Robotics-Assisted Needle Steering for Percutaneous Interventions: Modeling and Experiments

Needle insertion and guidance plays an important role in medical procedures such as brachytherapy and biopsy. Flexible needles have the potential to facilitate precise targeting and avoid collisions during medical interventions while reducing trauma to the patient and post-puncture issues. Nevertheless, error introduced during guidance degrades the effectiveness of the planned therapy or diagnosis. Although steering using flexible bevel-tip needles provides great mobility and dexterity, a major barrier is the complexity of needle-tissue interaction that does not lend itself to intuitive control. To overcome this problem, a robotic system can be employed to perform trajectory planning and tracking by manipulation of the needle base. This research project focuses on a control-theoretic approach and draws on the rich literature from control and systems theory to model needle-tissue interaction and needle flexion and then design a robotics-based strategy for needle insertion/steering. The resulting solutions will directly benefit a wide range of needle-based interventions. The outcome of this computer-assisted approach will not only enable us to perform efficient preoperative trajectory planning, but will also provide more insight into needle-tissue interaction that will be helpful in developing advanced intraoperative algorithms for needle steering. Experimental validation of the proposed methodologies was carried out on a state of-the-art 5-DOF robotic system designed and constructed in-house primarily for prostate brachytherapy. The system is equipped with a Nano43 6-DOF force/torque sensor (ATI Industrial Automation) to measure forces and torques acting on the needle shaft. In our setup, an Aurora electromagnetic tracker (Northern Digital Inc.) is the sensing device used for measuring needle deflection. A multi-threaded application for control, sensor readings, data logging and communication over the ethernet was developed using Microsoft Visual C 2005, MATLAB 2007 and the QuaRC Toolbox (Quanser Inc.). Various artificial phantoms were developed so as to create a realistic medium in terms of elasticity and insertion force ranges; however, they simulated a uniform environment without exhibiting complexities of organic tissues. Experiments were also conducted on beef liver and fresh chicken breast, beef, and ham, to investigate the behavior of a variety biological tissues

Technologies for Biomechanically-Informed Image Guidance of Laparoscopic Liver Surgery

Laparoscopic surgery for liver resection has a number medical advantages over open surgery, but also comes with inherent technical challenges. The surgeon only has a very limited field of view through the imaging modalities routinely employed intra-operatively, laparoscopic video and ultrasound, and the pneumoperitoneum required to create the operating space and gaining access to the organ can significantly deform and displace the liver from its pre-operative configuration. This can make relating what is visible intra-operatively to the pre-operative plan and inferring the location of sub-surface anatomy a very challenging task. Image guidance systems can help overcome these challenges by updating the pre-operative plan to the situation in theatre and visualising it in relation to the position of surgical instruments. In this thesis, I present a series of contributions to a biomechanically-informed image-guidance system made during my PhD. The most recent one is work on a pipeline for the estimation of the post-insufflation configuration of the liver by means of an algorithm that uses a database of segmented training images of patient abdomens where the post-insufflation configuration of the liver is known. The pipeline comprises an algorithm for inter and intra-subject registration of liver meshes by means of non-rigid spectral point-correspondence finding. My other contributions are more fundamental and less application specific, and are all contained and made available to the public in the NiftySim open-source finite element modelling package. Two of my contributions to NiftySim are of particular interest with regards to image guidance of laparoscopic liver surgery: 1) a novel general purpose contact modelling algorithm that can be used to simulate contact interactions between, e.g., the liver and surrounding anatomy; 2) membrane and shell elements that can be used to, e.g., simulate the Glisson capsule that has been shown to significantly influence the organ’s measured stiffness

Computer-Assisted Electroanatomical Guidance for Cardiac Electrophysiology Procedures

Cardiac arrhythmias are serious life-threatening episodes affecting both the aging population and younger patients with pre-existing heart conditions. One of the most effective therapeutic procedures is the minimally-invasive catheter-driven endovascular electrophysiology study, whereby electrical potentials and activation patterns in the affected cardiac chambers are measured and subsequent ablation of arrhythmogenic tissue is performed. Despite emerging technologies such as electroanatomical mapping and remote intraoperative navigation systems for improved catheter manipulation and stability, successful ablation of arrhythmias is still highly-dependent on the operator’s skills and experience. This thesis proposes a framework towards standardisation in the electroanatomical mapping and ablation planning by merging knowledge transfer from previous cases and patient-specific data. In particular, contributions towards four different procedural aspects were made: optimal electroanatomical mapping, arrhythmia path computation, catheter tip stability analysis, and ablation simulation and optimisation. In order to improve the intraoperative electroanatomical map, anatomical areas of high mapping interest were proposed, as learned from previous electrophysiology studies. Subsequently, the arrhythmic wave propagation on the endocardial surface and potential ablation points were computed. The ablation planning is further enhanced, firstly by the analysis of the catheter tip stability and the probability of slippage at sparse locations on the endocardium and, secondly, by the simulation of the ablation result from the computation of convolutional matrices which model mathematically the ablation process. The methods proposed by this thesis were validated on data from patients with complex congenital heart disease, who present unusual cardiac anatomy and consequently atypical arrhythmias. The proposed methods also build a generic framework for computer guidance of electrophysiology, with results showing complementary information that can be easily integrated into the clinical workflow.Open Acces

Apprentissage statistique pour la personnalisation de modèles cardiaques à partir de données d’imagerie

This thesis focuses on the calibration of an electromechanical model of the heart from patient-specific, image-based data; and on the related task of extracting the cardiac motion from 4D images. Long-term perspectives for personalized computer simulation of the cardiac function include aid to the diagnosis, aid to the planning of therapy and prevention of risks. To this end, we explore tools and possibilities offered by statistical learning. To personalize cardiac mechanics, we introduce an efficient framework coupling machine learning and an original statistical representation of shape & motion based on 3D+t currents. The method relies on a reduced mapping between the space of mechanical parameters and the space of cardiac motion. The second focus of the thesis is on cardiac motion tracking, a key processing step in the calibration pipeline, with an emphasis on quantification of uncertainty. We develop a generic sparse Bayesian model of image registration with three main contributions: an extended image similarity term, the automated tuning of registration parameters and uncertainty quantification. We propose an approximate inference scheme that is tractable on 4D clinical data. Finally, we wish to evaluate the quality of uncertainty estimates returned by the approximate inference scheme. We compare the predictions of the approximate scheme with those of an inference scheme developed on the grounds of reversible jump MCMC. We provide more insight into the theoretical properties of the sparse structured Bayesian model and into the empirical behaviour of both inference schemesCette thèse porte sur un problème de calibration d'un modèle électromécanique de cœur, personnalisé à partir de données d'imagerie médicale 3D+t ; et sur celui - en amont - de suivi du mouvement cardiaque. A cette fin, nous adoptons une méthodologie fondée sur l'apprentissage statistique. Pour la calibration du modèle mécanique, nous introduisons une méthode efficace mêlant apprentissage automatique et une description statistique originale du mouvement cardiaque utilisant la représentation des courants 3D+t. Notre approche repose sur la construction d'un modèle statistique réduit reliant l'espace des paramètres mécaniques à celui du mouvement cardiaque. L'extraction du mouvement à partir d'images médicales avec quantification d'incertitude apparaît essentielle pour cette calibration, et constitue l'objet de la seconde partie de cette thèse. Plus généralement, nous développons un modèle bayésien parcimonieux pour le problème de recalage d'images médicales. Notre contribution est triple et porte sur un modèle étendu de similarité entre images, sur l'ajustement automatique des paramètres du recalage et sur la quantification de l'incertitude. Nous proposons une technique rapide d'inférence gloutonne, applicable à des données cliniques 4D. Enfin, nous nous intéressons de plus près à la qualité des estimations d'incertitude fournies par le modèle. Nous comparons les prédictions du schéma d'inférence gloutonne avec celles données par une procédure d'inférence fidèle au modèle, que nous développons sur la base de techniques MCMC. Nous approfondissons les propriétés théoriques et empiriques du modèle bayésien parcimonieux et des deux schémas d'inférenc

When Cardiac Biophysics Meets Groupwise Statistics: Complementary Modelling Approaches for Patient-Specific Medicine

This habilitation manuscript contains research on biophysical and statistical modeling of the heart, as well as interactions between these two approaches