Robotic System Development for Precision MRI-Guided Needle-Based Interventions

This dissertation describes the development of a methodology for implementing robotic systems for interventional procedures under intraoperative Magnetic Resonance Imaging (MRI) guidance. MRI is an ideal imaging modality for surgical guidance of diagnostic and therapeutic procedures, thanks to its ability to perform high resolution, real-time, and high soft tissue contrast imaging without ionizing radiation. However, the strong magnetic field and sensitivity to radio frequency signals, as well as tightly confined scanner bore render great challenges to developing robotic systems within MRI environment. Discussed are potential solutions to address engineering topics related to development of MRI-compatible electro-mechanical systems and modeling of steerable needle interventions. A robotic framework is developed based on a modular design approach, supporting varying MRI-guided interventional procedures, with stereotactic neurosurgery and prostate cancer therapy as two driving exemplary applications. A piezoelectrically actuated electro-mechanical system is designed to provide precise needle placement in the bore of the scanner under interactive MRI-guidance, while overcoming the challenges inherent to MRI-guided procedures. This work presents the development of the robotic system in the aspects of requirements definition, clinical work flow development, mechanism optimization, control system design and experimental evaluation. A steerable needle is beneficial for interventional procedures with its capability to produce curved path, avoiding anatomical obstacles or compensating for needle placement errors. Two kinds of steerable needles are discussed, i.e. asymmetric-tip needle and concentric-tube cannula. A novel Gaussian-based ContinUous Rotation and Variable-curvature (CURV) model is proposed to steer asymmetric-tip needle, which enables variable curvature of the needle trajectory with independent control of needle rotation and insertion. While concentric-tube cannula is suitable for clinical applications where a curved trajectory is needed without relying on tissue interaction force. This dissertation addresses fundamental challenges in developing and deploying MRI-compatible robotic systems, and enables the technologies for MRI-guided needle-based interventions. This study applied and evaluated these techniques to a system for prostate biopsy that is currently in clinical trials, developed a neurosurgery robot prototype for interstitial thermal therapy of brain cancer under MRI guidance, and demonstrated needle steering using both asymmetric tip and pre-bent concentric-tube cannula approaches on a testbed

Reconfigurable Fiducial-Integrated Modular Needle Driver For MRI-Guided Percutaneous Interventions

Needle-based interventions are pervasive in Minimally Invasive Surgery (MIS), and are often used in a number of diagnostic and therapeutic procedures, including biopsy and brachytherapy seed placement. Magnetic Resonance Imaging (MRI) which can provide high quality, real time and high soft tissue contrast imaging, is an ideal guidance tool for image-guided therapy (IGT). Therefore, a MRI-guided needle-based surgical robot proves to have great potential in the application of percutaneous interventions. Presented here is the design of reconfigurable fiducial-integrated modular needle driver for MRI-guided percutaneous interventions. Further, an MRI-compatible hardware control system has been developed and enhanced to drive piezoelectric ultrasonic motors for a previously developed base robot designed to support the modular needle driver. A further contribution is the development of a fiber optic sensing system to detect robot position and joint limits. A transformer printed circuit board (PCB) and an interface board with integrated fiber optic limit sensing have been developed and tested to integrate the robot with the piezoelectric actuator control system designed by AIM Lab for closed loop control of ultrasonic Shinsei motors. A series of experiments were performed to evaluate the feasibility and accuracy of the modular needle driver. Bench top tests were conducted to validate the transformer board, fiber optic limit sensing and interface board in a lab environment. Finally, the whole robot control system was tested inside the MRI room to evaluate its MRI compatibility and stability

Image-Guided Robot-Assisted Techniques with Applications in Minimally Invasive Therapy and Cell Biology

There are several situations where tasks can be performed better robotically rather than manually. Among these are situations (a) where high accuracy and robustness are required, (b) where difficult or hazardous working conditions exist, and (c) where very large or very small motions or forces are involved. Recent advances in technology have resulted in smaller size robots with higher accuracy and reliability. As a result, robotics is fi nding more and more applications in Biomedical Engineering. Medical Robotics and Cell Micro-Manipulation are two of these applications involving interaction with delicate living organs at very di fferent scales.Availability of a wide range of imaging modalities from ultrasound and X-ray fluoroscopy to high magni cation optical microscopes, makes it possible to use imaging as a powerful means to guide and control robot manipulators. This thesis includes three parts focusing on three applications of Image-Guided Robotics in biomedical engineering, including: Vascular Catheterization: a robotic system was developed to insert a catheter through the vasculature and guide it to a desired point via visual servoing. The system provides shared control with the operator to perform a task semi-automatically or through master-slave control. The system provides control of a catheter tip with high accuracy while reducing X-ray exposure to the clinicians and providing a more ergonomic situation for the cardiologists. Cardiac Catheterization: a master-slave robotic system was developed to perform accurate control of a steerable catheter to touch and ablate faulty regions on the inner walls of a beating heart in order to treat arrhythmia. The system facilitates touching and making contact with a target point in a beating heart chamber through master-slave control with coordinated visual feedback. Live Neuron Micro-Manipulation: a microscope image-guided robotic system was developed to provide shared control over multiple micro-manipulators to touch cell membranes in order to perform patch clamp electrophysiology. Image-guided robot-assisted techniques with master-slave control were implemented for each case to provide shared control between a human operator and a robot. The results show increased accuracy and reduced operation time in all three cases

Modeling, Sensorization and Control of Concentric-Tube Robots

Since the concept of the Concentric-Tube Robot (CTR) was proposed in 2006, CTRs have been a popular research topic in the field of surgical robotics. The unique mechanical design of this robot allows it to navigate through narrow channels in the human anatomy and operate in highly constrained environments. It is therefore likely to become the next generation of surgical robots to overcome the challenges that cannot be addressed by current technologies. In CSTAR, we have had ongoing work over the past several years aimed at developing novel techniques and technologies for CTRs. This thesis describes the contributions made in this context, focusing primarily on topics such as modeling, sensorization, and control of CTRs. Prior to this work, one of the main challenges in CTRs was to develop a kinematic model that achieves a balance between the numerical accuracy and computational efficiency for surgical applications. In this thesis, a fast kinematic model of CTRs is proposed, which can be solved at a comparatively fast rate (0.2 ms) with minimal loss of accuracy (0.1 mm) for a 3-tube CTR. A Jacobian matrix is derived based on this model, leading to the development of a real-time trajectory tracking controller for CTRs. For tissue-robot interactions, a force-rejection controller is proposed for position control of CTRs under time-varying force disturbances. In contrast to rigid-link robots, instability of position control could be caused by non-unique solutions to the forward kinematics of CTRs. This phenomenon is modeled and analyzed, resulting in design criteria that can ensure kinematic stability of a CTR in its entire workspace. Force sensing is another major difficulty for CTRs. To address this issue, commercial force/torque sensors (Nano43, ATI Industrial Automation, United States) are integrated into one of our CTR prototypes. These force/torque sensors are replaced by Fiber-Bragg Grating (FBG) sensors that are helically-wrapped and embedded in CTRs. A strain-force calculation algorithm is proposed, to convert the reflected wavelength of FBGs into force measurements with 0.1 N force resolution at 100 Hz sampling rate. In addition, this thesis reports on our innovations in prototyping drive units for CTRs. Three designs of CTR prototypes are proposed, the latest one being significantly more compact and cost efficient in comparison with most designs in the literature. All of these contributions have brought this technology a few steps closer to being used in operating rooms. Some of the techniques and technologies mentioned above are not merely limited to CTRs, but are also suitable for problems arising in other types of surgical robots, for example, for sensorizing da Vinci surgical instruments for force sensing (see Appendix A)

Cable-driven parallel mechanisms for minimally invasive robotic surgery

Minimally invasive surgery (MIS) has revolutionised surgery by providing faster recovery times, less post-operative complications, improved cosmesis and reduced pain for the patient. Surgical robotics are used to further decrease the invasiveness of procedures, by using yet smaller and fewer incisions or using natural orifices as entry point. However, many robotic systems still suffer from technical challenges such as sufficient instrument dexterity and payloads, leading to limited adoption in clinical practice. Cable-driven parallel mechanisms (CDPMs) have unique properties, which can be used to overcome existing challenges in surgical robotics. These beneficial properties include high end-effector payloads, efficient force transmission and a large configurable instrument workspace. However, the use of CDPMs in MIS is largely unexplored. This research presents the first structured exploration of CDPMs for MIS and demonstrates the potential of this type of mechanism through the development of multiple prototypes: the ESD CYCLOPS, CDAQS, SIMPLE, neuroCYCLOPS and microCYCLOPS. One key challenge for MIS is the access method used to introduce CDPMs into the body. Three different access methods are presented by the prototypes. By focusing on the minimally invasive access method in which CDPMs are introduced into the body, the thesis provides a framework, which can be used by researchers, engineers and clinicians to identify future opportunities of CDPMs in MIS. Additionally, through user studies and pre-clinical studies, these prototypes demonstrate that this type of mechanism has several key advantages for surgical applications in which haptic feedback, safe automation or a high payload are required. These advantages, combined with the different access methods, demonstrate that CDPMs can have a key role in the advancement of MIS technology.Open Acces

Modeling, Analysis, Force Sensing and Control of Continuum Robots for Minimally Invasive Surgery

This dissertation describes design, modeling and application of continuum robotics for surgical applications, specifically parallel continuum robots (PCRs) and concentric tube manipulators (CTMs). The introduction of robotics into surgical applications has allowed for a greater degree of precision, less invasive access to more remote surgical sites, and user-intuitive interfaces with enhanced vision systems. The most recent developments have been in the space of continuum robots, whose exible structure create an inherent safety factor when in contact with fragile tissues. The design challenges that exist involve balancing size and strength of the manipulators, controlling the manipulators over long transmission pathways, and incorporating force sensing and feedback from the manipulators to the user. Contributions presented in this work include: (1) prototyping, design, force sensing, and force control investigations of PCRs, and (2) prototyping of a concentric tube manipulator for use in a standard colonoscope. A general kinetostatic model is presented for PCRs along with identification of multiple physical constraints encountered in design and construction. Design considerations and manipulator capabilities are examined in the form of matrix metrics and ellipsoid representations. Finally, force sensing and control are explored and experimental results are provided showing the accuracy of force estimates based on actuation force measurements and control capabilities. An overview of the design requirements, manipulator construction, analysis and experimental results are provided for a CTM used as a tool manipulator in a traditional colonoscope. Currently, tools used in colonoscopic procedures are straight and exit the front of the scope with 1 DOF of operation (jaws of a grasper, tightening of a loop, etc.). This research shows that with a CTM deployed, the dexterity of these tools can be increased dramatically, increasing accuracy of tool operation, ease of use and safety of the overall procedure. The prototype investigated in this work allows for multiple tools to be used during a single procedure. Experimental results show the feasibility and advantages of the newly-designed manipulators

Enabling technologies for MRI guided interventional procedures

This dissertation addresses topics related to developing interventional assistant devices for Magnetic Resonance Imaging (MRI). MRI can provide high-quality 3D visualization of target anatomy and surrounding tissue, but the benefits can not be readily harnessed for interventional procedures due to difficulties associated with the use of high-field (1.5T or greater) MRI. Discussed are potential solutions to the inability to use conventional mecha- tronics and the confined physical space in the scanner bore. This work describes the development of two apparently dissimilar systems that repre- sent different approaches to the same surgical problem - coupling information and action to perform percutaneous (through the skin) needle placement with MR imaging. The first system addressed takes MR images and projects them along with a surgical plan directly on the interventional site, thus providing in-situ imaging. With anatomical images and a corresponding plan visible in the appropriate pose, the clinician can use this information to perform the surgical action. My primary research effort has focused on a robotic assistant system that overcomes the difficulties inherent to MR-guided procedures, and promises safe and reliable intra-prostatic needle placement inside closed high-field MRI scanners. The robot is a servo pneumatically operated automatic needle guide, and effectively guides needles under real- time MR imaging. This thesis describes development of the robotic system including requirements, workspace analysis, mechanism design and optimization, and evaluation of MR compatibility. Further, a generally applicable MR-compatible robot controller is de- veloped, the pneumatic control system is implemented and evaluated, and the system is deployed in pre-clinical trials. The dissertation concludes with future work and lessons learned from this endeavor

AUGMENTED REALITY AND INTRAOPERATIVE C-ARM CONE-BEAM COMPUTED TOMOGRAPHY FOR IMAGE-GUIDED ROBOTIC SURGERY

Minimally-invasive robotic-assisted surgery is a rapidly-growing alternative to traditionally open and laparoscopic procedures; nevertheless, challenges remain. Standard of care derives surgical strategies from preoperative volumetric data (i.e., computed tomography (CT) and magnetic resonance (MR) images) that benefit from the ability of multiple modalities to delineate different anatomical boundaries. However, preoperative images may not reflect a possibly highly deformed perioperative setup or intraoperative deformation. Additionally, in current clinical practice, the correspondence of preoperative plans to the surgical scene is conducted as a mental exercise; thus, the accuracy of this practice is highly dependent on the surgeon’s experience and therefore subject to inconsistencies. In order to address these fundamental limitations in minimally-invasive robotic surgery, this dissertation combines a high-end robotic C-arm imaging system and a modern robotic surgical platform as an integrated intraoperative image-guided system. We performed deformable registration of preoperative plans to a perioperative cone-beam computed tomography (CBCT), acquired after the patient is positioned for intervention. From the registered surgical plans, we overlaid critical information onto the primary intraoperative visual source, the robotic endoscope, by using augmented reality. Guidance afforded by this system not only uses augmented reality to fuse virtual medical information, but also provides tool localization and other dynamic intraoperative updated behavior in order to present enhanced depth feedback and information to the surgeon. These techniques in guided robotic surgery required a streamlined approach to creating intuitive and effective human-machine interferences, especially in visualization. Our software design principles create an inherently information-driven modular architecture incorporating robotics and intraoperative imaging through augmented reality. The system's performance is evaluated using phantoms and preclinical in-vivo experiments for multiple applications, including transoral robotic surgery, robot-assisted thoracic interventions, and cocheostomy for cochlear implantation. The resulting functionality, proposed architecture, and implemented methodologies can be further generalized to other C-arm-based image guidance for additional extensions in robotic surgery