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Toledano Trincado M, Bellido-Luque J, Álvarez Gallego M. Robotic surgery as a driver of surgical digitalization. Cir Esp 2024; 102 Suppl 1:S16-S22. [PMID: 38801975 DOI: 10.1016/j.cireng.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/04/2024] [Indexed: 05/29/2024]
Abstract
Classical surgery, also called analog surgery, is transmitted to us by our mentors, whose knowledge has been delegated from generation to generation throughout the history of surgery. Its main limitations are limited surgical precision and dependence on the surgeon's skill to achieve surgical goals. So-called digital surgery incorporates the most advanced technology, with the aim of improving the results of all phases of the surgical process. Robotic platforms are currently considered to be one of the main drivers of the digital transformation of surgery. They bring considerable advances to the digitalization of surgery, including: higher quality visualization, more controlled and stable movements with elimination of tremor, minimized risk of errors, data integration throughout the patient's surgical process, use of various systems for better surgical planning, application of virtual and augmented reality, telementoring, and artificial intelligence.
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He X, Xiao Y, Zhang X, Zhang X, Zhang X, Wei Y, Zhang Z, Xue X, Zhang S. Low-dose CT fluoroscopy-guided interventional minimally invasive robot. Heliyon 2024; 10:e28914. [PMID: 38601523 PMCID: PMC11004810 DOI: 10.1016/j.heliyon.2024.e28914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/27/2024] [Accepted: 03/26/2024] [Indexed: 04/12/2024] Open
Abstract
Background This study aimed to assess the feasibility, safety, and accuracy of a low-dose CT fluoroscopy-guided remote-controlled robotic real-time puncture procedure. Methods The study involved two control groups with Taguchi method: Group A, which underwent low-dose traditional CT-guided manual puncture (blank control), and Group B, which underwent conditional control puncture. Additionally, an experimental group, Group C, underwent CT fluoroscopy-guided remote-controlled robotic real-time puncture. In a phantom experiment, various simulated targets were punctured, while in an animal experiment, attempts were made to puncture targets in different organs of four pigs. The number of needle adjustments, puncture time, total puncture operation time, and radiation dose were analyzed to evaluate the robot system. Results Successful punctures were achieved for each target, and no complications were observed. Dates were calculated for all parameters using Taguchi method. Conclusion The low-dose CT fluoroscopy-guided puncture robot system is a safe, feasible, and equally accurate alternative to traditional manual puncture procedures.
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Affiliation(s)
- Xiaofeng He
- The First Medical Center of Chinese PLA General Hospital, Department of Diagnostic Radiology, Beijing, China
| | - Yueyong Xiao
- The First Medical Center of Chinese PLA General Hospital, Department of Diagnostic Radiology, Beijing, China
| | - Xiao Zhang
- The First Medical Center of Chinese PLA General Hospital, Department of Diagnostic Radiology, Beijing, China
| | - Xiaobo Zhang
- The First Medical Center of Chinese PLA General Hospital, Department of Diagnostic Radiology, Beijing, China
| | - Xin Zhang
- The First Medical Center of Chinese PLA General Hospital, Department of Diagnostic Radiology, Beijing, China
| | - Yingtian Wei
- The First Medical Center of Chinese PLA General Hospital, Department of Diagnostic Radiology, Beijing, China
| | - Zhongliang Zhang
- The First Medical Center of Chinese PLA General Hospital, Department of Diagnostic Radiology, Beijing, China
| | - Xiaodong Xue
- The First Medical Center of Chinese PLA General Hospital, Department of Diagnostic Radiology, Beijing, China
| | - Shiwen Zhang
- The First Medical Center of Chinese PLA General Hospital, Department of Diagnostic Radiology, Beijing, China
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Chlorogiannis DD, Charalampopoulos G, Bale R, Odisio B, Wood BJ, Filippiadis DK. Innovations in Image-Guided Procedures: Unraveling Robot-Assisted Non-Hepatic Percutaneous Ablation. Semin Intervent Radiol 2024; 41:113-120. [PMID: 38993597 PMCID: PMC11236453 DOI: 10.1055/s-0044-1786724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Interventional oncology is routinely tasked with the feat of tumor characterization or destruction, via image-guided biopsy and tumor ablation, which may pose difficulties due to challenging-to-reach structures, target complexity, and proximity to critical structures. Such procedures carry a risk-to-benefit ratio along with measurable radiation exposure. To streamline the complexity and inherent variability of these interventions, various systems, including table-, floor-, gantry-, and patient-mounted (semi-) automatic robotic aiming devices, have been developed to decrease human error and interoperator and intraoperator outcome variability. Their implementation in clinical practice holds promise for enhancing lesion targeting, increasing accuracy and technical success rates, reducing procedure duration and radiation exposure, enhancing standardization of the field, and ultimately improving patient outcomes. This narrative review collates evidence regarding robotic tools and their implementation in interventional oncology, focusing on clinical efficacy and safety for nonhepatic malignancies.
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Affiliation(s)
| | - Georgios Charalampopoulos
- 2nd Department of Radiology, University General Hospital “ATTIKON,” Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Reto Bale
- Department of Radiology, Interventional Oncology - Stereotaxy and Robotics, Medical University Innsbruck, Innsbruck, Austria
| | - Bruno Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bradford J. Wood
- Interventional Radiology and Center for Interventional Oncology, NIH Clinical Center and National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Dimitrios K. Filippiadis
- 2nd Department of Radiology, University General Hospital “ATTIKON,” Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Matsui Y, Kamegawa T, Tomita K, Uka M, Umakoshi N, Kawabata T, Munetomo K, Iguchi T, Matsuno T, Hiraki T. Robotic systems in interventional oncology: a narrative review of the current status. Int J Clin Oncol 2024; 29:81-88. [PMID: 37115426 DOI: 10.1007/s10147-023-02344-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
Interventional oncology offers minimally invasive treatments for malignant tumors for curative and palliative purposes based on the percutaneous insertion of needles or catheters into the target location under image guidance. Robotic systems have been gaining increasing attention as tools that provide potential advantages for image-guided interventions. Among the robotic systems developed for intervention, those relevant to the oncology field are mainly those for guiding or driving the needles in non-vascular interventional procedures such as biopsy and tumor ablation. Needle-guiding robots support planning the needle path and align the needle robotically according to the planned trajectory, which is combined with subsequent manual needle insertion by the physician through the needle guide. Needle-driving robots can advance the needle robotically after determining its orientation. Although a wide variety of robotic systems have been developed, only a limited number of these systems have reached the clinical phase or commercialization thus far. The results of previous studies suggest that such interventional robots have the potential to increase the accuracy of needle placement, facilitate out-of-plane needle insertion, decrease the learning curve, and reduce radiation exposure. On the other hand, increased complexity and costs may be a concern when using robotic systems compared with conventional manual procedures. Further data should be collected to comprehensively assess the value of robotic systems in interventional oncology.
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Affiliation(s)
- Yusuke Matsui
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan.
| | - Tetsushi Kamegawa
- Faculty of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Noriyuki Umakoshi
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Takahiro Kawabata
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Kazuaki Munetomo
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Toshihiro Iguchi
- Department of Radiological Technology, Faculty of Health Sciences, Okayama University, Okayama, Japan
| | - Takayuki Matsuno
- Faculty of Natural Science and Technology, Okayama University, Okayama, Japan
| | - Takao Hiraki
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
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5
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Charalampopoulos G, Bale R, Filippiadis D, Odisio BC, Wood B, Solbiati L. Navigation and Robotics in Interventional Oncology: Current Status and Future Roadmap. Diagnostics (Basel) 2023; 14:98. [PMID: 38201407 PMCID: PMC10795729 DOI: 10.3390/diagnostics14010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/26/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
Interventional oncology (IO) is the field of Interventional Radiology that provides minimally invasive procedures under imaging guidance for the diagnosis and treatment of malignant tumors. Sophisticated devices can be utilized to increase standardization, accuracy, outcomes, and "repeatability" in performing percutaneous Interventional Oncology techniques. These technologies can reduce variability, reduce human error, and outperform human hand-to-eye coordination and spatial relations, thus potentially normalizing an otherwise broad diversity of IO techniques, impacting simulation, training, navigation, outcomes, and performance, as well as verification of desired minimum ablation margin or other measures of successful procedures. Stereotactic navigation and robotic systems may yield specific advantages, such as the potential to reduce procedure duration and ionizing radiation exposure during the procedure and, at the same time, increase accuracy. Enhanced accuracy, in turn, is linked to improved outcomes in many clinical scenarios. The present review focuses on the current role of percutaneous navigation systems and robotics in diagnostic and therapeutic Interventional Oncology procedures. The currently available alternatives are presented, including their potential impact on clinical practice as reflected in the peer-reviewed medical literature. A review of such data may inform wiser investment of time and resources toward the most impactful IR/IO applications of robotics and navigation to both standardize and address unmet clinical needs.
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Affiliation(s)
- Georgios Charalampopoulos
- 2nd Department of Radiology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 1 Rimini Str, 12462 Athens, Greece;
| | - Reto Bale
- Interventional Oncology/Stereotaxy and Robotics, Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 1 Rimini Str, 12462 Athens, Greece;
| | - Bruno C. Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Bradford Wood
- Interventional Radiology and Center for Interventional Oncology, NIH Clinical Center and National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Luigi Solbiati
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano (Milano), Italy and Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milano), 20072 Milano, Italy;
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Najafi G, Kreiser K, Abdelaziz MEMK, Hamady MS. Current State of Robotics in Interventional Radiology. Cardiovasc Intervent Radiol 2023; 46:549-561. [PMID: 37002481 PMCID: PMC10156773 DOI: 10.1007/s00270-023-03421-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/11/2023] [Indexed: 05/04/2023]
Abstract
As a relatively new specialty with a minimally invasive nature, the field of interventional radiology is rapidly growing. Although the application of robotic systems in this field shows great promise, such as with increased precision, accuracy, and safety, as well as reduced radiation dose and potential for teleoperated procedures, the progression of these technologies has been slow. This is partly due to the complex equipment with complicated setup procedures, the disruption to theatre flow, the high costs, as well as some device limitations, such as lack of haptic feedback. To further assess these robotic technologies, more evidence of their performance and cost-effectiveness is needed before their widespread adoption within the field. In this review, we summarise the current progress of robotic systems that have been investigated for use in vascular and non-vascular interventions.
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Affiliation(s)
- Ghazal Najafi
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK.
| | - Kornelia Kreiser
- Department of Neuroradiology, Rehabilitations - und Universitätskliniken Ulm, 89081, Ulm, Germany
| | - Mohamed E M K Abdelaziz
- The Hamlyn Centre, Imperial College London, London, SW7 2AZ, UK
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, SW7 2AZ, UK
| | - Mohamad S Hamady
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
- The Hamlyn Centre, Imperial College London, London, SW7 2AZ, UK
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Abstract
As robotics in spine surgery has progressed over the past 2 decades, studies have shown mixed results on its clinical outcomes and economic impact. In this review, we highlight the evolution of robotic technology over the past 30 years, discussing early limitations and failures. We provide an overview of the history and evolution of currently available spinal robotic platforms and compare and contrast the available features of each. We conclude by summarizing the literature on robotic instrumentation accuracy in pedicle screw placement and clinical outcomes such as complication rates and briefly discuss the future of robotic spine surgery.
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Affiliation(s)
| | | | | | | | - Darren R. Lebl
- Weill Cornell Medicine, New York, NY, USA
- Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz A. Qureshi
- Weill Cornell Medicine, New York, NY, USA
- Hospital for Special Surgery, New York, NY, USA
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Kochanski RB, Lombardi JM, Laratta JL, Lehman RA, O'Toole JE. Image-Guided Navigation and Robotics in Spine Surgery. Neurosurgery 2020; 84:1179-1189. [PMID: 30615160 DOI: 10.1093/neuros/nyy630] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/04/2018] [Indexed: 01/27/2023] Open
Abstract
Image guidance (IG) and robotics systems are becoming more widespread in their utilization and can be invaluable intraoperative adjuncts during spine surgery. Both are highly reliant upon stereotaxy and either pre- or intraoperative radiographic imaging. While user-operated IG systems have been commercially available longer and subsequently are more widely utilized across centers, robotics systems provide unique theoretical advantages over freehand and IG techniques for placing instrumentation within the spine. While there is a growing plethora of data showing that IG and robotic systems decrease the incidence of malpositioned screws, less is known about their impact on clinical outcomes. Both robotics and IG may be of particular value in cases of substantial deformity or complex anatomy. Indications for the use of these systems continue to expand with an increasing body of literature justifying their use in not only guiding thoracolumbar pedicle screw placement, but also in cases of cervical and pelvic instrumentation as well as spinal tumor resection. Both techniques also offer the potential benefit of reducing occupational exposures to ionizing radiation for the operating room staff, the surgeon, and the patient. As the use of IG and robotics in spine surgery continues to expand, these systems' value in improving surgical accuracy and clinical outcomes must be weighed against concerns over cost and workflow. As newer systems incorporating both real-time IG and robotics become more utilized, further research is necessary to better elucidate situations where these systems may be particularly beneficial in spine surgery.
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Affiliation(s)
- Ryan B Kochanski
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Joseph M Lombardi
- Department of Orthopedic Surgery, Columbia University, New York, New York
| | - Joseph L Laratta
- Department of Orthopedic Surgery, Columbia University, New York, New York
| | - Ronald A Lehman
- Department of Orthopedic Surgery, Columbia University, New York, New York
| | - John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
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Garg B, Mehta N, Malhotra R. Robotic spine surgery: Ushering in a new era. J Clin Orthop Trauma 2020; 11:753-760. [PMID: 32904238 PMCID: PMC7452360 DOI: 10.1016/j.jcot.2020.04.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 01/19/2023] Open
Abstract
The endeavour to make spine surgery safe with reproducible, consistent outcomes has led to growing interest and research in the field of intraoperative imaging, navigation and robotics. The advent of surgical robot systems in spine surgery is relatively recent - with only a few systems approved for commercial use. At present, pedicle screw insertion remains the primary application of robotic systems in spine surgery. The purported advantages of robot-assisted pedicle screw insertion over other conventional techniques are its increased accuracy, reproducible consistency and reduced radiation exposure. Many of these claims have been supported or refuted by individual studies - and high quality evidence for the same is lacking. Robotic spine surgery also has its share of limitations which include increased operative time, considerable learning curve and technical pitfalls unique to the robotic systems. The applications of robotic spine surgery are evolving and expanding to spinal deformity, spine oncology and needle-based interventional treatments. This review provides an overview of the evolution and current status of robotic spine surgery along with an evidence-based discussion of its current applications in spine surgery.
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Affiliation(s)
| | - Nishank Mehta
- Corresponding author. Department of Orthopaedics, 110029, India.
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Hiraki T, Kamegawa T, Matsuno T, Sakurai J, Komaki T, Yamaguchi T, Tomita K, Uka M, Matsui Y, Iguchi T, Gobara H, Kanazawa S. Robotic needle insertion during computed tomography fluoroscopy-guided biopsy: prospective first-in-human feasibility trial. Eur Radiol 2019; 30:927-933. [PMID: 31444597 DOI: 10.1007/s00330-019-06409-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/25/2019] [Accepted: 08/07/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION This was a prospective, first-in-human trial to evaluate the feasibility and safety of insertion of biopsy introducer needles with our robot during CT fluoroscopy-guided biopsy in humans. MATERIALS AND METHODS Eligible patients were adults with a lesion ≥ 10 mm in an extremity or the trunk requiring pathological diagnosis with CT fluoroscopy-guided biopsy. Patients in whom at-risk structures were located within 10 mm of the scheduled needle tract were excluded. Ten patients (4 females and 6 males; mean [range] age, 72 [52-87] years) with lesions (mean [range] maximum diameter, 28 [14-52] mm) in the kidney (n = 4), lung (n = 3), mediastinum (n = 1), adrenal gland (n = 1), and muscle (n = 1) were enrolled. The biopsy procedure involved robotic insertion of a biopsy introducer needle followed by manual acquisition of specimens using a biopsy needle. The patients were followed up for 14 days. Feasibility was defined as the distance of ≤ 10 mm between needle tip after insertion and the nearest lesion edge on the CT fluoroscopic images. The safety of robotic insertion was evaluated on the basis of machine-related troubles and adverse events according to the Clavien-Dindo classification. RESULTS Robotic insertion of the introducer needle was feasible in all patients, enabling pathological diagnosis. There was no machine-related trouble. A total of 11 adverse events occurred in 8 patients, including 10 grade I events and 1 grade IIIa event. CONCLUSION Insertion of biopsy introducer needles with our robot was feasible at several locations in the human body. KEY POINTS • Insertion of biopsy introducer needles with our robot during CT fluoroscopy-guided biopsy was feasible at several locations in the human body.
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Affiliation(s)
- Takao Hiraki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.
| | - Tetsushi Kamegawa
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, 3-1-1 Tsushimanaka, Kitaku, Okayama, 700-8530, Japan
| | - Takayuki Matsuno
- Graduate School of Natural Science and Technology, Okayama University, 3-1-1 Tsushimanaka, Kitaku, Okayama, 700-8530, Japan
| | - Jun Sakurai
- Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Toshiyuki Komaki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Takuya Yamaguchi
- Division of Radiology, Medical Technology Department, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Toshihiro Iguchi
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Hideo Gobara
- Division of Medical Informatics, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
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Hiraki T, Matsuno T, Kamegawa T, Komaki T, Sakurai J, Matsuura R, Yamaguchi T, Sasaki T, Iguchi T, Matsui Y, Gobara H, Kanazawa S. Robotic Insertion of Various Ablation Needles Under Computed Tomography Guidance: Accuracy in Animal Experiments. Eur J Radiol 2018; 105:162-167. [PMID: 30017274 DOI: 10.1016/j.ejrad.2018.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/31/2018] [Accepted: 06/11/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the accuracy of robotic insertion of various ablation needles at various locations under computed tomography (CT) guidance in swine. MATERIALS AND METHODS The robot was used for CT-guided insertion of four ablation needles, namely a single internally cooled radiofrequency ablation (RFA) needle (Cool-tip), a multi-tined expandable RFA needle (LeVeen), a cryoablation needle (IceRod), and an internally cooled microwave ablation needle (Emprint). One author remotely operated the robot with the operation interface in order to orient and insert the needles under CT guidance. Five insertions of each type of ablation needle towards 1.0-mm targets in the liver, kidney, lung, and hip muscle were attempted on the plane of an axial CT image in six swine. Accuracy of needle insertion was evaluated as the three-dimensional length between the target centre and needle tip. The accuracy of needle insertion was compared according to the type of needle used and the location using one-way analysis of variance. RESULTS The overall mean accuracy of all four needles in all four locations was 2.8 mm. The mean accuracy of insertion of the Cool-tip needle, LeVeen needle, IceRod needle, and Emprint needle was 2.8 mm, 3.1 mm, 2.5 mm, and 2.7 mm, respectively. The mean accuracy of insertion into the liver, kidney, lung, and hip muscle was 2.7 mm, 2.9 mm, 2.9 mm, and 2.5 mm, respectively. There was no significant difference in insertion accuracy among the needles (P = .38) or the locations (P = .53). CONCLUSION Robotic insertion of various ablation needles under CT guidance was accurate regardless of type of needle or location in swine.
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Affiliation(s)
- Takao Hiraki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan.
| | - Takayuki Matsuno
- Graduate School of Natural Science and Technology, Okayama University, 3-1-1 Tsusimanaka, Kitaku, Okayama 700-8530, Japan
| | - Tetsushi Kamegawa
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, 3-1-1 Tsusimanaka, Kitaku, Okayama 700-8530, Japan
| | - Toshiyuki Komaki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Jun Sakurai
- Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Ryutaro Matsuura
- Graduate School of Health Sciences, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Takuya Yamaguchi
- Division of Radiology, Medical Technology Department, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Takanori Sasaki
- Collaborative Research Center for OMIC, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Toshihiro Iguchi
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Hideo Gobara
- Division of Medical Informatics, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
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Ghelfi J, Moreau-Gaudry A, Hungr N, Fouard C, Véron B, Medici M, Chipon E, Cinquin P, Bricault I. Evaluation of the Needle Positioning Accuracy of a Light Puncture Robot Under MRI Guidance: Results of a Clinical Trial on Healthy Volunteers. Cardiovasc Intervent Radiol 2018; 41:1428-1435. [PMID: 29876597 DOI: 10.1007/s00270-018-2001-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/26/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE To assess the accuracy of Light Puncture Robot (LPR) as a patient-mounted robot, in positioning a sham needle under MRI guidance for abdominal percutaneous interventions. MATERIALS AND METHODS This monocentric, prospective and non-controlled study was approved by the ethics review board. The study evaluated the accuracy of LPR V3 to achieve a virtual puncture in 20 healthy volunteers. Three trajectories were tried on each volunteer, under 3-T MRI guidance. RESULTS Accuracy under 5 mm in attaining a 10 cm-deep target was reached in 72% of attempts after 2 robot motions with a median error of 4.1 mm [2.1; 5.1]. Median procedure time for one trajectory was 12.9 min [10.2; 18.0] and median installation time was 9.0 min [6.0; 13.0]. CONCLUSION LPR accuracy in the deployment of a sham needle inside the MRI tunnel and its setup time are promising. Further studies need to be conducted to confirm these results before clinical trials.
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Affiliation(s)
- Julien Ghelfi
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France.
| | - Alexandre Moreau-Gaudry
- TIMC-IMAG, Univ. Grenoble-Alpes, 38000, Grenoble, France.,TIMC-IMAG, CNRS, 38000, Grenoble, France.,Inserm CIC 1406, 38000, Grenoble, France.,Pole Sante Publique, CHU Grenoble-Alpes, 38000, Grenoble, France
| | - Nikolai Hungr
- Laboratoire TIMC-IMAG (UMR CNRS 5525) - Équipe GMCAO, Faculté de Médecine - Pavillon Taillefer, 38706, La Tronche Cedex, France
| | - Céline Fouard
- Laboratoire TIMC-IMAG (UMR CNRS 5525) - Équipe GMCAO, Faculté de Médecine - Pavillon Taillefer, 38706, La Tronche Cedex, France
| | - Baptiste Véron
- Laboratoire TIMC-IMAG (UMR CNRS 5525) - Équipe GMCAO, Faculté de Médecine - Pavillon Taillefer, 38706, La Tronche Cedex, France
| | - Maud Medici
- Inserm CIC 1406, 38000, Grenoble, France.,CIC 1406, Univ. Grenoble-Alpes, 38000, Grenoble, France.,Pole Recherche, CHU Grenoble-Alpes, 38000, Grenoble, France
| | - Emilie Chipon
- Inserm CIC 1406, 38000, Grenoble, France.,CIC 1406, Univ. Grenoble-Alpes, 38000, Grenoble, France.,Pole Recherche, CHU Grenoble-Alpes, 38000, Grenoble, France
| | - Philippe Cinquin
- Laboratoire TIMC-IMAG (UMR CNRS 5525) - Équipe GMCAO, Faculté de Médecine - Pavillon Taillefer, 38706, La Tronche Cedex, France
| | - Ivan Bricault
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
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13
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Hungr N, Bricault I, Cinquin P, Fouard C. Design and Validation of a CT- and MRI-Guided Robot for Percutaneous Needle Procedures. IEEE T ROBOT 2016. [DOI: 10.1109/tro.2016.2588884] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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14
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Abstract
PURPOSE OF REVIEW Robots in regional anesthesia are used as a tool to automate the performance of regional techniques reducing the anesthesiologist's workload and improving patient care. The purpose of this review is to show the latest findings in robotic regional anesthesia. RECENT FINDINGS The literature separates robots in anesthesia into two groups: pharmacological robots and manual robots. Pharmacological robots are mainly closed-loop systems that help in the titration of anesthetic drugs to patients undergoing surgery. Manual robots are mechanical robots that are used to support or replace the manual gestures performed by anesthesiologists. Although in the last decade researchers have focused on the development of decision support systems and closed-loop systems, more recent evidence supports the concept that robots can also be useful in performing regional anesthesia techniques. SUMMARY Robots can improve the performance and safety in regional anesthesia. In this review, we present the developments made in robotic and automated regional anesthesia, and discuss the current state of research in this field.
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Affiliation(s)
- Mohamad Wehbe
- aDivision of Experimental Surgery, McGill University, Montreal, Canada bDepartment of Anesthesia, University Pisa, Pisa, Italy cDepartment of Anesthesia, Division of Experimental Surgery & Arnold and Blema Steinberg Medical Simulation Centre, McGill University, Montreal, Canada
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15
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Hemmerling TM, Taddei R, Wehbe M, Cyr S, Zaouter C, Morse J. First Robotic Ultrasound-Guided Nerve Blocks in Humans Using the Magellan System. Anesth Analg 2013; 116:491-4. [DOI: 10.1213/ane.0b013e3182713b49] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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17
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Bertelsen A, Melo J, Sánchez E, Borro D. A review of surgical robots for spinal interventions. Int J Med Robot 2012; 9:407-22. [DOI: 10.1002/rcs.1469] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Alvaro Bertelsen
- Applied Mechanics Department CEIT and Tecnun; University of Navarra; San Sebastián Spain
| | - Javier Melo
- Applied Mechanics Department CEIT and Tecnun; University of Navarra; San Sebastián Spain
| | - Emilio Sánchez
- Applied Mechanics Department CEIT and Tecnun; University of Navarra; San Sebastián Spain
| | - Diego Borro
- Applied Mechanics Department CEIT and Tecnun; University of Navarra; San Sebastián Spain
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18
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Siauw T, Cunha A, Berenson D, Atamturk A, Hsu IC, Goldberg K, Pouliot J. NPIP: A skew line needle configuration optimization system for HDR brachytherapy. Med Phys 2012; 39:4339-46. [PMID: 22830767 DOI: 10.1118/1.4728226] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE In this study, the authors introduce skew line needle configurations for high dose rate (HDR) brachytherapy and needle planning by integer program (NPIP), a computational method for generating these configurations. NPIP generates needle configurations that are specific to the anatomy of the patient, avoid critical structures near the penile bulb and other healthy structures, and avoid needle collisions inside the body. METHODS NPIP consisted of three major components: a method for generating a set of candidate needles, a needle selection component that chose a candidate needle subset to be inserted, and a dose planner for verifying that the final needle configuration could meet dose objectives. NPIP was used to compute needle configurations for prostate cancer data sets from patients previously treated at our clinic. NPIP took two user-parameters: a number of candidate needles, and needle coverage radius, δ. The candidate needle set consisted of 5000 needles, and a range of δ values was used to compute different needle configurations for each patient. Dose plans were computed for each needle configuration. The number of needles generated and dosimetry were analyzed and compared to the physician implant. RESULTS NPIP computed at least one needle configuration for every patient that met dose objectives, avoided healthy structures and needle collisions, and used as many or fewer needles than standard practice. These needle configurations corresponded to a narrow range of δ values, which could be used as default values if this system is used in practice. The average end-to-end runtime for this implementation of NPIP was 286 s, but there was a wide variation from case to case. CONCLUSIONS The authors have shown that NPIP can automatically generate skew line needle configurations with the aforementioned properties, and that given the correct input parameters, NPIP can generate needle configurations which meet dose objectives and use as many or fewer needles than the current HDR brachytherapy workflow. Combined with robot assisted brachytherapy, this system has the potential to reduce side effects associated with treatment. A physical trial should be done to test the implant feasibility of NPIP needle configurations.
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Affiliation(s)
- Timmy Siauw
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA.
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19
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Zhang X, Nelson C, Oleynikov D. Usability Assessment of Two Different Control Modes for the Master Console of a Laparoscopic Surgical Robot. JOURNAL OF HEALTHCARE ENGINEERING 2012. [DOI: 10.1260/2040-2295.3.1.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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20
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CONRADIE JEANPIERRE, SCHEFFER CORNIE, SCHREVE KRISTIAAN, ZARRABI AMIR. SEMI-AUTONOMOUS NEEDLE-POSITIONING DEVICE FOR PERCUTANEOUS NEPHROLITHOTOMY PROCEDURES. J MECH MED BIOL 2011. [DOI: 10.1142/s0219519410003708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
At present, manual needle-positioning techniques known as "triangulation" and "keyhole surgery" are implemented during percutaneous nephrolithotomy (PCNL) to gain initial kidney access. These techniques do not ensure correct needle placement inside the kidney, resulting in multiple needle punctures, unnecessary hemorrhage, excessive radiation exposure to all involved and increased surgery time. A cost-effective fluoroscopy-guided needle-positioning system is proposed for aiding urologists in gaining accurate and repeatable kidney calyx access. Guidance is realized by modeling a C-arm fluoroscopic system as an adapted pinhole camera model and utilizing stereovision principles on an image pair. Targeting is realized with the aid of a graphical user interface operated by the surgeon. An average target registration error of 2.5 mm (SD = 0.8 mm) was achieved in a simulated environment. Similar results were achieved in the operating room environment with successful needle access in two in-vitro porcine kidneys.
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Affiliation(s)
- JEAN-PIERRE CONRADIE
- Department of Mechanical & Mechatronic Engineering, Stellenbosch University, Private Bag X1 Stellenbosch, 7600, South Africa
| | - CORNIE SCHEFFER
- Department of Mechanical & Mechatronic Engineering, Stellenbosch University, Private Bag X1 Stellenbosch, 7600, South Africa
| | - KRISTIAAN SCHREVE
- Department of Mechanical & Mechatronic Engineering, Stellenbosch University, Private Bag X1 Stellenbosch, 7600, South Africa
| | - AMIR ZARRABI
- Department of Urology, Tygerberg Hospital, Stellenbosch University, Private Bag X1 Stellenbosch, 7600, South Africa
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Hungr N, Fouard C, Robert A, Bricault I, Cinquin P. Interventional radiology robot for CT and MRI guided percutaneous interventions. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2011; 14:137-44. [PMID: 22003610 DOI: 10.1007/978-3-642-23623-5_18] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This paper introduces a new patient-mounted CT and MRI guided interventional radiology robot for percutaneous needle interventions. The 5 DOF robot uses ultrasonic motors and pneumatics to position the needle and then insert it progressively. The needle position and inclination can be registered in the images using two strategically placed fiducials visible in both imaging modalities. A first prototype is presented and described in terms of its sterilization, CT and MRI compatibility, and precision. Tests showed that 1) it is entirely sterilizable with hydrogen peroxide gas, 2) no image artifacts or deformations are noticeable in the CT and MRI images, 3) does not affect the SNR of MR images, and 4) its mechanical error is less than 5mm.
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Affiliation(s)
- Nikolai Hungr
- UJF-Grenoble 1 / CNRS / TIMC-IMAG UMR 5525 (GMCAO), Grenoble F-38041, France.
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Cunha JA, Hsu IC, Pouliot J, Roach Iii M, Shinohara K, Kurhanewicz J, Reed G, Stoianovici D. Toward adaptive stereotactic robotic brachytherapy for prostate cancer: demonstration of an adaptive workflow incorporating inverse planning and an MR stealth robot. MINIM INVASIV THER 2010; 19:189-202. [PMID: 20642386 PMCID: PMC3108452 DOI: 10.3109/13645706.2010.497000] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To translate any robot into a clinical environment, it is critical that the robot can seamlessly integrate with all the technology of a modern clinic. MRBot, an MR-stealth brachytherapy delivery device, was used in a closed-bore 3T MRI and a clinical brachytherapy cone beam CT suite. Targets included ceramic dummy seeds, MR-Spectroscopy-sensitive metabolite, and a prostate phantom. Acquired DICOM images were exported to planning software to register the robot coordinates in the imager's frame, contour and verify target locations, create dose plans, and export needle and seed positions to the robot. The coordination of each system element (imaging device, brachytherapy planning system, robot control, robot) was validated with a seed delivery accuracy of within 2 mm in both a phantom and soft tissue. An adaptive workflow was demonstrated by acquiring images after needle insertion and prior to seed deposition. This allows for adjustment if the needle is in the wrong position. Inverse planning (IPSA) was used to generate a seed placement plan and coordinates for ten needles and 29 seeds were transferred to the robot. After every two needles placed, an image was acquired. The placed seeds were identified and validated prior to placing the seeds in the next two needles. The ability to robotically deliver seeds to locations determined by IPSA and the ability of the system to incorporate novel needle patterns were demonstrated. Shown here is the ability to overcome this critical step. An adaptive brachytherapy workflow is demonstrated which integrates a clinical anatomy-based seed location optimization engine and a robotic brachytherapy device. Demonstration of this workflow is a key element of a successful translation to the clinic of the MRI stealth robotic delivery system, MRBot.
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Affiliation(s)
- J Adam Cunha
- Department of Radiation Oncology, University of California, San Francisco, CA, USA.
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Chang J, Wen B, Kazanzides P, Zanzonico P, Finn RD, Fichtinger G, Ling CC. A robotic system for 18F-FMISO PET-guided intratumoral pO2 measurements. Med Phys 2010; 36:5301-9. [PMID: 19994538 DOI: 10.1118/1.3239491] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
An image-guided robotic system was used to measure the oxygen tension (pO2) in rodent tumor xenografts using interstitial probes guided by tumor hypoxia PET images. Rats with approximately 1 cm diameter tumors were anesthetized and immobilized in a custom-fabricated whole-body mold. Imaging was performed using a dedicated small-animal PET scanner (R4 or Focus 120 microPET) approximately 2 h after the injection of the hypoxia tracer 18F-fluoromisonidazole (18F-FMISO). The coordinate systems of the robot and PET were registered based on fiducial markers in the rodent bed visible on the PET images. Guided by the 3D microPET image set, measurements were performed at various locations in the tumor and compared to the corresponding 18F-FMISO image intensity at the respective measurement points. Experiments were performed on four tumor-bearing rats with 4 (86), 3 (80), 7 (162), and 8 (235) measurement tracks (points) for each experiment. The 18F-FMISO image intensities were inversely correlated with the measured pO2, with a Pearson coefficient ranging from -0.14 to -0.97 for the 22 measurement tracks. The cumulative scatterplots of pO2 versus image intensity yielded a hyperbolic relationship, with correlation coefficients of 0.52, 0.48, 0.64, and 0.73, respectively, for the four tumors. In conclusion, PET image-guided pO2 measurement is feasible with this robot system and, more generally, this system will permit point-by-point comparison of physiological probe measurements and image voxel values as a means of validating molecularly targeted radiotracers. Although the overall data fitting suggested that 18F-FMISO may be an effective hypoxia marker, the use of static 18F-FMISO PET postinjection scans to guide radiotherapy might be problematic due to the observed high variation in some individual data pairs from the fitted curve, indicating potential temporal fluctuation of oxygen tension in individual voxels or possible suboptimal imaging time postadministration of hypoxia-related trapping of 18F-FMISO.
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Affiliation(s)
- Jenghwa Chang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA.
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Shah S, Kapoor A, Ding J, Guion P, Petrisor D, Karanian J, Pritchard WF, Stoianovici D, Wood BJ, Cleary K. Robotically assisted needle driver: evaluation of safety release, force profiles, and needle spin in a swine abdominal model. Int J Comput Assist Radiol Surg 2008. [DOI: 10.1007/s11548-008-0164-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
AbstractThis study develops a novel image-guided robotic system that can be used to position biopsy needles or drill fixation holes. After the patient has received a CT-scan, the registration of the image, localizer (patient), and robot frames will be done by finding the optimum transformation matrix among the image and localizer coordinates of the fiducial markers and the DRFs mounted on the robot. Then, surgical paths planned on the computer displayed images can be transformed to the robot frame, and the robot is thus capable to move surgical tools to the preplanned location. The positioning error is about 2 mm and the orientation error is about 0.23°.
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Abstract
Contemporary imaging modalities can now provide the surgeon with high quality three- and four-dimensional images depicting not only normal anatomy and pathology, but also vascularity and function. A key component of image-guided surgery (IGS) is the ability to register multi-modal pre-operative images to each other and to the patient. The other important component of IGS is the ability to track instruments in real time during the procedure and to display them as part of a realistic model of the operative volume. Stereoscopic, virtual- and augmented-reality techniques have been implemented to enhance the visualization and guidance process. For the most part, IGS relies on the assumption that the pre-operatively acquired images used to guide the surgery accurately represent the morphology of the tissue during the procedure. This assumption may not necessarily be valid, and so intra-operative real-time imaging using interventional MRI, ultrasound, video and electrophysiological recordings are often employed to ameliorate this situation. Although IGS is now in extensive routine clinical use in neurosurgery and is gaining ground in other surgical disciplines, there remain many drawbacks that must be overcome before it can be employed in more general minimally-invasive procedures. This review overviews the roots of IGS in neurosurgery, provides examples of its use outside the brain, discusses the infrastructure required for successful implementation of IGS approaches and outlines the challenges that must be overcome for IGS to advance further.
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Affiliation(s)
- Terry M Peters
- Robarts Research Institute, University of Western Ontario, PO Box 5015, 100 Perth Drive, London, ON N6A 5K8, Canada.
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