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

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

SMART IMAGE-GUIDED NEEDLE INSERTION FOR TISSUE BIOPSY

M.S

MR fluoroscopy in vascular and cardiac interventions (review)

Vascular and cardiac disease remains a leading cause of morbidity and mortality in developed and emerging countries. Vascular and cardiac interventions require extensive fluoroscopic guidance to navigate endovascular catheters. X-ray fluoroscopy is considered the current modality for real time imaging. It provides excellent spatial and temporal resolution, but is limited by exposure of patients and staff to ionizing radiation, poor soft tissue characterization and lack of quantitative physiologic information. MR fluoroscopy has been introduced with substantial progress during the last decade. Clinical and experimental studies performed under MR fluoroscopy have indicated the suitability of this modality for: delivery of ASD closure, aortic valves, and endovascular stents (aortic, carotid, iliac, renal arteries, inferior vena cava). It aids in performing ablation, creation of hepatic shunts and local delivery of therapies. Development of more MR compatible equipment and devices will widen the applications of MR-guided procedures. At post-intervention, MR imaging aids in assessing the efficacy of therapies, success of interventions. It also provides information on vascular flow and cardiac morphology, function, perfusion and viability. MR fluoroscopy has the potential to form the basis for minimally invasive image–guided surgeries that offer improved patient management and cost effectiveness

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

DESIGN, DEVELOPMENT, AND EVALUATION OF A DISCRETELY ACTUATED STEERABLE CANNULA

Needle-based procedures require the guidance of the needle to a target region to deliver therapy or to remove tissue samples for diagnosis. During needle insertion, needle deflection occurs due to needle-tissue interaction which deviates the needle from its insertion direction. Manipulating the needle at the base provides limited control over the needle trajectory after the insertion. Furthermore, some sites are inaccessible using straight-line trajectories due to delicate structures that need to be avoided. The goal of this research is to develop a discretely actuated steerable cannula to enable active trajectory corrections and achieve accurate targeting in needle-based procedures. The cannula is composed of straight segments connected by shape memory alloy (SMA) actuators and has multiple degrees-of-freedom. To control the motion of the cannula two approaches have been explored. One approach is to measure the cannula configuration directly from the imaging modality and to use this information as a feedback to control the joint motion. The second approach is a model-based controller where the strain of the SMA actuator is controlled by controlling the temperature of the SMA actuator. The constitutive model relates the stress, strain and the temperature of the SMA actuator. The uniaxial constitutive model of the SMA that describes the tensile behavior was extended to one-dimensional pure- bending case to model the phase transformation of the arc-shaped SMA wire. An experimental characterization procedure was devised to obtain the parameters of the SMA that are used in the constitutive model. Experimental results demonstrate that temperature feedback can be effectively used to control the strain of the SMA actuator and image feedback can be reliably used to control the joint motion. Using tools from differential geometry and the configuration control approach, motion planning algorithms were developed to create pre-operative plans that steer the cannula to a desired surgical site (nodule or suspicious tissue). Ultrasound-based tracking algorithms were developed to automate the needle insertion procedure using 2D ultrasound guidance. The effectiveness of the proposed in-plane and out-of-plane tracking methods were demonstrated through experiments inside tissue phantom made of gelatin and ex-vivo experiments. An optical coherence tomography probe was integrated into the cannula and in-situ microscale imaging was performed. The results demonstrate the use of the cannula as a delivery mechanism for diagnostic applications. The tools that were developed in this dissertation form the foundations of developing a complete steerable-cannula system. It is anticipated that the cannula could be used as a delivery mechanism in image-guided needle-based interventions to introduce therapeutic and diagnostic tools to a target region

Sensorisation of a novel biologically inspired flexible needle

Percutaneous interventions are commonly performed during minimally invasive brain surgery, where a straight rigid instrument is inserted through a small incision to access a deep lesion in the brain. Puncturing a vessel during this procedure can be a life-threatening complication. Embedding a forward-looking sensor in a rigid needle has been proposed to tackle this problem; however, using a rigid needle, the procedure needs to be interrupted if a vessel is detected. Steerable needle technology could be used to avoid obstacles, such as blood vessels, due to its ability to follow curvilinear paths, but research to date was lacking in this respect. This thesis aims to investigate the deployment of forward-looking sensors for vessel detection in a steerable needle. The needle itself is based on a bioinspired programmable bevel-tip needle (PBN), a multi-segment design featuring four hollow working channels. In this thesis, laser Doppler flowmetry (LDF) is initially characterised to ensure that the sensor fulfils the minimum requirements for it to be used in conjunction with the needle. Subsequently, vessel reconstruction algorithms are proposed. To determine the axial and off-axis position of the vessel with respect to the probe, successive measurements of the LDF sensor are used. Ideally, full knowledge of the vessel orientation is required to execute an avoidance strategy. Using two LDF probes and a novel signal processing method described in this thesis, the predicted possible vessel orientations can be reduced to four, a setup which is explored here to demonstrate viable obstacle detection with only partial sensor information. Relative measurements from four LDF sensors are also explored to classify possible vessel orientations in full and without ambiguity, but under the assumption that the vessel is perpendicular to the needle insertion axis. Experimental results on a synthetic grey matter phantom are presented, which confirm these findings. To release the perpendicularity assumption, the thesis concludes with the description of a machine learning technique based on a Long Short-term memory network, which enables a vessel's spatial position, cross-sectional diameter and full pose to be predicted with sub-millimetre accuracy. Simulated and in-vitro examinations of vessel detection with this approach are used to demonstrate effective predictive ability. Collectively, these results demonstrate that the proposed steerable needle sensorisation is viable and could lead to improved safety during robotic assisted needle steering interventions.Open Acces

Medical Robotics for use in MRI Guided Endoscopy

Interventional Magnetic Resonance Imaging (MRI) is a developing field that aims to provide intra-operative MRI to a clinician to guide diagnostic or therapeutic medical procedures. MRI provides excellent soft tissue contrast at sub-millimetre resolution in both 2D and 3D without the need for ionizing radiation. Images can be acquired in near real-time for guidance purposes. Operating in the MR environment brings challenges due to the high static magnetic field, switching magnetic field gradients and RF excitation pulses. In addition high field closed bore scanners have spatial constraints that severely limit access to the patient. This thesis presents a system for MRI-guided Endoscopic Retrograde Cholangio-pancreatography (ERCP). This includes a remote actuation system that enables an MRI-compatible endoscope to be controlled whilst the patient is inside the MRI scanner, overcoming the spatial and procedural constraints imposed by the closed scanner bore. The modular system utilises non-magnetic ultrasonic motors and is designed for image-guided user-in-the-loop control. A novel miniature MRI compatible clutch has been incorporated into the design to reduce the need for multiple parallel motors. The actuation system is MRI compatible does not degrade the MR images below acceptable levels. User testing showed that the actuation system requires some degree of training but enables completion of a simulated ERCP procedure with no loss of performance. This was demonstrated using a tailored ERCP simulator and kinematic assessment tool, which was validated with users from a range of skill levels to ensure that it provides an objective measurement of endoscopic skill. Methods of tracking the endoscope in real-time using the MRI scanner are explored and presented here. Use of the MRI-guided ERCP system was shown to improve the operator’s ability to position the endoscope in an experimental environment compared with a standard fluoroscopic-guided system.Open Acces