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

Origami lesion-targeting device for CT-guided interventions

The objective of this study is to preliminarily evaluate a lesion-targeting device for CT-guided interventions. The device is created by laser cutting the structure from a sheet of medical grade paperboard, 3D printing two radiocontrast agent grids onto the surface and folding the structure into a rectangular prism with a viewing window. An abdominal imaging phantom was used to evaluate the device through CT imaging and the targeting of lesions for needle insertion. The lesion-targeting trials resulted in a mean targeting error of 2.53 mm (SD 0.59 mm, n = 30). The device is rigid enough to adequately support standard biopsy needles, and it attaches to the patient, reducing the risk of tissue laceration by needles held rigidly in place by an external manipulator. Additional advantages include adequate support for the insertion of multiple surgical tools at once for procedures such as composite ablation and the potential to guide off-axial needle insertion. The low-cost and disposability of the device make it well-suited for the minimally invasive image-guided therapy environment

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

Developing and testing a robotic MRI/CT fusion biopsy technique using a purpose-built interventional phantom.

BACKGROUND: Magnetic resonance imaging (MRI) can be used to target tumour components in biopsy procedures, while the ability to precisely correlate histology and MRI signal is crucial for imaging biomarker validation. Robotic MRI/computed tomography (CT) fusion biopsy offers the potential for this without in-gantry biopsy, although requires development. METHODS: Test-retest T1 and T2 relaxation times, attenuation (Hounsfield units, HU), and biopsy core quality were prospectively assessed (January-December 2021) in a range of gelatin, agar, and mixed gelatin/agar solutions of differing concentrations on days 1 and 8 after manufacture. Suitable materials were chosen, and four biopsy phantoms were constructed with twelve spherical 1-3-cm diameter targets visible on MRI, but not on CT. A technical pipeline was developed, and intraoperator and interoperator reliability was tested in four operators performing a total of 96 biopsies. Statistical analysis included T1, T2, and HU repeatability using Bland-Altman analysis, Dice similarity coefficient (DSC), and intraoperator and interoperator reliability. RESULTS: T1, T2, and HU repeatability had 95% limits-of-agreement of 8.3%, 3.4%, and 17.9%, respectively. The phantom was highly reproducible, with DSC of 0.93 versus 0.92 for scanning the same or two different phantoms, respectively. Hit rate was 100% (96/96 targets), and all operators performed robotic biopsies using a single volumetric acquisition. The fastest procedure time was 32 min for all 12 targets. CONCLUSIONS: A reproducible biopsy phantom was developed, validated, and used to test robotic MRI/CT-fusion biopsy. The technique was highly accurate, reliable, and achievable in clinically acceptable timescales meaning it is suitable for clinical application

Stereotactic Image-Guidance for Ablation of Malignant Liver Tumors

Stereotactic percutaneous ablation is a rapidly advancing modality for treatment of tumors in soft solid organs such as the liver. Each year, there are about 850,000 cases of primary liver cancer worldwide. Although surgical resection still is the gold standard for most cases, only 20–30% of patients are candidates for it, due to the advanced stage of the disease. Surgery can also be a huge burden to the patient and his/her quality of life might be temporarily severely reduced due to long hospital stays, complications, and slow recovery. To overcome these disadvantages, thermo-ablation of tumors of up to 3 cm has become a more viable alternative especially in the last decade, offering a potentially equally effective but minimally invasive and tissue sparing treatment alternative. In conjunction with improved CT imaging, stereotactic image-guidance techniques and image fusion technology were introduced to increase safety, efficacy, and accuracy of this treatment. Stereotactic image-guidance leads to a simple, fast, and accurate placement of the ablation probe into the liver tumor, which is a prerequisite for a complete destruction of the tumor by ablation. More and more physicians, including surgeons, consider ablation a viable alternative to resection whenever feasible. Patients undergoing such a minimally invasive treatment benefit from a shorter hospital stays, reduced complication rates, and faster recovery

Robotic CT-guided out-of-plane needle insertion: comparison of angle accuracy with manual insertion in phantom and measurement of distance accuracy in animals

Objectives To evaluate the accuracy of robotic CT-guided out-of-plane needle insertion in phantom and animal experiments. Methods A robotic system (Zerobot), developed at our institution, was used for needle insertion. In the phantom experiment, 12 robotic needle insertions into a phantom at various angles in the XY and YZ planes were performed, and the same insertions were manually performed freehand, as well as guided by a smartphone application (SmartPuncture). Angle errors were compared between the robotic and smartphone-guided manual insertions using Student’s t test. In the animal experiment, 6 robotic out-of-plane needle insertions toward targets of 1.0 mm in diameter placed in the kidneys and hip muscles of swine were performed, each with and without adjustment of needle orientation based on reconstructed CT images during insertion. Distance accuracy was calculated as the distance between the needle tip and the target center. Results In the phantom experiment, the mean angle errors of the robotic, freehand manual, and smartphone-guided manual insertions were 0.4°, 7.0°, and 3.7° in the XY plane and 0.6°, 6.3°, and 0.6° in the YZ plane, respectively. Robotic insertions in the XY plane were significantly (p Conclusion Robotic CT-guided out-of-plane needle insertions were more accurate than smartphone-guided manual insertions in the phantom and were also accurate in the in vivo procedure, particularly with adjustment during insertion

New Technology and Techniques for Needle-Based Magnetic Resonance Image-Guided Prostate Focal Therapy

The most common diagnosis of prostate cancer is that of localized disease, and unfortunately the optimal type of treatment for these men is not yet certain. Magnetic resonance image (MRI)-guided focal laser ablation (FLA) therapy is a promising potential treatment option for select men with localized prostate cancer, and may result in fewer side effects than whole-gland therapies, while still achieving oncologic control. The objective of this thesis was to develop methods of accurately guiding needles to the prostate within the bore of a clinical MRI scanner for MRI-guided FLA therapy. To achieve this goal, a mechatronic needle guidance system was developed. The system enables precise targeting of prostate tumours through angulated trajectories and insertion of needles with the patient in the bore of a clinical MRI scanner. After confirming sufficient accuracy in phantoms, and good MRI-compatibility, the system was used to guide needles for MRI-guided FLA therapy in eight patients. Results from this case series demonstrated an improvement in needle guidance time and ease of needle delivery compared to conventional approaches. Methods of more reliable treatment planning were sought, leading to the development of a systematic treatment planning method, and Monte Carlo simulations of needle placement uncertainty. The result was an estimate of the maximum size of focal target that can be confidently ablated using the mechatronic needle guidance system, leading to better guidelines for patient eligibility. These results also quantified the benefit that could be gained with improved techniques for needle guidance