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Chlorogiannis DD, Charalampopoulos G, Bale R, Odisio B, Wood BJ, Filippiadis DK. Innovations in Image-Guided Procedures: Unraveling Robot-Assisted Non-Hepatic Percutaneous Ablation. Semin Intervent Radiol 2024; 41:113-120. [PMID: 38993597 PMCID: PMC11236453 DOI: 10.1055/s-0044-1786724] [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: 07/13/2024]
Abstract
Interventional oncology is routinely tasked with the feat of tumor characterization or destruction, via image-guided biopsy and tumor ablation, which may pose difficulties due to challenging-to-reach structures, target complexity, and proximity to critical structures. Such procedures carry a risk-to-benefit ratio along with measurable radiation exposure. To streamline the complexity and inherent variability of these interventions, various systems, including table-, floor-, gantry-, and patient-mounted (semi-) automatic robotic aiming devices, have been developed to decrease human error and interoperator and intraoperator outcome variability. Their implementation in clinical practice holds promise for enhancing lesion targeting, increasing accuracy and technical success rates, reducing procedure duration and radiation exposure, enhancing standardization of the field, and ultimately improving patient outcomes. This narrative review collates evidence regarding robotic tools and their implementation in interventional oncology, focusing on clinical efficacy and safety for nonhepatic malignancies.
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Affiliation(s)
| | - Georgios Charalampopoulos
- 2nd Department of Radiology, University General Hospital “ATTIKON,” Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Reto Bale
- Department of Radiology, Interventional Oncology - Stereotaxy and Robotics, Medical University Innsbruck, Innsbruck, Austria
| | - Bruno Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bradford J. Wood
- Interventional Radiology and Center for Interventional Oncology, NIH Clinical Center and National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Dimitrios K. Filippiadis
- 2nd Department of Radiology, University General Hospital “ATTIKON,” Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Matsui Y, Kamegawa T, Tomita K, Uka M, Umakoshi N, Kawabata T, Munetomo K, Iguchi T, Matsuno T, Hiraki T. Robotic systems in interventional oncology: a narrative review of the current status. Int J Clin Oncol 2024; 29:81-88. [PMID: 37115426 DOI: 10.1007/s10147-023-02344-8] [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: 02/28/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
Interventional oncology offers minimally invasive treatments for malignant tumors for curative and palliative purposes based on the percutaneous insertion of needles or catheters into the target location under image guidance. Robotic systems have been gaining increasing attention as tools that provide potential advantages for image-guided interventions. Among the robotic systems developed for intervention, those relevant to the oncology field are mainly those for guiding or driving the needles in non-vascular interventional procedures such as biopsy and tumor ablation. Needle-guiding robots support planning the needle path and align the needle robotically according to the planned trajectory, which is combined with subsequent manual needle insertion by the physician through the needle guide. Needle-driving robots can advance the needle robotically after determining its orientation. Although a wide variety of robotic systems have been developed, only a limited number of these systems have reached the clinical phase or commercialization thus far. The results of previous studies suggest that such interventional robots have the potential to increase the accuracy of needle placement, facilitate out-of-plane needle insertion, decrease the learning curve, and reduce radiation exposure. On the other hand, increased complexity and costs may be a concern when using robotic systems compared with conventional manual procedures. Further data should be collected to comprehensively assess the value of robotic systems in interventional oncology.
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Affiliation(s)
- Yusuke Matsui
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan.
| | - Tetsushi Kamegawa
- Faculty of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Noriyuki Umakoshi
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Takahiro Kawabata
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Kazuaki Munetomo
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Toshihiro Iguchi
- Department of Radiological Technology, Faculty of Health Sciences, Okayama University, Okayama, Japan
| | - Takayuki Matsuno
- Faculty of Natural Science and Technology, Okayama University, Okayama, Japan
| | - Takao Hiraki
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
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Swikehardt M, Newsome J, Macey M, Park P, Vilvendhan R, Kamil A, Bercu Z, Flacke S. Percutaneous Robotics in Interventional Radiology. Tech Vasc Interv Radiol 2023; 26:100917. [PMID: 38071024 DOI: 10.1016/j.tvir.2023.100917] [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] [Indexed: 12/18/2023]
Abstract
The accuracy of the robotic device not only relies on a reproducible needle advancement, but also on the possibility to correct target movement at chosen checkpoints and to deviate from a linear to a nonlinear trajectory. We report our experience in using the robotic device for the insertion of trocar needles in CT guided procedures. The majority of procedures were targeted organ biopsies in the chest abdomen or pelvis. The accuracy of needle placement after target adjustments did not significantly differ from those patients where a linear trajectory could be used. The steering capabilities of the robot allow correction of target movement of the fly.
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Affiliation(s)
- Michael Swikehardt
- Department of Radiology, Lahey Hospital and Medical Center, Tufts University Medical School, Burlington, MA
| | - Janice Newsome
- Division or Interventional Radiology and Image guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, GA
| | - Matthew Macey
- Department of Radiology, Lahey Hospital and Medical Center, Tufts University Medical School, Burlington, MA
| | - Peter Park
- Division or Interventional Radiology and Image guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, GA
| | - Rajendran Vilvendhan
- Department of Radiology, Lahey Hospital and Medical Center, Tufts University Medical School, Burlington, MA
| | - Arif Kamil
- Division or Interventional Radiology and Image guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, GA
| | - Zachary Bercu
- Division or Interventional Radiology and Image guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, GA
| | - Sebastian Flacke
- Department of Radiology, Lahey Hospital and Medical Center, Tufts University Medical School, Burlington, MA.
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Hu S, Lu R, Zhu Y, Zhu W, Jiang H, Bi S. Application of Medical Image Navigation Technology in Minimally Invasive Puncture Robot. SENSORS (BASEL, SWITZERLAND) 2023; 23:7196. [PMID: 37631733 PMCID: PMC10459274 DOI: 10.3390/s23167196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023]
Abstract
Microneedle puncture is a standard minimally invasive treatment and surgical method, which is widely used in extracting blood, tissues, and their secretions for pathological examination, needle-puncture-directed drug therapy, local anaesthesia, microwave ablation needle therapy, radiotherapy, and other procedures. The use of robots for microneedle puncture has become a worldwide research hotspot, and medical imaging navigation technology plays an essential role in preoperative robotic puncture path planning, intraoperative assisted puncture, and surgical efficacy detection. This paper introduces medical imaging technology and minimally invasive puncture robots, reviews the current status of research on the application of medical imaging navigation technology in minimally invasive puncture robots, and points out its future development trends and challenges.
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Affiliation(s)
| | - Rongjian Lu
- School of Mechanical and Electronic Engineering, Nanjing Forestry University, Nanjing 210037, China; (S.H.)
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Chen X, Yan Y, Li A, Wang T, Wang Y. Robot-Assisted Needle Insertion for CT-Guided Puncture: Experimental Study with a Phantom and Animals. Cardiovasc Intervent Radiol 2023; 46:128-135. [PMID: 36380153 DOI: 10.1007/s00270-022-03301-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aimed to evaluate the accuracy and safety of robotic CT-guided needle insertion in phantom and animal experiments. MATERIALS AND METHODS A robotic system was developed for CT-guided needle insertion. For the phantom experiment, a specially made phantom containing multiple spherical was used. 15 robotic and manual insertions were conducted, and the accuracy, time, number of needle insertions, and radiation dose were compared between the robotic and manual insertion using Student's t-test. For the animal experiment, 20 robotic needle insertions were attempted toward simulated pulmonary nodules in the swine lung. The accuracy and safety of robotic CT-guided needle insertions were evaluated. RESULTS In the phantom experiment, the mean accuracies of manual and robotic insertion were 1.8 ± 0.3 mm and 1.9 ± 0.2 mm. The accuracy of robotic needle insertion had no significant difference with manual needle insertion, but the number of needle insertions and radiation dose of the robotic needle placement significantly decreased compared to manual needle placement. In the animal experiment, the mean accuracy of the robotic needle insertion was 3.8 ± 1.3 mm. The time for the whole needle insertion was 14.4 ± 4.8 min. The whole robotic needle insertions were safe and only one mild pneumothorax occurred. CONCLUSION CT-guided robotic needle insertion showed accuracy comparable to manual needle insertion, but the number of needle insertions, confirmatory scans, and radiation exposure had been reduced significantly. In future, we will further apply the robotic system to clinical experiments.
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Affiliation(s)
- Xiangqian Chen
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Yadong Yan
- School of Biological Science and Medical Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Ailing Li
- Beijing TrueHealth Medical Technology Co., Ltd., Beijing, China
| | - Tianmiao Wang
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Yu Wang
- School of Biological Science and Medical Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China.
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Scharll Y, Letrari S, Laimer G, Schullian P, Bale R. Puncture accuracy of an optical tracked robotic aiming device-a phantom study. Eur Radiol 2022; 32:6769-6776. [PMID: 35678863 PMCID: PMC9474375 DOI: 10.1007/s00330-022-08915-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/05/2022] [Accepted: 05/30/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the targeting accuracy of stereotactic punctures based on a hybrid robotic device in combination with optical tracking-a phantom study. METHODS CT data sets of a gelatin-filled plexiglass phantom with 1-, 3-, and 5-mm slice thickness were acquired. An optical navigation device served for planning of a total of 150 needle trajectories. All punctures were carried out semi-automatically with help of the trackable iSYS-1 robotic device. Conically shaped targets inside the phantom were punctured using Kirschner wires. Up to 8 K-wires were positioned sequentially based on the same planning CT and placement accuracy was assessed by taking control CTs and measuring the Euclidean (ED) and normal distances (NDs) between the wire and the entry and target point. RESULTS Using the StealthStation S7, the accomplished mean ND at the target for the 1-mm, 3-mm, and 5-mm slice thickness was 0.89 mm (SD ± 0.42), 0.93 mm (SD ± 0.45), and 0.73 mm (SD ± 0.50), respectively. The corresponding mean ED was 1.61 mm (SD ± 0.36), 2.04 mm (SD ± 0.59), and 1.76 mm (SD ± 0.45). The mean duration of the total procedure was 27.9 min, including image acquisition, trajectory planning, registration, placement of 8 wires, and the control-CT. CONCLUSIONS The optically tracked iSYS-1 robot allows for precise punctures in a phantom. The StealthStation S7 provided acceptable results and may be helpful for interventions in difficult anatomical regions and for those requiring complex multi-angle trajectories. In combination with our optical navigation tool, the trackable robot unit allows to cover a large treatment field and the compact design facilitates placement of needle-like instruments. KEY POINTS • The use of a robotic targeting device in combination with optical tracking (hybrid system) allows for accurate placement of needle-like instruments without repeated control imaging. • The compact robotic positioning unit in combination with a camera for optical tracking facilitates sequential placement of multiple K-wires in a large treatment volume.
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Affiliation(s)
- Yannick Scharll
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Sofia Letrari
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gregor Laimer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Peter Schullian
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Zhang W, Xia P, Liu S, Huang X, Zhao X, Liu Z, Dang H, Li X, Niu G. A coordinate positioning puncture method under robot-assisted CT-guidance: phantom and animal experiments. MINIM INVASIV THER 2022; 31:206-215. [PMID: 32633586 DOI: 10.1080/13645706.2020.1787451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the accuracy of the robot-assisted computed tomography (CT)-guided coordinate positioning puncture method by phantom and animal experiments. MATERIAL AND METHODS In the phantom experiment, seven robot-assisted punctures were made to evaluate the accuracy of the method. In the animal experiment, 18 punctures (nine robotic and nine manual) were made in the livers of nine rabbits. The indicators, such as needle-tract length, angle deviation, puncture accuracy, number of scans required, and radiation exposure dose were compared between manual and robotic punctures. The paired-samples t-test was used for analysis. RESULTS In the phantom experiment, the mean accuracy of seven punctures was 2.67 mm. In the animal experiment, there was no significant difference in needle-tract length (32.58 mm vs. 34.04 mm, p = .606), angle deviation (17.21° vs. 21.23° p = .557) and puncture accuracy (8.42 vs. 8.77 mm, p = .851) between the two groups. However, the number CT scans required (2.44 vs. 3.33, p = .002), and the radiation exposure dose (772.98 vs. 1077.89 mGy/cm, p = .003) were lower in the robot group than in the manual group. CONCLUSIONS The coordinate positioning puncture method under robot-assisted CT-guidance can reach an accuracy that is comparable to that of the traditional manual CT-guided puncture method and with fewer CT scanning times accompanied with a lower radiation dosage.
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Affiliation(s)
- Weifan Zhang
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Peng Xia
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Shijie Liu
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, PR China
| | - Xiaowei Huang
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, PR China
| | - Xinhui Zhao
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Zhao Liu
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Hui Dang
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Xiaohu Li
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, PR China
| | - Gang Niu
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
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Banerjee M, Chiew D, Patel KT, Johns I, Chappell D, Linton N, Cole GD, Francis DP, Szram J, Ross J, Zaman S. The impact of artificial intelligence on clinical education: perceptions of postgraduate trainee doctors in London (UK) and recommendations for trainers. BMC MEDICAL EDUCATION 2021; 21:429. [PMID: 34391424 PMCID: PMC8364021 DOI: 10.1186/s12909-021-02870-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/04/2021] [Indexed: 05/04/2023]
Abstract
BACKGROUND Artificial intelligence (AI) technologies are increasingly used in clinical practice. Although there is robust evidence that AI innovations can improve patient care, reduce clinicians' workload and increase efficiency, their impact on medical training and education remains unclear. METHODS A survey of trainee doctors' perceived impact of AI technologies on clinical training and education was conducted at UK NHS postgraduate centers in London between October and December 2020. Impact assessment mirrored domains in training curricula such as 'clinical judgement', 'practical skills' and 'research and quality improvement skills'. Significance between Likert-type data was analysed using Fisher's exact test. Response variations between clinical specialities were analysed using k-modes clustering. Free-text responses were analysed by thematic analysis. RESULTS Two hundred ten doctors responded to the survey (response rate 72%). The majority (58%) perceived an overall positive impact of AI technologies on their training and education. Respondents agreed that AI would reduce clinical workload (62%) and improve research and audit training (68%). Trainees were skeptical that it would improve clinical judgement (46% agree, p = 0.12) and practical skills training (32% agree, p < 0.01). The majority reported insufficient AI training in their current curricula (92%), and supported having more formal AI training (81%). CONCLUSIONS Trainee doctors have an overall positive perception of AI technologies' impact on clinical training. There is optimism that it will improve 'research and quality improvement' skills and facilitate 'curriculum mapping'. There is skepticism that it may reduce educational opportunities to develop 'clinical judgement' and 'practical skills'. Medical educators should be mindful that these domains are protected as AI develops. We recommend that 'Applied AI' topics are formalized in curricula and digital technologies leveraged to deliver clinical education.
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Affiliation(s)
- Maya Banerjee
- University College London, Gower Street, London, WC1E 6BT, UK
| | - Daphne Chiew
- Imperial College London, Exhibition Road, London, SW7 2AZ, UK
| | - Keval T Patel
- Guy's & St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Ieuan Johns
- Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK
| | - Digby Chappell
- Imperial College London, Exhibition Road, London, SW7 2AZ, UK
| | - Nick Linton
- Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK
| | - Graham D Cole
- Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK
| | | | - Jo Szram
- Royal College of Physicians, 11 St. Andrews Place, London, NW1 4LE, UK
| | - Jack Ross
- Guy's & St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Sameer Zaman
- Imperial College London, Exhibition Road, London, SW7 2AZ, UK.
- Guy's & St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
- Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK.
- Artificial Intelligence for Healthcare Centre for Doctoral Training, Imperial College London, South Kensington Campus, London, SW7 2BX, UK.
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Robotic CT-guided out-of-plane needle insertion: comparison of angle accuracy with manual insertion in phantom and measurement of distance accuracy in animals. Eur Radiol 2019; 30:1342-1349. [PMID: 31773299 PMCID: PMC7033049 DOI: 10.1007/s00330-019-06477-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/30/2019] [Accepted: 09/27/2019] [Indexed: 01/21/2023]
Abstract
Objectives To evaluate the accuracy of robotic CT-guided out-of-plane needle insertion in phantom and animal experiments. Methods A robotic system (Zerobot), developed at our institution, was used for needle insertion. In the phantom experiment, 12 robotic needle insertions into a phantom at various angles in the XY and YZ planes were performed, and the same insertions were manually performed freehand, as well as guided by a smartphone application (SmartPuncture). Angle errors were compared between the robotic and smartphone-guided manual insertions using Student’s t test. In the animal experiment, 6 robotic out-of-plane needle insertions toward targets of 1.0 mm in diameter placed in the kidneys and hip muscles of swine were performed, each with and without adjustment of needle orientation based on reconstructed CT images during insertion. Distance accuracy was calculated as the distance between the needle tip and the target center. Results In the phantom experiment, the mean angle errors of the robotic, freehand manual, and smartphone-guided manual insertions were 0.4°, 7.0°, and 3.7° in the XY plane and 0.6°, 6.3°, and 0.6° in the YZ plane, respectively. Robotic insertions in the XY plane were significantly (p < 0.001) more accurate than smartphone-guided insertions. In the animal experiment, the overall mean distance accuracy of robotic insertions with and without adjustment of needle orientation was 2.5 mm and 5.0 mm, respectively. Conclusion Robotic CT-guided out-of-plane needle insertions were more accurate than smartphone-guided manual insertions in the phantom and were also accurate in the in vivo procedure, particularly with adjustment during insertion. Key Points • Out-of-plane needle insertions performed using our robot were more accurate than smartphone-guided manual insertions in the phantom experiment and were also accurate in the in vivo procedure. • In the phantom experiment, the mean angle errors of the robotic and smartphone-guided manual out-of-plane needle insertions were 0.4° and 3.7° in the XY plane (p < 0.001) and 0.6° and 0.6° in the YZ plane (p = 0.65), respectively. • In the animal experiment, the overall mean distance accuracies of the robotic out-of-plane needle insertions with and without adjustments of needle orientation during insertion were 2.5 mm and 5.0 mm, respectively. Electronic supplementary material The online version of this article (10.1007/s00330-019-06477-1) contains supplementary material, which is available to authorized users.
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Hiraki T, Kamegawa T, Matsuno T, Sakurai J, Komaki T, Yamaguchi T, Tomita K, Uka M, Matsui Y, Iguchi T, Gobara H, Kanazawa S. Robotic needle insertion during computed tomography fluoroscopy-guided biopsy: prospective first-in-human feasibility trial. Eur Radiol 2019; 30:927-933. [PMID: 31444597 DOI: 10.1007/s00330-019-06409-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/25/2019] [Accepted: 08/07/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION This was a prospective, first-in-human trial to evaluate the feasibility and safety of insertion of biopsy introducer needles with our robot during CT fluoroscopy-guided biopsy in humans. MATERIALS AND METHODS Eligible patients were adults with a lesion ≥ 10 mm in an extremity or the trunk requiring pathological diagnosis with CT fluoroscopy-guided biopsy. Patients in whom at-risk structures were located within 10 mm of the scheduled needle tract were excluded. Ten patients (4 females and 6 males; mean [range] age, 72 [52-87] years) with lesions (mean [range] maximum diameter, 28 [14-52] mm) in the kidney (n = 4), lung (n = 3), mediastinum (n = 1), adrenal gland (n = 1), and muscle (n = 1) were enrolled. The biopsy procedure involved robotic insertion of a biopsy introducer needle followed by manual acquisition of specimens using a biopsy needle. The patients were followed up for 14 days. Feasibility was defined as the distance of ≤ 10 mm between needle tip after insertion and the nearest lesion edge on the CT fluoroscopic images. The safety of robotic insertion was evaluated on the basis of machine-related troubles and adverse events according to the Clavien-Dindo classification. RESULTS Robotic insertion of the introducer needle was feasible in all patients, enabling pathological diagnosis. There was no machine-related trouble. A total of 11 adverse events occurred in 8 patients, including 10 grade I events and 1 grade IIIa event. CONCLUSION Insertion of biopsy introducer needles with our robot was feasible at several locations in the human body. KEY POINTS • Insertion of biopsy introducer needles with our robot during CT fluoroscopy-guided biopsy was feasible at several locations in the human body.
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Affiliation(s)
- Takao Hiraki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.
| | - Tetsushi Kamegawa
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, 3-1-1 Tsushimanaka, Kitaku, Okayama, 700-8530, Japan
| | - Takayuki Matsuno
- Graduate School of Natural Science and Technology, Okayama University, 3-1-1 Tsushimanaka, Kitaku, Okayama, 700-8530, Japan
| | - Jun Sakurai
- Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Toshiyuki Komaki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Takuya Yamaguchi
- Division of Radiology, Medical Technology Department, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Toshihiro Iguchi
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Hideo Gobara
- Division of Medical Informatics, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
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Origami Lesion-Targeting Device for CT-Guided Interventions. J Imaging 2019; 5:jimaging5020023. [PMID: 34460471 PMCID: PMC8320902 DOI: 10.3390/jimaging5020023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 11/17/2022] Open
Abstract
The objective of this study is to preliminarily evaluate a lesion-targeting device for CT-guided interventions. The device is created by laser cutting the structure from a sheet of medical grade paperboard, 3D printing two radiocontrast agent grids onto the surface and folding the structure into a rectangular prism with a viewing window. An abdominal imaging phantom was used to evaluate the device through CT imaging and the targeting of lesions for needle insertion. The lesion-targeting trials resulted in a mean targeting error of 2.53 mm (SD 0.59 mm, n = 30). The device is rigid enough to adequately support standard biopsy needles, and it attaches to the patient, reducing the risk of tissue laceration by needles held rigidly in place by an external manipulator. Additional advantages include adequate support for the insertion of multiple surgical tools at once for procedures such as composite ablation and the potential to guide off-axial needle insertion. The low-cost and disposability of the device make it well-suited for the minimally invasive image-guided therapy environment.
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Pfeil A, Cazzato RL, Barbé L, De Marini P, Chiang JB, Garnon J, Renaud P, Gangi A. Robotically Assisted CBCT-Guided Needle Insertions: Preliminary Results in a Phantom Model. Cardiovasc Intervent Radiol 2018; 42:283-288. [DOI: 10.1007/s00270-018-2088-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 10/01/2018] [Indexed: 12/18/2022]
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Ghelfi J, Moreau-Gaudry A, Hungr N, Fouard C, Véron B, Medici M, Chipon E, Cinquin P, Bricault I. Evaluation of the Needle Positioning Accuracy of a Light Puncture Robot Under MRI Guidance: Results of a Clinical Trial on Healthy Volunteers. Cardiovasc Intervent Radiol 2018; 41:1428-1435. [PMID: 29876597 DOI: 10.1007/s00270-018-2001-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/26/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE To assess the accuracy of Light Puncture Robot (LPR) as a patient-mounted robot, in positioning a sham needle under MRI guidance for abdominal percutaneous interventions. MATERIALS AND METHODS This monocentric, prospective and non-controlled study was approved by the ethics review board. The study evaluated the accuracy of LPR V3 to achieve a virtual puncture in 20 healthy volunteers. Three trajectories were tried on each volunteer, under 3-T MRI guidance. RESULTS Accuracy under 5 mm in attaining a 10 cm-deep target was reached in 72% of attempts after 2 robot motions with a median error of 4.1 mm [2.1; 5.1]. Median procedure time for one trajectory was 12.9 min [10.2; 18.0] and median installation time was 9.0 min [6.0; 13.0]. CONCLUSION LPR accuracy in the deployment of a sham needle inside the MRI tunnel and its setup time are promising. Further studies need to be conducted to confirm these results before clinical trials.
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Affiliation(s)
- Julien Ghelfi
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France.
| | - Alexandre Moreau-Gaudry
- TIMC-IMAG, Univ. Grenoble-Alpes, 38000, Grenoble, France.,TIMC-IMAG, CNRS, 38000, Grenoble, France.,Inserm CIC 1406, 38000, Grenoble, France.,Pole Sante Publique, CHU Grenoble-Alpes, 38000, Grenoble, France
| | - Nikolai Hungr
- Laboratoire TIMC-IMAG (UMR CNRS 5525) - Équipe GMCAO, Faculté de Médecine - Pavillon Taillefer, 38706, La Tronche Cedex, France
| | - Céline Fouard
- Laboratoire TIMC-IMAG (UMR CNRS 5525) - Équipe GMCAO, Faculté de Médecine - Pavillon Taillefer, 38706, La Tronche Cedex, France
| | - Baptiste Véron
- Laboratoire TIMC-IMAG (UMR CNRS 5525) - Équipe GMCAO, Faculté de Médecine - Pavillon Taillefer, 38706, La Tronche Cedex, France
| | - Maud Medici
- Inserm CIC 1406, 38000, Grenoble, France.,CIC 1406, Univ. Grenoble-Alpes, 38000, Grenoble, France.,Pole Recherche, CHU Grenoble-Alpes, 38000, Grenoble, France
| | - Emilie Chipon
- Inserm CIC 1406, 38000, Grenoble, France.,CIC 1406, Univ. Grenoble-Alpes, 38000, Grenoble, France.,Pole Recherche, CHU Grenoble-Alpes, 38000, Grenoble, France
| | - Philippe Cinquin
- Laboratoire TIMC-IMAG (UMR CNRS 5525) - Équipe GMCAO, Faculté de Médecine - Pavillon Taillefer, 38706, La Tronche Cedex, France
| | - Ivan Bricault
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
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Shar B, Leis J, Coucher J. Infrared needle mapping to assist biopsy procedures and training. Healthc Technol Lett 2018; 5:65-69. [PMID: 29750115 PMCID: PMC5933369 DOI: 10.1049/htl.2017.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/25/2017] [Accepted: 10/04/2017] [Indexed: 11/19/2022] Open
Abstract
A computed tomography (CT) biopsy is a radiological procedure which involves using a needle to withdraw tissue or a fluid specimen from a lesion of interest inside a patient's body. The needle is progressively advanced into the patient's body, guided by the most recent CT scan. CT guided biopsies invariably expose patients to high dosages of radiation, due to the number of scans required whilst the needle is advanced. This study details the design of a novel method to aid biopsy procedures using infrared cameras. Two cameras are used to image the biopsy needle area, from which the proposed algorithm computes an estimate of the needle endpoint, which is projected onto the CT image space. This estimated position may be used to guide the needle between scans, and results in a reduction in the number of CT scans that need to be performed during the biopsy procedure. The authors formulate a 2D augmentation system which compensates for camera pose, and show that multiple low-cost infrared imaging devices provide a promising approach.
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Affiliation(s)
- Bruce Shar
- Division of Diagnostic Radiology Princess Alexandra Hospital Brisbane Queensland Australia
| | - John Leis
- School of Mechanical and Electrical Engineering University of Southern Queensland Toowoomba Queensland Australia
| | - John Coucher
- Division of Diagnostic Radiology Princess Alexandra Hospital Brisbane Queensland Australia
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