1
|
Barat M, Milot L. Is robotic assistance the future of percutaneous interventional radiology? Diagn Interv Imaging 2024; 105:209-210. [PMID: 38403506 DOI: 10.1016/j.diii.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Maxime Barat
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Génomique et Signalisation des Tumeurs Endocrines, Institut Cochin, INSERM U 1016, CNRS UMR8104, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France.
| | - Laurent Milot
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69005 Lyon, France; LabTAU, INSERM U1032, 69003 Lyon, France; Université Claude Bernard Lyon 1, 69003 Lyon, France
| |
Collapse
|
2
|
Grüne B, Burger R, Bauer D, Schäfer A, Rothfuss A, Stallkamp J, Rassweiler J, Kriegmair MC, Rassweiler-Seyfried MC. Robotic-assisted versus manual Uro Dyna-CT-guided puncture in an ex-vivo kidney phantom. MINIM INVASIV THER 2024; 33:102-108. [PMID: 38047308 DOI: 10.1080/13645706.2023.2289477] [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: 03/27/2023] [Accepted: 11/15/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION AND OBJECTIVES Challenging percutaneous renal punctures to gain access to the kidney requiring guidance by cross-sectional imaging. To test the feasibility of robotic-assisted CT-guided punctures (RP) and compare them with manual laser-guided punctures (MP) with Uro Dyna-CT (Siemens Healthcare Solutions, Erlangen, Germany). MATERIAL AND METHODS The silicon kidney phantom contained target lesions of three sizes. RP were performed using a robotic assistance system (guidoo, BEC GmbH, Pfullingen, Germany) with a robotic arm (LBR med R800, KUKA AG, Augsburg, Germany) and a navigation software with a cone-beam-CT Artis zeego (Siemens Healthcare GmbH, Erlangen, Germany). MP were performed using the syngo iGuide Uro-Dyna Artis Zee Ceiling CT (Siemens Healthcare Solutions). Three urologists with varying experience performed 20 punctures each. Success rate, puncture accuracy, puncture planning time (PPT), and needle placement time (NPT) were measured and compared with ANOVA and Chi-Square Test. RESULTS One hundred eighteen punctures with a success rate of 100% for RP and 78% for MP were included. Puncture accuracy was significantly higher for RP. PPT (RP: 238 ± 90s, MP: 104 ± 21s) and NPT (RP: 128 ± 40s, MP: 81 ± 18s) were significantly longer for RP. The outcome variables did not differ significantly with regard to levels of investigators' experience. CONCLUSION The accuracy of RP was superior to that of MP. This study paves the way for first in-human application of this robotic puncture system.
Collapse
Affiliation(s)
- Britta Grüne
- Department of Urology and Urosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ralph Burger
- Department of Urology and Urosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Dominik Bauer
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Mannheim Institute for Intelligent Systems in Medicine, University of Heidelberg, Mannheim, Germany
| | - Armin Schäfer
- Fraunhofer IPA - Project group for Automation in Medicine and Biotechnology (PAMB), Mannheim, Germany
| | | | - Jan Stallkamp
- Medical Faculty Mannheim, Mannheim Institute for Intelligent Systems in Medicine, Heidelberg University, Mannheim, Germany
| | | | | | | |
Collapse
|
3
|
Barral M, Chevallier O, Cornelis FH. Perspectives of Cone-beam Computed Tomography in Interventional Radiology: Techniques for Planning, Guidance, and Monitoring. Tech Vasc Interv Radiol 2023; 26:100912. [PMID: 38071025 DOI: 10.1016/j.tvir.2023.100912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Cone-beam computed tomography (CBCT) has emerged as a prominent imaging modality in interventional radiology that offers real-time visualization and precise guidance in various procedures. This article aims to provide an overview of the techniques used to guide and monitor interventions that use CBCT. It discusses the advantages of CBCT, its current applications, and potential future CBCT-related developments in the field of interventional radiology.
Collapse
Affiliation(s)
- Matthias Barral
- Department of Radiology, Tenon Hospital, Paris, France; Paris Sorbonne Université, France.
| | | | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medicine Medical College, New York, NY
| |
Collapse
|
4
|
Spenkelink IM, Heidkamp J, Avital Y, Fütterer JJ. Evaluation of the performance of robot assisted CT-guided percutaneous needle insertion: Comparison with freehand insertion in a phantom. Eur J Radiol 2023; 162:110753. [PMID: 36863276 DOI: 10.1016/j.ejrad.2023.110753] [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: 12/07/2022] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE To evaluate the performance of a novel robot for CT-guided needle positioning procedures and compare it to the freehand technique in an abdominal phantom. METHODS One interventional radiology fellow and one experienced interventional radiologist (IR) performed twelve robot-assisted and twelve freehand needle positionings in a phantom over predetermined trajectories. The robot automatically aimed a needle-guide according to the planned trajectories, after which the clinician manually inserted the needle. Using repeated CT scans, the needle position was assessed and adjusted if the clinician deemed it necessary. Technical success, accuracy, number of position adjustments, and procedure time were measured. All outcomes were analyzed using descriptive statistics and were compared between the robot-assisted and freehand procedures using the paired t-test and Wilcoxon signed rank test. RESULTS Compared with the freehand technique, the robot system improved the number of technically successfully needle targeting (20/24 vs 14/24), with higher accuracy (mean Euclidean deviation from target center: 3.5 ± 1.8 mm vs 4.6 ± 2.1 mm, p = 0.02) and required fewer needle position adjustments (0.0 ± 0.2 steps vs 1.7 ± 0.9 steps, p < 0.001), respectively. The robot improved the needle positioning for both, the fellow and the expert IR, compared to their freehand performances, with more improvement for the fellow than for the expert IR. The procedure time was similar for the robot-assisted and freehand procedures (19.5 ± 9.2 min. vs 21.0 ± 6.9 min., p = 0.777). CONCLUSIONS CT-guided needle positioning with the robot was more successful and accurate than freehand needle positioning and required fewer needle position adjustments without prolonging the procedure.
Collapse
Affiliation(s)
- Ilse M Spenkelink
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Jan Heidkamp
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Yaniv Avital
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Interventional Radiology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Jurgen J Fütterer
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
5
|
Zhang W, Xia P, Liu S, Huang X, Zhao X, Liu Z, Dang H, Li X, Niu G. A coordinate positioning puncture method under robot-assisted CT-guidance: phantom and animal experiments. MINIM INVASIV THER 2022; 31:206-215. [PMID: 32633586 DOI: 10.1080/13645706.2020.1787451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the accuracy of the robot-assisted computed tomography (CT)-guided coordinate positioning puncture method by phantom and animal experiments. MATERIAL AND METHODS In the phantom experiment, seven robot-assisted punctures were made to evaluate the accuracy of the method. In the animal experiment, 18 punctures (nine robotic and nine manual) were made in the livers of nine rabbits. The indicators, such as needle-tract length, angle deviation, puncture accuracy, number of scans required, and radiation exposure dose were compared between manual and robotic punctures. The paired-samples t-test was used for analysis. RESULTS In the phantom experiment, the mean accuracy of seven punctures was 2.67 mm. In the animal experiment, there was no significant difference in needle-tract length (32.58 mm vs. 34.04 mm, p = .606), angle deviation (17.21° vs. 21.23° p = .557) and puncture accuracy (8.42 vs. 8.77 mm, p = .851) between the two groups. However, the number CT scans required (2.44 vs. 3.33, p = .002), and the radiation exposure dose (772.98 vs. 1077.89 mGy/cm, p = .003) were lower in the robot group than in the manual group. CONCLUSIONS The coordinate positioning puncture method under robot-assisted CT-guidance can reach an accuracy that is comparable to that of the traditional manual CT-guided puncture method and with fewer CT scanning times accompanied with a lower radiation dosage.
Collapse
Affiliation(s)
- Weifan Zhang
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Peng Xia
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Shijie Liu
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, PR China
| | - Xiaowei Huang
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, PR China
| | - Xinhui Zhao
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Zhao Liu
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Hui Dang
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Xiaohu Li
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, PR China
| | - Gang Niu
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| |
Collapse
|
6
|
Christou AS, Amalou A, Lee H, Rivera J, Li R, Kassin MT, Varble N, Tsz Ho Tse Z, Xu S, Wood BJ. Image-Guided Robotics for Standardized and Automated Biopsy and Ablation. Semin Intervent Radiol 2021; 38:565-575. [PMID: 34853503 DOI: 10.1055/s-0041-1739164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Image-guided robotics for biopsy and ablation aims to minimize procedure times, reduce needle manipulations, radiation, and complications, and enable treatment of larger and more complex tumors, while facilitating standardization for more uniform and improved outcomes. Robotic navigation of needles enables standardized and uniform procedures which enhance reproducibility via real-time precision feedback, while avoiding radiation exposure to the operator. Robots can be integrated with computed tomography (CT), cone beam CT, magnetic resonance imaging, and ultrasound and through various techniques, including stereotaxy, table-mounted, floor-mounted, and patient-mounted robots. The history, challenges, solutions, and questions facing the field of interventional radiology (IR) and interventional oncology are reviewed, to enable responsible clinical adoption and value definition via ergonomics, workflows, business models, and outcome data. IR-integrated robotics is ready for broader adoption. The robots are coming!
Collapse
Affiliation(s)
- Anna S Christou
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland
| | - Amel Amalou
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland
| | - HooWon Lee
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland
| | - Jocelyne Rivera
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland
| | - Rui Li
- Tandon School of Engineering, New York University, Brooklyn, New York
| | - Michael T Kassin
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland
| | - Nicole Varble
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland.,Philips Research North America, Cambridge, Massachusetts
| | - Zion Tsz Ho Tse
- Department of Electrical Engineering, University of York, Heslington, York, United Kingdom
| | - Sheng Xu
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland
| | - Bradford J Wood
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland.,Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland.,National Cancer Institute, National Institutes of Health, Bethesda, Maryland.,Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
7
|
Dalili D, Isaac A, Cazzato RL, Åström G, Bergh J, Mansour R, Weber MA, Garnon J, Gangi A. Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part II. Stabilization. Semin Musculoskelet Radiol 2020; 24:710-725. [PMID: 33307586 DOI: 10.1055/s-0040-1719104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Percutaneous image-guided oncologic interventions have rapidly evolved over the last two decades as an independent strategy or used within a first-, second-, or even third-line strategy in the treatment of musculoskeletal (MSK) tumors. Abundant mostly nonrandomized publications have described the safety, efficacy, and reproducibility of implementing percutaneous therapies both with curative and palliative intent. In this article, we continue to share our experience in bone and MSK soft tissue interventions focusing on stabilization and combined ablation and stabilization. We propose a pathway and explore future directions of image-guided interventional oncology related to skeletal disease. We reflect on the advantages and limitations of each technique and offer guidance and pearls to improve outcomes. Representing patterns from our practices, we demonstrate the role of collaborative working within a multidisciplinary team, ideally within a dedicated tumor treatment center, to deliver patient-specific therapy plans that are value based and favored by patients when given the choice.
Collapse
Affiliation(s)
- Danoob Dalili
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Amanda Isaac
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Roberto Luigi Cazzato
- Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France
| | - Gunnar Åström
- Department of Immunology, Genetics and Pathology (Oncology) and Department of Surgical Sciences (Radiology), Uppsala University, Uppsala, Sweden
| | - Jonas Bergh
- Department of Oncology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ramy Mansour
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Rostock, Germany
| | - Julien Garnon
- Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France
| | - Afshin Gangi
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom.,Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France
| |
Collapse
|
8
|
Cazzato RL, Garnon J, Koch G, Dalili D, Rao PP, Weiss J, Bauones S, Auloge P, de Marini P, Gangi A. Musculoskeletal interventional oncology: current and future practices. Br J Radiol 2020; 93:20200465. [DOI: 10.1259/bjr.20200465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Management of musculoskeletal (MSK) tumours has traditionally been delivered by surgeons and medical oncologists. However, in recent years, image-guided interventional oncology (IO) has significantly impacted the clinical management of MSK tumours. With the rapid evolution of relevant technologies and the expanding range of clinical indications, it is likely that the impact of IO will significantly grow and further evolve in the near future.In this narrative review, we describe well-established and new interventional technologies that are currently integrating into the IO armamentarium available to radiologists to treat MSK tumours and illustrate new emerging IO indications for treatment.
Collapse
Affiliation(s)
- Roberto Luigi Cazzato
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Guillaume Koch
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust Windmill Rd, Oxford OX3 7LD, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - Julia Weiss
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Salem Bauones
- Department of Radiology, King Fahad Medical City, Riyadh, 11525, Saudi Arabia
| | - Pierre Auloge
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Pierre de Marini
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Afshin Gangi
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
- Department of Interventional Radiolgy, Guy's and St Thomas' NHS Foundation Trust, King's College London, London WC2R 2LS, United Kingdom
| |
Collapse
|
9
|
Venturi D, Glossop N, Bale R. Patient-specific templates for image-guided intervention - a phantom study. MINIM INVASIV THER 2019; 29:251-260. [PMID: 31204536 DOI: 10.1080/13645706.2019.1626251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To evaluate the in vitro accuracy of a new device and method for simultaneous stereotactic CT-guided punctures.Material and methods: 240 needle paths were planned in 1 mm, 1.5 mm and 3 mm slice thickness with a custom-designed software. The data were transferred to a three-axis tabletop CNC machine that then drilled the hole pattern for the needles into square plastic plates. Kirschner wires were slid through the holes of the two parallel fixed plates to aim at the chosen targets inside the phantom. The accuracy was calculated by taking control CTs and measuring the Euclidean distance and the normal distance between the wire and the entry and target point.Results: The mean Euclidean distance of the wire tip to the target for the 1 mm, 1.5mm and 3 mm slice thickness were 2.5 mm (SD ± 0.64), 2.71mm (SD ± 0.78) and 2.8 mm (SD ± 1.0). The mean normal distance was 1.42 mm (SD ± 0.65), 1.43mm (SD ± 0.75) and 1.9 mm (SD ± 1.1), respectively.Conclusion: The system yields satisfactory accuracy comparable to other image-guided intervention systems. Involuntary movements of the patient need to be taken into account in a clinical setting.
Collapse
Affiliation(s)
- David Venturi
- Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Neil Glossop
- Queen's University School of Computing, Kingston, Canada.,ArciTrax Inc, Toronto, Canada
| | - Reto Bale
- Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|