Needle-guiding robot for laser ablation of liver tumors under MRI guidance

This paper presents the design, control and experimental evaluation of a needle-guiding robot intended for use in laser ablation (LA) of liver tumors under guidance by Magnetic Resonance Imaging (MRI). The robot provides alignment of a needle guide inside the MRI scanner bore and employs manual needle insertion. In order to minimize MR-image deterioration, the robot is actuated using plastic pneumatic cylinders and long pipes connecting to control valves located outside the MRI scanner room. A new Time Delay Control scheme (TDC) was employed to achieve high position accuracy without requiring pressure or force measurements in the MRI scanner. The control scheme was compared with experiments to a previously developed Sliding Mode Controller (SMC). A marker localization method based on the convolution theorem of Fourier transform was employed to register the robot in the MRI scanner coordinate system and to verify the position of the needle guide before the manual needle insertion. Experiments in a closed-bore MRI scanner showed a variation in SNR below 5%. A phantom study indicates that the targeting error in robot-assisted needle insertions is below 5 mm and suggest a potential time saving of 30 minutes compared to the manual MRI-guided LA procedure

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

Image-guided robots for dot-matrix tumor ablation

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2010.Cataloged from PDF version of thesis.Includes bibliographical references (p. 203-208).Advances in medical imaging now provides detailed images of solid tumors inside the body and miniaturized energy delivery systems enable tumor destruction through local heating powered by a thin electrode. However, the use of thermal ablation as a first line of treatment is limited due to the difficulty in accurately matching a desired treatment and a limited region of active heating around an electrode. The purpose of this research is to identify and quantify the current limitations of image-guided interventional procedures and subsequently develop a procedure and devices to enable accurate and efficient execution of image-based interventional plans and thus ablation of a tumor of any shape with minimal damage to surrounding tissue. Current limitations of probe placement for ablation therapy were determined by a detailed retrospective study of 50 representative CT-guided procedures. On average, 21 CT scans were performed for a given procedure (range 11-38), with the majority devoted to needle orientation and insertion (mean number of scans was 54%) and trajectory planning (mean number of scans was 19%). A regression analysis yielded that smaller and deeper lesions were associated with a higher number of CT scans for needle orientation and insertion; highlighting the difficulty in targeting. Another challenge identified was repositioning the instrument distal tip within tissue. The first robot is a patient-mounted device that aligns an instrument along a desired trajectory via two motor-actuated concentric, crossed, and partially nested hoops. A carriage rides in the hoops and grips and inserts an instrument via a two degree-of-freedom friction drive. An imagebased point-and-click user interface relates appropriate clicks on the medical images to robot commands. Mounting directly on the patient provides a sufficiently stable and safe platform for actuation and eliminates the need to compensate for chest motion; thereby reducing the cost and complexity compared to other devices. Phantom experiments in a realistic clinical setting demonstrated a mean targeting accuracy of 3.5 mm with an average of five CT scans. The second robot is for repositioning the distal tip of a medical instrument to adjacent points within tissue. The steering mechanism is based on the concept of substantially straightening a pre-curved Nitinol stylet by retracting it into a concentric outer cannula, and re-deploying it at different axial and rotational cannula positions. The proximal end of the cannula is attached to the distal end of a screw-spline that enables it to be translated and rotated with respect to the casing. Translation of the stylet relative to the cannula is achieved with a second concentric, nested smaller diameter screw that is constrained to rotate with the cannula. The robot mechanism is compatible with the CT images, light enough to be supported on a patient's chest or attached to standard stereotactic frames. Targeting experiments in a gelatin phantom demonstrated a mean targeting error of 1.8 mm between the stylet tip and that predicted with a kinematic model. Ultimately, these types of systems are envisioned being used together as part of a highly dexterous patient-mounted positioning platform that can accurately perform ablation of large and irregularly shaped tumors inside medical imaging machines - offering the potential to replace expensive and traumatic surgeries with minimally invasive out-patient procedures.by Conor James Walsh.Ph.D

Using the Fringe Field of MRI Scanner for the Navigation of Microguidewires in the Vascular System

Le traitement du cancer, la prévention des accidents vasculaires cérébraux et le diagnostic ou le traitement des maladies vasculaires périphériques sont tous des cas d'application d'interventions à base de cathéter par le biais d'un traitement invasif minimal. Cependant, la pratique du cathétérisme est généralement pratiquée manuellement et dépend fortement de l'expérience et des compétences de l'interventionniste. La robotisation du cathétérisme a été étudiée pour faciliter la procédure en augmentant les niveaux d’autonomie par rapport à cette pratique clinique. En ce qui concerne ce problème, un des problèmes concerne le placement super sélectif du cathéter dans les artères plus étroites nécessitant une miniaturisation de l'instrument cathéter / fil de guidage attaché. Un microguide qui fonctionne dans des vaisseaux sanguins étroits et tortueux subit différentes forces mécaniques telles que le frottement avec la paroi du vaisseau. Ces forces peuvent empêcher la progression de la pointe du fil de guidage dans les vaisseaux. Une méthode proposée consiste à appliquer une force de traction à la pointe du microguide pour diriger et insérer le dispositif tout en poussant l’instrument attaché à partir de l’autre extrémité n’est plus pratique, et à exploiter le gradient du champ de franges IRM surnommé Fringe Field Navigation (FFN ) est proposée comme solution pour assurer cet actionnement. Le concept de FFN repose sur le positionnement d'un patient sur six DOF dans le champ périphérique du scanner IRM afin de permettre un actionnement directionnel pour la navigation du fil-guide. Ce travail rend compte des développements requis pour la mise en oeuvre de la FFN et l’étude du potentiel et des possibilités qu’elle offre au cathétérisme, en veillant au renforcement de l’autonomie. La cartographie du champ de franges d'un scanner IRM 3T est effectuée et la structure du champ de franges en ce qui concerne son uniformité locale est examinée. Une méthode pour la navigation d'un fil de guidage le long d'un chemin vasculaire souhaité basée sur le positionnement robotique du patient à six DOF est développée. Des expériences de FFN guidées par rayons X in vitro et in vivo sur un modèle porcin sont effectuées pour naviguer dans un fil de guidage dans la multibifurcation et les vaisseaux étroits. Une caractéristique unique de FFN est le haut gradient du champ magnétique. Il est démontré in vitro et in vivo que cette force surmonte le problème de l'insertion d'un fil microguide dans des vaisseaux tortueux et étroits pour permettre de faire avancer le fil-guide avec une distale douce au-delà de la limite d'insertion manuelle. La robustesse de FFN contre les erreurs de positionnement du patient est étudiée en relation avec l'uniformité locale dans le champ périphérique. La force élevée du champ magnétique disponible dans le champ de franges IRM peut amener les matériaux magnétiques doux à son état de saturation. Ici, le concept d'utilisation d'un ressort est présenté comme une alternative vi déformable aux aimants permanents solides pour la pointe du fil-guide. La navigation d'un microguide avec une pointe de ressort en structure vasculaire complexe est également réalisée in vitro. L'autonomie de FFN en ce qui concerne la planification d'une procédure avec autonomie de tâche obtenue dans ce travail augmente le potentiel de FFN en automatisant certaines étapes d'une procédure. En conclusion, FFN pour naviguer dans les microguides dans la structure vasculaire complexe avec autonomie pour effectuer le positionnement du patient et contrôler l'insertion du fil de guidage - avec démonstration in vivo dans un modèle porcin - peut être considéré comme un nouvel outil robotique facilitant le cathétérisme vasculaire. tout en aidant à cibler les vaisseaux lointains dans le système vasculaire.----------ABSTRACT Treatment of cancer, prevention of stroke, and diagnosis or treatment of peripheral vascular diseases are all the cases of application of catheter-based interventions through a minimal-invasive treatment. However, performing catheterization is generally practiced manually, and it highly depends on the experience and the skills of the interventionist. Robotization of catheterization has been investigated to facilitate the procedure by increasing the levels of autonomy to this clinical practice. Regarding it, one issue is the super selective placement of the catheter in the narrower arteries that require miniaturization of the tethered catheter/guidewire instrument. A microguidewire that operates in narrow and tortuous blood vessels experiences different mechanical forces like friction with the vessel wall. These forces can prevent the advancement of the tip of the guidewire in the vessels. A proposed method is applying a pulling force at the tip of the microguidewire to steer and insert the device while pushing the tethered instrument from the other end is no longer practical, and exploiting the gradient of the MRI fringe field dubbed as Fringe Field Navigation (FFN) is proposed as a solution to provide this actuation. The concept of FFN is based on six DOF positioning of a patient in the fringe field of the MRI scanner to enable directional actuation for the navigation of the guidewire. This work reports on the required developments for implementing FFN and investigating the potential and the possibilities that FFN introduces to the catheterization, with attention to enhancing the autonomy. Mapping the fringe field of a 3T MRI scanner is performed, and the structure of the fringe field regarding its local uniformity is investigated. A method for the navigation of a guidewire along a desired vascular path based on six DOF robotic patient positioning is developed. In vitro and in vivo x-ray Guided FFN experiments on a swine model of are performed to navigate a guidewire in the multibifurcation and narrow vessels. A unique feature of FFN is the high gradient of the magnetic field. It is demonstrated in vitro and in vivo that this force overcomes the issue of insertion of a microguidewire in tortuous and narrow vessels to enable advancing the guidewire with a soft distal beyond the limit of manual insertion. Robustness of FFN against the error in the positioning of the patient is investigated in relation to the local uniformity in the fringe field. The high strength of the magnetic field available in MRI fringe field can bring soft magnetic materials to its saturation state. Here, the concept of using a spring is introduced as a deformable alternative to solid permanent magnets for the tip of the guidewire. Navigation of a microguidewire with a viii spring tip in complex vascular structure is also performed in vitro. The autonomy of FFN regarding planning a procedure with Task Autonomy achieved in this work enhances the potential of FFN by automatization of certain steps of a procedure. As a conclusion, FFN to navigate microguidewires in the complex vascular structure with autonomy in performing tasks of patient positioning and controlling the insertion of the guidewire – with in vivo demonstration in swine model – can be considered as a novel robotic tool for facilitating the vascular catheterization while helping to target remote vessels in the vascular system

Neurological Disease Diagnosis and Treatment via Precise Robotic Intervention

This work focuses on the development and application of mechatronic systems for measurement, diagnosis and treatment of acute and chronic neurological conditions. The development of an automated tendon reflex stimulation device, as well as analysis and classification methods for both automated and manual stimulus delivery will provide the groundwork for improvements to both diagnosis and treatment of neurological injuries. In a similar vein, development of a variable resonance actuator for Magnetic Resonance Elastography imaging enables tissue property measurement of the intervertebral discs, hopefully providing an early marker and better understanding of degeneration. In addition to MRI based spinal tissue property measurements, an MRI guided high precision robot is developed for direct injection into the spinal cord, along with an accompanying image guided control scheme. The novel parallel plane mechanism enables control of 4 degrees of freedom, while the linear piezoelectric actuators in a direct drive configuration enables superior accuracy. Taken together, these robotic device developments constitute contributions to the field of precision medical robotics with applications to physiological understanding of the human body.Ph.D

Fluoroscopic Navigation for Robot-Assisted Orthopedic Surgery

Robot-assisted orthopedic surgery has gained increasing attention due to its improved accuracy and stability in minimally-invasive interventions compared to a surgeon's manual operation. An effective navigation system is critical, which estimates the intra-operative tool-to-tissue pose relationship to guide the robotic surgical device. However, most existing navigation systems use fiducial markers, such as bone pin markers, to close the calibration loop, which requires a clear line of sight and is not ideal for patients. This dissertation presents fiducial-free, fluoroscopic image-based navigation pipelines for three robot-assisted orthopedic applications: femoroplasty, core decompression of the hip, and transforaminal lumbar epidural injections. We propose custom-designed image intensity-based 2D/3D registration algorithms for pose estimation of bone anatomies, including femur and spine, and pose estimation of a rigid surgical tool and a flexible continuum manipulator. We performed system calibration and integration into a surgical robotic platform. We validated the navigation system's performance in comprehensive simulation and ex vivo cadaveric experiments. Our results suggest the feasibility of applying our proposed navigation methods for robot-assisted orthopedic applications. We also investigated machine learning approaches that can benefit the medical imaging analysis, automate the navigation component or address the registration challenges. We present a synthetic X-ray data generation pipeline called SyntheX, which enables large-scale machine learning model training. SyntheX was used to train feature detection tasks of the pelvis anatomy and the continuum manipulator, which were used to initialize the registration pipelines. Last but not least, we propose a projective spatial transformer module that learns a convex shape similarity function and extends the registration capture range. We believe that our image-based navigation solutions can benefit and inspire related orthopedic robot-assisted system designs and eventually be used in the operating rooms to improve patient outcomes