Medical image computing and computer-aided medical interventions applied to soft tissues. Work in progress in urology

Until recently, Computer-Aided Medical Interventions (CAMI) and Medical Robotics have focused on rigid and non deformable anatomical structures. Nowadays, special attention is paid to soft tissues, raising complex issues due to their mobility and deformation. Mini-invasive digestive surgery was probably one of the first fields where soft tissues were handled through the development of simulators, tracking of anatomical structures and specific assistance robots. However, other clinical domains, for instance urology, are concerned. Indeed, laparoscopic surgery, new tumour destruction techniques (e.g. HIFU, radiofrequency, or cryoablation), increasingly early detection of cancer, and use of interventional and diagnostic imaging modalities, recently opened new challenges to the urologist and scientists involved in CAMI. This resulted in the last five years in a very significant increase of research and developments of computer-aided urology systems. In this paper, we propose a description of the main problems related to computer-aided diagnostic and therapy of soft tissues and give a survey of the different types of assistance offered to the urologist: robotization, image fusion, surgical navigation. Both research projects and operational industrial systems are discussed

An Open-Source 7-Axis, Robotic Platform to Enable Dexterous Procedures within CT Scanners

This paper describes the design, manufacture, and performance of a highly dexterous, low-profile, 7 Degree-of-Freedom (DOF) robotic arm for CT-guided percutaneous needle biopsy. Direct CT guidance allows physicians to localize tumours quickly; however, needle insertion is still performed by hand. This system is mounted to a fully active gantry superior to the patient's head and teleoperated by a radiologist. Unlike other similar robots, this robot's fully serial-link approach uses a unique combination of belt and cable drives for high-transparency and minimal-backlash, allowing for an expansive working area and numerous approach angles to targets all while maintaining a small in-bore cross-section of less than $16cm^2$. Simulations verified the system's expansive collision free work-space and ability to hit targets across the entire chest, as required for lung cancer biopsy. Targeting error is on average $<1mm$ on a teleoperated accuracy task, illustrating the system's sufficient accuracy to perform biopsy procedures. The system is designed for lung biopsies due to the large working volume that is required for reaching peripheral lung lesions, though, with its large working volume and small in-bore cross-sectional area, the robotic system is effectively a general-purpose CT-compatible manipulation device for percutaneous procedures. Finally, with the considerable development time undertaken in designing a precise and flexible-use system and with the desire to reduce the burden of other researchers in developing algorithms for image-guided surgery, this system provides open-access, and to the best of our knowledge, is the first open-hardware image-guided biopsy robot of its kind.Comment: 8 pages, 9 figures, final submission to IROS 201

Image-Guided Robot-Assisted Needle Intervention Devices and Methods to Improve Targeting Accuracy

This dissertation addresses the development of medical devices, image-guided robots, and their application in needle-based interventions, as well as methods to improve accuracy and safety in clinical procedures. Needle access is an essential component of minimally invasive diagnostic and therapeutic procedures. Image-guiding devices are often required to help physicians handle the needle based on the images. Integrating robotic accuracy and precision with digital medical imaging has the potential to improve the clinical outcomes. The dissertation presents two robotic devices for interventions under Magnetic Resonance Imaging (MRI) respectively Computed Tomography (CT) – Ultrasound(US) cross modality guidance. The MRI robot is a MR Safe Remote Center of Motion (RCM) robot for direct image-guided needle interventions such as brain surgery. The dissertation also presents the integration of the robot with an intraoperative MRI scanner, and preclinical tests for deep brain needle access. The CT-Ultrasound guidance uses a robotic manipulator to handle an US probe within a CT scanner. The dissertation presents methods related to the co-registration of multi-image spaces with an intermediary frame, experiments for needle targeting. The dissertation also presents method on using optical tracking measurements specifically for medical robots. The method was derived to test the robots presented above. With advanced image-guidance, such as the robotic approaches, needle targeting accuracy may still be deteriorated by errors related to needle defections. Methods and associated devices for needle steering on the straight path are presented. These are a robotic approach that uses real-time ultrasound guidance to steer the needle; Modeling and testing of a method to markedly reduce targeting errors with bevel-point needles; Dynamic design, manufacturing, and testing of a novel core biopsy needle with straighter path, power assistance, reduced noise, and safer operation. Overall, the dissertation presents several developments that contribute to the field of medical devices, image-guided robots, and needle interventions. These include robot testing methods that can be used by other researchers, needle steering methods that can be used directly by physicians or for robotic devices, as well as several methods to improve the accuracy in image-guided interventions. Collectively, these contribute to the field and may have a significant clinical impact

Using CamiTK for rapid prototyping of interactive Computer Assisted Medical Intervention applications

Computer Assisted Medical Intervention (CAMI hereafter) is a complex multi-disciplinary field. CAMI research requires the collaboration of experts in several fields as diverse as medicine, computer science, mathematics, instrumentation, signal processing, mechanics, modeling, automatics, optics, etc

Needle and Biopsy Robots: a Review

Purpose of the review Robotics is a rapidly advancing field, and its introduction in healthcare can have a multitude of benefits for clinical practice. Especially, applications depending on the radiologist\u2019s accuracy and precision, such as percutaneous interventions, may profit. This paper provides an overview of recent robot-assisted percutaneous solutions. Recent findings Percutaneous interventions are relatively simple and the quality of the procedure increases a lot by introducing robotics due to the improved accuracy and precision. The success of the procedure is heavily dependent on the ability to merge pre- and intraoperative images, as an accurate estimation of the current target location allows to exploit the robot\u2019s capabilities. Summary Despite much research, the application of robotics in some branches of healthcare is not commonplace yet. Recent advances in percutaneous robotic solutions and imaging are highlighted, as they will pave the way to more widespread implementation of robotics in clinical practic

Medical robots for MRI guided diagnosis and therapy

Magnetic Resonance Imaging (MRI) provides the capability of imaging tissue with fine resolution and superior soft tissue contrast, when compared with conventional ultrasound and CT imaging, which makes it an important tool for clinicians to perform more accurate diagnosis and image guided therapy. Medical robotic devices combining the high resolution anatomical images with real-time navigation, are ideal for precise and repeatable interventions. Despite these advantages, the MR environment imposes constraints on mechatronic devices operating within it. This thesis presents a study on the design and development of robotic systems for particular MR interventions, in which the issue of testing the MR compatibility of mechatronic components, actuation control, kinematics and workspace analysis, and mechanical and electrical design of the robot have been investigated. Two types of robotic systems have therefore been developed and evaluated along the above aspects. (i) A device for MR guided transrectal prostate biopsy: The system was designed from components which are proven to be MR compatible, actuated by pneumatic motors and ultrasonic motors, and tracked by optical position sensors and ducial markers. Clinical trials have been performed with the device on three patients, and the results reported have demonstrated its capability to perform needle positioning under MR guidance, with a procedure time of around 40mins and with no compromised image quality, which achieved our system speci cations. (ii) Limb positioning devices to facilitate the magic angle effect for diagnosis of tendinous injuries: Two systems were designed particularly for lower and upper limb positioning, which are actuated and tracked by the similar methods as the first device. A group of volunteers were recruited to conduct tests to verify the functionality of the systems. The results demonstrate the clear enhancement of the image quality with an increase in signal intensity up to 24 times in the tendon tissue caused by the magic angle effect, showing the feasibility of the proposed devices to be applied in clinical diagnosis

Evaluation of a robotic technique for transrectal MRI-guided prostate biopsies

Item does not contain fulltextOBJECTIVES: To evaluate the accuracy and speed of a novel robotic technique as an aid to perform magnetic resonance image (MRI)-guided prostate biopsies on patients with cancer suspicious regions. METHODS: A pneumatic controlled MR-compatible manipulator with 5 degrees of freedom was developed in-house to guide biopsies under real-time imaging. From 13 consecutive biopsy procedures, the targeting error, biopsy error and target displacement were calculated to evaluate the accuracy. The time was recorded to evaluate manipulation and procedure time. RESULTS: The robotic and manual techniques demonstrated comparable results regarding mean targeting error (5.7 vs 5.8 mm, respectively) and mean target displacement (6.6 vs 6.0 mm, respectively). The mean biopsy error was larger (6.5 vs 4.4 mm) when using the robotic technique, although not significant. Mean procedure and manipulation time were 76 min and 6 min, respectively using the robotic technique and 61 and 8 min with the manual technique. CONCLUSIONS: Although comparable results regarding accuracy and speed were found, the extended technical effort of the robotic technique make the manual technique - currently - more suitable to perform MRI-guided biopsies. Furthermore, this study provided a better insight in displacement of the target during in vivo biopsy procedures.01 februari 201

Increasing the precision of the biopsy with robots: two case studies

Robotics is a rapidly advancing field and its introduction in healthcare can have a multitude of benefits for clinical practice. Especially applications depending on the radiologist’s accuracy and precision, such as percutaneous interventions, may profit. Percutaneous interventions are relatively simple and the quality of the procedure increases a lot by introducing robotics due to the improved accuracy and precision. This paper provides the description of two robotic systems for percutaneous interventions: breast biopsy and prostate biopsy. The systems presented here are complete prototypes in an advanced state ready to be tested in clinical practice.https://youtu.be/KZxfRtg0afg https://www.youtube.com/watch?v=AB3Qa6LyHP

Image-guided Breast Biopsy of MRI-visible Lesions with a Hand-mounted Motorised Needle Steering Tool

A biopsy is the only diagnostic procedure for accurate histological confirmation of breast cancer. When sonographic placement is not feasible, a Magnetic Resonance Imaging(MRI)-guided biopsy is often preferred. The lack of real-time imaging information and the deformations of the breast make it challenging to bring the needle precisely towards the tumour detected in pre-interventional Magnetic Resonance (MR) images. The current manual MRI-guided biopsy workflow is inaccurate and would benefit from a technique that allows real-time tracking and localisation of the tumour lesion during needle insertion. This paper proposes a robotic setup and software architecture to assist the radiologist in targeting MR-detected suspicious tumours. The approach benefits from image fusion of preoperative images with intraoperative optical tracking of markers attached to the patient's skin. A hand-mounted biopsy device has been constructed with an actuated needle base to drive the tip toward the desired direction. The steering commands may be provided both by user input and by computer guidance. The workflow is validated through phantom experiments. On average, the suspicious breast lesion is targeted with a radius down to 2.3 mm. The results suggest that robotic systems taking into account breast deformations have the potentials to tackle this clinical challenge.Comment: Submitted to 2021 International Symposium on Medical Robotics (ISMR