New Mechatronic Systems for the Diagnosis and Treatment of Cancer

Both two dimensional (2D) and three dimensional (3D) imaging modalities are useful tools for viewing the internal anatomy. Three dimensional imaging techniques are required for accurate targeting of needles. This improves the efficiency and control over the intervention as the high temporal resolution of medical images can be used to validate the location of needle and target in real time. Relying on imaging alone, however, means the intervention is still operator dependent because of the difficulty of controlling the location of the needle within the image. The objective of this thesis is to improve the accuracy and repeatability of needle-based interventions over conventional techniques: both manual and automated techniques. This includes increasing the accuracy and repeatability of these procedures in order to minimize the invasiveness of the procedure. In this thesis, I propose that by combining the remote center of motion concept using spherical linkage components into a passive or semi-automated device, the physician will have a useful tracking and guidance system at their disposal in a package, which is less threatening than a robot to both the patient and physician. This design concept offers both the manipulative transparency of a freehand system, and tremor reduction through scaling currently offered in automated systems. In addressing each objective of this thesis, a number of novel mechanical designs incorporating an remote center of motion architecture with varying degrees of freedom have been presented. Each of these designs can be deployed in a variety of imaging modalities and clinical applications, ranging from preclinical to human interventions, with an accuracy of control in the millimeter to sub-millimeter range

Computer- and robot-assisted Medical Intervention

Medical robotics includes assistive devices used by the physician in order to make his/her diagnostic or therapeutic practices easier and more efficient. This chapter focuses on such systems. It introduces the general field of Computer-Assisted Medical Interventions, its aims, its different components and describes the place of robots in that context. The evolutions in terms of general design and control paradigms in the development of medical robots are presented and issues specific to that application domain are discussed. A view of existing systems, on-going developments and future trends is given. A case-study is detailed. Other types of robotic help in the medical environment (such as for assisting a handicapped person, for rehabilitation of a patient or for replacement of some damaged/suppressed limbs or organs) are out of the scope of this chapter.Comment: Handbook of Automation, Shimon Nof (Ed.) (2009) 000-00

Real-time Prostate Motion Tracking For Robot-assisted Laparoscopic Radical Prostatectomy

Radical prostatectomy surgery (RP) is the gold standard for treatment of localized prostate cancer (PCa). Recently, emergence of minimally invasive techniques such as Laparoscopic Radical Prostatectomy (LRP) and Robot-Assisted Laparoscopic Radical Prostatectomy (RARP) has improved the outcomes for prostatectomy. However, it remains difficult for surgeons to make informed decisions regarding resection margins and nerve sparing since the location of the tumour within the organ is not usually visible in a laparoscopic view. While MRI enables visualization of the salient structures and cancer foci, its efficacy in LRP is reduced unless it is fused into a stereoscopic view such that homologous structures overlap. Registration of the MRI image and peri-operative ultrasound image either via visual manual alignment or using a fully automated registration can potentially be exploited to bring the pre-operative information into alignment with the patient coordinate system at the beginning of the procedure. While doing so, prostate motion needs to be compensated in real-time to synchronize the stereoscopic view with the pre-operative MRI during the prostatectomy procedure. In this thesis, two tracking methods are proposed to assess prostate rigid rotation and translation for the prostatectomy. The first method presents a 2D-to-3D point-to-line registration algorithm to measure prostate motion and translation with respect to an initial 3D TRUS image. The second method investigates a point-based stereoscopic tracking technique to compensate for rigid prostate motion so that the same motion can be applied to the pre-operative images

Ultra-High Field Strength MR Image-Guided Robotic Needle Delivery Device for In-Bore Small Animal Interventions

Current methods of accurate soft tissue injections in small animals are prone to many sources of error. Although efforts have been made to improve the accuracy of needle deliveries, none of the efforts have provided accurate soft tissue references. An MR image-guided robot was designed to function inside the bore of a 9.4T MR scanner to accurately deliver needles to locations within the mouse brain. The robot was designed to have no noticeable negative effects on the image quality and was localized in the MR images through the use of an MR image visible fiducial. The robot was mechanically calibrated and subsequently validated in an image-guided phantom experiment, where the mean needle targeting accuracy and needle trajectory accuracy were calculated to be 178 ± 54µm and 0.27 ± 0.65º, respectively. Finally, the device successfully demonstrated an image-guided needle targeting procedure in situ

RobUSt-An Autonomous Robotic Ultrasound System for Medical Imaging

Medical ultrasound (US) systems are widely used for the diagnosis of internal tissues. However, there are challenges associated with acquiring and interpreting US images, such as incorrect US probe placement and limited available spatial information. In this study, we expand the capabilities of medical US imaging using a robotic framework with a high level of autonomy. A 3D camera is used to capture the surface of an anthropomorphic phantom as a point cloud, which is then used for path planning and navigation of the US probe. Robotic positioning of the probe is realised using an impedance controller, which maintains stable contact with the surface during US scanning and compensates for uneven and moving surfaces. Robotic US positioning accuracy is measured to be 1.19 +/- 0.76mm. The mean force along US probe z-direction is measured to be 6.11 +/- 1.18N on static surfaces and 6.63 +/- 2.18N on moving surfaces. Overall lowest measured force of 1.58N demonstrates constant probe-to-surface contact during scanning. Acquired US images are used for the 3D reconstruction and multi-modal visualization of the surface and the inner anatomical structures of the phantom. Finally, K-means clustering is used to segment different tissues. Best segmentation accuracy of the jugular vein according to Jaccard similarity coefficient is measured to be 0.89. With such an accuracy, this system could substantially improve autonomous US acquisition and enhance the diagnostic confidence of clinicians

Ultrasound Guided Robot for Human Liver Biopsy using High Intensity Focused Ultrasound for Hemostasis

Percutaneous liver biopsy is the gold standard among clinician\u27s tool to diagnose and guide subsequent therapy for liver disease. Ultrasound image guidance is being increasingly used to reduce associated procedural risks but post–biopsy complications still persist. The major and most common complication is hemorrhage, which is highly unpredictable and may sometimes lead to death. Though the risk of mortality is low, it is too high for a diagnostic procedure. Post-biopsy care and additional surgical intervention to arrest hemorrhage make liver biopsy a costly procedure for health care delivery systems. Non-invasive methods to stop bleeding exist like electro–cautery, microwave, lasers, radio frequency, argon–beam, and High Intensity Focused Ultrasound (HIFU). All the methods except HIFU require direct exposure of the needle puncture site for hemostasis. HIFU is an ultrasound modality and uses mechanical sound waves for focused energy delivery. Ultrasound waves are minimally affected by tissue attenuation and focus internal targets without direct exposure. Human error in focusing HIFU renders it unusable for a medical procedure especially when noninvasive. In this project we designed and developed an ultrasound guided prototype robot for accurate HIFU targeting to induce hemostasis. The robotic system performs percutaneous needle biopsy and a 7.5 cm focal length HIFU is fired at the puncture point when the needle tip retracts to the liver surface after sample collection. The robot has 4 degrees of freedom (DOF) for biopsy needle insertion, HIFU positioning, needle angle alignment and US probe image plane orientation. As the needle puncture point is always in the needle path, mechanically constraining the HIFU to focus on the needle reduced the required functionality significantly. Two mini c-arms are designed for needle angle alignment and US probe image plane orientation. This reduced the contact foot print of the robot over the patient providing a greater dexterity for positioning the robot. The robot is validated for HIFU hemostasis by a series of experiments on chicken breasts. HIFU initiated hemorrhage control with robotic biopsy ensures arrest of post-biopsy hemorrhage and decreases patient anxiety, hospital stay, morbidity, time of procedure, and cost. This can also be extended to other organs like kidneys, lungs etc. and has widespread implications such as control of hemorrhage in post-biopsies in patients with reduced ability for hemostasis. This research opens a greater scope for research for automation and design making it a physician friendly tool for eventual clinical use

Advanced Endoscopic Navigation:Surgical Big Data,Methodology,and Applications

随着科学技术的飞速发展，健康与环境问题日益成为人类面临的最重大问题之一。信息科学、计算机技术、电子工程与生物医学工程等学科的综合应用交叉前沿课题，研究现代工程技术方法，探索肿瘤癌症等疾病早期诊断、治疗和康复手段。本论文综述了计算机辅助微创外科手术导航、多模态医疗大数据、方法论及其临床应用：从引入微创外科手术导航概念出发，介绍了医疗大数据的术前与术中多模态医学成像方法、阐述了先进微创外科手术导航的核心流程包括计算解剖模型、术中实时导航方案、三维可视化方法及交互式软件技术，归纳了各类微创外科手术方法的临床应用。同时，重点讨论了全球各种手术导航技术在临床应用中的优缺点，分析了目前手术导航领域内的最新技术方法。在此基础上，提出了微创外科手术方法正向数字化、个性化、精准化、诊疗一体化、机器人化以及高度智能化的发展趋势。【Abstract】Interventional endoscopy (e.g., bronchoscopy, colonoscopy, laparoscopy, cystoscopy) is a widely performed procedure that involves either diagnosis of suspicious lesions or guidance for minimally invasive surgery in a variety of organs within the body cavity. Endoscopy may also be used to guide the introduction of certain items (e.g., stents) into the body. Endoscopic navigation systems seek to integrate big data with multimodal information (e.g., computed tomography, magnetic resonance images, endoscopic video sequences, ultrasound images, external trackers) relative to the patient's anatomy, control the movement of medical endoscopes and surgical tools, and guide the surgeon's actions during endoscopic interventions. Nevertheless, it remains challenging to realize the next generation of context-aware navigated endoscopy. This review presents a broad survey of various aspects of endoscopic navigation, particularly with respect to the development of endoscopic navigation techniques. First, we investigate big data with multimodal information involved in endoscopic navigation. Next, we focus on numerous methodologies used for endoscopic navigation. We then review different endoscopic procedures in clinical applications. Finally, we discuss novel techniques and promising directions for the development of endoscopic navigation.X.L. acknowledges funding from the Fundamental Research Funds for the Central Universities. T.M.P. acknowledges funding from the Canadian Foundation for Innovation, the Canadian Institutes for Health Research, the National Sciences and Engineering Research Council of Canada, and a grant from Intuitive Surgical Inc

Ultrasound-Guided Mechatronic System for Targeted Delivery of Cell-Based Cancer Vaccine Immunotherapy in Preclinical Models

Injection of dendritic cell (DC) vaccines into lymph nodes (LN) is a promising strategy for eliciting immune responses against cancer, but these injections in mouse cancer models are challenging due to the small target scale (~ 1 mm × 2 mm). Direct manual intranodal injection is difficult and can cause architectural damage to the LN, potentially disrupting crucial interactions between DC and T cells. Therefore, a second-generation ultrasound-guided mechatronic device has been developed to perform this intervention. A targeting accuracy of \u3c 500 μm will enable targeted delivery of the DCs specifically to a LN subcapsular space. The device was redesigned from its original CT-guided edition, which used a remote centre of motion architecture, to be easily integrated onto a commercially available VisualSonics imaging rail system. Subtle modifications were made to ensure simple workflow that allows for live-animal interventions that fall within the knockout periods stated in study protocols. Several calibration and registration techniques were developed in order to achieve an overall targeting accuracy appropriate for the intended application. A variety of methods to quantify the positioning accuracy of the device were investigated. The method chosen involved validating a guided injection into a tissue-mimicking phantom using ultrasound imaging post-operatively to localize the end-point position of the needle tip in the track left behind by the needle. Ultrasound-guided injections into a tissue-mimicking phantom revealed a targeting accuracy of 285 ± 94 μm for the developed robot compared to 508 ± 166 μm for a commercial-available manually-actuated injection device from VisuailSonics. The utility of the robot was also demonstrated by performing in vivo injections into the lymph nodes of mice