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

Development of a Three-Dimensional Image-Guided Needle Positioning System for Small Animal Interventions

Conventional needle positioning techniques for small animal microinjections are fraught with issues of repeatability and targeting accuracy. To improve the outcomes of these interventions a small animal needle positioning system guided by micro-computed tomography (micro-CT) imaging was developed. A phantom was developed to calibrate the geometric accuracy of micro-CT scanners to a traceable standard of measurement. Use of the phantom ensures the geometric fidelity of micro-CT images for use in image-guided interventions or other demanding quantitative applications. The design of a robot is described which features a remote center of motion architecture and is compact enough to operate within a micro-CT bore. Methods to calibrate the robot and register it to a micro-CT scanner are introduced. The performance of the robot is characterized and a mean targeting accuracy of 149 ± 41 µm estimated. The robot is finally demonstrated by completing an in vivo biomedical application

Inverse real-time Finite Element simulation for robotic control of flexible needle insertion in deformable tissues

International audienceThis paper introduces a new method for automatic robotic needle steering in deformable tissues. The main contribution relies on the use of an inverse Finite Element (FE) simulation to control an articulated robot interacting with deformable structures. In this work we consider a flexible needle, embedded in the end effector of a 6 arm Mitsubishi RV1A robot, and its insertion into a silicone phantom. Given a trajectory on the rest configuration of the silicone phantom, our method provides in real-time the displacements of the articulated robot which guarantee the permanence of the needle within the predefined path, taking into account any undergoing deformation on both the needle and the trajectory itself. A forward simulation combines i) a kinematic model of the robot, ii) FE models of the needle and phantom gel iii) an interaction model allowing the simulation of friction and puncture force. A Newton-type method is then used to provide the displacement of the robot to minimize the distance between the needle's tip and the desired trajectory. We validate our approach with a simulation in which a virtual robot can successfully perform the insertion while both the needle and the trajectory undergo significant deformations

Real-time membrane puncture detection using force sensors for micro-injections in phantoms

Micro-manipulators provide tools for researchers to improve workflow in common preclinical and clinical applications. Following drug delivery injections where drugs did not reach their target will squander research time, experimental animals and other resources. An ultrasound-guided robot developed at Robarts Research Institute was revised to implement closed-loop force feedback to compensate for tissue deformation during micro-interventions. Force sensors can detect puncture events as the needle penetrates tissue membranes, thereby reducing damage to surrounding tissues by preventing the needle from overshooting its target. Changing the angle of injection determined that the range of detectable forces during injections into tissue-mimicking phantoms suggests that sensors accurately measure projection of the needle force onto the vertical direction and are sensitive to puncture events through relatively thick (0.15 mm) membranes. Injections into mouse tissue yielded low success rates, suggesting different experimental designs are necessary to provide safer and less traumatic procedures, thus accelerating preclinical research

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

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

CRANE: A Redundant, Multi-Degree-of-Freedom Computed Tomography Robot for Heightened Needle Dexterity within a Medical Imaging Bore

Computed Tomography (CT) image guidance enables accurate and safe minimally invasive treatment of diseases, including cancer and chronic pain, with needle-like tools via a percutaneous approach. The physician incrementally inserts and adjusts the needle with intermediate images due to the accuracy limitation of free-hand adjustment and patient physiological motion. Scanning frequency is limited to minimize ionizing radiation exposure for the patient and physician. Robots can provide high positional accuracy and compensate for physiological motion with fewer scans. To accomplish this, the robots must operate within the confined imaging bore while retaining sufficient dexterity to insert and manipulate the needle. This paper presents CRANE: CT Robotic Arm and Needle Emplacer, a CT-compatible robot with a design focused on system dexterity that enables physicians to manipulate and insert needles within the scanner bore as naturally as they would be able to by hand. We define abstract and measurable clinically motivated metrics for in-bore dexterity applicable to general-purpose intra-bore image-guided needle placement robots, develop an automatic robot planning and control method for intra-bore needle manipulation and device setup, and demonstrate the redundant linkage design provides dexterity across various human morphology and meets the clinical requirements for target accuracy during an in-situ evaluation.Comment: 20 pages, 13 figures, Transactions on Robotic

From Concept to Market: Surgical Robot Development

Surgical robotics and supporting technologies have really become a prime example of modern applied information technology infiltrating our everyday lives. The development of these systems spans across four decades, and only the last few years brought the market value and saw the rising customer base imagined already by the early developers. This chapter guides through the historical development of the most important systems, and provide references and lessons learnt for current engineers facing similar challenges. A special emphasis is put on system validation, assessment and clearance, as the most commonly cited barrier hindering the wider deployment of a system