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

A Pneumatic Driven MRI-Guided Robot System for Prostate Interventions

Under the guidance of high-resolution Magnetic Resonance Imaging (MRI), robotic devices offer a great advantage for prostate intervention. This paper presents an MR-safe robot, where a needle is attached to the needle guide to obtain prostate biopsies during surgeries. The robot is powered by three actuators, two of them are customized to function as a work plane that allows the needle to move horizontally and vertically, and the third actuator controls the rotation of the work plane, allowing the needle to be inserted into the prostate from different directions. All the actuators are pneumatically actuated to allow them to work in a Magnetic Resonance (MR) environment. The kinematics and mechanism of the robot are analyzed. A user interface developed using LabView is created to calculate the target position and generate a control signal for the valves. In the open-air test, the needle can reach the target with an accuracy of 1.3 mm. The signal-to-noise ratio (SNR) variation was measured below 5% under a 3T MR scanner

MR conditional prostate intervention systems and actuations review

Magnetic resonance imaging (MRI) has the ability to provide high-resolution images of soft tissues without the use of radiation. So much research has been focused on the development of actuators and robotic devices that can be used in the MRI environment so “real-time” images can be obtained during surgeries. With real-time guidance from MRI, robots can perform surgical procedures with high accuracy and through less invasive routes. This technique can also significantly reduce the operation time and simplify pre-surgical procedures. Therefore, research on robot-assisted MRI-guided prostate intervention has attracted a great deal of interest, and several successful clinical trials have been published in recent years, pointing to the great potential of this technology. However, the development of MRI-guided robots is still in the primary stage, and collaboration between researchers and commercial suppliers is still needed to improve such robot systems. This review presents an overview of MRI-guided prostate intervention devices and actuators. Additionally, the expected technical challenges and future advances in this field are discussed

Design and control of 3-DOF needle positioner for MRI-guided laser ablation of liver tumours

This article presents the design and control of a pneumatic needle positioner for laser ablation of liver tumours under guidance by magnetic resonance imaging (MRI). The prototype was developed to provide accurate point-to-point remote positioning of a needle guide inside an MR scanner with the aim of evaluating the potential advantages over the manual procedure. In order to minimise alterations to the MR environment, the system employs plastic pneumatic actuators and 9 m long supply lines connecting with the control hardware located outside the magnet room. An improved sliding mode control (SMC) scheme was designed for the position control of the device. Wireless micro-coil fiducials are used for automatic registration in the reference frame of the MR scanner. The MRI-compatibility and the accuracy of the prototype are demonstrated with experiments in the MR scanner

Design, Development, and Evaluation of a Teleoperated Master-Slave Surgical System for Breast Biopsy under Continuous MRI Guidance

The goal of this project is to design and develop a teleoperated master-slave surgical system that can potentially assist the physician in performing breast biopsy with a magnetic resonance imaging (MRI) compatible robotic system. MRI provides superior soft-tissue contrast compared to other imaging modalities such as computed tomography or ultrasound and is used for both diagnostic and therapeutic procedures. The strong magnetic field and the limited space inside the MRI bore, however, restrict direct means of breast biopsy while performing real-time imaging. Therefore, current breast biopsy procedures employ a blind targeting approach based on magnetic resonance (MR) images obtained a priori. Due to possible patient involuntary motion or inaccurate insertion through the registration grid, such approach could lead to tool tip positioning errors thereby affecting diagnostic accuracy and leading to a long and painful process, if repeated procedures are required. Hence, it is desired to develop the aforementioned teleoperation system to take advantages of real-time MR imaging and avoid multiple biopsy needle insertions, improving the procedure accuracy as well as reducing the sampling errors. The design, implementation, and evaluation of the teleoperation system is presented in this dissertation. A MRI-compatible slave robot is implemented, which consists of a 1 degree of freedom (DOF) needle driver, a 3-DOF parallel mechanism, and a 2-DOF X-Y stage. This slave robot is actuated with pneumatic cylinders through long transmission lines except the 1-DOF needle driver is actuated with a piezo motor. Pneumatic actuation through long transmission lines is then investigated using proportional pressure valves and controllers based on sliding mode control are presented. A dedicated master robot is also developed, and the kinematic map between the master and the slave robot is established. The two robots are integrated into a teleoperation system and a graphical user interface is developed to provide visual feedback to the physician. MRI experiment shows that the slave robot is MRI-compatible, and the ex vivo test shows over 85%success rate in targeting with the MRI-compatible robotic system. The success in performing in vivo animal experiments further confirm the potential of further developing the proposed robotic system for clinical applications

Achieving commutation control of an MRI-powered robot actuator

Actuators that are powered, imaged, and controlled by magnetic resonance (MR) scanners could inexpensively provide wireless control of MR-guided robots. Similar to traditional electric motors, the MR scanner acts as the stator and generates propulsive torques on an actuator rotor containing one or more ferrous particles. Generating maximum motor torque while avoiding instabilities and slippage requires closed-loop control of the electromagnetic field gradients, i.e., commutation. Accurately estimating the position and velocity of the rotor is essential for high-speed control, which is a challenge due to the low refresh rate and high latency associated with MR signal acquisition. This paper proposes and demonstrates a method for closed-loop commutation based on interleaving pulse sequences for rotor imaging and rotor propulsion. This approach is shown to increase motor torque and velocity, eliminate rotor slip, and enable regulation of rotor angle. Experiments with a closed-loop MR imaging actuator produced a maximum force of 9.4 N

Interactive Multi-Stage Robotic Positioner for Intra-Operative MRI-Guided Stereotactic Neurosurgery

Magnetic resonance imaging (MRI) demonstrates clear advantages over other imaging modalities in neurosurgery with its ability to delineate critical neurovascular structures and cancerous tissue in high-resolution 3D anatomical roadmaps. However, its application has been limited to interventions performed based on static pre/post-operative imaging, where errors accrue from stereotactic frame setup, image registration, and brain shift. To leverage the powerful intra-operative functions of MRI, e.g., instrument tracking, monitoring of physiological changes and tissue temperature in MRI-guided bilateral stereotactic neurosurgery, a multi-stage robotic positioner is proposed. The system positions cannula/needle instruments using a lightweight (203 g) and compact (Ø97 × 81 mm) skull-mounted structure that fits within most standard imaging head coils. With optimized design in soft robotics, the system operates in two stages: i) manual coarse adjustment performed interactively by the surgeon (workspace of ±30°), ii) automatic fine adjustment with precise (<0.2° orientation error), responsive (1.4 Hz bandwidth), and high-resolution (0.058°) soft robotic positioning. Orientation locking provides sufficient transmission stiffness (4.07 N/mm) for instrument advancement. The system's clinical workflow and accuracy is validated with lab-based (<0.8 mm) and MRI-based testing on skull phantoms (<1.7 mm) and a cadaver subject (<2.2 mm). Custom-made wireless omni-directional tracking markers facilitated robot registration under MRI

Needle-guiding robot for laser ablation of liver tumors under MRI guidance

This paper presents the design, control and experimental evaluation of a needle-guiding robot intended for use in laser ablation (LA) of liver tumors under guidance by Magnetic Resonance Imaging (MRI). The robot provides alignment of a needle guide inside the MRI scanner bore and employs manual needle insertion. In order to minimize MR-image deterioration, the robot is actuated using plastic pneumatic cylinders and long pipes connecting to control valves located outside the MRI scanner room. A new Time Delay Control scheme (TDC) was employed to achieve high position accuracy without requiring pressure or force measurements in the MRI scanner. The control scheme was compared with experiments to a previously developed Sliding Mode Controller (SMC). A marker localization method based on the convolution theorem of Fourier transform was employed to register the robot in the MRI scanner coordinate system and to verify the position of the needle guide before the manual needle insertion. Experiments in a closed-bore MRI scanner showed a variation in SNR below 5%. A phantom study indicates that the targeting error in robot-assisted needle insertions is below 5 mm and suggest a potential time saving of 30 minutes compared to the manual MRI-guided LA procedure

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