Medical Robotics for use in MRI Guided Endoscopy

Interventional Magnetic Resonance Imaging (MRI) is a developing field that aims to provide intra-operative MRI to a clinician to guide diagnostic or therapeutic medical procedures. MRI provides excellent soft tissue contrast at sub-millimetre resolution in both 2D and 3D without the need for ionizing radiation. Images can be acquired in near real-time for guidance purposes. Operating in the MR environment brings challenges due to the high static magnetic field, switching magnetic field gradients and RF excitation pulses. In addition high field closed bore scanners have spatial constraints that severely limit access to the patient. This thesis presents a system for MRI-guided Endoscopic Retrograde Cholangio-pancreatography (ERCP). This includes a remote actuation system that enables an MRI-compatible endoscope to be controlled whilst the patient is inside the MRI scanner, overcoming the spatial and procedural constraints imposed by the closed scanner bore. The modular system utilises non-magnetic ultrasonic motors and is designed for image-guided user-in-the-loop control. A novel miniature MRI compatible clutch has been incorporated into the design to reduce the need for multiple parallel motors. The actuation system is MRI compatible does not degrade the MR images below acceptable levels. User testing showed that the actuation system requires some degree of training but enables completion of a simulated ERCP procedure with no loss of performance. This was demonstrated using a tailored ERCP simulator and kinematic assessment tool, which was validated with users from a range of skill levels to ensure that it provides an objective measurement of endoscopic skill. Methods of tracking the endoscope in real-time using the MRI scanner are explored and presented here. Use of the MRI-guided ERCP system was shown to improve the operator’s ability to position the endoscope in an experimental environment compared with a standard fluoroscopic-guided system.Open Acces

In-vivo magnetic resonance imaging of hyperpolarized silicon particles

Silicon-based micro and nanoparticles have gained popularity in a wide range of biomedical applications due to their biocompatibility and biodegradability in-vivo, as well as a flexible surface chemistry, which allows drug loading, functionalization and targeting. Here we report direct in-vivo imaging of hyperpolarized 29Si nuclei in silicon microparticles by MRI. Natural physical properties of silicon provide surface electronic states for dynamic nuclear polarization (DNP), extremely long depolarization times, insensitivity to the in-vivo environment or particle tumbling, and surfaces favorable for functionalization. Potential applications to gastrointestinal, intravascular, and tumor perfusion imaging at sub-picomolar concentrations are presented. These results demonstrate a new background-free imaging modality applicable to a range of inexpensive, readily available, and biocompatible Si particles.Comment: Supplemental Material include

Methods for interventional magnetic resonance imaging

This thesis has as its central aim to demonstrate, develop, discuss and promote new methods and technology for improving interventional low field magnetic resonance imaging. The work addresses problems related to accurate localization of minimally invasive surgical tools by describing novel devices and improvements to prior art techniques, such as optical tracking. In addition to instrument guidance, ablative treatment of liver tumours is discussed in connection with low field temperature measurement and the work describes suitable sequences for qualitative temperature imaging. For instrument localization, a method utilising ex vivo Overhauser enhancement of a catheter like structure was demonstrated. An enhancement factor of 10 was achieved, proving that a substantial signal gain is possible through the use of ex vivo-enhanced liquid. Similarly, a method for biopsy needle tip tracking was developed; where the position of the tip was tracked with a signal from a miniaturized electron spin resonance sample and gradient pulses. At an update rate of 10 samples per second, the accuracy was measured to be better than ±2 mm within a homogeneous sphere of 300 mm. Optical tracking methods concentrated on new indications of use for the developed optical tracking system and associated software: The system was applied to guide the needle 35 times into first sacral root foramina, with a success rate of 97%. It was also used in five bone biopsies, all of which were performed successfully, the samples allowed for a pathologic diagnosis, and the percutaneous procedures could be performed in less than 40 minutes. A new patient tracker device was developed for staged neurosurgical procedures and demonstrated with two patient cases. In the temperature measurement study, spin echo, gradient echo and completely balanced steady-state free precession sequences were optimized for maximal temperature sensitivity and the optimized sequences compared. The steady-state sequence seemed the most promising for the prediction of ablated volume in liver.reviewe

MR Safe Robotic Manipulator for MRI-Guided Intracardiac Catheterization

This paper introduces a robotic manipulator to realize robot-assisted intracardiac catheterization in magnetic resonance imaging (MRI) environment. MRI can offer high-resolution images to visualize soft tissue features such as scars or edema. We hypothesize that robotic catheterization, combined with the enhanced monitoring of lesions creation using MRI intraoperatively, will significantly improve the procedural safety, accuracy, and effectiveness. This is designed particularly for cardiac electrophysiological (EP) intervention, which is an effective treatment of arrhythmia. We present the first MR Safe robot for intracardiac EP intervention. The robot actuation features small hysteresis, effective force transmission, and quick response, which has been experimentally verified for its capability to precisely telemanipulate a standard clinically used EP catheter. We also present timely techniques for real-time positional tracking in MRI and intraoperative image registration, which can be integrated with the presented manipulator to im prove the performance of teleoperated robotic catheterization

Cardiovascular magnetic resonance guided electrophysiology studies

Catheter ablation is a first line treatment for many cardiac arrhythmias and is generally performed under x-ray fluoroscopy guidance. However, current techniques for ablating complex arrhythmias such as atrial fibrillation and ventricular tachycardia are associated with suboptimal success rates and prolonged radiation exposure. Pre-procedure 3D CMR has improved understanding of the anatomic basis of complex arrhythmias and is being used for planning and guidance of ablation procedures. A particular strength of CMR compared to other imaging modalities is the ability to visualize ablation lesions. Post-procedure CMR is now being applied to assess ablation lesion location and permanence with the goal of indentifying factors leading to procedure success and failure. In the future, intra-procedure real-time CMR, together with the ability to image complex 3-D arrhythmogenic anatomy and target additional ablation to regions of incomplete lesion formation, may allow for more successful treatment of even complex arrhythmias without exposure to ionizing radiation. Development of clinical grade CMR compatible electrophysiology devices is required to transition intra-procedure CMR from pre-clinical studies to more routine use in patients

MRI for Guided Right and Left Heart Cardiac Catheterization: A Prospective Study in Congenital Heart Disease

[Background] Improvements in outcomes for patients with congenital heart disease (CHD) have increased the need for diagnostic and interventional procedures. Cumulative radiation risk is a growing concern. MRI-guided interventions are a promising ionizing radiation-free, alternative approach.[Purpose] To assess the feasibility of MRI-guided catheterization in young patients with CHD using advanced visualization passive tracking techniques.[Study Type] Prospective.[Population] A total of 30 patients with CHD referred for MRI-guided catheterization and pulmonary vascular resistance analysis (median age/weight: 4 years / 15 kg).[Field Strength/Sequence] 1.5T; partially saturated (pSAT) real-time single-shot balanced steady-state free-precession (bSSFP) sequence.[Assessment] Images were visualized by a single viewer on the scanner console (interactive mode) or using a commercially available advanced visualization platform (iSuite, Philips). Image quality for anatomy and catheter visualization was evaluated by three cardiologists with >5 years' experience in MRI-catheterization using a 1–5 scale (1, poor, 5, excellent). Catheter balloon signal-to-noise ratio (SNR), blood and myocardium SNR, catheter balloon/blood contrast-to-noise ratio (CNR), balloon/myocardium CNR, and blood/myocardium CNR were measured. Procedure findings, feasibility, and adverse events were recorded. A fraction of time in which the catheter was visible was compared between iSuite and the interactive mode.[Statistical Tests] T-test for numerical variables. Wilcoxon signed rank test for categorical variables.[Results] Nine patients had right heart catheterization, 11 had both left and right heart catheterization, and 10 had single ventricle circulation. Nine patients underwent solely MRI-guided catheterization. The mean score for anatomical visualization and contrast between balloon tip and soft tissue was 3.9 ± 0.9 and 4.5 ± 0.7, respectively. iSuite provided a significant improvement in the time during which the balloon was visible in relation to interactive imaging mode (66 ± 17% vs. 46 ± 14%, P < 0.05).[Data Conclusion] MRI-guided catheterizations were carried out safely and is feasible in children and adults with CHD. The pSAT sequence offered robust and simultaneous high contrast visualization of the catheter and cardiac anatomy.Peer reviewe