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de Vries M, Wijntjes M, Sikorski J, Moreira P, van de Berg NJ, van den Dobbelsteen JJ, Misra S. MR-guided HDR prostate brachytherapy with teleoperated steerable needles. J Robot Surg 2023; 17:2461-2469. [PMID: 37480476 PMCID: PMC10492758 DOI: 10.1007/s11701-023-01676-x] [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: 05/26/2023] [Accepted: 07/08/2023] [Indexed: 07/24/2023]
Abstract
Conformity of tumour volumes and dose plans in prostate brachytherapy (BT) can be constrained by unwanted needle deflections, needle access restrictions and visualisation limitations. This work validates the feasibility of teleoperated robotic control of an active steerable needle using magnetic resonance (MR) for guidance. With this system, perturbations can be counteracted and critical structures can be circumvented to access currently inaccessible areas. The system comprises of (1) a novel steerable needle, (2) the minimally invasive robotics in an MR environment (MIRIAM) system, and (3) the daVinci Research Kit (dVRK). MR scans provide visual feedback to the operator controlling the dVRK. Needle steering is performed along curved trajectories to avoid the urethra towards targets (representing tumour tissue) in a prostate phantom with a targeting error of 1.2 ± 1.0 mm. This work shows the potential clinical applicability of active needle steering for prostate BT with a teleoperated robotic system in an MR environment.
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Affiliation(s)
- M de Vries
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.
| | - M Wijntjes
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - J Sikorski
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - P Moreira
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - N J van de Berg
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
- Department of Gynaecological Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - J J van den Dobbelsteen
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - S Misra
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
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Detterich J, Taylor MD, Slesnick TC, DiLorenzo M, Hlavacek A, Lam CZ, Sachdeva S, Lang SM, Campbell MJ, Gerardin J, Whitehead KK, Rathod RH, Cartoski M, Menon S, Trachtenberg F, Gongwer R, Newburger J, Goldberg C, Dorfman AL. Cardiac Magnetic Resonance Imaging to Determine Single Ventricle Function in a Pediatric Population is Feasible in a Large Trial Setting: Experience from the Single Ventricle Reconstruction Trial Longitudinal Follow up. Pediatr Cardiol 2023; 44:1454-1461. [PMID: 37405456 PMCID: PMC10435402 DOI: 10.1007/s00246-023-03216-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/15/2023] [Indexed: 07/06/2023]
Abstract
The Single Ventricle Reconstruction (SVR) Trial was a randomized prospective trial designed to determine survival advantage of the modified Blalock-Taussig-Thomas shunt (BTTS) vs the right ventricle to pulmonary artery conduit (RVPAS) for patients with hypoplastic left heart syndrome. The primary aim of the long-term follow-up (SVRIII) was to determine the impact of shunt type on RV function. In this work, we describe the use of CMR in a large cohort follow up from the SVR Trial as a focused study of single ventricle function. The SVRIII protocol included short axis steady-state free precession imaging to assess single ventricle systolic function and flow quantification. There were 313 eligible SVRIII participants and 237 enrolled, ages ranging from 10 to 12.5 years. 177/237 (75%) participants underwent CMR. The most common reasons for not undergoing CMR exam were requirement for anesthesia (n = 14) or ICD/pacemaker (n = 11). A total of 168/177 (94%) CMR studies were diagnostic for RVEF. Median exam time was 54 [IQR 40-74] minutes, cine function exam time 20 [IQR 14-27] minutes, and flow quantification time 18 [IQR 12-25] minutes. There were 69/177 (39%) studies noted to have intra-thoracic artifacts, most common being susceptibility artifact from intra-thoracic metal. Not all artifacts resulted in non-diagnostic exams. These data describe the use and limitations of CMR for the assessment of cardiac function in a prospective trial setting in a grade-school-aged pediatric population with congenital heart disease. Many of the limitations are expected to decrease with the continued advancement of CMR technology.
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Affiliation(s)
- Jon Detterich
- Division of Cardiology, Children's Hospital Los Angeles and the University of Southern California, 4650 Sunset Blvd MS34, Los Angeles, CA, 90027, USA.
| | - Michael D Taylor
- Department of Pediatrics, Heart Institute Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Timothy C Slesnick
- Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, GA, USA
| | - Michael DiLorenzo
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Anthony Hlavacek
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Christopher Z Lam
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
- Division of Pediatric Imaging, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Shagun Sachdeva
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Sean M Lang
- Department of Pediatrics, Heart Institute Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jennifer Gerardin
- Departments of Internal Medicine and Pediatrics, Children's Hospital Wisconsin-Herma Heart Institute, Medical College of Wiscosin, Milwaukee, WI, USA
| | - Kevin K Whitehead
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rahul H Rathod
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark Cartoski
- Division of Pediatric Cardiology, Nemours Cardiac Center, Nemours Children's Hospital, Wilmington, DE,, USA
| | - Shaji Menon
- Division of Pediatric Cardiology, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | | | | | - Jane Newburger
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Caren Goldberg
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Adam L Dorfman
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
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Design and evaluation of an MRI-ready, self-propelled needle for prostate interventions. PLoS One 2022; 17:e0274063. [PMID: 36070302 PMCID: PMC9451087 DOI: 10.1371/journal.pone.0274063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/19/2022] [Indexed: 11/19/2022] Open
Abstract
Prostate cancer diagnosis and focal laser ablation treatment both require the insertion of a needle for biopsy and optical fibre positioning. Needle insertion in soft tissues may cause tissue motion and deformation, which can, in turn, result in tissue damage and needle positioning errors. In this study, we present a prototype system making use of a wasp-inspired (bioinspired) self-propelled needle, which is able to move forward with zero external push force, thereby avoiding large tissue motion and deformation. Additionally, the actuation system solely consists of 3D printed parts and is therefore safe to use inside a magnetic resonance imaging (MRI) system. The needle consists of six parallel 0.25-mm diameter Nitinol rods driven by the actuation system. In the prototype, the self-propelled motion is achieved by advancing one needle segment while retracting the others. The advancing needle segment has to overcome a cutting and friction force while the retracting needle segments experience a friction force in the opposite direction. The needle self-propels through the tissue when the friction force of the five retracting needle segments overcomes the sum of the friction and cutting forces of the advancing needle segment. We tested the performance of the prototype in ex vivo human prostate tissue inside a preclinical MRI system in terms of the slip ratio of the needle with respect to the prostate tissue. The results showed that the needle was visible in MR images and that the needle was able to self-propel through the tissue with a slip ratio in the range of 0.78–0.95. The prototype is a step toward self-propelled needles for MRI-guided transperineal laser ablation as a method to treat prostate cancer.
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MR Imaging Safety in the Interventional Environment. Magn Reson Imaging Clin N Am 2020; 28:583-591. [PMID: 33040998 DOI: 10.1016/j.mric.2020.07.007] [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: 11/23/2022]
Abstract
Interventional MR imaging procedures are rapidly growing in number owing to the excellent soft tissue resolution of MR imaging, lack of ionizing radiation, hardware and software advancements, and technical developments in MR imaging-compatible robots, lasers, and ultrasound equipment. The safe operation of an interventional MR imaging system is a complex undertaking, which is only possible with multidisciplinary planning, training, operations and oversight. Safety for both patients and operators is essential for successful operations. Herein, we review the safety concerns, solutions and challenges associated with the operation of a modern interventional MR imaging system.
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Kalmar M, Boese A, Maldonado I, Landes R, Friebe M. NITINOL-based actuator for device control even in high-field MRI environment. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 12:285-296. [PMID: 31920406 PMCID: PMC6936299 DOI: 10.2147/mder.s211686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/28/2019] [Indexed: 12/24/2022] Open
Abstract
Background The magnetic resonance imaging (MRI) environment with its high-strength magnetic fields requires specialized and sometimes sophisticated solutions for otherwise simple problems. One of these problems is MR-compatible actuator mechanisms that transfer a signal into an action. Purpose Normal actuators are based on a magnetic effect (eg, relays) and will typically not work in magnetic fields exceeding 1000 G, eg, inside the bore of an MR scanner. To enable the use of clinical devices inside the MRI, eg, for interventional procedures, there is a need for fully compatible actuators. Patients and methods Various actuators were compared for the purpose as a simple on-off switch within an MRI. NITNOL wire as an actuator showed the highest potential because of its simplicity and reliability. We tested the possible force achieved by the NITINOL wire related to the respective energy consumption, to provide a travel range of 2 mm. Results Compared to other actuators, the NITNOL wire is cheaper and requires less space. In the switching process however, there is a delay due to the time required for the heating of the wire up to the transformation temperature. The NITINOL switch shows a reliable behavior with regard to the generated force and the switching path over the entire measurement. Significant artifacts, caused by the NITNOL wire could not be detected in the MRI. Conclusion NITINOL wires can be repeatedly used, are relatively easy to implement and could be an economic alternative to other more complicated actuator technologies.
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Affiliation(s)
- Marco Kalmar
- Intelligente Katheter Inka, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Axel Boese
- Intelligente Katheter Inka, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Ivan Maldonado
- Intelligente Katheter Inka, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Rainer Landes
- Intelligente Katheter Inka, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Michael Friebe
- Intelligente Katheter Inka, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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Stoll A, van Oepen A, Friebe M. Intraoperative delivery of cell-killing boost radiation – a review of current and future methods. MINIM INVASIV THER 2016; 25:176-87. [DOI: 10.3109/13645706.2016.1173563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wireless mobile technology to improve workflow and feasibility of MR-guided percutaneous interventions. Int J Comput Assist Radiol Surg 2014; 10:665-76. [PMID: 25179151 DOI: 10.1007/s11548-014-1109-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 08/10/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE A wireless interactive display and control device combined with a platform-independent web-based user interface (UI) was developed to improve the workflow for interventional magnetic resonance imaging (iMRI). METHODS The iMRI-UI enables image acquisition of up to three independent slices using various pulse sequences with different contrast weighting. Pulse sequence, scan geometry and related parameters can be changed on the fly via the iMRI-UI using a tablet computer for improved lesion detection and interventional device targeting. The iMRI-UI was validated for core biopsies with a liver phantom ([Formula: see text] [Formula: see text] 40) and Thiel soft-embalmed human cadavers ([Formula: see text] [Formula: see text] 24) in a clinical 1.5T MRI scanner. RESULTS The iMRI-UI components and setup were tested and found conditionally MRI-safe to use according to current ASTM standards. Despite minor temporary touch screen interference at a close distance to the bore ([Formula: see text]20 cm), no other issues regarding quality or imaging artefacts were observed. The 3D root-mean-square distance error was [Formula: see text] (phantom)/[Formula: see text] mm (cadaver), and overall procedure times ranged between 12 and 22 (phantom)/20 and 55 min (cadaver). CONCLUSION The wireless iMRI-UI control setup enabled fast and accurate interventional biopsy needle placements along complex trajectories and improved the workflow for percutaneous interventions under MRI guidance in a preclinical trial.
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Rube MA, Fernandez-Gutierrez F, Cox BF, Holbrook AB, Houston JG, White RD, McLeod H, Fatahi M, Melzer A. Preclinical feasibility of a technology framework for MRI-guided iliac angioplasty. Int J Comput Assist Radiol Surg 2014; 10:637-50. [PMID: 25102933 DOI: 10.1007/s11548-014-1102-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 07/02/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Interventional MRI has significant potential for image guidance of iliac angioplasty and related vascular procedures. A technology framework with in-room image display, control, communication and MRI-guided intervention techniques was designed and tested for its potential to provide safe, fast and efficient MRI-guided angioplasty of the iliac arteries. METHODS A 1.5-T MRI scanner was adapted for interactive imaging during endovascular procedures using new or modified interventional devices such as guidewires and catheters. A perfused vascular phantom was used for testing. Pre-, intra- and post-procedural visualization and measurement of vascular morphology and flow was implemented. A detailed analysis of X-ray fluoroscopic angiography workflow was conducted and applied. Two interventional radiologists and one physician in training performed 39 procedures. All procedures were timed and analyzed. RESULTS MRI-guided iliac angioplasty procedures were successfully performed with progressive adaptation of techniques and workflow. The workflow, setup and protocol enabled a reduction in table time for a dedicated MRI-guided procedure to 6 min 33 s with a mean procedure time of 9 min 2 s, comparable to the mean procedure time of 8 min 42 s for the standard X-ray-guided procedure. CONCLUSIONS MRI-guided iliac vascular interventions were found to be feasible and practical using this framework and optimized workflow. In particular, the real-time flow analysis was found to be helpful for pre- and post-interventional assessments. Design optimization of the catheters and in vivo experiments are required before clinical evaluation.
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Affiliation(s)
- Martin A Rube
- Division of Imaging and Technology, Institute for Medical Science and Technology, University of Dundee, Wilson House, 1 Wurzburg Loan, Dundee, DD2 1FD, UK,
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Comparison of CT and MRI artefacts from coils and vascular plugs used for portal vein embolization. Eur J Radiol 2014; 83:692-5. [DOI: 10.1016/j.ejrad.2014.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 11/26/2013] [Accepted: 01/06/2014] [Indexed: 12/28/2022]
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Smith B, Thomson J, Crossland D, Spence MS, Morgan GJ. UK multicenter experience using the gore septal occluder (GSOTM) for atrial septal defect closure in children and adults. Catheter Cardiovasc Interv 2013; 83:581-6. [DOI: 10.1002/ccd.25216] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 08/05/2013] [Accepted: 09/14/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Ben Smith
- Yorkhill Hospital; Glasgow United Kingdom
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Morgan G, Lee KJ, Chaturvedi R, Benson L. A biodegradable device (BioSTAR™) for atrial septal defect closure in children. Catheter Cardiovasc Interv 2010; 76:241-5. [DOI: 10.1002/ccd.22517] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Peeters JM, van Faassen EEH, Bakker CJG. Magnetic resonance imaging of phase transitions in nitinol. J Biomed Mater Res A 2007; 80:938-45. [PMID: 17075800 DOI: 10.1002/jbm.a.30966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Magnetic resonance images are prone to artifacts caused by metallic objects. Apart from being a source of image degradation, such artifacts can also provide information about the magnetic properties of the foreign object. In this work, we aim to explore the potential of magnetic resonance imaging to detect and characterize changes in magnetic properties of nitinol undergoing temperature- or strain-induced phase changes. A spin echo and a gradient echo method were used to measure the magnetization changes related to the phase transformations. Results of both methods were in agreement and in accordance with the independent measurements using a vibrating sample magnetometer. Magnetic resonance imaging turned out to be a suitable method to visualize and quantify magnetization and phase changes in situ. It is not restricted to a single imaging strategy and does not require any modification of the test object. The results indicate the potential of magnetic resonance imaging to provide direct feedback of the thermomechanical state of the alloy.
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Affiliation(s)
- Johannes M Peeters
- Department of Radiology, Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, RM Q0S.459, 3584 CX Utrecht, The Netherlands.
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Abstract
Vascular implants can cause significant MR image artifacts due to the material (susceptibility artifact) or the electromagnetic characteristics (RF artifact). These artifacts are caused by the distortion of the magnetic field and interferences with the radio frequency (RF) waves of the MR imaging process. Void or complete vanishing of signals occurs in close proximity or inside implants. The artifacts can be minimized by using a material with low magnetic susceptibility and a design of the implant which avoids electrical conductive loops. But not all designs can be made loop-free and non conductive. A resonant circuit tuned to the Larmor frequency of the MR tomography overcomes the RF artifact and thus improves the visualization of the implant lumen. The paper reviews the state-of-the-art technology of the MR-signal improvement in implants lumen, with particular regard to the use of resonant circuits such as stents or Vena Cava Filter (VCF), with resonators in 1.0 Tesla and 1.5Tesla MRT.
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Affiliation(s)
- Erwin Immel
- BIOPHAN Europe GmbH, Castrop Rauxel, Germany
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