Fiber-Optic Fabry-Pérot Interferometers for Axial Force Sensing on the Tip of a Needle

A Review of Recent Advancements in Sensor-Integrated Medical Tools

A medical tool is a general instrument intended for use in the prevention, diagnosis, and treatment of diseases in humans or other animals. Nowadays, sensors are widely employed in medical tools to analyze or quantify disease-related parameters for the diagnosis and monitoring of patients' diseases. Recent explosive advancements in sensor technologies have extended the integration and application of sensors in medical tools by providing more versatile in vivo sensing capabilities. These unique sensing capabilities, especially for medical tools for surgery or medical treatment, are getting more attention owing to the rapid growth of minimally invasive surgery. In this review, recent advancements in sensor-integrated medical tools are presented, and their necessity, use, and examples are comprehensively introduced. Specifically, medical tools often utilized for medical surgery or treatment, for example, medical needles, catheters, robotic surgery, sutures, endoscopes, and tubes, are covered, and in-depth discussions about the working mechanism used for each sensor-integrated medical tool are provided.

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

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

Novel approaches to needle tracking and visualisation

The accuracy and reliability of ultrasound are still insufficient to guarantee complete and safe nerve block for all patients. Injection of local anaesthetic close to, but not touching, the nerve is key to outcomes, but the exact relationship between the needle tip and nerve epineurium is difficult to evaluate, even with ultrasound. Ultrasound has insufficient resolution, tissues are difficult to discern due to acoustic impedance and needles are more difficult to see with increased angulation. The limitations of ultrasound have shifted the focus of innovation towards bio-markers that help detect needle tip position by utilising the physical properties of tissues, (e.g. pressure, electrical, optics, acoustic and elastic). Although most are at the laboratory stage and results are as yet only available from phantom or cadaver studies, clinical trials are imminent. For example, fine optical fibres placed within the lumen of block needles can measure needle tip pressure. Electrical impedance differentiates between intraneural and perineural needle tip placement. A new tip tracker needle has a piezo element embedded at its distal end that tracks the needle tip in-plane and out-of-plane as a blue/red or green circle depending on its relative location within the beam. Micro-ultrasound at the tip of the needle is in development. Early images using 40MHz in anaesthetised pigs reveal muscle striation, distinct epineurium and 30-40 fascicles > 75 micron in diameter. The next few years will see a technological revolution in tip-tracking technology that has the potential to improve patient safety and, in doing so, change practice.

Spatio-temporal deep learning models for tip force estimation during needle insertion

PURPOSE

Precise placement of needles is a challenge in a number of clinical applications such as brachytherapy or biopsy. Forces acting at the needle cause tissue deformation and needle deflection which in turn may lead to misplacement or injury. Hence, a number of approaches to estimate the forces at the needle have been proposed. Yet, integrating sensors into the needle tip is challenging and a careful calibration is required to obtain good force estimates.

METHODS

We describe a fiber-optic needle tip force sensor design using a single OCT fiber for measurement. The fiber images the deformation of an epoxy layer placed below the needle tip which results in a stream of 1D depth profiles. We study different deep learning approaches to facilitate calibration between this spatio-temporal image data and the related forces. In particular, we propose a novel convGRU-CNN architecture for simultaneous spatial and temporal data processing.

RESULTS

The needle can be adapted to different operating ranges by changing the stiffness of the epoxy layer. Likewise, calibration can be adapted by training the deep learning models. Our novel convGRU-CNN architecture results in the lowest mean absolute error of [Formula: see text] and a cross-correlation coefficient of 0.9997 and clearly outperforms the other methods. Ex vivo experiments in human prostate tissue demonstrate the needle's application.

CONCLUSIONS

Our OCT-based fiber-optic sensor presents a viable alternative for needle tip force estimation. The results indicate that the rich spatio-temporal information included in the stream of images showing the deformation throughout the epoxy layer can be effectively used by deep learning models. Particularly, we demonstrate that the convGRU-CNN architecture performs favorably, making it a promising approach for other spatio-temporal learning problems.

Modular Optic Force Sensor for a Surgical Device Using a Fabry–Perot Interferometer

The ability to sense force in surgery is in high demand in many applications such asforce feedback in surgical robots and remote palpation (e.g., tumor detection in endoscopic surgery).In addition, recording and analyzing surgical data is of substantial value in terms of evidence-basedmedicine. However, force sensing in surgery remains challenging because of the specific requirementsof surgical instruments, namely, they must be small, bio-compatible, sterilizable, and tolerant tonoise. In this study, we propose a modular optic force sensor using a Fabry–Perot interferometer thatcan be used on surgical devices. The the proposed sensor can be implemented like a strain gauge,which is widely used in industrial applications but not compatible with surgery. The proposed sensorincludes two key elements, a fiber-optic pressure sensor using a Fabry–Perot interferometer thatwas previously developed by one of the authors and a structure that includes a carbide pin thatcontacts the pressure sensor along the long axis. These two elements are fixed in a guide channelfabricated in a 3 × 2 × 0.5 mm sensor housing. The experimental results are promising, revealinga linear relationship between the output and the applied load while showing a linear temperaturecharacteristic that suggests temperature compensation will be needed in use.

Enhancing haptic feedback of subsurfaces during needle insertion

Haptic feedback can be helpful for accurate needle insertion but is complicated by friction on the needle shaft. Concepts to directly measure the forces at the needle tip exist but cause additional cost and complexity. Moreover, haptic devices may show inaccuracies in recreating forces. We present a novel force feedback method that uses needle shaft forces and enhances haptic feedback of subsurfaces based on robotic ultrasound elastography. This approach allows to overcome accuracy limitations of haptic devices. We evaluate our method in a volunteer subject study using recordings from a robotic needle driver setup. We compare haptic feedback based on shaft and enhanced force for the detection of surfaces inside of gelatin phantoms. Using our method, the error of subsurface detection decreased from more than 16 to about 1.7 mm for the first subsurface. A second subsurface was solely detectable using our method with an error of only 1.4 mm. Insertion time decreased by more than 32%. The results indicate that our enhanced sensor is suitable to detect subsurfaces for untrained subjects using a haptic feedback device of limited accuracy.

MR-Compatible Haptic Display of Membrane Puncture in Robot-Assisted Needle Procedures

Multilayer electroactive polymer films actuate a small hand-held device that can display tool tip forces during MR-guided interventions. The display produces localized skin stretch at the thumb and index fingertips. Tests confirm that the device does not significantly affect MR imaging and produces detectable stimuli in response to forces measured by a biopsy needle instrumented with optical fibers. Tests with human subjects explored robotic and teleoperated paradigms to detect when the needle contacted a membrane embedded at variable depth in a tissue phantom that approximated the properties of porcine liver. In the first case, naive users detected membranes with a 98.9% success rate as the needle was driven at fixed speed. In the second case, users with experience in needle-based procedures controlled the needle insertion and detected membranes embedded in tissue phantoms with a 98% success rate. In the second experiment, some users detected membranes with very light contact forces, but there was greater subject-to-subject variation.