Magnetic resonance imaging-guided focused ultrasound robotic system with the subject placed in the prone position

A Comprehensive Review of Piezoelectric Ultrasonic Motors: Classifications, Characterization, Fabrication, Applications, and Future Challenges

Piezoelectric ultrasonic motors (USMs) are actuators that use ultrasonic frequency piezoelectric vibration-generated waves to transform electrical energy into rotary or translating motion. USMs receive more attention because they offer distinct qualities over traditional magnet-coil-based motors, such as miniaturization, great accuracy, speed, non-magnetic nature, silent operation, straightforward construction, broad temperature operations, and adaptability. This review study focuses on the principle of USMs and their classifications, characterization, fabrication methods, applications, and future challenges. Firstly, the classifications of USMs, especially, standing-wave, traveling-wave, hybrid-mode, and multi-degree-of-freedom USMs, are summarized, and their respective functioning principles are explained. Secondly, finite element modeling analysis for design and performance predictions, conventional and nano/micro-fabrication methods, and various characterization methods are presented. Thirdly, their advantages, such as high accuracy, small size, and silent operation, and their benefits over conventional motors for the different specific applications are examined. Fourthly, the advantages and disadvantages of USMs are highlighted. In addition, their substantial contributions to a variety of technical fields like surgical robots and industrial, aerospace, and biomedical applications are introduced. Finally, their future prospects and challenges, as well as research directions in USM development, are outlined, with an emphasis on downsizing, increasing efficiency, and new materials.

Focused ultrasound heating in brain tissue/skull phantoms with 1 MHz single-element transducer

PURPOSE

The study aims to provide insights on the practicality of using single-element transducers for transcranial Focused Ultrasound (tFUS) thermal applications.

METHODS

FUS sonications were performed through skull phantoms embedding agar-based tissue mimicking gels using a 1 MHz single-element spherically focused transducer. The skull phantoms were 3D printed with Acrylonitrile Butadiene Styrene (ABS) and Resin thermoplastics having the exact skull bone geometry of a healthy volunteer. The temperature field distribution during and after heating was monitored in a 3 T Magnetic Resonance Imaging (MRI) scanner using MR thermometry. The effect of the skull's thickness on intracranial heating was investigated.

RESULTS

A single FUS sonication at focal acoustic intensities close to 1580 W/cm2 for 60 s in free field heated up the agar phantom to ablative temperatures reaching about 90 °C (baseline of 37 °C). The ABS skull strongly blocked the ultrasonic waves, resulting in zero temperature increase within the phantom. Considerable heating was achieved through the Resin skull, but it remained at hyperthermia levels. Conversely, tFUS through a 1 mm Resin skull showed enhanced ultrasonic penetration and heating, with the focal temperature reaching 70 °C.

CONCLUSIONS

The ABS skull demonstrated poorer performance in terms of tFUS compared to the Resin skull owing to its higher ultrasonic attenuation and porosity. The thin Resin phantom of 1 mm thickness provided an efficient acoustic window for delivering tFUS and heating up deep phantom areas. The results of such studies could be particularly useful for accelerating the establishment of a wider range of tFUS applications.

Effect of Magnetic Resonance Imaging on the Motion Accuracy of Magnetic Resonance Imaging-compatible Focused Ultrasound Robotic System

PURPOSE

The current study provides insights into the challenges of safely operating a magnetic resonance imaging (MRI)-guided focused ultrasound (MRgFUS) robotic system in a high-field MRI scanner in terms of robotic motion accuracy.

MATERIALS AND METHODS

Grid sonications were carried out in phantoms and excised porcine tissue in a 3T MRI scanner using an existing MRgFUS robotic system. Fast low-angle shot-based magnetic resonance thermometry was employed for the intraprocedural monitoring of thermal distribution.

RESULTS

Strong shifting of the heated spots from the intended points was observed owing to electromagnetic interference (EMI)-induced malfunctions in system's operation. Increasing the slice thickness of the thermometry sequence to at least 8 mm was proven an efficient method for preserving the robotic motion accuracy.

CONCLUSIONS

These findings raise awareness about EMI effects on the motion accuracy of MRgFUS robotic devices and how they can be mitigated by employing suitable thermometry parameters.

MRI compatibility testing of commercial high intensity focused ultrasound transducers

PURPOSE

The study aimed to compare the performance of eight commercially available single-element High Intensity Focused Ultrasound (HIFU) transducers in terms of Magnetic Resonance Imaging (MRI) compatibility.

METHODS

Imaging of an agar-based MRI phantom was performed in a 3 T MRI scanner utilizing T2-Weighted Fast Spin Echo (FSE) and Fast low angle shot (FLASH) sequences, which are typically employed for high resolution anatomical imaging and thermometry, respectively. Reference magnitude and phase images of the phantom were compared with images acquired in the presence of each transducer in terms of the signal to noise ratio (SNR), introduced artifacts, and overall image quality.

RESULTS

The degree of observed artifacts highly differed among the various transducers. The transducer whose backing material included magnetic impurities showed poor performance in the MRI, introducing significant susceptibility artifacts such as geometric distortions and signal void bands. Additionally, it caused the most significant SNR drop. Other transducers were shown to exhibit high level of MRI compatibility as the resulting images closely resembled the reference images with minimal to no apparent artifacts and comparable SNR values.

CONCLUSIONS

The study findings may facilitate researchers to select the most suitable transducer for their research, simultaneously avoiding unnecessary testing. The study further provides useful design considerations for MRI compatible transducers.

Simple, inexpensive, and ergonomic phantom for quality assurance control of MRI guided Focused Ultrasound systems

PURPOSE

The popularity of Magnetic Resonance guided Focused Ultrasound (MRgFUS) as a beneficial therapeutic solution for many diseases is increasing rapidly, thus raising the need for reliable quality assurance (QA) phantoms for routine testing of MRgFUS systems. In this study, we propose a thin acrylic film as the cheapest and most easily accessible phantom for assessing the functionality of MRgFUS hardware and software.

METHODS

Through the paper, specific QA tests are detailed in the framework of evaluating an MRgFUS preclinical robotic device comprising a single element spherically focused transducer with a nominal frequency of 2.75 MHz. These tests take advantage of the reflection of ultrasonic waves at a plastic-air interface, which results in almost immediate lesion formation on the film at a threshold of applied acoustic energy.

RESULTS

The phantom offered qualitative information on the power field distribution of the FUS transducer and the ability to visualize different FUS protocols. It also enabled quick and reliable assessment of various navigation algorithms as they are used in real treatments, and also allowed for the assessment of the accuracy of robotic motion.

CONCLUSION

Therefore, it could serve as a useful tool for detecting defects in system's performance over its lifetime after establishing a baseline while concurrently contributing to establish QA and calibration guidelines for clinical routine controls.

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.

Review of Robot-Assisted HIFU Therapy

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

Preclinical robotic device for magnetic resonance imaging guided focussed ultrasound

BACKGROUND

A robotic device featuring three motion axes was manufactured for preclinical research on focussed ultrasound (FUS). The device comprises a 2.75 MHz single element ultrasonic transducer and is guided by Magnetic Resonance Imaging (MRI).

METHODS

The compatibility of the device with the MRI was evaluated by estimating the influence on the signal-to-noise ratio (SNR). The efficacy of the transducer in generating ablative temperatures was evaluated in phantoms and excised porcine tissue.

RESULTS

System's activation in the MRI scanner reduced the SNR to an acceptable level without compromising the image quality. The transducer demonstrated efficient heating ability as proved by MR thermometry. Discrete and overlapping thermal lesions were inflicted in excised tissue.

CONCLUSIONS

The FUS system was proven effective for FUS thermal applications in the MRI setting. It can thus be used for multiple preclinical applications of the emerging MRI-guided FUS technology. The device can be scaled-up for human use with minor modifications.

Treatment of canine and feline sarcoma using MR-guided focused ultrasound system

PURPOSE

In recent years, veterinary medicine has enhanced its applications beyond traditional approaches, progressively incorporating the Focused Ultrasound (FUS) technology. This study investigated the ability of FUS to precisely ablate naturally occurring canine and feline soft tissue sarcomas (STS).

METHODS

Six dogs and four cats with superficial tumours were enrolled in the study. The tumours were treated with a Magnetic Resonance guided FUS (MRgFUS) robotic system featuring a single element spherically focused transducer of 2.6 MHz. The tumours were then removed by surgery and sent for hematoxylin and eosin (H&E) staining.

RESULTS

The MRgFUS system was capable of inflicting well-defined overlapping lesions in the tumours. The anatomical sites of the treated tumours were the neck, leg, face, back and belly. Coagulative necrosis was evidenced by histopathology assessment in 80% of cases.

CONCLUSION

Therefore, this technology can be a therapeutic solution for veterinary cancer and a model for advancing the knowledge on human STS.

Robotic system for top to bottom MRgFUS therapy of multiple cancer types

BACKGROUND

A robotic system for Magnetic Resonance guided Focussed Ultrasound (MRgFUS) therapy of tumours in the breast, bone, thyroid, and abdomen was developed.

METHODS

A special C-shaped structure was designed to be attached to the table of conventional magnetic resonance imaging (MRI) systems carrying 4 computer-controlled motion stages dedicated to positioning a 2.75 MHz spherically focussed transducer relative to a patient placed in the supine position. The developed system was evaluated for its MRI compatibility and heating abilities in agar-based phantoms and freshly excised tissue.

RESULTS

Compatibility of the system with a clinical high-field MRI scanner was demonstrated. FUS heating in the phantom was successfully monitored by magnetic resonance thermometry without any evidence of magnetically induced phenomena. Cigar-shaped discrete lesions and well-defined areas of overlapping lesions were inflicted in excised tissue by robotic movement along grid patterns.

CONCLUSIONS

The developed MRgFUS robotic system was proven safe and efficient by ex-vivo feasibility studies.

Robotic system for magnetic resonance guided focused ultrasound ablation of abdominal cancer

BACKGROUND

A prototype robotic system that uses magnetic resonance guided focused ultrasound (MRgFUS) technology is presented. It features three degrees of freedom (DOF) and is intended for thermal ablation of abdominal cancer.

METHODS

The device is equipped with three identical transducers being offset between them, thus focussing at different depths in tissue. The efficacy and safety of the system in ablating rabbit liver and kidney was assessed, both in laboratory and magnetic resonance imaging (MRI) conditions.

RESULTS

Despite these organs' challenging location, in situ coagulative necrosis of a tissue area was achieved. Heating of abdominal organs in rabbit was successfully monitored with MR thermometry.

CONCLUSIONS

The MRgFUS system was proven successful in creating lesions in the abdominal area of rabbits. The outcomes of the study are promising for future translation of the technology to the clinic.