Image-Guided Robot-Assisted Needle Intervention Devices and Methods to Improve Targeting Accuracy

This dissertation addresses the development of medical devices, image-guided robots, and their application in needle-based interventions, as well as methods to improve accuracy and safety in clinical procedures. Needle access is an essential component of minimally invasive diagnostic and therapeutic procedures. Image-guiding devices are often required to help physicians handle the needle based on the images. Integrating robotic accuracy and precision with digital medical imaging has the potential to improve the clinical outcomes. The dissertation presents two robotic devices for interventions under Magnetic Resonance Imaging (MRI) respectively Computed Tomography (CT) – Ultrasound(US) cross modality guidance. The MRI robot is a MR Safe Remote Center of Motion (RCM) robot for direct image-guided needle interventions such as brain surgery. The dissertation also presents the integration of the robot with an intraoperative MRI scanner, and preclinical tests for deep brain needle access. The CT-Ultrasound guidance uses a robotic manipulator to handle an US probe within a CT scanner. The dissertation presents methods related to the co-registration of multi-image spaces with an intermediary frame, experiments for needle targeting. The dissertation also presents method on using optical tracking measurements specifically for medical robots. The method was derived to test the robots presented above. With advanced image-guidance, such as the robotic approaches, needle targeting accuracy may still be deteriorated by errors related to needle defections. Methods and associated devices for needle steering on the straight path are presented. These are a robotic approach that uses real-time ultrasound guidance to steer the needle; Modeling and testing of a method to markedly reduce targeting errors with bevel-point needles; Dynamic design, manufacturing, and testing of a novel core biopsy needle with straighter path, power assistance, reduced noise, and safer operation. Overall, the dissertation presents several developments that contribute to the field of medical devices, image-guided robots, and needle interventions. These include robot testing methods that can be used by other researchers, needle steering methods that can be used directly by physicians or for robotic devices, as well as several methods to improve the accuracy in image-guided interventions. Collectively, these contribute to the field and may have a significant clinical impact

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

Hydraulically-actuated compliant revolute joint for medical robotic systems based on multimaterial additive manufacturing

IEEE International Conference on Robotics and Automation (ICRA), Montréal, Canada, janvier 2019 Research team : AV

Robotic System Development for Precision MRI-Guided Needle-Based Interventions

This dissertation describes the development of a methodology for implementing robotic systems for interventional procedures under intraoperative Magnetic Resonance Imaging (MRI) guidance. MRI is an ideal imaging modality for surgical guidance of diagnostic and therapeutic procedures, thanks to its ability to perform high resolution, real-time, and high soft tissue contrast imaging without ionizing radiation. However, the strong magnetic field and sensitivity to radio frequency signals, as well as tightly confined scanner bore render great challenges to developing robotic systems within MRI environment. Discussed are potential solutions to address engineering topics related to development of MRI-compatible electro-mechanical systems and modeling of steerable needle interventions. A robotic framework is developed based on a modular design approach, supporting varying MRI-guided interventional procedures, with stereotactic neurosurgery and prostate cancer therapy as two driving exemplary applications. A piezoelectrically actuated electro-mechanical system is designed to provide precise needle placement in the bore of the scanner under interactive MRI-guidance, while overcoming the challenges inherent to MRI-guided procedures. This work presents the development of the robotic system in the aspects of requirements definition, clinical work flow development, mechanism optimization, control system design and experimental evaluation. A steerable needle is beneficial for interventional procedures with its capability to produce curved path, avoiding anatomical obstacles or compensating for needle placement errors. Two kinds of steerable needles are discussed, i.e. asymmetric-tip needle and concentric-tube cannula. A novel Gaussian-based ContinUous Rotation and Variable-curvature (CURV) model is proposed to steer asymmetric-tip needle, which enables variable curvature of the needle trajectory with independent control of needle rotation and insertion. While concentric-tube cannula is suitable for clinical applications where a curved trajectory is needed without relying on tissue interaction force. This dissertation addresses fundamental challenges in developing and deploying MRI-compatible robotic systems, and enables the technologies for MRI-guided needle-based interventions. This study applied and evaluated these techniques to a system for prostate biopsy that is currently in clinical trials, developed a neurosurgery robot prototype for interstitial thermal therapy of brain cancer under MRI guidance, and demonstrated needle steering using both asymmetric tip and pre-bent concentric-tube cannula approaches on a testbed

Magnetic resonance and ultrasound image-guided navigation system using a needle manipulator.

PURPOSE:Image guidance is crucial for percutaneous tumor ablations, enabling accurate needle-like applicator placement into target tumors while avoiding tissues that are sensitive to injury and/or correcting needle deflection. Although ultrasound (US) is widely used for image guidance, magnetic resonance (MR) is preferable due to its superior soft tissue contrast. The objective of this study was to develop and evaluate an MR and US multi-modal image-guided navigation system with a needle manipulator to enable US-guided applicator placement during MR imaging (MRI)-guided percutaneous tumor ablation.METHODS:The MRI-compatible needle manipulator with US probe was installed adjacent to a 3 Tesla MRI scanner patient table. Coordinate systems for the MR image, patient table, manipulator, and US probe were all registered using an optical tracking sensor. The patient was initially scanned in the MRI scanner bore for planning and then moved outside the bore for treatment. Needle insertion was guided by real-time US imaging fused with the reformatted static MR image to enhance soft tissue contrast. Feasibility, targeting accuracy, and MR compatibility of the system were evaluated using a bovine liver and agar phantoms.RESULTS:Targeting error for 50 needle insertions was 1.6 ± 0.6 mm (mean ± standard deviation). The experiment confirmed that fused MR and US images provided real-time needle localization against static MR images with soft tissue contrast.CONCLUSIONS:The proposed MR and US multi-modal image-guided navigation system using a needle manipulator enabled accurate needle insertion by taking advantage of static MR and real-time US images simultaneously. Real-time visualization helped determine needle depth, tissue monitoring surrounding the needle path, target organ shifts, and needle deviation from the path

Image Guided Robots for Urology

This dissertation addresses the development of medical image-guided robots and their applications in urology. Image-guided robots integrate medical image information with robotic precision to assist the planning and execution of the image-guided interventions. Robots guided by two different image modalities, ultrasound and MR image, were developed. Ultrasound image-guided robots manipulate an ultrasound probe and a needle-guide that are calibrated with respect to the robot for image-guided targeting. A method for calibration was developed and verified through the image-guided targeting experiments. Robotic manipulation of the calibrated probe allows acquisition of image slices at precise location, which can be combined to generate a 3D ultrasound image. Software for 3D ultrasound image acquisition, processing, and segmentation was developed as a part of the image-guided robot system. The feasibility of several image-guided intervention procedures using the ultrasound image-guided robot system was tested. The robot was used in a clinical trial of intraoperative transrectal ultrasound (TRUS) guided prostatectomy. The accuracy of TRUS-guided prostate biopsy using the robot was evaluated in a comparative study versus the classic human operation of the probe. Robot controlled palpation and image processing methods were developed for ultrasound elastography imaging of the prostate. An ultrasound to CT image-fusion method using the robot as a common reference was developed for percutaneous access of the kidney. MRI-guided robots were developed for transrectal and transperineal prostate biopsy. Extensive in-vitro tests were performed to ensure MRI compatibility and image-guided accuracy of the robots. The transrectal robot was evaluated in an animal study and the transperineal robot is undergoing a clinical trial. The collection of methods and algorithms presented in this dissertation can contribute to the development of image-guided robots that may provide less invasive and more precise interventions in urology, interventional radiology, and other fields

Observations And Experiments For The Definition Of A New Robotic Device Dedicated To CT, CBCT And MRI-Guided Percutaneous Procedures.

In this paper, we present the work achieved to define the robotic functionalities of interest for percutaneous procedures as performed in interventional radiology. Our contributions are twofold. First, a detailed task analysis is performed with workflow analysis of biopsies, one of the most frequent tasks, under three imaging modalities, namely CT, CBCT and MRI. Second, the functionalities of a robotic assistant are identified, and we analyze whether a single device can bring an added value during procedures in the three modalities while keeping the robotized workflow close to manual tasks, to minimize learning time and difficulty of use. Experimental analysis on CBCT is notably used to confirm the interest of the determined robotic functionalities.journal articleresearch support, non-u.s. gov't2018 07importedIEEE Engineering in Medicine and Biology Society, Honolulu, United States, juillet 2018 Research team : AV

Passive Resonant Coil Based Fast Registration And Tracking System For Real-Time Mri-Guided Minimally Invasive Surgery

This thesis presents a single-slice based fast stereotactic registration and tracking technique along with a corresponding modular system for guiding robotic mechanism or interventional instrument to perform needle-based interventions under live MRI guidance. The system can provide tracking of full 6 degree-of-freedom (DOF) in stereotactic interventional surgery based upon a single, rapidly acquired cross-sectional image. The whole system is constructed with a modular data transmission software framework and mechanical structure so that it supports remote supervision and manipulation between a 3D Matlab tracking user interface (UI) and an existing MRI robot controller by using the OpenIGTLink network communication protocol. It provides better closed-loop control by implementing a feedback output interface to the MRI-guided robot. A new compact fiducial frame design is presented, and the fiducial is wrapped with a passive resonant coil. The coil resonates at the Larmor frequency for 3T MRI to enhance signal strength and enable for rapid imaging. The fiducial can be attached near the distal end of the robot and coaxially with a needle so as to visualize target tissue and track the surgical tool synchronously. The MRI-compatible design of fiducial frame, robust tracking algorithm and modular interface allow this tracking system to be conveniently used on different robots or devices and in different size of MRI bores. Several iterations of the tracking fiducial and passive resonant coils were constructed and evaluated in a Phillips Achieva 3T MRI. To assess accuracy and robustness of the tracking algorithm, 25 groups of images with different poses were successively scanned along specific sequence in and MRI experiment. The translational RMS error along depth is 0.271mm with standard deviation of 0.277mm for totally 100 samples. The overall angular RMS error is less than 0.426 degree with standard deviation of 0.526 degree for totally 150 samples. The passive resonant coils were shown to significantly increase signal intensity in the fiducial relative to the surroundings and provide for rapid imaging with low flip angles