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Huang Z, Gunderman AL, Wilcox SE, Sengupta S, Shah J, Lu A, Woodrum D, Chen Y. Body-Mounted MR-Conditional Robot for Minimally Invasive Liver Intervention. Ann Biomed Eng 2024; 52:2065-2075. [PMID: 38634953 DOI: 10.1007/s10439-024-03503-2] [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: 10/11/2023] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
MR-guided microwave ablation (MWA) has proven effective in treating hepatocellular carcinoma (HCC) with small-sized tumors, but the state-of-the-art technique suffers from sub-optimal workflow due to the limited accuracy provided by the manual needle insertions. This paper presents a compact body-mounted MR-conditional robot that can operate in closed-bore MR scanners for accurate needle guidance. The robotic platform consists of two stacked Cartesian XY stages, each with two degrees of freedom, that facilitate needle insertion pose control. The robot is actuated using 3D-printed pneumatic turbines with MR-conditional bevel gear transmission systems. Pneumatic valves and control mechatronics are located inside the MRI control room and are connected to the robot with pneumatic transmission lines and optical fibers. Free-space experiments indicated robot-assisted needle insertion error of 2.6 ± 1.3 mm at an insertion depth of 80 mm. The MR-guided phantom studies were conducted to verify the MR-conditionality and targeting performance of the robot. Future work will focus on the system optimization and validations in animal trials.
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Affiliation(s)
- Zhefeng Huang
- Institute of Robotics and Intelligent Machines, Georgia Institute of Technology, 801 Atlantic Dr NW, Atlanta, GA, 30332, USA
| | - Anthony L Gunderman
- Institute of Robotics and Intelligent Machines, Georgia Institute of Technology, 801 Atlantic Dr NW, Atlanta, GA, 30332, USA
| | - Samuel E Wilcox
- Institute of Robotics and Intelligent Machines, Georgia Institute of Technology, 801 Atlantic Dr NW, Atlanta, GA, 30332, USA
| | - Saikat Sengupta
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Ave South Medical Center North, Nashville, TN, 37232, USA
| | - Jay Shah
- Department of Radiology, Emory University, 1364 Clifton Rd, Atlanta, GA, 30329, USA
| | - Aiming Lu
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - David Woodrum
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Yue Chen
- Institute of Robotics and Intelligent Machines, Georgia Institute of Technology, 801 Atlantic Dr NW, Atlanta, GA, 30332, USA.
- Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, 313 Ferst Dr, Atlanta, GA, 30332, USA.
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Huang Z, Alkhars H, Gunderman A, Sigounas D, Cleary K, Chen Y. Optimal Concentric Tube Robot Design for Safe Intracerebral Hemorrhage Removal. JOURNAL OF MECHANISMS AND ROBOTICS 2024; 16:081005. [PMID: 38434486 PMCID: PMC10906783 DOI: 10.1115/1.4063979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Purpose The purpose of this paper is to investigate the geometrical design and path planning of Concentric tube robots (CTR) for intracerebral hemorrhage (ICH) evacuation, with a focus on minimizing the risk of damaging white matter tracts and cerebral arteries. Methods To achieve our objective, we propose a parametrization method describing a general class of CTR geometric designs. We present mathematical models that describe the CTR design constraints and provide the calculation of a path risk value. We then use a genetic algorithm to determine the optimal tube geometry for targeting within the brain. Results Our results show that a multi-tube CTR design can significantly reduce the risk of damaging critical brain structures compared to the conventional straight tube design. However, there is no significant relationship between the path risk value and the number and shape of the additional inner curved tubes. Conclusion Considering the challenges of CTR hardware design, fabrication, and control, we conclude that the most practical geometry for a CTR path in ICH treatment is a straight outer tube followed by a planar curved inner tube. These findings have important implications for the development of safe and effective CTRs for ICH evacuation by enabling dexterous manipulation to minimize damage to critical brain structures.
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Affiliation(s)
- Zhefeng Huang
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Hussain Alkhars
- George Washington University School of Medicine, Washington, DC, USA
| | - Anthony Gunderman
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Dimitri Sigounas
- George Washington University School of Medicine, Washington, DC, USA
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington, DC, USA
| | - Yue Chen
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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Gunderman AL, Azizkhani M, Sengupta S, Cleary K, Chen Y. Modeling and Control of an MR-Safe Pneumatic Radial Inflow Motor and Encoder (PRIME). IEEE/ASME TRANSACTIONS ON MECHATRONICS : A JOINT PUBLICATION OF THE IEEE INDUSTRIAL ELECTRONICS SOCIETY AND THE ASME DYNAMIC SYSTEMS AND CONTROL DIVISION 2024; 29:1714-1725. [PMID: 38895598 PMCID: PMC11185264 DOI: 10.1109/tmech.2023.3329296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Magnetic resonance (MR) conditional actuators and encoders are the key components for MR-guided robotic systems. In this article, we present the modeling and control of our MR-safe pneumatic radial inflow motor and encoder. A comprehensive model is developed that considers the primary dynamic elements of the system, including: 1) motor dynamics, 2) pneumatic transmission line dynamics, and 3) valve dynamics. After model validation, we present a simplified third order model that facilitates design of a first order sliding mode controller (TO-SMC). Finally, the motor hardware is tested in a 7T MRI. No image distortion or artifacts were observed. We posit the MR-safe motor and dynamic model will lower the entry barriers for researchers interested in MR-guided robots and promote wider adoption of MR-guided robotic systems.
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Affiliation(s)
- Anthony L Gunderman
- Department of Biomedical Engineering, Georgia Institute of Technology/Emory, Atlanta, GA 30338 USA
| | - Milad Azizkhani
- Department of Biomedical Engineering, Georgia Institute of Technology/Emory, Atlanta, GA 30338 USA
| | - Saikat Sengupta
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Kevin Cleary
- Children's National Hospital, Washington, DC 20010 USA
| | - Yue Chen
- Department of Biomedical Engineering, Georgia Institute of Technology/Emory, Atlanta, GA 30338 USA
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Gunderman AL, Sengupta S, Huang Z, Sigounas D, Oluigbo C, Godage IS, Cleary K, Chen Y. Towards MR-Guided Robotic Intracerebral Hemorrhage Evacuation: Aiming Device Design and ex vivo Ovine Head Trial. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2024; 6:577-588. [PMID: 38911181 PMCID: PMC11189651 DOI: 10.1109/tmrb.2024.3385794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Stereotactic neurosurgery is a well-established surgical technique for navigation and guidance during treatment of intracranial pathologies. Intracerebral hemorrhage (ICH) is an example of various neurosurgical conditions that can benefit from stereotactic neurosurgery. As a part of our ongoing work toward real-time MR-guided ICH evacuation, we aim to address an unmet clinical need for a skull-mounted frameless stereotactic aiming device that can be used with minimally invasive robotic systems for MR-guided interventions. In this paper, we present NICE-Aiming, a Neurosurgical, Interventional, Configurable device for Effective-Aiming in MR-guided robotic neurosurgical interventions. A kinematic model was developed and the system was used with a concentric tube robot (CTR) for ICH evacuation in (i) a skull phantom and (ii) in the first ever reported ex vivo CTR ICH evacuation using an ex vivo ovine head. The NICE-Aiming prototype provided a tip accuracy of 1.41±0.35 mm in free-space. In the MR-guided gel phantom experiment, the targeting accuracy was 2.07±0.42 mm and the residual hematoma volume was 12.87 mL (24.32% of the original volume). In the MR-guided ex vivo ovine head experiment, the targeting accuracy was 2.48±0.48 mm and the residual hematoma volume was 1.42 mL (25.08% of the original volume).
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Affiliation(s)
- Anthony L Gunderman
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30338 USA
| | - Saikat Sengupta
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Zhefeng Huang
- Department of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30338 USA
| | - Dimitri Sigounas
- The George Washington University School of Medicine and Health Sciences, Department of Neurosurgery, The George Washington University, Washington, DC, US
| | - Chima Oluigbo
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC 20010 USA
| | - Isuru S Godage
- Department of Engineering Technology and Industrial Distribution, Texas A&M University, College Station, TX, USA
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC 20010 USA
| | - Yue Chen
- Biomedical Engineering Department, Georgia Institute of Technology/Emory, Atlanta 30338 USA
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Tang C, Zhang M, Li W. Meta-analysis of stereotactic hematoma removal and craniotomy hematoma removal in the treatment of hypertensive intracerebral hemorrhage in the elderly. Medicine (Baltimore) 2023; 102:e36533. [PMID: 38065865 PMCID: PMC10713175 DOI: 10.1097/md.0000000000036533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND A large number of clinical studies suggested that surgery might be a better choice than conservative treatment for treating hypertensive intracerebral hemorrhage in the middle-aged and elderly. Stereotactic puncture can reduce the mass effect caused by hematoma, reduce the intervention of body homeostasis, reduce brain tissue damage, and improve the prognosis of patients with cerebral hemorrhage. This meta-analysis aims to evaluate the efficacy of stereotactic puncture and craniotomy in elderly patients with hypertensive intracerebral hemorrhage. METHODS A search strategy was designed to search in databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials, CNKI, Wanfang database and relevant references. Literature on the efficacy and safety of different surgical methods for hypertensive cerebral hemorrhage in the middle-aged and elderly were retrieved. The search time was until August 17, 2022. Keywords included "hypertensive intracerebral hemorrhage," "stereotactic hematoma removal," "craniotomy." After the literature search, 2 researchers independently conducted literature screening, quality evaluation of included trials and data extraction. RevMan5.4 software was used to perform a Meta-analysis on the operation time, hospital stay, postoperative Glasgow Coma Scale (GCS) score, postoperative daily activity ability, postoperative complications and neurological prognosis scores included in the included studies. RESULTS A total of 1988 samples were included in 9 studies. 1022 patients underwent stereotactic hematoma removal, and 968 patients underwent craniotomy hematoma removal. The orientation group had more advantages in the length of hospital stay, postoperative disability, pulmonary infection, intracranial infection and digestive tract ulcer, and the difference was statistically significant (P < .05). In addition, the length of stay (I²= 83%) of the included articles had good homogeneity (I²< 50%), and there was no significant difference between the 2 groups in operation time, postoperative GCS score, postoperative daily activity ability, and neurological prognosis score (P > .05). CONCLUSION The meta-analysis indicate that compared to craniotomy for hematoma removal, stereotactic hematoma removal can reduce the postoperative disability rate, intracranial infection rate, lung infection rate, and digestive tract ulcer rate in middle-aged and elderly patients with hypertensive intracerebral hemorrhage.
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Affiliation(s)
- Chao Tang
- Department of neurosurgery, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Min Zhang
- Department of neurosurgery, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Li
- Department of neurosurgery, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Gunderman AL, Sengupta S, Siampli E, Sigounas D, Kellner C, Oluigbo C, Sharma K, Godage I, Cleary K, Chen Y. Non-Metallic MR-Guided Concentric Tube Robot for Intracerebral Hemorrhage Evacuation. IEEE Trans Biomed Eng 2023; 70:2895-2904. [PMID: 37074885 PMCID: PMC10699321 DOI: 10.1109/tbme.2023.3268279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
OBJECTIVE We aim to develop and evaluate an MR-conditional concentric tube robot for intracerebral hemorrhage (ICH) evacuation. METHODS We fabricated the concentric tube robot hardware with plastic tubes and customized pneumatic motors. The robot kinematic model was developed using a discretized piece-wise constant curvature (D-PCC) approach to account for variable curvature along the tube shape, and tube mechanics model was used to compensate torsional deflection of the inner tube. The MR-safe pneumatic motors were controlled using a variable gain PID algorithm. The robot hardware was validated in a series of bench-top and MRI experiments, and the robot's evacuation efficacy was tested in MR-guided phantom trials. RESULTS The pneumatic motor was able to achieve a rotational accuracy of 0.32°±0.30° with the proposed variable gain PID control algorithm. The kinematic model provided a positional accuracy of the tube tip of 1.39 ± 0.54 mm. The robot was able to evacuate an initial 38.36 mL clot, leaving a residual hematoma of 8.14 mL after 5 minutes, well below the 15 mL guideline suggesting good post-ICH evacuation clinical outcomes. CONCLUSION This robotic platform provides an effective method for MR-guided ICH evacuation. SIGNIFICANCE ICH evacuation is feasible under MRI guidance using a plastic concentric tube, indicating potential feasibility in future live animal studies.
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Wu Z, Chen D, Pan C, Zhang G, Chen S, Shi J, Meng C, Zhao X, Tao B, Chen D, Liu W, Ding H, Tang Z. Surgical Robotics for Intracerebral Hemorrhage Treatment: State of the Art and Future Directions. Ann Biomed Eng 2023; 51:1933-1941. [PMID: 37405558 PMCID: PMC10409846 DOI: 10.1007/s10439-023-03295-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/17/2023] [Indexed: 07/06/2023]
Abstract
Intracerebral hemorrhage (ICH) is a stroke subtype with high mortality and disability, and there are no proven medical treatments that can improve the functional outcome of ICH patients. Robot-assisted neurosurgery is a significant advancement in the development of minimally invasive surgery for ICH. This review encompasses the latest advances and future directions of surgical robots for ICH. First, three robotic systems for neurosurgery applied to ICH are illustrated. Second, the key technologies of robot-assisted surgery for ICH are introduced in aspects of stereotactic technique and navigation, the puncture instrument, and hematoma evacuation. Finally, the limitations of current surgical robots are summarized, and the possible development direction is discussed, which is named "multisensor fusion and intelligent aspiration control of minimally invasive surgical robot for ICH". It is expected that the new generation of surgical robots for ICH will facilitate quantitative, precise, individualized, standardized treatment strategies for ICH.
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Affiliation(s)
- Zhuojin Wu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Danyang Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chao Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ge Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shiling Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jian Shi
- School of Mechanical Science & Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Cai Meng
- School of Mechanical Engineering & Automation-BUAA, Beihang University, Beijing, 100083, China
| | - Xingwei Zhao
- School of Mechanical Science & Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Bo Tao
- School of Mechanical Science & Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Diansheng Chen
- School of Mechanical Engineering & Automation-BUAA, Beihang University, Beijing, 100083, China
| | - Wenjie Liu
- Beijing WanTeFu Medical Instrument Co., Ltd, Beijing, 102299, China
| | - Han Ding
- School of Mechanical Science & Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China.
| | - Zhouping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Gunderman AL, Schmidt EJ, Xiao Q, Tokuda J, Seethamraju RT, Neri L, Halperin HR, Kut C, Viswanathan AN, Morcos M, Chen Y. MRI-Conditional Eccentric-Tube Injection Needle: Design, Fabrication, and Animal Trial. IEEE/ASME TRANSACTIONS ON MECHATRONICS : A JOINT PUBLICATION OF THE IEEE INDUSTRIAL ELECTRONICS SOCIETY AND THE ASME DYNAMIC SYSTEMS AND CONTROL DIVISION 2023; 28:2405-2410. [PMID: 39104914 PMCID: PMC11299889 DOI: 10.1109/tmech.2022.3232546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
Effective radiation therapy aims to maximize the radiation dose delivered to the tumor while minimizing damage to the surrounding healthy tissues, which can be a challenging task when the tissue-tumor space is small. To eliminate the damage to healthy tissue, it is now possible to inject biocompatible hydrogels between cancerous targets and surrounding tissues to create a spacer pocket. Conventional methods have limitations in poor target visualization and device tracking. In this paper, we leverage our MR-tracking technique to develop a novel injection needle for hydrogel spacer deployment. Herein, we present the working principle and fabrication method, followed by benchtop validation in an agar phantom, and MRI-guided validation in tissue-mimic prostate phantom and sexually mature female swine. Animal trials indicated that the spacer pockets in the rectovaginal septum can be accurately visualized on T2-weighted MRI. The experimental results showed that the vaginal-rectal spacing was successfully increased by 12 ± 2 mm anterior-posterior.
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Affiliation(s)
- Anthony L Gunderman
- Biomedical Engineering Department, Georgia Institute of Technology/Emory University, Atlanta, GA, 30318 USA
| | - Ehud J Schmidt
- Department of Medicine, Johns Hopkins University, Baltimore, MD., 21205
| | - Qingyu Xiao
- Biomedical Engineering Department, Georgia Institute of Technology/Emory University, Atlanta, GA, 30318 USA
| | - Junichi Tokuda
- Department of Radiology, Harvard Medical School, Boston, MA., 02115
| | | | - Luca Neri
- Department of Medicine, Johns Hopkins University, Baltimore, MD., 21205
| | - Henry R Halperin
- Department of Medicine, Johns Hopkins University, Baltimore, MD., 21205
| | - Carmen Kut
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD., 21205
| | - Akila N Viswanathan
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD., 21205
| | - Marc Morcos
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD., 21205
| | - Yue Chen
- Biomedical Engineering Department, Georgia Institute of Technology/Emory University, Atlanta, GA, 30318 USA
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Musa M, Sengupta S, Chen Y. Design of a 6-DoF Parallel Robotic Platform for MRI Applications. JOURNAL OF MEDICAL ROBOTICS RESEARCH 2022; 7:2241005. [PMID: 37614779 PMCID: PMC10445425 DOI: 10.1142/s2424905x22410057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
In this work, the design, analysis, and characterization of a parallel robotic motion generation platform with 6-degrees of freedom (DoF) for magnetic resonance imaging (MRI) applications are presented. The motivation for the development of this robot is the need for a robotic platform able to produce accurate 6-DoF motion inside the MRI bore to serve as the ground truth for motion modeling; other applications include manipulation of interventional tools such as biopsy and ablation needles and ultrasound probes for therapy and neuromodulation under MRI guidance. The robot is comprised of six pneumatic cylinder actuators controlled via a robust sliding mode controller. Tracking experiments of the pneumatic actuator indicates that the system is able to achieve an average error of 0.69 ± 0.14 mm and 0.67 ± 0.40 mm for step signal tracking and sinusoidal signal tracking, respectively. To demonstrate the feasibility and potential of using the proposed robot for minimally invasive procedures, a phantom experiment was performed in the benchtop environment, which showed a mean positional error of 1.20 ± 0.43 mm and a mean orientational error of 1.09 ± 0.57°, respectively. Experiments conducted in a 3T whole body human MRI scanner indicate that the robot is MRI compatible and capable of achieving positional error of 1.68 ± 0.31 mm and orientational error of 1.51 ± 0.32° inside the scanner, respectively. This study demonstrates the potential of this device to enable accurate 6-DoF motions in the MRI environment.
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Affiliation(s)
- Mishek Musa
- Department of Mechanical Engineering, University of Arkansas, Fayetteville, AR 72701, USA
| | - Saikat Sengupta
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Yue Chen
- Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA 30332, USA
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Insights into Infusion-Based Targeted Drug Delivery in the Brain: Perspectives, Challenges and Opportunities. Int J Mol Sci 2022; 23:ijms23063139. [PMID: 35328558 PMCID: PMC8949870 DOI: 10.3390/ijms23063139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 01/31/2023] Open
Abstract
Targeted drug delivery in the brain is instrumental in the treatment of lethal brain diseases, such as glioblastoma multiforme, the most aggressive primary central nervous system tumour in adults. Infusion-based drug delivery techniques, which directly administer to the tissue for local treatment, as in convection-enhanced delivery (CED), provide an important opportunity; however, poor understanding of the pressure-driven drug transport mechanisms in the brain has hindered its ultimate success in clinical applications. In this review, we focus on the biomechanical and biochemical aspects of infusion-based targeted drug delivery in the brain and look into the underlying molecular level mechanisms. We discuss recent advances and challenges in the complementary field of medical robotics and its use in targeted drug delivery in the brain. A critical overview of current research in these areas and their clinical implications is provided. This review delivers new ideas and perspectives for further studies of targeted drug delivery in the brain.
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Yan J, Chen J, Chen J, Yan W, Ding Q, Yan K, Du J, Lam CP, Wong GKC, Cheng SS. A Continuum Robotic Cannula with Tip Following Capability and Distal Dexterity for Intracerebral Hemorrhage Evacuation. IEEE Trans Biomed Eng 2022; 69:2958-2969. [PMID: 35275807 DOI: 10.1109/tbme.2022.3158539] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This paper aims to investigate a new continuum robot design and its motion implementation methods appropriate for a minimally invasive intracerebral hemorrhage (ICH) evacuation. METHODS We propose a continuum robotic cannula, consisting of a precurved body and a 2-degree-of-freedom (DoF) flexible tip, monolithically fabricated. Kinematics model with cable elongation model, and a dedicated design optimization and motion planning algorithm were developed to enable the follow-the-leader (FTL) motion of the cannula. A task-dependent Jacobian-based closed loop control was also designed to track the cannula motion during the insertion and its independent tip motion. RESULTS Comprehensive experiments were conducted to verify the kinematic model and submillimeter motion coupling between the cannula precurved body and its flexible tip. The cannula was also capable of achieving FTL motion within around 2.5 mm shape deviation and control performance within submillimeter errors. It was finally demonstrated to be capable of the nonlinear insertion and tip manipulation in the brain phantom. CONCLUSION The new cannula design, together with the proposed algorithms, provides the unique ability to access ICH in a nonlinear trajectory and dexterous tip motion. SIGNIFICANCE These motion capabilities of the robot in such a slender form factor will lead to more complete ICH evacuation and reduced trauma to the healthy brain tissues.
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Musa MJ, Carpenter AB, Kellner C, Sigounas D, Godage I, Sengupta S, Oluigbo C, Cleary K, Chen Y. Minimally Invasive Intracerebral Hemorrhage Evacuation: A review. Ann Biomed Eng 2022; 50:365-386. [PMID: 35226279 DOI: 10.1007/s10439-022-02934-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/11/2022] [Indexed: 11/01/2022]
Abstract
Intracerebral hemorrhage is a leading cause of morbidity and mortality worldwide. To date, there is no specific treatment that clearly provides a benefit in functional outcome or mortality. Surgical treatment for hematoma evacuation has not yet shown clear benefit over medical management despite promising preclinical studies. Minimally invasive treatment options for hematoma evacuation are under investigation but remain in early-stage clinical trials. Robotics has the potential to improve treatment. In this paper, we review intracerebral hemorrhage pathology, currently available treatments, and potential robotic approaches to date. We also discuss the future role of robotics in stroke treatment.
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Affiliation(s)
- Mishek J Musa
- Department of Mechanical Engineering, University of Arkansas, Fayetteville, AR, USA
| | | | - Christopher Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Medical System, New York, NY, USA
| | - Dimitri Sigounas
- Department of Neurosurgery, The George Washington University, Washington, Washington, DC, USA
| | - Isuru Godage
- College of Computing and Digital Media, DePaul University, Chicago, IL, USA
| | - Saikat Sengupta
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chima Oluigbo
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Yue Chen
- Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Dr NW, Atlanta, GA, 30332, USA.
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Gunderman AL, Schmidt EJ, Morcos M, Tokuda J, Seethamraju RT, Halperin HR, Viswanathan AN, Chen Y. MR-Tracked Deflectable Stylet for Gynecologic Brachytherapy. IEEE/ASME TRANSACTIONS ON MECHATRONICS : A JOINT PUBLICATION OF THE IEEE INDUSTRIAL ELECTRONICS SOCIETY AND THE ASME DYNAMIC SYSTEMS AND CONTROL DIVISION 2022; 27:407-417. [PMID: 35185321 PMCID: PMC8855967 DOI: 10.1109/tmech.2021.3064954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Brachytherapy is a radiation based treatment that is implemented by precisely placing focused radiation sources into tumors. In advanced interstitial cervical cancer bracytherapy treatment, this is performed by placing a metallic rod ("stylet") inside a hollow cylindrical tube ("catheter") and advancing the pair to the desired target. The stylet is removed once the target is reached, followed by the insertion of radiation sources into the catheter. However, manually advancing an initially straight stylet into the tumor with millimeter spatial accuracy has been a long-standing challenge, which requires multiple insertions and retractions, due to the unforeseen stylet deflection caused by the stiff muscle tissue that is traversed. In this paper, we develop a novel tendon-actuated deflectable stylet equipped with MR active-tracking coils that may enhance brachytherapy treatment outcomes by allowing accurate stylet trajectory control. Herein we present the design concept and fabrication method, followed by the kinematic and mechanics models of the deflectable stylet. The hardware and theoretical models are extensively validated via benchtop and MRI-guided characterization. At insertion depths of 60 mm, benchtop phantom targeting tests provided a targeting error of 1. 23 ± 0. 47 mm, and porcine tissue targeting tests provided a targeting error of 1. 65 ± 0. 64 mm, after only a single insertion. MR-guided experiments indicate that the stylet can be safely and accurately located within the MRI environment.
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Affiliation(s)
- Anthony L Gunderman
- Mechanical Engineering Department, University of Arkansas, Fayetteville, AR 72701 USA
| | - Ehud J Schmidt
- Department of Medicine, Johns Hopkins University, Baltimore, MD., 21205
| | - Marc Morcos
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD., 21205
| | - Junichi Tokuda
- Department of Radiology, Harvard Medical School, Boston, MA., 02115
| | | | - Henry R Halperin
- Department of Medicine, Johns Hopkins University, Baltimore, MD., 21205
| | - Akila N Viswanathan
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD., 21205
| | - Yue Chen
- Mechanical Engineering Department, University of Arkansas, Fayetteville, AR 72701 USA
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14
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Wang Y, Li G, Kwok KW, Cleary K, Taylor RH, Iordachita I. Towards Safe In Situ Needle Manipulation for Robot Assisted Lumbar Injection in Interventional MRI. PROCEEDINGS OF THE ... IEEE/RSJ INTERNATIONAL CONFERENCE ON INTELLIGENT ROBOTS AND SYSTEMS. IEEE/RSJ INTERNATIONAL CONFERENCE ON INTELLIGENT ROBOTS AND SYSTEMS 2021; 2021:1835-1842. [PMID: 35173994 PMCID: PMC8845499 DOI: 10.1109/iros51168.2021.9636220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Lumbar injection is an image-guided procedure performed manually for diagnosis and treatment of lower back pain and leg pain. Previously, we have developed and verified an MR-Conditional robotic solution to assisting the needle insertion process. Drawing on our clinical experiences, a virtual remote center of motion (RCM) constraint is implemented to enable our robot to mimic a clinician's hand motion to adjust the needle tip position in situ. Force and image data are collected to study the needle behavior in gel phantoms during this motion, and a mechanics-based needle-tissue interaction model is proposed and evaluated to further examine the underlying physics. This work extends the commonly-adopted notion of an RCM for flexible needles, and introduces new motion parameters to describe the needle behavior. The model parameters can be tuned to match the experimental result to sub-millimeter accuracy, and this proposed needle manipulation method presents a safer alternative to laterally translating the needle during in situ needle adjustments.
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Affiliation(s)
- Yanzhou Wang
- Department of Mechanical Engineering and Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gang Li
- Department of Mechanical Engineering and Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ka-Wai Kwok
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
| | - Russell H Taylor
- Department of Computer Science and Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Iulian Iordachita
- Department of Mechanical Engineering and Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
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15
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Yan K, Yan W, Zeng W, Ding Q, Chen J, Yan J, Lam CP, Wan S, Cheng SS. Towards a Wristed Percutaneous Robot With Variable Stiffness for Pericardiocentesis. IEEE Robot Autom Lett 2021. [DOI: 10.1109/lra.2021.3062583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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16
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Xiao Q, Monfaredi R, Musa M, Cleary K, Chen Y. MR-Conditional Actuations: A Review. Ann Biomed Eng 2020; 48:2707-2733. [PMID: 32856179 PMCID: PMC10620609 DOI: 10.1007/s10439-020-02597-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
Abstract
Magnetic resonance imaging (MRI) is one of the most prevailing technologies to enable noninvasive and radiation-free soft tissue imaging. Operating a robotic device under MRI guidance is an active research area that has the potential to provide efficient and precise surgical therapies. MR-conditional actuators that can safely drive these robotic devices without causing safety hazards or adversely affecting the image quality are crucial for the development of MR-guided robotic devices. This paper aims to summarize recent advances in actuation methods for MR-guided robots and each MR-conditional actuator was reviewed based on its working principles, construction materials, the noteworthy features, and corresponding robotic application systems, if any. Primary characteristics, such as torque, force, accuracy, and signal-to-noise ratio (SNR) variation due to the variance of the actuator, are also covered. This paper concludes with a perspective on the current development and future of MR-conditional actuators.
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Affiliation(s)
- Qingyu Xiao
- Department of Mechanical Engineering, University of Arkansas, Fayetteville, AR, USA
| | | | - Mishek Musa
- Department of Mechanical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Kevin Cleary
- Children's National Medical Center, Washington, DC, USA
| | - Yue Chen
- Department of Mechanical Engineering, University of Arkansas, Fayetteville, AR, USA.
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17
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Alfalahi H, Renda F, Stefanini C. Concentric Tube Robots for Minimally Invasive Surgery: Current Applications and Future Opportunities. ACTA ACUST UNITED AC 2020. [DOI: 10.1109/tmrb.2020.3000899] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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18
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Shao S, Sun B, Ding Q, Yan W, Zheng W, Yan K, Hong Y, Cheng SS. Design, Modeling, and Control of a Compact SMA-Actuated MR-Conditional Steerable Neurosurgical Robot. IEEE Robot Autom Lett 2020. [DOI: 10.1109/lra.2020.2967297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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19
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Chen Y, Howard J, Godage I, Sengupta S. Closed Loop Control of an MR-Conditional Robot with Wireless Tracking Coil Feedback. Ann Biomed Eng 2019; 47:2322-2333. [PMID: 31218486 DOI: 10.1007/s10439-019-02311-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/12/2019] [Indexed: 12/23/2022]
Abstract
This paper presents a hardware and software system to implement the task space control of an MR-conditional robot by integrating inductively coupled wireless coil based tracking feedback into the control loop. The main motivation of this work is to increase the accuracy performance and address the system uncertainties in the practical scenarios. We present the MR-conditional robot hardware design, wireless tracking method, and custom-designed communication software for real-time tracking data transfer. Based on these working principles, we fabricate the robot platform and evaluate the complete system with respect to various performance indices, i.e. data communication speed, targeting accuracy, tracking coil resolution, image quality, temperature variation, and task space control accuracy for static and dynamic targeting inside MRI scanner. The in-scanner targeting results show that the MR-conditional robot with wireless tracking coil feedback achieves the targeting error of 0.17 ± 0.08 mm, while the error calculated from the joint space optical encoder feedback is 0.68 ± 0.19 mm.
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Affiliation(s)
- Yue Chen
- Department of Mechanical Engineering, University of Arkansas, Fayetteville, AR, 72701, USA.
| | - Joseph Howard
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, 37212, USA
| | - Isuru Godage
- School of Computing, DePaul University, Chicago, IL, 60604, USA
| | - Saikat Sengupta
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
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Chen Y, Godage I, Su H, Song A, Yu H. Stereotactic Systems for MRI-Guided Neurosurgeries: A State-of-the-Art Review. Ann Biomed Eng 2018; 47:335-353. [PMID: 30377898 DOI: 10.1007/s10439-018-02158-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
Abstract
Recent technological developments in magnetic resonance imaging (MRI) and stereotactic techniques have significantly improved surgical outcomes. Despite the advantages offered by the conventional MRI-guided stereotactic neurosurgery, the robotic-assisted stereotactic approach has potential to further improve the safety and accuracy of neurosurgeries. This review aims to provide an update on the potential and continued growth of the MRI-guided stereotactic neurosurgical techniques by describing the state of the art in MR conditional stereotactic devices including manual and robotic-assisted. The paper also presents a detailed overview of MRI-guided stereotactic devices, MR conditional actuators and encoders used in MR conditional robotic-assisted stereotactic devices. The review concludes with several research challenges and future perspectives, including actuator and sensor technique, MR image guidance, and robot design issues.
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Affiliation(s)
- Yue Chen
- Department of Mechanical Engineering, University of Arkansas, Fayetteville, AR, USA.
| | - Isuru Godage
- School of Computing, DePaul University, Chicago, IL, USA
| | - Hao Su
- Department of Mechanical Engineering, City College of New York, New York, NY, USA
| | - Aiguo Song
- School of Instrument Science and Engineering, Southeast University, Nanjing, People's Republic of China
| | - Hong Yu
- Department of Neurological Surgery, Vanderbilt University, Nashville, TN, USA
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