian Iordachita
- Gang Li, Niravkumar A. Patel, Yanzhou Wang, and Iulian Iordachita are with Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
18
|
Li G, Patel NA, Liu W, Wu D, Sharma K, Cleary K, Fritz J, Iordachita I. A Fully Actuated Body-Mounted Robotic Assistant for MRI-Guided Low Back Pain Injection. IEEE INTERNATIONAL CONFERENCE ON ROBOTICS AND AUTOMATION : ICRA : [PROCEEDINGS]. IEEE INTERNATIONAL CONFERENCE ON ROBOTICS AND AUTOMATION 2020; 2020:10.1109/icra40945.2020.9197534. [PMID: 34422445 PMCID: PMC8375549 DOI: 10.1109/icra40945.2020.9197534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
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.
Collapse
Affiliation(s)
- Gang Li
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, USA
| | - Niravkumar A Patel
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, USA
| | - Weiqiang Liu
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, USA
| | - Di Wu
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, USA
| | - Karun Sharma
- Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Kevin Cleary
- Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Jan Fritz
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
19
|
Li G, Patel NA, Hagemeister J, Yan J, Wu D, Sharma K, Cleary K, Iordachita I. Body-mounted robotic assistant for MRI-guided low back pain injection. Int J Comput Assist Radiol Surg 2020; 15:321-331. [PMID: 31625021 PMCID: PMC7027988 DOI: 10.1007/s11548-019-02080-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE This paper presents the development of a body-mounted robotic assistant for magnetic resonance imaging (MRI)-guided low back pain injection. Our goal was to eliminate the radiation exposure of traditional X-ray guided procedures while enabling the exquisite image quality available under MRI. The robot is designed with a compact and lightweight profile that can be mounted directly on the patient's lower back via straps, thus minimizing the effect of patient motion by moving along with the patient. The robot was built with MR-conditional materials and actuated with piezoelectric motors so it can operate inside the MRI scanner bore during imaging and therefore streamline the clinical workflow by utilizing intraoperative MR images. METHODS The robot is designed with a four degrees of freedom parallel mechanism, stacking two identical Cartesian stages, to align the needle under intraoperative MRI-guidance. The system targeting accuracy was first evaluated in free space with an optical tracking system, and further assessed with a phantom study under live MRI-guidance. Qualitative imaging quality evaluation was performed on a human volunteer to assess the image quality degradation caused by the robotic assistant. RESULTS Free space positioning accuracy study demonstrated that the mean error of the tip position to be [Formula: see text] mm and needle angle to be [Formula: see text]. MRI-guided phantom study indicated the mean errors of the target to be [Formula: see text] mm, entry point to be [Formula: see text] mm, and needle angle to be [Formula: see text]. Qualitative imaging quality evaluation validated that the image degradation caused by the robotic assistant in the lumbar spine anatomy is negligible. CONCLUSIONS The study demonstrates that the proposed body-mounted robotic system is able to perform MRI-guided low back injection in a phantom study with sufficient accuracy and with minimal visible image degradation that should not affect the procedure.
Collapse
Affiliation(s)
- Gang Li
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, USA.
| | - Niravkumar A Patel
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, USA
| | - Jan Hagemeister
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, USA
| | - Jiawen Yan
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, USA
| | - Di Wu
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, USA
| | - Karun Sharma
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
20
|
Wu D, Li G, Patel N, Yan J, Kim GH, Monfaredi R, Cleary K, Iordachita I. Remotely Actuated Needle Driving Device for MRI-Guided Percutaneous Interventions: Force and Accuracy Evaluation .. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:1985-1989. [PMID: 31946289 DOI: 10.1109/embc.2019.8857260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper presents a 2 degrees-of-freedom (DOF) remotely actuated needle driving device for Magnetic Resonance Imaging (MRI) guided pain injections. The device is evaluated in phantom studies under real-time MRI guidance. The force and torque asserted by the device on the 4-DOF base robot are measured. The needle driving device consists of a needle driver, a 1.2-meter long beaded chain transmission, an actuation box, a robot controller and a Graphical User Interface (GUI). The needle driver can fit within a typical MRI scanner bore and is remotely actuated at the end of the MRI table through a novel beaded chain transmission. The remote actuation mechanism significantly reduces the weight and size of the needle driver at the patient end as well as the artifacts introduced by the motors. The clinician can manually steer the needle by rotating the knobs on the actuation box or remotely through a software interface in the MRI console room. The force and torque resulting from the needle driver in various configurations both in static and dynamic status were measured and reported. An accuracy experiment in the MRI environment under real-time image feedback demonstrates a small mean targeting error (<; 1.5 mm) in a phantom study.
Collapse
|
21
|
Wu D, Li G, Patel N, Yan J, Monfaredi R, Cleary K, Iordachita I. Remotely Actuated Needle Driving Device for MRI-Guided Percutaneous Interventions. ... INTERNATIONAL SYMPOSIUM ON MEDICAL ROBOTICS. INTERNATIONAL SYMPOSIUM ON MEDICAL ROBOTICS 2019; 2019:10.1109/ismr.2019.8710176. [PMID: 32864663 PMCID: PMC7451234 DOI: 10.1109/ismr.2019.8710176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this paper we introduce a remotely actuated MRI-compatible needle driving device for pain injections in the lower back. This device is able to manipulate the needle inside the closed-bore MRI scanner under the control of the interventional radiologist inside both the scanner room and the console room. The device consists of a 2 degrees of freedom (DOF) needle driver and an actuation box. The 2-DOF needle driver is placed inside the scanner bore and driven by the actuation box settled at the end of the table through a beaded chain transmission. This novel remote actuation design could reduce the weight and profile of the needle driver that is mounted on the patient, as well as minimize the potential imaging noise introduced by the actuation electronics. The actuation box is designed to perform needle intervention in both manual and motorized fashion by utilizing a mode switch mechanism. A mechanical hard stop is also incorporated to improve the device's safety. The bench-top accuracy evaluation of the device demonstrated a small mean needle placement error (< 1 mm) in a phantom study.
Collapse
Affiliation(s)
- Di Wu
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Mechanical Engineering, Technical University of Munich, Garching 85748, Germany
| | - Gang Li
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Niravkumar Patel
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Jiawen Yan
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Reza Monfaredi
- Childrens National Medical Center, 111 Michigan Avenue, NW Washington, DC 20010
| | - Kevin Cleary
- Childrens National Medical Center, 111 Michigan Avenue, NW Washington, DC 20010
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA
| |
Collapse
|
22
|
Patel N, Yan J, Monfaredi R, Sharma K, Cleary K, Iordachita I. Preclinical evaluation of an integrated robotic system for magnetic resonance imaging guided shoulder arthrography. J Med Imaging (Bellingham) 2019; 6:025006. [PMID: 31131290 PMCID: PMC6519665 DOI: 10.1117/1.jmi.6.2.025006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/15/2019] [Indexed: 11/14/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Niravkumar Patel
- Johns Hopkins University, Laboratory for Computational Sensing and Robotics, Baltimore, Maryland, United States
| | - Jiawen Yan
- Johns Hopkins University, Laboratory for Computational Sensing and Robotics, Baltimore, Maryland, United States
| | - Reza Monfaredi
- Children’s National Medical Center, Washington, DC, United States
| | - Karun Sharma
- Children’s National Medical Center, Washington, DC, United States
| | - Kevin Cleary
- Children’s National Medical Center, Washington, DC, United States
| | - Iulian Iordachita
- Johns Hopkins University, Laboratory for Computational Sensing and Robotics, Baltimore, Maryland, United States
| |
Collapse
|