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In-bore biopsies of the prostate assisted by a remote-controlled manipulator at 1.5 T. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 32:599-605. [DOI: 10.1007/s10334-019-00751-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 02/25/2019] [Accepted: 04/29/2019] [Indexed: 01/04/2023]
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Abstract
The indications, technique, results and limitations of MRI vacuum-assisted breast biopsies are discussed from a review of the literature. This was initially a home-grown technique and its development was slowed down by several factors. As a result of major technical advances, it has become a reliable and very consistent procedure with a low rate of underestimation. It is now an undisputed technique when suspicious MRI enhancement is seen with no corresponding mammography or ultrasound features.
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Affiliation(s)
- R Plantade
- Nice Europe Imaging Centre, 15, rue Alberti, 06000 Nice, France.
| | - I Thomassin-Naggara
- Department of Radiology, Tenon Hospital, Paris Public Hospitals Health Service (AP-HP), Pierre et Marie Curie University Oncology Institute, 4, rue de la Chine, 75020 Paris, France
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Comber DB, Barth EJ, Webster RJ. Design and Control of an Magnetic Resonance Compatible Precision Pneumatic Active Cannula Robot. J Med Device 2013. [DOI: 10.1115/1.4024832] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The versatile uses and excellent soft tissue distinction afforded by magnetic resonance imaging (MRI) has led to the development of many MR-compatible devices for MRI-guided interventions. This paper presents a fully pneumatic MR-compatible robotic platform designed for neurosurgical interventions. Actuated by nonmagnetic pneumatic piston-cylinders, the robotic platform manipulates a five degree-of-freedom active cannula designed for deep brain interventions. Long lines of tubing connect the cylinders to remotely located pressure sensors and valves, and MRI-compatible optical sensors mounted on the robot provide the robot joint positions. A robust, nonlinear, model-based controller precisely translates and rotates the robot joints, with mean steady-state errors of 0.032 mm and 0.447 deg, respectively. MRI-compatibility testing in a 3-Tesla closed-bore scanner has shown that the robot has no impact on the signal-to-noise ratio, and that geometric distortion remains within recommended calibration limits for the scanner. These results demonstrate that pneumatic actuation is a promising solution for neurosurgical interventions that either require or can benefit from submillimeter precision. Additionally, this paper provides a detailed solution to the control problems imposed by severe nonlinearities in the pneumatic system, which has not previously been discussed in the context of MR-compatible devices.
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Affiliation(s)
| | | | - Robert J. Webster
- Assistant Professor Mem. ASME e-mail: Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235
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Meeuwis C, Veltman J, van Hall HN, Mus RDM, Boetes C, Barentsz JO, Mann RM. MR-guided breast biopsy at 3T: diagnostic yield of large core needle biopsy compared with vacuum-assisted biopsy. Eur Radiol 2011; 22:341-9. [PMID: 21915606 PMCID: PMC3249028 DOI: 10.1007/s00330-011-2272-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 07/09/2011] [Accepted: 07/15/2011] [Indexed: 11/24/2022]
Abstract
Objective The purpose of this study was to evaluate two MR-guided biopsy techniques at 3 T, large core needle breast biopsy (LCNB) and vacuum-assisted breast biopsy (VAB) and to compare the diagnostic yield and rate of complications to determine the optimal biopsy technique at 3 T. Methods 55 LCNB and 64 VAB were consecutively performed. Benign biopsy results were verified by retrospective correlation of histology, with pre-interventional, post-interventional MRI studies and follow-up and were classified as representative or non-representative. Time to follow-up was up to 2 years for the considered non-representative benign lesions. Statistical analysis was performed using the Chi-squared test. Results LCNB was technically successful in 100% of patients (55/55) and VAB in 98% of patients (63/64). Histopathological analysis resulted in 45 (82%) benign, 3 (5%) high-risk and 7 (13%) malignant lesions for LCNB and 43 (67%) benign, 3 (5%) high-risk and 18 (28%) malignant lesions. Distribution was significantly different (p < 0.001), favouring VAB over LCNB. Conclusion Because of the substantially higher diagnostic yield and certainty of a benign diagnosis, VAB is the optimal biopsy technique at 3 T. LCNB should be considered when VAB is not feasible.
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Affiliation(s)
- Carla Meeuwis
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein-Zuid 10, 6525GA Nijmegen, the Netherlands.
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Moche M, Zajonz D, Kahn T, Busse H. MRI-guided procedures in various regions of the body using a robotic assistance system in a closed-bore scanner: Preliminary clinical experience and limitations. J Magn Reson Imaging 2010; 31:964-74. [DOI: 10.1002/jmri.21990] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Tsekos NV. MRI-guided robotics at the U of Houston: evolving methodologies for interventions and surgeries. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2009:5637-40. [PMID: 19964404 DOI: 10.1109/iembs.2009.5333681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Currently, we witness the rapid evolution of minimally invasive surgeries (MIS) and image guided interventions (IGI) for offering improved patient management and cost effectiveness. It is well recognized that sustaining and expand this paradigm shift would require new computational methodology that integrates sensing with multimodal imaging, actively controlled robotic manipulators, the patient and the operator. Such approach would include (1) assessing in real-time tissue deformation secondary to the procedure and physiologic motion, (2) monitoring the tool(s) in 3D, and (3) on-the-fly update information about the pathophysiology of the targeted tissue. With those capabilities, real time image guidance may facilitate a paradigm shift and methodological leap from "keyhole" visualization (i.e. endoscopy or laparoscopy) to one that uses a volumetric and informational rich perception of the Area of Operation (AoO). This capability may eventually enable a wider range and level of complexity IGI and MIS.
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Affiliation(s)
- Nikolaos V Tsekos
- Medical Robotics Laboratory at the Department of Computer Science, University of Houston, 4800 Calhoun, Houston, TX 77204-3010, USA.
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Morikawa S, Naka S, Murakami K, Kurumi Y, Shiomi H, Tani T, Haque HA, Tokuda J, Hata N, Inubushi T. Preliminary clinical experiences of a motorized manipulator for magnetic resonance image–guided microwave coagulation therapy of liver tumors. Am J Surg 2009; 198:340-7. [DOI: 10.1016/j.amjsurg.2009.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2008] [Revised: 02/13/2009] [Accepted: 02/16/2009] [Indexed: 11/29/2022]
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Tsekos NV, Christoforou E, Ozcan A. A general-purpose MR-compatible robotic system: implementation and image guidance for performing minimally invasive interventions.. ACTA ACUST UNITED AC 2008; 27:51-8. [PMID: 18519182 DOI: 10.1109/emb.2007.910270] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Nikolaos V Tsekos
- Cardiovascular Imaging Laboratory, Mallinckrodt Institute of Radiology, Washington University Medical Center, St. Louis, MO 63110, USA.
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Hata N, Tokuda J, Hurwitz S, Morikawa S. MRI-compatible manipulator with remote-center-of-motion control. J Magn Reson Imaging 2008; 27:1130-8. [PMID: 18407542 DOI: 10.1002/jmri.21314] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To develop and assess a needle-guiding manipulator for MRI-guided therapy that allows a physician to freely select the needle insertion path while maintaining remote center of motion (RCM) at the tumor site. MATERIALS AND METHODS The manipulator consists of a three-degrees-of-freedom (DOF) base stage and passive needle holder with unconstrained two-DOF rotation. The synergistic control keeps the Virtual RCM at the preplanned target using encoder outputs from the needle holder as input to motorize the base stage. RESULTS The manipulator assists in searching for an optimal needle insertion path which is a complex and time-consuming task in MRI-guided ablation therapy for liver tumors. The assessment study showed that accuracy of keeping the virtual RCM to predefined position is 3.0 mm. In a phantom test, the physicians found the needle insertion path faster with than without the manipulator (number of physicians = 3, P = 0.001). However, the alignment time with the virtual RCM was not shorter when imaging time for planning were considered. CONCLUSION The study indicated that the robot holds promise as a tool for accurately and interactively selecting the optimal needle insertion path in liver ablation therapy guided by open-configuration MRI.
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Affiliation(s)
- Nobuhiko Hata
- Department of Radiology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts 02115, USA.
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Weiss CR, Nour SG, Lewin JS. MR-guided biopsy: a review of current techniques and applications. J Magn Reson Imaging 2008; 27:311-25. [PMID: 18219685 DOI: 10.1002/jmri.21270] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Biopsy has become a cornerstone of modern medicine and most modern biopsies are performed percutaneously using image guidance, typically computed tomography or ultrasound. MR-guided biopsy offers many advantages over these more traditional modalities, and the recent development of interventional MR imaging techniques has made MR-guided percutaneous biopsies and aspirations a clinical reality. As the field of MR-guided procedures continues to expand and to attract more attention from radiologists, it is important to understand the concepts, techniques, applications, advantages, and limitations of MR-guided biopsy/percutaneous procedures. Radiologists should also recognize the need for their significant involvement in the technical aspects of MR-guided procedures, since several user-defined parameters can alter device visualization in the MR imaging environment and affect procedure safety. This article reviews the prerequisites, systems, and applications of MR-guided biopsy.
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Affiliation(s)
- Clifford R Weiss
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Moche M, Trampel R, Kahn T, Busse H. Navigation concepts for MR image-guided interventions. J Magn Reson Imaging 2008; 27:276-91. [DOI: 10.1002/jmri.21262] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Tsekos NV, Khanicheh A, Christoforou E, Mavroidis C. Magnetic resonance-compatible robotic and mechatronics systems for image-guided interventions and rehabilitation: a review study. Annu Rev Biomed Eng 2007; 9:351-87. [PMID: 17439358 DOI: 10.1146/annurev.bioeng.9.121806.160642] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The continuous technological progress of magnetic resonance imaging (MRI), as well as its widespread clinical use as a highly sensitive tool in diagnostics and advanced brain research, has brought a high demand for the development of magnetic resonance (MR)-compatible robotic/mechatronic systems. Revolutionary robots guided by real-time three-dimensional (3-D)-MRI allow reliable and precise minimally invasive interventions with relatively short recovery times. Dedicated robotic interfaces used in conjunction with fMRI allow neuroscientists to investigate the brain mechanisms of manipulation and motor learning, as well as to improve rehabilitation therapies. This paper gives an overview of the motivation, advantages, technical challenges, and existing prototypes for MR-compatible robotic/mechatronic devices.
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Affiliation(s)
- Nikolaos V Tsekos
- Cardiovascular Imaging Laboratory, Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri 63110, USA.
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Hauth EA, Jaeger HJ, Lubnau J, Maderwald S, Otterbach F, Kimmig R, Forsting M. MR-guided vacuum-assisted breast biopsy with a handheld biopsy system: clinical experience and results in postinterventional MR mammography after 24 h. Eur Radiol 2007; 18:168-76. [PMID: 17609959 DOI: 10.1007/s00330-007-0704-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Revised: 04/27/2007] [Accepted: 06/04/2007] [Indexed: 11/27/2022]
Abstract
This prospective study evaluates the feasibility of the magnetic resonance (MR)-guided vacuum-assisted breast biopsy with a handheld vacuum-biopsy system and documents the biopsy results with MR mammography 24 h after the procedure. MR-guided biopsy was undertaken in 33 patients with 34 lesions on dynamic MR mammography. The interventions were performed with the handheld 10-gauge Vacora vacuum-biopsy system. In all cases, dynamic MR mammography was performed 24 h after the procedure to determine the extent of the lesion removal and to identify the lesions that were missed. In 5/34 (14.7%) lesions, biopsy was not performed because no suspicious lesion was identified on the day of biopsy. In 25/29 (86.2%) lesions, the biopsy was successfully performed with a complete removal in 4/29 (13.8%) and a partial removal of 21/29 (72.4%) lesions. In 4/29 (13.8%) interventions the lesion was missed with the biopsy. In one case, histopathology after surgical excision revealed ductal carcinoma in situ. Histopathology revealed 9/29 (31%) malignant and 20/29 (68.9%) benign lesions. MR-guided vacuum-assisted breast biopsy with the handheld Vacora vacuum-biopsy system is technically feasible in most cases. MR mammography 24 h after the biopsy should be performed in those cases in which the biopsy success is unclear immediately after the procedure.
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Affiliation(s)
- E A Hauth
- Department of Diagnostic and Interventional, Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany.
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Floery D, Helbich TH. MRI-Guided percutaneous biopsy of breast lesions: materials, techniques, success rates, and management in patients with suspected radiologic-pathologic mismatch. Magn Reson Imaging Clin N Am 2007; 14:411-25, viii. [PMID: 17098182 DOI: 10.1016/j.mric.2006.10.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
MR imaging of the breast allows the detection of suspicious breast lesions that are occult at mammography and ultrasound. For the histologic verification of such lesions, percutaneous MR imaging-guided biopsy techniques can now be offered as an alternative to open breast biopsy. This review focuses on the currently available devices and techniques for MR imaging-guided percutaneous breast biopsy and reports their achievable diagnostic accuracy. Technical success rates and strategies for patient management are also outlined. In addition, new developments in MR imaging-guided minimally invasive therapeutic interventions are discussed, as well as the potential for research opportunities and directions.
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Affiliation(s)
- Daniel Floery
- Department of Radiology, Medical University of Vienna-AKH WIEN, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Christoforou E, Akbudak E, Ozcan A, Karanikolas M, Tsekos NV. Performance of interventions with manipulator-driven real-time MR guidance: implementation and initial in vitro tests. Magn Reson Imaging 2007; 25:69-77. [PMID: 17222717 DOI: 10.1016/j.mri.2006.08.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2006] [Accepted: 08/25/2006] [Indexed: 11/24/2022]
Abstract
The purpose of this work was to implement and assess the performance of interventions inside a cylindrical magnetic resonance imaging (MRI) scanner with an MR-compatible manipulator system and manipulator-driven real-time MR guidance. The interventional system is based on a seven degree-of-freedom MR-compatible manipulator, which offers man-in-the-loop control either with a graphical user interface or with a master/slave device. The position and the orientation of the interventional tool are sent to an MR scanner for a manipulator-driven dynamic update of the imaging plane to track, visualize and guide the motion of an end-effector. Studies on phantoms were performed with a cylindrical 1.5-T scanner using an operator-managed triggered gradient-recalled echo (GRE) or a computer-managed dynamic True Fast Imaging with Steady Precession (TrueFISP). Targets were acquired with an accuracy of 3.2 mm and with an in-plane path orientation of 2.5 degrees relative to the prescribed one. Path planning, including negotiation of obstacles and needle bending, was successfully performed. The signal-to-noise ratio (SNR) of TrueFISP was 25.3+/-2.1 when the manipulator was idle and was 18.6+/-2.4 during its operation. The SNR of triggered GRE (acquired only when the manipulator was idle) was 61.3+/-1.8. In conclusion, this study shows the feasibility of performing manually directed interventions inside cylindrical MR scanners with real-time MRI.
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Affiliation(s)
- Eftychios Christoforou
- Mallinckrodt Institute of Radiology, Washington University Medical School, Box 8225, St. Louis, MO 63110, USA
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Busse H, Trampel R, Gründer W, Moche M, Kahn T. Method for automatic localization of MR-visible markers using morphological image processing and conventional pulse sequences: Feasibility for image-guided procedures. J Magn Reson Imaging 2007; 26:1087-96. [PMID: 17896386 DOI: 10.1002/jmri.21129] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate the feasibility and accuracy of an automated method to determine the 3D position of MR-visible markers. MATERIALS AND METHODS Inductively coupled RF coils were imaged in a whole-body 1.5T scanner using the body coil and two conventional gradient echo sequences (FLASH and TrueFISP) and large imaging volumes up to (300 mm(3)). To minimize background signals, a flip angle of approximately 1 degrees was used. Morphological 2D image processing in orthogonal scan planes was used to determine the 3D positions of a configuration of three fiducial markers (FMC). The accuracies of the marker positions and of the orientation of the plane defined by the FMC were evaluated at various distances r(M) from the isocenter. RESULTS Fiducial marker detection with conventional equipment (pulse sequences, imaging coils) was very reliable and highly reproducible over a wide range of experimental conditions. For r(M) </= 100 mm, the estimated maximum errors in 3D position and angular orientation were 1.7 mm and 0.33 degrees , respectively. For r(M) </= 175 mm, the respective values were 2.9 mm and 0.44 degrees . CONCLUSIONS Detection and localization of MR-visible markers by morphological image processing is feasible, simple, and very accurate. In combination with safe wireless markers, the method is found to be useful for image-guided procedures.
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Affiliation(s)
- Harald Busse
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany.
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Wacker FK, Vogt S, Khamene A, Jesberger JA, Nour SG, Elgort DR, Sauer F, Duerk JL, Lewin JS. An Augmented Reality System for MR Image–guided Needle Biopsy: Initial Results in a Swine Model. Radiology 2006; 238:497-504. [PMID: 16436814 DOI: 10.1148/radiol.2382041441] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate an augmented reality (AR) system in combination with a 1.5-T closed-bore magnetic resonance (MR) imager as a navigation tool for needle biopsies. MATERIALS AND METHODS The experimental protocol had institutional animal care and use committee approval. Seventy biopsies were performed in phantoms by using 20 tube targets, each with a diameter of 6 mm, and 50 virtual targets. The position of the needle tip in AR and MR space was compared in multiple imaging planes, and virtual and real needle tip localization errors were calculated. Ten AR-guided biopsies were performed in three pigs, and the duration of each procedure was determined. After successful puncture, the distance to the target was measured on MR images. The confidence limits for the achieved in-plane hit rate and for lateral deviation were calculated. A repeated measures analysis of variance was used to determine whether the placement error in a particular dimension (x, y, or z) differed from the others. RESULTS For the 50 virtual targets, a mean error of 1.1 mm +/- 0.5 (standard deviation) was calculated. A repeated measures analysis of variance indicated no statistically significant difference (P > .99) in the errors in any particular orientation. For the real targets, all punctures were inside the 6-mm-diameter tube in the transverse plane. The needle depth was within the target plane in 11 biopsy procedures; the mean distance to the center of the target was 2.55 mm (95% confidence interval: 1.77 mm, 3.34 mm). For nine biopsy procedures, the needle tip was outside the target plane, with a mean distance to the edge of the target plane of 1.5 mm (range, 0.07-3.46 mm). In the animal experiments, the puncture was successful in all 10 cases, with a mean target-needle distance of 9.6 mm +/- 4.85. The average procedure time was 18 minutes per puncture. CONCLUSION Biopsy procedures performed with a combination of a closed-bore MR system and an AR system are feasible and accurate.
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Affiliation(s)
- Frank K Wacker
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA
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Werner R, Krueger S, Winkel A, Albrecht C, Schaeffter T, Heller M, Frahm C. MR-guided breast biopsy using an active marker: A phantom study. J Magn Reson Imaging 2006; 24:235-41. [PMID: 16755541 DOI: 10.1002/jmri.20600] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To evaluate the advantages of using an active marker (active micro coil) for MR-guided breast biopsy procedures. MATERIALS AND METHODS An add-on breast biopsy guidance device used with a standard breast coil was equipped with an active marker. The marker's position was determined with a dedicated MRI sequence. In combination with custom software, the biopsy planning process was reduced basically to defining the target in the diagnostic MR images. Automatic control scans verified the settings of the biopsy guidance device. To measure the targeting accuracy, x-ray control of the needle placement was performed in phantoms containing 36 small titanium cylinders. The reliability of the procedure was evaluated in 24 core needle biopsies on phantoms. Workflow enhancements were analyzed. RESULTS The root mean square deviation of the needle position from the target perpendicular to the needle axis was 1.25 mm, in three-dimensions it was 1.35 mm. All targets were sampled successfully. The duration of a phantom biopsy was nine minutes. CONCLUSION The use of an active marker can offer advantages for MR-guided breast biopsies in terms of handling and procedure time as well as accuracy.
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Affiliation(s)
- Richard Werner
- Section of Neuroradiology, Christian-Albrechts-Universität, Kiel, Germany
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Pfleiderer SOR, Marx C, Camara O, Gajda M, Kaiser WA. Ultrasound-guided, percutaneous cryotherapy of small (< or = 15 mm) breast cancers. Invest Radiol 2005; 40:472-7. [PMID: 15973140 DOI: 10.1097/01.rli.0000166935.56971.ff] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVE The purpose of this study was to investigate the feasibility, efficacy, and safety of ultrasound-guided percutaneous cryotherapy of stage T1 breast cancers. MATERIALS AND METHODS Thirty patients with biopsy-confirmed breast cancers with tumor diameters of 15 mm or smaller (range, 5-15 mm; median, 12 mm) underwent cryotherapy. After local anesthesia, a 3-mm cryo probe was placed into the tumor under ultrasound guidance. All tumors were subjected to 2 freeze cycles with an interposing thawing cycle. The size of the ice-balls, their distance to the skin, and the temperature at the tip of the probe were closely monitored during the procedure. The patients underwent surgery within 6 weeks and the specimens were evaluated histologically. RESULTS The median minimum temperature reached -146 degrees C (range, -117 degrees C to -167 degrees C). In 5 of 29 patients, remnant ductal carcinoma in situ was detectable histologically after cryotherapy beyond the margin of the cryosite in the specimens after open surgery. In 24 patients, no viable tumor cells were found. No severe side effects occurred. In one patient, the cryo procedure was not performed completely because of technical problems. DISCUSSION Percutaneous cryotherapy is a feasible and safe procedure in minimally invasive therapy for small breast cancers. Residual ductal carcinoma in situ may be attributable to the beginning of a learning curve or by false-negative detection in pre-interventional imaging. Magnetic resonance mammography might aid in treatment planning and for therapy monitoring to better define target tissue and to correlate the tumor margin with the ice-ball.
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Affiliation(s)
- Stefan O R Pfleiderer
- Institute of Diagnostic and Interventional Radiology, Friedrich-Schiller-University Jena, Jena, Germany.
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Merkle EM, Lewin JS, Liebenthal R, Lorenz CH. The Interventional MR Imaging Suite: Magnet Designs and Equipment Requirements. Magn Reson Imaging Clin N Am 2005; 13:401-13. [PMID: 16084409 DOI: 10.1016/j.mric.2005.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Soon after the introduction of MR imaging as an imaging tool, researchers began to investigate its capabilities to guide interventional minimally invasive procedures, such as biopsies. These early efforts have encouraged vendors and numerous research groups worldwide to identify clinical problems in the field of image-guided intervention, for which MR imaging is beneficial as an imaging modality, and to develop and refine soft-ware and hardware components to meet the specific requirements of interventional MR imaging. Over nearly 20 years, continuous advances in magnet and system design have accelerated the progress of MR-guided intervention.
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Affiliation(s)
- Elmar M Merkle
- Department of Radiology, Duke University Medical Center, Erwin Road, Durham, NC 27710, USA.
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Nour SG, Lewin JS. Percutaneous Biopsy from Blinded to MR Guided: An Update on Current Techniques and Applications. Magn Reson Imaging Clin N Am 2005; 13:441-64. [PMID: 16084412 DOI: 10.1016/j.mric.2005.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The advent of interventional MR imaging techniques as well as their adoption to guide percutaneous biopsies and aspirations has served as a further step along a series of technical refinements that commenced with the implementation of image-guided approaches for tissue sampling. Nowadays, the practice of and the expectations from these procedures are quite different from those of the blind percutaneous thrusts performed in the late nineteenth and early twentieth centuries. As the field of interventional MR imaging continues to flourish and to attract more radiologists who realize the many opportunities that this technology can offer to their patients, there is a need for a full comprehension of the concepts, techniques, limitations, and cost-effectiveness of MR imaging guidance to present this service to clinical partners in the appropriate setting. Radiologists should also recognize the need for their significant involvement in the technical aspects of MR-guided procedures, because several user-defined parameters and trajectory decisions can alter device visualization in the MR imaging environment and hence affect procedure safety.
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Affiliation(s)
- Sherif Gamal Nour
- Department of Radiology, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
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Pfleiderer SOR, Marx C, Vagner J, Franke RP, Reichenbach JR, Kaiser WA. Magnetic Resonance-Guided Large-Core Breast Biopsy Inside a 1.5-T Magnetic Resonance Scanner Using an Automatic System. Invest Radiol 2005; 40:458-63. [PMID: 15973138 DOI: 10.1097/01.rli.0000167423.27180.54] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVE The aim of this study was to investigate the feasibility and the precision of magnetic resonance (MR)-guided large-core breast biopsies (LCBB) by using the second prototype of an automatic system (ROBITOM II), which is used to localize lesions while operating at the isocenter of a 1.5-T whole-body scanner. METHODS AND MATERIALS In comparison to the first prototype, ROBITOM II is equipped with a dedicated double breast coil and a high-speed trocar setting unit. In vitro experiments (n = 25) with grapefruit phantoms, which contained multiple vitamin E capsules (12 x 7 mm in size) as artificial lesions, were performed. Four patients with MR-detectable breast lesions underwent biopsy. A trocar was positioned in front of the lesion and inserted into the breast. Specimens were harvested with a coaxial technique by using a 14-G core needle biopsy gun. RESULTS In all 25 in vitro experiments, capsule material was detected in the specimen cylinder. In 4 patients, the coaxial needle was detected exactly at the expected position. Between 8 and 16 tissue cylinders were harvested. Histologic evaluation resulted in 1 invasive ductal carcinoma and 1 papilloma, which were confirmed after open surgery. One patient who had a proven breast cancer was biopsied for exclusion of multifocal disease. She showed fibrocystic changes, whereas open surgery revealed 3 small areas of ductal carcinoma in situ (DCIS). Another patient showed fibroadenoma after biopsy. This patient is in the follow-up period, which has lasted between 3 and 4 months up until now. CONCLUSIONS In this pilot patient study, the feasibility of manipulator-assisted large-core breast biopsy inside a 1.5-T whole-body scanner was demonstrated by using ROBITOM II. The precision of the device was confirmed with in vitro experiments. Although these findings are preliminary and the follow-up period is rather short, they nevertheless represent a successful proof-of-principle of LCBB with ROBITOM II.
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Affiliation(s)
- Stefan O R Pfleiderer
- Institute of Diagnostic and Interventional Radiology, Friedrich-Schiller-University Jena, Jena, Germany.
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Schulz T, Puccini S, Schneider JP, Kahn T. Interventional and intraoperative MR: review and update of techniques and clinical experience. Eur Radiol 2004; 14:2212-27. [PMID: 15480689 DOI: 10.1007/s00330-004-2496-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2004] [Revised: 08/12/2004] [Accepted: 08/16/2004] [Indexed: 11/30/2022]
Abstract
The concept of interventional magnetic resonance imaging (MRI) is based on the integration of diagnostic and therapeutic procedures, favored by the combination of the excellent morphological and functional imaging characteristics of MRI. The spectrum of MRI-assisted interventions ranges from biopsies and intraoperative guidance to thermal ablation modalities and vascular interventions. The most relevant recently published experimental and clinical results are discussed. In the future, interventional MRI is expected to play an important role in interventional radiology, minimal invasive therapy and guidance of surgical procedures. However, the associated high costs require a careful evaluation of its potentials in order to ensure cost-effective medical care.
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Affiliation(s)
- Thomas Schulz
- Department of Diagnostic Radiology, Leipzig University Hospital, Liebigstrasse 20, 04103 Leipzig, Germany.
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Hong J, Dohi T, Hashizume M, Konishi K, Hata N. An ultrasound-driven needle-insertion robot for percutaneous cholecystostomy. Phys Med Biol 2004; 49:441-55. [PMID: 15012012 DOI: 10.1088/0031-9155/49/3/007] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A real-time ultrasound-guided needle-insertion medical robot for percutaneous cholecystostomy has been developed. Image-guided interventions have become widely accepted because they are consistent with minimal invasiveness. However, organ or abnormality displacement due to involuntary patient motion may undesirably affect the intervention. The proposed instrument uses intraoperative images and modifies the needle path in real time by using a novel ultrasonic image segmentation technique. In phantom and volunteer experiments, the needle path updating time was 130 and 301 ms per cycle, respectively. In animal experiments, the needle could be placed accurately in the target.
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Affiliation(s)
- J Hong
- Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
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