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Su H, Kwok KW, Cleary K, Iordachita I, Cavusoglu MC, Desai JP, Fischer GS. State of the Art and Future Opportunities in MRI-Guided Robot-Assisted Surgery and Interventions. PROCEEDINGS OF THE IEEE. INSTITUTE OF ELECTRICAL AND ELECTRONICS ENGINEERS 2022; 110:968-992. [PMID: 35756185 PMCID: PMC9231642 DOI: 10.1109/jproc.2022.3169146] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Magnetic resonance imaging (MRI) can provide high-quality 3-D visualization of target anatomy, surrounding tissue, and instrumentation, but there are significant challenges in harnessing it for effectively guiding interventional procedures. Challenges include the strong static magnetic field, rapidly switching magnetic field gradients, high-power radio frequency pulses, sensitivity to electrical noise, and constrained space to operate within the bore of the scanner. MRI has a number of advantages over other medical imaging modalities, including no ionizing radiation, excellent soft-tissue contrast that allows for visualization of tumors and other features that are not readily visible by other modalities, true 3-D imaging capabilities, including the ability to image arbitrary scan plane geometry or perform volumetric imaging, and capability for multimodality sensing, including diffusion, dynamic contrast, blood flow, blood oxygenation, temperature, and tracking of biomarkers. The use of robotic assistants within the MRI bore, alongside the patient during imaging, enables intraoperative MR imaging (iMRI) to guide a surgical intervention in a closed-loop fashion that can include tracking of tissue deformation and target motion, localization of instrumentation, and monitoring of therapy delivery. With the ever-expanding clinical use of MRI, MRI-compatible robotic systems have been heralded as a new approach to assist interventional procedures to allow physicians to treat patients more accurately and effectively. Deploying robotic systems inside the bore synergizes the visual capability of MRI and the manipulation capability of robotic assistance, resulting in a closed-loop surgery architecture. This article details the challenges and history of robotic systems intended to operate in an MRI environment and outlines promising clinical applications and associated state-of-the-art MRI-compatible robotic systems and technology for making this possible.
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Affiliation(s)
- Hao Su
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695 USA
| | - Ka-Wai Kwok
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong
| | - Kevin Cleary
- Children's National Health System, Washington, DC 20010 USA
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD 21218 USA
| | - M Cenk Cavusoglu
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH 44106 USA
| | - Jaydev P Desai
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332 USA
| | - Gregory S Fischer
- Department of Robotics Engineering, Worcester Polytechnic Institute, Worcester, MA 01609 USA
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Lillaney PV, Yang JK, Losey AD, Martin AJ, Cooke DL, Thorne BRH, Barry DC, Chu A, Stillson C, Do L, Arenson RL, Saeed M, Wilson MW, Hetts SW. Endovascular MR-guided Renal Embolization by Using a Magnetically Assisted Remote-controlled Catheter System. Radiology 2016; 281:219-28. [PMID: 27019290 DOI: 10.1148/radiol.2016152036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose To assess the feasibility of a magnetically assisted remote-controlled (MARC) catheter system under magnetic resonance (MR) imaging guidance for performing a simple endovascular procedure (ie, renal artery embolization) in vivo and to compare with x-ray guidance to determine the value of MR imaging guidance and the specific areas where the MARC system can be improved. Materials and Methods In concordance with the Institutional Animal Care and Use Committee protocol, in vivo renal artery navigation and embolization were tested in three farm pigs (mean weight 43 kg ± 2 [standard deviation]) under real-time MR imaging at 1.5 T. The MARC catheter device was constructed by using an intramural copper-braided catheter connected to a laser-lithographed saddle coil at the distal tip. Interventionalists controlled an in-room cart that delivered electrical current to deflect the catheter in the MR imager. Contralateral kidneys were similarly embolized under x-ray guidance by using standard clinical catheters and guidewires. Changes in renal artery flow and perfusion were measured before and after embolization by using velocity-encoded and perfusion MR imaging. Catheter navigation times, renal parenchymal perfusion, and renal artery flow rates were measured for MR-guided and x-ray-guided embolization procedures and are presented as means ± standard deviation in this pilot study. Results Embolization was successful in all six kidneys under both x-ray and MR imaging guidance. Mean catheterization time with MR guidance was 93 seconds ± 56, compared with 60 seconds ± 22 for x-ray guidance. Mean changes in perfusion rates were 4.9 au/sec ± 0.8 versus 4.6 au/sec ± 0.6, and mean changes in renal flow rate were 2.1 mL/min/g ± 0.2 versus 1.9 mL/min/g ± 0.2 with MR imaging and x-ray guidance, respectively. Conclusion The MARC catheter system is feasible for renal artery catheterization and embolization under real-time MR imaging in vivo, and quantitative physiologic measures under MR imaging guidance were similar to those measured under x-ray guidance, suggesting that the MARC catheter system could be used for endovascular procedures with interventional MR imaging. (©) RSNA, 2016.
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Affiliation(s)
- Prasheel V Lillaney
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Jeffrey K Yang
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Aaron D Losey
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Alastair J Martin
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Daniel L Cooke
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Bradford R H Thorne
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - David C Barry
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Andrew Chu
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Carol Stillson
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Loi Do
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Ronald L Arenson
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Maythem Saeed
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Mark W Wilson
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Steven W Hetts
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
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