Comparing deflection measurements of a magnetically steerable catheter using optical imaging and MRI

MRI-guided endovascular intervention: current methods and future potential

INTRODUCTION

Image-guided endovascular interventions, performed using the insertion and navigation of catheters through the vasculature, have been increasing in number over the years, as minimally invasive procedures continue to replace invasive surgical procedures. Such endovascular interventions are almost exclusively performed under x-ray fluoroscopy, which has the best spatial and temporal resolution of all clinical imaging modalities. Magnetic resonance imaging (MRI) offers unique advantages and could be an attractive alternative to conventional x-ray guidance, but also brings with it distinctive challenges.

AREAS COVERED

In this review, the benefits and limitations of MRI-guided endovascular interventions are addressed, systems and devices for guiding such interventions are summarized, and clinical applications are discussed.

EXPERT OPINION

MRI-guided endovascular interventions are still relatively new to the interventional radiology field, since significant technical hurdles remain to justify significant costs and demonstrate safety, design, and robustness. Clinical applications of MRI-guided interventions are promising but their full potential may not be realized until proper tools designed to function in the MRI environment are available. Translational research and further preclinical studies are needed before MRI-guided interventions will be practical in a clinical interventional setting.

Heat-Mitigated Design and Lorentz Force-Based Steering of an MRI-Driven Microcatheter toward Minimally Invasive Surgery

Catheters integrated with microcoils for electromagnetic steering under the high, uniform magnetic field within magnetic resonance (MR) scanners (3-7 Tesla) have enabled an alternative approach for active catheter operations. Achieving larger ranges of tip motion for Lorentz force-based steering have previously been dependent on using high power coupled with active cooling, bulkier catheter designs, or introducing additional microcoil sets along the catheter. This work proposes an alternative approach using a heat-mitigated design and actuation strategy for a magnetic resonance imaging (MRI)-driven microcatheter. A quad-configuration microcoil (QCM) design is introduced, allowing miniaturization of existing MRI-driven, Lorentz force-based catheters down to 1-mm diameters with minimal power consumption (0.44 W). Heating concerns are experimentally validated using noninvasive MRI thermometry. The Cosserat model is implemented within an MR scanner and results demonstrate a desired tip range up to 110° with 4° error. The QCM is used to validate the proposed model and power-optimized steering algorithm using an MRI-compatible neurovascular phantom and ex vivo kidney tissue. The power-optimized tip orientation controller conserves as much as 25% power regardless of the catheter's initial orientation. These results demonstrate the implementation of an MRI-driven, electromagnetic catheter steering platform for minimally invasive surgical applications without the need for camera feedback or manual advancement via guidewires. The incorporation of such system in clinics using the proposed design and actuation strategy can further improve the safety and reliability of future MRI-driven active catheter operations.

Wireless MRI-Powered Reversible Orientation-Locking Capsule Robot

Magnetic resonance imaging (MRI) scanners do not provide only high-resolution medical imaging but also magnetic robot actuation and tracking. However, the rotational motion capabilities of MRI-powered wireless magnetic capsule-type robots have been limited due to the very high axial magnetic field inside the MRI scanner. Medical functionalities of such robots also remain a challenge due to the miniature robot designs. Therefore, a wireless capsule-type reversible orientation-locking robot (REVOLBOT) is proposed that has decoupled translational motion and planar orientation change capability by locking and unlocking the rotation of a spherical ferrous bead inside the robot on demand. Such an on-demand locking/unlocking mechanism is achieved by a phase-changing wax material in which the ferrous bead is embedded inside. Controlled and on-demand hyperthermia and drug delivery using wireless power transfer-based Joule heating induced by external alternating magnetic fields are the additional features of this robot. The experimental feasibility of the REVOLBOT prototype with steerable navigation, medical function, and MRI tracking capabilities with an 1.33 Hz scan rate is demonstrated inside a preclinical 7T small-animal MRI scanner. The proposed robot has the potential for future clinical use in teleoperated minimally invasive treatment procedures with hyperthermia and drug delivery capabilities while being wirelessly powered and monitored inside MRI scanners.

Interventional neuro-oncology

Interventional neuro-oncology encompasses an array of image-guided therapies-intra-arterial chemotherapy, regional drug delivery, chemoembolization, tumor ablation-along with techniques to improve therapy delivery such as physical or chemical blood-brain barrier disruption and percutaneous catheter placement. Endovascular and percutaneous image-guided approaches to the treatment of the brain, eye, and other head and neck tumors will be discussed.

Catadioptric Stereo Tracking for Three Dimensional Shape Measurement of MRI Guided Catheters

The recent introduction of Magnetic Resonance Imaging (MRI)-actuated steerable catheters lays the ground work for increasing the efficacy of cardiac catheter procedures. The MRI, while capable of imaging the catheter for tracking and control, does not fulfill all of the needs required to identify and develop a complete catheter model. Specifially, the frequency response of the catheter must be identified to ensure stable control of the catheter system. This requires a higher frequency imaging than the MRI can achieve. This work uses a catadioptric stereo camera system consisting of a mirror and a single camera in order to track a MRI actuated catheter inside a MRI machine. The catadioptric system works in parallel to the MRI and is capable of recording the catheter at 60 fps for post processing. The accuracy of the catadioptric system is verified in imaging conditions that would be found inside the MRI. The stereo camera is then used to track a catheter as it is actuated inside the MRI.

Endovascular MR-guided Renal Embolization by Using a Magnetically Assisted Remote-controlled Catheter System

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.

Modeling and Validation of the Three-Dimensional Deflection of an MRI-Compatible Magnetically Actuated Steerable Catheter

OBJECTIVE

This paper presents the 3-D kinematic modeling of a novel steerable robotic ablation catheter system. The catheter, embedded with a set of current-carrying microcoils, is actuated by the magnetic forces generated by the magnetic field of the magnetic resonance imaging (MRI) scanner.

METHODS

This paper develops a 3-D model of the MRI-actuated steerable catheter system by using finite differences approach. For each finite segment, a quasi-static torque-deflection equilibrium equation is calculated using beam theory. By using the deflection displacements and torsion angles, the kinematic model of the catheter system is derived.

RESULTS

The proposed models are validated by comparing the simulation results of the proposed model with the experimental results of a hardware prototype of the catheter design. The maximum tip deflection error is 4.70 mm and the maximum root-mean-square error of the shape estimation is 3.48 mm.

CONCLUSION

The results demonstrate that the proposed model can successfully estimate the deflection motion of the catheter.

SIGNIFICANCE

The presented 3-D deflection model of the magnetically controlled catheter design paves the way to efficient control of the robotic catheter for the treatment of atrial fibrillation.

New-Generation Laser-lithographed Dual-Axis Magnetically Assisted Remote-controlled Endovascular Catheter for Interventional MR Imaging: In Vitro Multiplanar Navigation at 1.5 T and 3 T versus X-ray Fluoroscopy

PURPOSE

To assess the feasibility of multiplanar vascular navigation with a new magnetically assisted remote-controlled (MARC) catheter with real-time magnetic resonance (MR) imaging at 1.5 T and 3 T and to compare it with standard x-ray guidance in simulated endovascular catheterization procedures.

MATERIALS AND METHODS

A 1.6-mm-diameter custom clinical-grade microcatheter prototype with lithographed double-saddle coils at the distal tip was deflected with real-time MR imaging. Two inexperienced operators and two experienced operators catheterized anteroposterior (celiac, superior mesenteric, and inferior mesenteric arteries) and mediolateral (renal arteries) branch vessels in a cryogel abdominal aortic phantom. This was repeated with conventional x-ray fluoroscopy by using clinical catheters and guidewires. Mean procedure times and percentage success data were analyzed with linear mixed-effects regression.

RESULTS

The MARC catheter tip was visible at 1.5 T and 3 T. Among inexperienced operators, MARC MR imaging guidance was not statistically different from x-ray guidance at 1.5 T (67% successful vessel selection turns with MR imaging vs 76% with x-ray guidance, P = .157) and at 3 T (75% successful turns with MR imaging vs 76% with x-ray guidance, P = .869). Experienced operators were more successful in catheterizing vessels with x-ray guidance (98% success within 60 seconds) than with 1.5-T (65%, P < .001) or 3-T (75%) MR imaging. Among inexperienced operators, mean procedure time was nearly equivalent by using MR imaging (31 seconds) and x-ray guidance (34 seconds, P = .436). Among experienced operators, catheterization was faster with x-ray guidance (20 seconds) compared with 1.5-T MR imaging (42 seconds, P < .001), but MARC guidance improved at 3 T (31 seconds). MARC MR imaging guidance at 3 T was not significantly different from x-ray guidance for the celiac (P = .755), superior mesenteric (P = .358), and inferior mesenteric (P = .065) arteries.

CONCLUSION

Multiplanar navigation with a new MARC catheter with real-time MR imaging at 1.5 T and 3 T is feasible and comparable to x-ray guidance for anteroposterior vessels at 3 T in a vascular phantom.