1
|
Bernardes MC, Moreira P, Lezcano D, Foley L, Tuncali K, Tempany C, Kim JS, Hata N, Iordachita I, Tokuda J. In Vivo Feasibility Study: Evaluating Autonomous Data-Driven Robotic Needle Trajectory Correction in MRI-Guided Transperineal Procedures. IEEE Robot Autom Lett 2024; 9:8975-8982. [PMID: 39371576 PMCID: PMC11448709 DOI: 10.1109/lra.2024.3455940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
This study addresses the targeting challenges in MRI-guided transperineal needle placement for prostate cancer (PCa) diagnosis and treatment, a procedure where accuracy is crucial for effective outcomes. We introduce a parameter-agnostic trajectory correction approach incorporating a data-driven closed-loop strategy by radial displacement and an FBG-based shape sensing to enable autonomous needle steering. In an animal study designed to emulate clinical complexity and assess MRI compatibility through a PCa mock biopsy procedure, our approach demonstrated a significant improvement in targeting accuracy (p<0.05), with mean target error of only 2.2 ± 1.9 mm on first insertion attempts, without needle reinsertions. To the best of our knowledge, this work represents the first in vivo evaluation of robotic needle steering with FBG-sensor feedback, marking a significant step towards its clinical translation.
Collapse
Affiliation(s)
| | - Pedro Moreira
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | - Lori Foley
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Kemal Tuncali
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Clare Tempany
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jin Seob Kim
- Johns Hopkins University, Baltimore, MD 21218, USA
| | - Nobuhiko Hata
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | - Junichi Tokuda
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| |
Collapse
|
2
|
Bloemberg J, de Vries M, van Riel LAMJG, de Reijke TM, Sakes A, Breedveld P, van den Dobbelsteen JJ. Therapeutic prostate cancer interventions: a systematic review on pubic arch interference and needle positioning errors. Expert Rev Med Devices 2024; 21:625-641. [PMID: 38946519 DOI: 10.1080/17434440.2024.2374761] [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: 03/26/2024] [Accepted: 06/27/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION This study focuses on the quantification of and current guidelines on the hazards related to needle positioning in prostate cancer treatment: (1) access restrictions to the prostate gland by the pubic arch, so-called Pubic Arch Interference (PAI) and (2) needle positioning errors. Next, we propose solution strategies to mitigate these hazards. METHODS The literature search was executed in the Embase, Medline ALL, Web of Science Core Collection*, and Cochrane Central Register of Controlled Trials databases. RESULTS The literature search resulted in 50 included articles. PAI was reported in patients with various prostate volumes. The level of reported PAI varied between 0 and 22.3 mm, depending on the patient's position and the measuring method. Low-Dose-Rate Brachytherapy induced the largest reported misplacement errors, especially in the cranio-caudal direction (up to 10 mm) and the largest displacement errors were reported for High-Dose-Rate Brachytherapy in the cranio-caudal direction (up to 47 mm), generally increasing over time. CONCLUSIONS Current clinical guidelines related to prostate volume, needle positioning accuracy, and maximum allowable PAI are ambiguous, and compliance in the clinical setting differs between institutions. Solutions, such as steerable needles, assist in mitigating the hazards and potentially allow the physician to proceed with the procedure.This systematic review was performed in accordance with the PRISMA guidelines. The review was registered at Protocols.io (DOI: dx.doi.org/10.17504/protocols.io.6qpvr89eplmk/v1).
Collapse
Affiliation(s)
- Jette Bloemberg
- Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Martijn de Vries
- Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Luigi A M J G van Riel
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Theo M de Reijke
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Aimée Sakes
- Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Paul Breedveld
- Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - John J van den Dobbelsteen
- Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands
| |
Collapse
|
3
|
de Vries M, Christianen MEMC, Luthart L, de Vries KC, Kolkman-Deurloo IKK, van den Dobbelsteen JJ. Dosimetric benefits and preclinical performance of steerable needles in HDR prostate brachytherapy. Med Eng Phys 2024; 128:104177. [PMID: 38789214 DOI: 10.1016/j.medengphy.2024.104177] [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: 02/17/2023] [Revised: 04/19/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Abstract
Prostate cancer patients with an enlarged prostate and/or excessive pubic arch interference (PAI) are generally considered non-eligible for high-dose-rate (HDR) brachytherapy (BT). Steerable needles have been developed to make these patients eligible again. This study aims to validate the dosimetric impact and performance of steerable needles within the conventional clinical setting. HDR BT treatment plans were generated, needle implantations were performed in a prostate phantom, with prostate volume > 55 cm3 and excessive PAI of 10 mm, and pre- and post-implant dosimetry were compared considering the dosimetric constraints: prostate V100 > 95 % (13.50 Gy), urethra D0.1cm3 < 115 % (15.53 Gy) and rectum D1cm3 < 75 % (10.13 Gy). The inclusion of steerable needles resulted in a notable enhancement of the dose distribution and prostate V100 compared to treatment plans exclusively employing rigid needles to address PAI. Furthermore, the steerable needle plan demonstrated better agreement between pre- and post-implant dosimetry (prostate V100: 96.24 % vs. 93.74 %) compared to the rigid needle plans (79.13 % vs. 72.86 % and 87.70 % vs. 81.76 %), with no major changes in the clinical workflow and no changes in the clinical set-up. The steerable needle approach allows for more flexibility in needle positioning, ensuring a highly conformal dose distribution, and hence, HDR BT is a feasible treatment option again for prostate cancer patients with an enlarged prostate and/or excessive PAI.
Collapse
Affiliation(s)
- M de Vries
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, Netherlands.
| | - M E M C Christianen
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - L Luthart
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - K C de Vries
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - I K K Kolkman-Deurloo
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - J J van den Dobbelsteen
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, Netherlands
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Bernardes MC, Moreira P, Mareschal L, Tempany C, Tuncali K, Hata N, Tokuda J. Data-driven adaptive needle insertion assist for transperineal prostate interventions. Phys Med Biol 2023; 68:10.1088/1361-6560/accefa. [PMID: 37080237 PMCID: PMC10249778 DOI: 10.1088/1361-6560/accefa] [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] [Received: 11/30/2022] [Accepted: 04/20/2023] [Indexed: 04/22/2023]
Abstract
Objective.Clinical outcomes of transperineal prostate interventions, such as biopsy, thermal ablations, and brachytherapy, depend on accurate needle placement for effectiveness. However, the accurate placement of a long needle, typically 150-200 mm in length, is challenging due to needle deviation induced by needle-tissue interaction. While several approaches for needle trajectory correction have been studied, many of them do not translate well to practical applications due to the use of specialized needles not yet approved for clinical use, or to relying on needle-tissue models that need to be tailored to individual patients.Approach.In this paper, we present a robot-assisted collaborative needle insertion method that only requires an actuated passive needle guide and a conventional needle. The method is designed to assist a physician inserting a needle manually through a needle guide. If the needle is deviated from the intended path, actuators shifts the needle radially in order to steer the needle trajectory and compensate for needle deviation adaptively. The needle guide is controlled by a new data-driven algorithm which does not requirea prioriinformation about needle or tissue properties. The method was evaluated in experiments with bothin vitroandex vivophantoms.Main results.The experiments inex vivotissue reported a mean final placement error of 0.36 mm with a reduction of 96.25% of placement error when compared to insertions without the use of assistive correction.Significance.Presented results show that the proposed closed-loop formulation can be successfully used to correct needle deflection during collaborative manual insertion with potential to be easily translated into clinical application.
Collapse
Affiliation(s)
- Mariana C Bernardes
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Pedro Moreira
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Lisa Mareschal
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Clare Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Nobuhiko Hata
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Junichi Tokuda
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| |
Collapse
|
6
|
Lu M, Zhang Y, Lim CM, Ren H. Flexible Needle Steering with Tethered and Untethered Actuation: Current States, Targeting Errors, Challenges and Opportunities. Ann Biomed Eng 2023; 51:905-924. [PMID: 36943414 DOI: 10.1007/s10439-023-03163-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/05/2023] [Indexed: 03/23/2023]
Abstract
Accurate needle targeting is critical for many clinical procedures, such as transcutaneous biopsy or radiofrequency ablation of tumors. However, targeting errors may arise, limiting the widespread adoption of these procedures. Advances in flexible needle (FN) steering are emerging to mitigate these errors. This review summarizes the state-of-the-art developments of FNs and addresses possible targeting errors that can be overcome with steering actuation techniques. FN steering techniques can be classified as passive and active. Passive steering directly results from the needle-tissue interaction forces, whereas active steering requires additional forces to be applied at the needle tip, which enhances needle steerability. Therefore, the corresponding targeting errors of most passive FNs and active FNs are between 1 and 2 mm, and less than 1 mm, respectively. However, the diameters of active FNs range from 1.42 to 12 mm, which is larger than the passive steering needle varying from 0.5 to 1.4 mm. Therefore, the development of active FNs is an area of active research. These active FNs can be steered using tethered internal direct actuation or untethered external actuation. Examples of tethered internal direct actuation include tendon-driven, longitudinal segment transmission and concentric tube transmission. Tendon-driven FNs have various structures, and longitudinal segment transmission needles could be adapted to reduce tissue damage. Additionally, concentric tube needles have immediate advantages and clinical applications in natural orifice surgery. Magnetic actuation enables active FN steering with untethered external actuation and facilitates miniaturization. The challenges faced in the fabrication, sensing, and actuation methods of FN are analyzed. Finally, bio-inspired FNs may offer solutions to address the challenges faced in FN active steering mechanisms.
Collapse
Affiliation(s)
- Mingyue Lu
- The Key Laboratory of Advanced Manufacturing and Intelligent Technology, Harbin University of Science and Technology, Harbin, China
- Duke-NUS Graduate Medical School, Singapore, Singapore
- The Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Yongde Zhang
- The Key Laboratory of Advanced Manufacturing and Intelligent Technology, Harbin University of Science and Technology, Harbin, China
| | - Chwee Ming Lim
- The Department of Otolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Hongliang Ren
- The Department of Electronic Engineering and the Shun Hing Institute of Advanced Engineering, The Chinese University of Hong Kong, Hong Kong, China.
- The Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore.
| |
Collapse
|
7
|
de Vries M, Wilby SL, Palmer AL, Polak W, O’Hea I, Hodgson D, van den Dobbelsteen JJ. Overcoming pubic arch interference in prostate brachytherapy using steerable needles. J Contemp Brachytherapy 2022; 14:495-500. [PMID: 36478701 PMCID: PMC9720690 DOI: 10.5114/jcb.2022.121562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/19/2022] [Indexed: 07/24/2023] Open
Abstract
PURPOSE A proportion of patients are not directly eligible for prostate brachytherapy (BT) due to pubic arch interference (PAI). Constraints in positioning sources behind the pubic arch due to linear, horizontal needle paths, may hamper effective irradiation of the target volume. This work evaluated the effect of prostate volume (Vp) and patient posture change on the amount of PAI, and demonstrated that steerable needles may broaden the inclusion criteria for patients with enlarged prostates and observed PAI. MATERIAL AND METHODS Twenty-seven patients (Vp > 60 cc) were included in this study. Access obstruction to the prostate was evaluated using diagnostic magnetic resonance imaging (MRI) scans, after six upward rotations of the pelvis and the prostate in 5 degree steps, to indicate the effect of patient posture change from supine to lithotomy position. For patients with PAI, we evaluated if the steerable needle could access the obstructed volume of the prostate. RESULTS The data showed no clear relation between Vp and PAI. In 23 of the 27 patients, in which PAI was observed, 14 showed obstruction of the prostate of ≥ 10 mm in the supine position (mean PAI ± standard deviation: 15.2 ±3.8 mm). Anatomical rotation reduced PAI by 4.8 mm after every 10 degrees of upward rotation, still resulting in obstructions of 8.1 ±2.4 mm in 10 of the 14 cases after 15 degree rotation. The steerable needle enabled access to all the required coordinates of the prostate. CONCLUSIONS The ability to steer along curved paths enables prostate BT in patients with enlarged prostates and PAI, and reduces the change of needing to abandon treatment.
Collapse
Affiliation(s)
- Martijn de Vries
- Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - Sarah L. Wilby
- Medical Physics Department, Portsmouth Hospital University NHS Trust, Portsmouth, United Kingdom
| | - Antony L. Palmer
- Medical Physics Department, Portsmouth Hospital University NHS Trust, Portsmouth, United Kingdom
| | - Wojciech Polak
- Medical Physics Department, Portsmouth Hospital University NHS Trust, Portsmouth, United Kingdom
| | - Inna O’Hea
- Medical Physics Department, Portsmouth Hospital University NHS Trust, Portsmouth, United Kingdom
| | - Dominic Hodgson
- Urology Department, Portsmouth Hospital University NHS Trust, Portsmouth, United Kingdom
| | - John J. van den Dobbelsteen
- Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| |
Collapse
|