416 research outputs found
Medical image computing and computer-aided medical interventions applied to soft tissues. Work in progress in urology
Until recently, Computer-Aided Medical Interventions (CAMI) and Medical
Robotics have focused on rigid and non deformable anatomical structures.
Nowadays, special attention is paid to soft tissues, raising complex issues due
to their mobility and deformation. Mini-invasive digestive surgery was probably
one of the first fields where soft tissues were handled through the development
of simulators, tracking of anatomical structures and specific assistance
robots. However, other clinical domains, for instance urology, are concerned.
Indeed, laparoscopic surgery, new tumour destruction techniques (e.g. HIFU,
radiofrequency, or cryoablation), increasingly early detection of cancer, and
use of interventional and diagnostic imaging modalities, recently opened new
challenges to the urologist and scientists involved in CAMI. This resulted in
the last five years in a very significant increase of research and developments
of computer-aided urology systems. In this paper, we propose a description of
the main problems related to computer-aided diagnostic and therapy of soft
tissues and give a survey of the different types of assistance offered to the
urologist: robotization, image fusion, surgical navigation. Both research
projects and operational industrial systems are discussed
Prostate biopsies assisted by comanipulated probe-holder: first in man
International audiencePurpose: a comanipulator for assisting endorectal prostate biopsies is evaluated through a first-in man clinical trial. This lightweight system, based on conventional robotic components, possesses 6 degrees of freedom. It uses 3 electric motors and 3 brakes. It features a free mode, where its low friction and inertia allow for natural manipulation of the probe and a locked mode, exhibiting both a very low stiffness and a high steady state precision. Methods: Clinical trials focusing on the free mode and the locked mode of the robot are presented. The objective is to evaluate the practical usability and performance of the robot during clinical procedures. A research protocol for a prospective randomized clinical trial has been designed. Its specific goal is to compare the accuracy of biopsies performed with and without the assistance of the comanipulator. Results:The accuracy is compared between biopsies performed with and without the assistance of the comanipulator, across the 10 first patients included in the trial. Results show a statistically significant increase of the precision.. This work is partially funded french state funds managed by the ANR within the Investissements d'Avenir programme (Labex CAMI) under reference ANR-11-LABX-0004. 2 Marie-Aude Vitrani et al
Robot Autonomy for Surgery
Autonomous surgery involves having surgical tasks performed by a robot
operating under its own will, with partial or no human involvement. There are
several important advantages of automation in surgery, which include increasing
precision of care due to sub-millimeter robot control, real-time utilization of
biosignals for interventional care, improvements to surgical efficiency and
execution, and computer-aided guidance under various medical imaging and
sensing modalities. While these methods may displace some tasks of surgical
teams and individual surgeons, they also present new capabilities in
interventions that are too difficult or go beyond the skills of a human. In
this chapter, we provide an overview of robot autonomy in commercial use and in
research, and present some of the challenges faced in developing autonomous
surgical robots
Development of a Novel Robot for Transperineal Needle Based Interventions: Focal Therapy, Brachytherapy and Prostate Biopsies
Purpose: We report what is to our knowledge the initial experience with a new
3-dimensional ultrasound robotic system for prostate brachytherapy assistance,
focal therapy and prostate biopsies. Its ability to track prostate motion
intraoperatively allows it to manage motions and guide needles to predefined
targets. Materials and Methods: A robotic system was created for transrectal
ultrasound guided needle implantation combined with intraoperative prostate
tracking. Experiments were done on 90 targets embedded in a total of 9 mobile,
deformable, synthetic prostate phantoms. Experiments involved trying to insert
glass beads as close as possible to targets in multimodal anthropomorphic
imaging phantoms. Results were measured by segmenting the inserted beads in
computerized tomography volumes of the phantoms. Results: The robot reached the
chosen targets in phantoms with a median accuracy of 2.73 mm and a median
prostate motion of 5.46 mm. Accuracy was better at the apex than at the base
(2.28 vs 3.83 mm, p <0.001), and similar for horizontal and angled needle
inclinations (2.7 vs 2.82 mm, p = 0.18). Conclusions: To our knowledge this
robot for prostate focal therapy, brachytherapy and targeted prostate biopsies
is the first system to use intraoperative prostate motion tracking to guide
needles into the prostate. Preliminary experiments show its ability to reach
targets despite prostate motion
Design of an ultrasound-guided robotic brachytherapy needle insertion system
In this paper we describe a new robotic brachytherapy needle-insertion system
that is designed to replace the template used in the manual technique. After a
brief review of existing robotic systems, we describe the requirements that we
based our design upon. A detailed description of the proposed system follows.
Our design is capable of positioning and inclining a needle within the same
workspace as the manual template. To help improve accuracy, the needle can be
rotated about its axis during insertion into the prostate. The system can be
mounted on existing steppers and also easily accommodates existing seed
dispensers, such as the Mick Applicator
LOW DOSE RATE PROSTATE BRACHYTHERAPY WITH OBLIQUE NEEDLES TO TREAT LARGE GLANDS AND OVERCOME PUBIC ARCH INTERFERENCE
The goal of this thesis was to evaluate the use of oblique needle trajectories in low dose rate prostate brachytherapy for large glands with pubic arch interference (PAI).
A planning study was conducted with five Subject prostate contours, from 3D Transrectal Ultrasound (TRUS) images, artificially enlarged to 60 cc to increase PAI. Oblique needles no template plans (OBL) and parallel needle no template plans (PNT), were compared to parallel needle template plans for each prostate. Iodine-125 (145 Gy prescription dose), 0.43 U air kerma strength, and needle angles \u3c 15° were used. Beneficial improvements (p \u3c 0.05) in dose parameters were shown for OBL plans (all organs), and PNT plans (only PTV VI00), when compared to template plans in paired one-sided t-tests.
An oblique plan was delivered to a 60 cc prostate phantom with PAI using a 3D TRUS guided mechatronic system. Seed placement accuracy was sub-millimeter in all directions
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
InterNAV3D: A Navigation Tool for Robot-Assisted Needle-Based Intervention for the Lung
Lung cancer is one of the leading causes of cancer deaths in North America. There are recent advances in cancer treatment techniques that can treat cancerous tumors, but require a real-time imaging modality to provide intraoperative assistive feedback. Ultrasound (US) imaging is one such modality. However, while its application to the lungs has been limited because of the deterioration of US image quality (due to the presence of air in the lungs); recent work has shown that appropriate lung deflation can help to improve the quality sufficiently to enable intraoperative, US-guided robotics-assisted techniques to be used. The work described in this thesis focuses on this approach.
The thesis describes a project undertaken at Canadian Surgical Technologies and Advanced Robotics (CSTAR) that utilizes the image processing techniques to further enhance US images and implements an advanced 3D virtual visualization software approach. The application considered is that for minimally invasive lung cancer treatment using procedures such as brachytherapy and microwave ablation while taking advantage of the accuracy and teleoperation capabilities of surgical robots, to gain higher dexterity and precise control over the therapy tools (needles and probes). A number of modules and widgets are developed and explained which improve the visibility of the physical features of interest in the treatment and help the clinician to have more reliable and accurate control of the treatment. Finally the developed tools are validated with extensive experimental evaluations and future developments are suggested to enhance the scope of the applications
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