Towards Closed-loop, Robot Assisted Percutaneous Interventions under MRI Guidance

Image guided therapy procedures under MRI guidance has been a focused research area over past decade. Also, over the last decade, various MRI guided robotic devices have been developed and used clinically for percutaneous interventions, such as prostate biopsy, brachytherapy, and tissue ablation. Though MRI provides better soft tissue contrast compared to Computed Tomography and Ultrasound, it poses various challenges like constrained space, less ergonomic patient access and limited material choices due to its high magnetic field. Even after, advancements in MRI compatible actuation methods and robotic devices using them, most MRI guided interventions are still open-loop in nature and relies on preoperative or intraoperative images. In this thesis, an intraoperative MRI guided robotic system for prostate biopsy comprising of an MRI compatible 4-DOF robotic manipulator, robot controller and control application with Clinical User Interface (CUI) and surgical planning applications (3DSlicer and RadVision) is presented. This system utilizes intraoperative images acquired after each full or partial needle insertion for needle tip localization. Presented system was approved by Institutional Review Board at Brigham and Women\u27s Hospital(BWH) and has been used in 30 patient trials. Successful translation of such a system utilizing intraoperative MR images motivated towards the development of a system architecture for close-loop, real-time MRI guided percutaneous interventions. Robot assisted, close-loop intervention could help in accurate positioning and localization of the therapy delivery instrument, improve physician and patient comfort and allow real-time therapy monitoring. Also, utilizing real-time MR images could allow correction of surgical instrument trajectory and controlled therapy delivery. Two of the applications validating the presented architecture; closed-loop needle steering and MRI guided brain tumor ablation are demonstrated under real-time MRI guidance

Image-guided prostate biopsy robots: A review

At present, the incidence of prostate cancer (PCa) in men is increasing year by year. So, the early diagnosis of PCa is of great significance. Transrectal ultrasonography (TRUS)-guided biopsy is a common method for diagnosing PCa. The biopsy process is performed manually by urologists but the diagnostic rate is only 20%–30% and its reliability and accuracy can no longer meet clinical needs. The image-guided prostate biopsy robot has the advantages of a high degree of automation, does not rely on the skills and experience of operators, reduces the work intensity and operation time of urologists and so on. Capable of delivering biopsy needles to pre-defined biopsy locations with minimal needle placement errors, it makes up for the shortcomings of traditional free-hand biopsy and improves the reliability and accuracy of biopsy. The integration of medical imaging technology and the robotic system is an important means for accurate tumor location, biopsy puncture path planning and visualization. This paper mainly reviews image-guided prostate biopsy robots. According to the existing literature, guidance modalities are divided into magnetic resonance imaging (MRI), ultrasound (US) and fusion image. First, the robot structure research by different guided methods is the main line and the actuators and material research of these guided modalities is the auxiliary line to introduce and compare. Second, the robot image-guided localization technology is discussed. Finally, the image-guided prostate biopsy robot is summarized and suggestions for future development are provided

Study and development of stretchable sensors for flexible surgical instrumentation.

Recently, attention has been focused to minimize the invasiveness of existing minimally invasive surgery (MIS) approaches: one example is the development of continuum-like and soft robots that can bend, extend, contract at any point along their length. This provides them with capabilities well beyond those of their rigid-link counterparts, thus allowing to perform whole arm manipulation. One recent approach to soft and modular systems is represented by the on-going EU project STIFF-FLOP (www.stiff-flop.eu). The STIFF-FLOP arm is not fabricated by rigid structures, but soft ones showing advanced manipulation capabilities for surgical applications, with multiple degrees of freedom (DOFs), and ability of multi-bending. Ideally, the entire robotic structure should safely move with contact and bend detection and the embedded sensors should not interfere with the movements: the use of small sensors, both soft and stretchable, which remain functional when deformed, becomes necessary. For the aforementioned reasons, we introduce a small, low-cost, soft and stretchable sensor composed of a silicone rubber (EcoFlex0030, SmoothOn), integrating a conductive liquid channel filled with biocompatible Sodium Chloride (NaCl) solution. By stretching the sensor the cross-section of the channel deforms, thus leading to a change in electrical resistance. The functionality of the sensor has been proved through testing: changes in electrical resistance are measured as a function of the applied strain. The advantage of using silicone rubber is its mechanical durability and high flexibility, non-toxicity, chemical stability and low cost. Furthermore, liquid conductors eliminate the need for rigid electronics and preserve the natural elasticity of the sensor, and the NaCl solution fulfills the need for a biocompatible liquid. Differently from existing solutions that are not truly stretchable and biocompatible, the contribution of this work is an effort for improving the current soft sensors technologies through the demonstration that NaCl filled channel rubbers represent a valid solution for measuring deformations in flexible surgical instrumentation

Medical robots for MRI guided diagnosis and therapy

Magnetic Resonance Imaging (MRI) provides the capability of imaging tissue with fine resolution and superior soft tissue contrast, when compared with conventional ultrasound and CT imaging, which makes it an important tool for clinicians to perform more accurate diagnosis and image guided therapy. Medical robotic devices combining the high resolution anatomical images with real-time navigation, are ideal for precise and repeatable interventions. Despite these advantages, the MR environment imposes constraints on mechatronic devices operating within it. This thesis presents a study on the design and development of robotic systems for particular MR interventions, in which the issue of testing the MR compatibility of mechatronic components, actuation control, kinematics and workspace analysis, and mechanical and electrical design of the robot have been investigated. Two types of robotic systems have therefore been developed and evaluated along the above aspects. (i) A device for MR guided transrectal prostate biopsy: The system was designed from components which are proven to be MR compatible, actuated by pneumatic motors and ultrasonic motors, and tracked by optical position sensors and ducial markers. Clinical trials have been performed with the device on three patients, and the results reported have demonstrated its capability to perform needle positioning under MR guidance, with a procedure time of around 40mins and with no compromised image quality, which achieved our system speci cations. (ii) Limb positioning devices to facilitate the magic angle effect for diagnosis of tendinous injuries: Two systems were designed particularly for lower and upper limb positioning, which are actuated and tracked by the similar methods as the first device. A group of volunteers were recruited to conduct tests to verify the functionality of the systems. The results demonstrate the clear enhancement of the image quality with an increase in signal intensity up to 24 times in the tendon tissue caused by the magic angle effect, showing the feasibility of the proposed devices to be applied in clinical diagnosis

Efficient design of precision medical robotics

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2012.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.Cataloged from student-submitted PDF version of thesis.Includes bibliographical references (p. 106-114).Medical robotics is increasingly demonstrating the potential to improve patient care through more precise interventions. However, taking inspiration from industrial robotics has often resulted in large, sometimes cumbersome designs, which represent high capital and per procedure expenditures, as well as increased procedure times. This thesis proposes and demonstrates an alternative model and method for developing economical, appropriately scaled medical robots that improve care and efficiency, while moderating costs. Key to this approach is a structured design process that actively reduces complexity. A selected medical procedure is decomposed into discrete tasks which are then separated into those that are conducted satisfactorily and those where the clinician encounters limitations, often where robots' strengths would be complimentary. Then by following deterministic principles and with continual user participation, prototyping and testing, a system can be designed that integrates into and assists with current procedures, rather than requiring a completely new protocol. This model is expected to lay the groundwork for increasing the use of hands-on technology in interventional medicine.by Nevan Clancy Hanumara.Ph.D

Design, fabrication and stiffening of soft pneumatic robots

Although compliance allows the soft robot to be under-actuated and generalise its control, it also impacts the ability of the robot to exert forces on the environment. There is a trade-off between robots being compliant or precise and strong. Many mechanisms that change robots' stiffness on demand have been proposed, but none are perfect, usually compromising the device's compliance and restricting its motion capabilities. Keeping the above issues in mind, this thesis focuses on creating robust and reliable pneumatic actuators, that are designed to be easily manufactured with simple tools. They are optimised towards linear behaviour, which simplifies modelling and improve control strategies. The principle idea in relation to linearisation is a reinforcement strategy designed to amplify the desired, and limit the unwanted, deformation of the device. Such reinforcement can be achieved using fibres or 3D printed structures. I have shown that the linearity of the actuation is, among others, a function of the reinforcement density and shape, in that the response of dense fibre-reinforced actuators with a circular cross-section is significantly more linear than that of non-reinforced or non-circular actuators. I have explored moulding manufacturing techniques and a mixture of 3D printing and moulding. Many aspects of these techniques have been optimised for reliability, repeatability, and process simplification. I have proposed and implemented a novel moulding technique that uses disposable moulds and can easily be used by an inexperienced operator. I also tried to address the compliance-stiffness trade-off issue. As a result, I have proposed an intelligent structure that behaves differently depending on the conditions. Thanks to its properties, such a structure could be used in applications that require flexibility, but also the ability to resist external disturbances when necessary. Due to its nature, individual cells of the proposed system could be used to implement physical logic elements, resulting in embodied intelligent behaviours. As a proof-of-concept, I have demonstrated use of my actuators in several applications including prosthetic hands, octopus, and fish robots. Each of those devices benefits from a slightly different actuation system but each is based on the same core idea - fibre reinforced actuators. I have shown that the proposed design and manufacturing techniques have several advantages over the methods used so far. The manufacturing methods I developed are more reliable, repeatable, and require less manual work than the various other methods described in the literature. I have also shown that the proposed actuators can be successfully used in real-life applications. Finally, one of the most important outcomes of my research is a contribution to an orthotic device based on soft pneumatic actuators. The device has been successfully deployed, and, at the time of submission of this thesis, has been used for several months, with good results reported, by a patient

Biomechatronics: Harmonizing Mechatronic Systems with Human Beings

This eBook provides a comprehensive treatise on modern biomechatronic systems centred around human applications. A particular emphasis is given to exoskeleton designs for assistance and training with advanced interfaces in human-machine interaction. Some of these designs are validated with experimental results which the reader will find very informative as building-blocks for designing such systems. This eBook will be ideally suited to those researching in biomechatronic area with bio-feedback applications or those who are involved in high-end research on manmachine interfaces. This may also serve as a textbook for biomechatronic design at post-graduate level