Human-scale navigation of magnetic microrobots in hepatic arteries

Using external actuation sources to navigate untethered drug-eluting microrobots in the bloodstream offers great promise in improving the selectivity of drug delivery, especially in oncology, but the current field forces are difficult to maintain with enough strength inside the human body (>70-centimeter-diameter range) to achieve this operation. Here, we present an algorithm to predict the optimal patient position with respect to gravity during endovascular microrobot navigation. Magnetic resonance navigation, using magnetic field gradients in clinical magnetic resonance imaging (MRI), is combined with the algorithm to improve the targeting efficiency of magnetic microrobots (MMRs). Using a dedicated microparticle injector, a high-precision MRI-compatible balloon inflation system, and a clinical MRI, MMRs were successfully steered into targeted lobes via the hepatic arteries of living pigs. The distribution ratio of the microrobots (roughly 2000 MMRs per pig) in the right liver lobe increased from 47.7 to 86.4% and increased in the left lobe from 52.2 to 84.1%. After passing through multiple vascular bifurcations, the number of MMRs reaching four different target liver lobes had a 1.7- to 2.6-fold increase in the navigation groups compared with the control group. Performing simulations on 19 patients with hepatocellular carcinoma (HCC) demonstrated that the proposed technique can meet the need for hepatic embolization in patients with HCC. Our technology offers selectable direction for actuator-based navigation of microrobots at the human scale.

Design of a Low-Cost, Self-Adaptive and MRI-Compatible Cardiac Gating System

OBJECTIVE

Cardiac gating, synchronizing medical scans with cardiac activity, is widely used to make quantitative measurements of physiological events and to obtain high-quality scans free of pulsatile artefacts. This can provide important information for disease diagnosis, targeted control of medical microrobots, etc. The current work proposes a low-cost, self-adaptive, MRI-compatible cardiac gating system.

METHOD

The system and its processing algorithm, based on the monitoring and analysis of blood pressure waveforms, are proposed. The system is tested in an in vitro experiment and two living pigs using four-dimensional (4D) flow magnetic resonance imaging (MRI) and two-dimensional phase-contrast (2D-PC) sequences.

RESULTS

in vitro and in vivo experiments reveal that the proposed system can provide stable cardiac synchronicity, has good MRI compatibility, and can cope with the fringe magnetic field of the MRI scanner, radiofrequency signals during image acquisition, and heart rate changes. High-resolution 4D flow imaging is successfully acquired both in vivo and in vitro. The difference between the 2D and 4D measurements is ≤ 21%. The incidence of false triggers is 0% in all tests, which is unattainable for other known cardiac gating methods.

CONCLUSION

The system has good MRI compatibility and can provide a stable and accurate trigger signal based on pressure waveform. It opens the door to applications where the previous gating methods were difficult to implement or not applicable.

Improving flat fluorescence microscopy in scattering tissue through deep learning strategies

Intravital microscopy in small animals growingly contributes to the visualization of short- and long-term mammalian biological processes. Miniaturized fluorescence microscopy has revolutionized the observation of live animals' neural circuits. The technology's ability to further miniaturize to improve freely moving experimental settings is limited by its standard lens-based layout. Typical miniature microscope designs contain a stack of heavy and bulky optical components adjusted at relatively long distances. Computational lensless microscopy can overcome this limitation by replacing the lenses with a simple thin mask. Among other critical applications, Flat Fluorescence Microscope (FFM) holds promise to allow for real-time brain circuits imaging in freely moving animals, but recent research reports show that the quality needs to be improved, compared with imaging in clear tissue, for instance. Although promising results were reported with mask-based fluorescence microscopes in clear tissues, the impact of light scattering in biological tissue remains a major challenge. The outstanding performance of deep learning (DL) networks in computational flat cameras and imaging through scattering media studies motivates the development of deep learning models for FFMs. Our holistic ray-tracing and Monte Carlo FFM computational model assisted us in evaluating deep scattering medium imaging with DL techniques. We demonstrate that physics-based DL models combined with the classical reconstruction technique of the alternating direction method of multipliers (ADMM) perform a fast and robust image reconstruction, particularly in the scattering medium. The structural similarity indexes of the reconstructed images in scattering media recordings were increased by up to 20% compared with the prevalent iterative models. We also introduce and discuss the challenges of DL approaches for FFMs under physics-informed supervised and unsupervised learning.

Towards recycling of waste carbon fiber: Strength, morphology and structural features of recovered carbon fibers

Carbon fiber is one of the most widely used materials in high demand applications due to its high specific properties, however, its post-recycling properties limit its use to low performance applications. In this research, the carbon fiber recovering is examined using two methods: two-step pyrolysis and microwave-assisted thermolysis. The results indicate that the fibers recovered by pyrolysis show reduced surface and structural damage, maintaining the original mechanical properties of the fiber with losses below 5%. The fibers recovered by microwaves undergo significant surface changes that reduce their tensile strength by up to 60% and changes in their graphitic structure, increasing their degree of crystallinity by Raman index I_D/I_G from 1.98 to 2.86 and their amorphous degree by I_D"/I_G ratio from 0.411 to 1.599. Recovering fibers from microwave technique is 70% faster compared to two step pyrolysis, and provides recycled fibers with superior surface activation with the presence of polar functional groups -OH, -CO, and -CH that react with the epoxy matrix. The thermal, morphological, structural and mechanical characterizations of the recovered fibers detailed in this work provide valuable findings to evaluate their direct reuse in new composite materials.

Design of a Patient-Specific Respiratory-Motion-Simulating Platform for In Vitro 4D Flow MRI

Four-dimensional (4D) flow magnetic resonance imaging (MRI) is a leading-edge imaging technique and has numerous medicinal applications. In vitro 4D flow MRI can offer some advantages over in vivo ones, especially in accurately controlling flow rate (gold standard), removing patient and user-specific variations, and minimizing animal testing. Here, a complete testing method and a respiratory-motion-simulating platform are proposed for in vitro validation of 4D flow MRI. A silicon phantom based on the hepatic arteries of a living pig is made. Under the free-breathing, a human volunteer's liver motion (inferior-superior direction) is tracked using a pencil-beam MRI navigator and is extracted and converted into velocity-distance pairs to program the respiratory-motion-simulating platform. With the magnitude displacement of about 1.3 cm, the difference between the motions obtained from the volunteer and our platform is ≤ 1 mm which is within the positioning error of the MRI navigator. The influence of the platform on the MRI signal-to-noise ratio can be eliminated even if the actuator is placed in the MRI room. The 4D flow measurement errors are respectively 0.4% (stationary phantom), 9.4% (gating window = 3 mm), 27.3% (gating window = 4 mm) and 33.1% (gating window = 7 mm). The vessel resolutions decreased with the increase of the gating window. The low-cost simulation system, assembled from commercially available components, is easy to be duplicated.

Quantification and 3D localization of magnetically navigated superparamagnetic particles using MRI in phantom and swine chemoembolization models

OBJECTIVE

Superparamagnetic nanoparticles (SPIONs) can be combined with tumor chemoembolization agents to form magnetic drug-eluting beads (MDEBs), which are navigated magnetically in the MRI scanner through the vascular system. We aim to develop a method to accurately quantify and localize these particles and to validate the method in phantoms and swine models.

METHODS

MDEBs were made of Fe₃O₄ SPIONs. After injected known numbers of MDEBs, susceptibility artifacts in three-dimensional (3D) volumetric interpolated breath-hold examination (VIBE) sequences were acquired in glass and Polyvinyl alcohol (PVA) phantoms, and two living swine. Image processing of VIBE images provided the volume relationship between MDEBs and their artifact at different VIBE acquisitions and post-processing parameters. Simulated hepatic-artery embolization was performed in vivo with an MRI-conditional magnetic-injection system, using the volume relationship to locate and quantify MDEB distribution.

RESULTS

Individual MDEBs were spatially identified, and their artifacts quantified, showing no correlation with magnetic-field orientation or sequence bandwidth, but exhibiting a relationship with echo time and providing a linear volume relationship. Two MDEB aggregates were magnetically steered into desired liver regions while the other 19 had no steering, and 25 aggregates were injected into another swine without steering. The MDEBs were spatially identified and the volume relationship showed accuracy in assessing the number of the MDEBs, with small errors (8.8%).

CONCLUSION AND SIGNIFICANCE

MDEBs were able to be steered into desired body regions and then localized using 3D VIBE sequences. The resulting volume relationship was linear, robust, and allowed for quantitative analysis of the MDEB distribution.

Effect of the donor´s age and type of extender (egg yolk versus clarified egg yolk) over the sperm quality of Majorera bucks preserved at 4 ºC: in vitro results and fertility trials

This study assessed the effect of donor´s age and two different extenders in the sperm quality of chilled semen in Majorera bucks. In experiment 1, semen was individually processed from 5 young (10–12 months old) and 4 mature (3–5 years old) bucks and then was diluted in two different extenders: EY (Tris‐glucose, 12% egg yolk) and CEY (Tris‐glucose, 12% clarified egg yolk) and cooled at 4°C; semen quality (sperm motility, percentages of alive spermatozoa, acrosome status and abnormal spermatozoa) was evaluated at 24, 48, 72 and 96 hr after cooling. In experiment II, 72 Majorera goats were assigned to four experimental groups: for groups 24‐EY (n = 18) and 24‐CEY (n = 18), goats were inseminated with EY and CEY cooled semen for 24 hr, respectively, while for groups 72‐EY (n = 18) and 72‐CEY (n = 18), goats were inseminated with EY and CEY cooled semen for 72 hr, respectively. In vitro results confirmed that only ejaculate volume and sperm concentration were significantly different between young and mature bucks. In addition, semen quality was similar between both diluents, presenting values for the first 48 hr similar to that recorded in fresh samples. The fertility rate was around 70% after 24 hr (4°C) in both groups, but the kidding rate was significantly lower (44.4%, p < .05) in goats inseminated with EY diluent preserved for 72 hr. Our results showed that the semen samples may be stored at 4°C in media with egg yolk or clarified egg yolk, and, therefore, the use of clarified egg yolk may represent a valid alternative to chill semen samples. Finally, young bucks (older than 10–12 months) of Majorera breed could be successfully used in breeding programmes with similar efficacy to older males.

Navigation of Microrobots by MRI: Impact of Gravitational, Friction and Thrust Forces on Steering Success

INTRODUCTION

Magnetic resonance navigation (MRN) uses MRI gradients to steer magnetic drug-eluting beads (MDEBs) across vascular bifurcations. We aim to experimentally verify our theoretical forces balance model (gravitational, thrust, friction, buoyant and gradient steering forces) to improve the MRN targeted success rate.

METHOD

A single-bifurcation phantom (3 mm inner diameter) made of poly-vinyl alcohol was connected to a cardiac pump at 0.8 mL/s, 60 beats/minutes with a glycerol solution to reproduce the viscosity of blood. MDEB aggregates (25 ± 6 particles, 200 [Formula: see text]) were released into the main branch through a 5F catheter. The phantom was tilted horizontally from - 10° to +25° to evaluate the MRN performance.

RESULTS

The gravitational force was equivalent to 71.85 mT/m in a 3T MRI. The gradient duration and amplitude had a power relationship (amplitude=78.717 [Formula: see text]). It was possible, in 15° elevated vascular branches, to steer 87% of injected aggregates if two MRI gradients are simultaneously activated ([Formula: see text] = +26.5 mT/m, [Formula: see text]= +18 mT/m for 57% duty cycle), the flow velocity was minimized to 8 cm/s and a residual pulsatile flow to minimize the force of friction.

CONCLUSION

Our experimental model can determine the maximum elevation angle MRN can perform in a single-bifurcation phantom simulating in vivo conditions.

Consensus statement: summary of the Quebec Lung Cancer Network recommendations for prioritizing patients with thoracic cancers in the context of the COVID-19 pandemic

Background

The emergence of covid-19 has the potential to change the way in which the health care system can accommodate various patient populations and might affect patients with non-covid-19 problems. The Quebec Lung Cancer Network, which oversees thoracic oncology services in the province of Quebec under the direction of the Ministère de la Santé et des Services sociaux, convened to develop recommendations to deal with the potential disruption of services in thoracic oncology in the province of Quebec. The summary provided here has been adapted from the original document posted on the Programme québécois du cancer Web site at: https://www.msss.gouv.qc.ca/professionnels/documents/coronavirus-2019-ncov/PJ1_Recommandations_oncologie-thoracique-200415.pdf.

Methods

Plans to optimize the health care system and potentially to prioritize services were discussed with respect to various levels of activity. For each level-of-activity scenario, suggestions were made for the services and treatments to prioritize and for those that might have to be postponed, as well as for potential alternatives to care.

Results

The principal recommendation is that the cancer centre executive committee and the multidisciplinary tumour board always try to find a solution to maintain standard-of-care therapy for all patients with thoracic tumours, using novel approaches to treatment and the adoption of a network approach to care, as needed.

Conclusions

The effect of the covid-19 pandemic on the health care system remains unpredictable and requires that cancer teams unite and offer the most efficient and innovative therapies to all patients under the various conditions that might be forced upon them.

Using the fringe field of a clinical MRI scanner enables robotic navigation of tethered instruments in deeper vascular regions

Navigating tethered instruments through the vasculatures to reach deeper physiological locations presently inaccessible would extend the applicability of many medical interventions, including but not limited to local diagnostics, imaging, and therapies. Navigation through narrower vessels requires minimizing the diameter of the instrument, resulting in a decrease of its stiffness until steerability becomes unpractical, while pushing the instrument at the insertion site to counteract the friction forces from the vessel walls caused by the bending of the instrument. To reach beyond the limit of using a pushing force alone, we report a method relying on a complementary directional pulling force at the tip created by gradients resulting from the magnetic fringe field emanating outside a clinical magnetic resonance imaging (MRI) scanner. The pulling force resulting from gradients exceeding 2 tesla per meter in a space that supports human-scale interventions allows the use of smaller magnets, such as the deformable spring as described here, at the tip of the instrument. Directional forces are achieved by robotically positioning the patient at predetermined successive locations inside the fringe field, a method that we refer to as fringe field navigation (FFN). We show through in vitro and in vivo experiments that x-ray-guided FFN could navigate microguidewires through complex vasculatures well beyond the limit of manual procedures and existing magnetic platforms. Our approach facilitated miniaturization of the instrument by replacing the torque from a relatively weak magnetic field with a configuration designed to exploit the superconducting magnet-based directional forces available in clinical MRI rooms.

Magnetic Resonance Navigation for Targeted Embolization in a Two-Level Bifurcation Phantom

This work combines a particle injection system with our proposed magnetic resonance navigation (MRN) sequence with the intention of validating MRN in a two-bifurcation phantom for endovascular treatment of hepatocellular carcinoma (HCC). A theoretical physical model used to calculate the most appropriate size of the magnetic drug-eluting bead (MDEB, 200 μm) aggregates was proposed. The aggregates were injected into the phantom by a dedicated particle injector while a trigger signal was automatically sent to the MRI to start MRN which consists of interleaved tracking and steering sequences. When the main branch of the phantom was parallel to B₀, the aggregate distribution ratio in the (left-left, left-right, right-left and right-right divisions was obtained with results of 8, 68, 24 and 0% respectively at baseline (no MRN) and increased to 84%, 100, 84 and 92% (p < 0.001, p = 0.004, p < 0.001, p < 0.001) after implementing our MRN protocol. When the main branch was perpendicular to B₀, the right-left branch, having the smallest baseline distribution rate of 0%, reached 80% (p < 0.001) after applying MRN. Moreover, the success rate of MRN was always more than 92% at the 1st bifurcation in the experiments above.

Multifunctional Self-Assembled Supernanoparticles for Deep-Tissue Bimodal Imaging and Amplified Dual-Mode Heating Treatment

Developing multifunctional therapeutic and diagnostic (theranostic) nanoplatforms is critical for addressing challenging issues associated with cancers. Here, self-assembled supernanoparticles consisting of superparamagnetic Fe₃O₄ nanoparticles and photoluminescent PbS/CdS quantum dots whose emission lies within the second biological window (II-BW) are developed. The proposed self-assembled Fe₃O₄ and PbS/CdS (II-BW) supernanoparticles [SASNs (II-BW)] exhibit outstanding photoluminescence detectable through a tissue as thick as 14 mm, by overcoming severe light extinction and concomitant autofluorescence in II-BW, and significantly enhanced T₂ relaxivity (282 mM^-1 s^-1, ca. 4 times higher than free Fe₃O₄ nanoparticles) due to largely enhanced magnetic field inhomogeneity. On the other hand, SASNs (II-BW) possess the dual capacity to act as both magnetothermal and photothermal agents, overcoming the main drawbacks of each type of heating separately. When SASNs (II-BW) are exposed to the dual-mode (magnetothermal and photothermal) heating, the thermal energy transfer efficiency is amplified 7-fold compared with magnetic heating alone. These results, in hand with the excellent photo- and colloidal stability, and negligible cytotoxicity, demonstrate the potential use of SASNs (II-BW) for deep-tissue bimodal (magnetic resonance and photoluminescence) in vivo imaging, while simultaneously providing the possibility of SASNs (II-BW)-mediated amplified dual-mode heating treatment for cancer therapy.

MRI-Compatible Injection System for Magnetic Microparticle Embolization

OBJECTIVE

Dipole field navigation and magnetic resonance navigation exploit B₀ magnetic fields and imaging gradients for targeted intra-arterial therapies by using magnetic drug-eluting beads (MDEBs). The strong magnetic strength (1.5 or 3 T) of clinical magnetic resonance imaging (MRI) scanners is the main challenge preventing the formation and controlled injection of specific-sized particle aggregates. Here, an MRI-compatible injector is proposed to solve the above problem.

METHODS

The injector consists of two peristaltic pumps, an optical counter, and a magnetic trap. The magnetic property of microparticles, the magnetic compatibility of different parts within the injector, and the field distribution of the MRI system were studied to determine the optimal design and setup of the injector. The performance was investigated through 30.4-emu/g biocompatible magnetic microparticles (230 ± 35 μm in diameter) corresponding to the specifications needed for trans-arterial chemoembolization in human adults.

RESULTS

The system can form aggregates containing 20 to 60 microparticles with a precision of six particles. The corresponding aggregate lengths range from 1.6 to 3.2 mm. Based on the injections of 50 MRI-visible boluses into a phantom which mimics realistic physiological conditions, 82% of the aggregates successfully reached subbranches.

CONCLUSION AND SIGNIFICANCE

This system has the capability to operate within the strong magnetic field of a clinical 3-T MRI, to form proper particle aggregates and to automatically inject these aggregates into the MRI bore. Moreover, the versatility of the proposed injector renders it suitable for selective injections of MDEBs during MR-guided embolization procedures.

Selective embolization with magnetized microbeads using magnetic resonance navigation in a controlled-flow liver model

PURPOSE

The purpose of this study was to demonstrate the feasibility of using a custom gradient sequence on an unmodified 3T magnetic resonance imaging (MRI) scanner to perform magnetic resonance navigation (MRN) by investigating the blood flow control method in vivo, reproducing the obtained rheology in a phantom mimicking porcine hepatic arterial anatomy, injecting magnetized microbead aggregates through an implantable catheter, and steering the aggregates across arterial bifurcations for selective tumor embolization.

MATERIALS AND METHODS

In the first phase, arterial hepatic velocity was measured using cine phase-contrast imaging in seven pigs under free-flow conditions and controlled-flow conditions, whereby a balloon catheter is used to occlude arterial flow and saline is injected at different rates. Three of the seven pigs previously underwent selective lobe embolization to simulate a chemoembolization procedure. In the second phase, the measured in vivo controlled-flow velocities were approximately reproduced in a Y-shaped vascular bifurcation phantom by injecting saline at an average rate of 0.6 mL/s with a pulsatile component. Aggregates of 200-μm magnetized particles were steered toward the right or left hepatic branch using a 20-mT/m MRN gradient. The phantom was oriented at 0°, 45°, and 90° with respect to the B₀ magnetic field. The steering differences between left-right gradient and baseline were calculated using Fisher's exact test. A theoretical model of the trajectory of the aggregate within the main phantom branch taking into account gravity, magnetic force, and hydrodynamic drag was also designed, solved, and validated against the experimental results to characterize the physical limitations of the method.

RESULTS

At an injection rate of 0.5 mL/s, the average flow velocity decreased from 20 ± 15 to 8.4 ± 5.0 cm/s after occlusion in nonembolized pigs and from 13.6 ± 2.0 to 5.4 ± 3.0 cm/s in previously embolized pigs. The pulsatility index measured to be 1.7 ± 1.8 and 1.1 ± 0.1 for nonembolized and embolized pigs, respectively, decreased to 0.6 ± 0.4 and 0.7 ± 0.3 after occlusion. For MRN performed at each orientation, the left-right distribution of aggregates was 55%, 25%, and 75% on baseline and 100%, 100%, and 100% (P < 0.001, P = 0.003, P = 0.003) after the application of MRN, respectively. According to the theoretical model, the aggregate reaches a stable transverse position located toward the direction of the gradient at a distance equal to 5.8% of the radius away from the centerline within 0.11 s, at which point the aggregate will have transited through a longitudinal distance of 1.0 mm from its release position.

CONCLUSION

In this study, we showed that the use of a balloon catheter reduces arterial hepatic flow magnitude and variation with the aim to reduce steering failures caused by fast blood flow rates and low magnetic steering forces. A mathematical model confirmed that the reduced flow rate is low enough to maximize steering ratio. After reproducing the flow rate in a vascular bifurcation phantom, we demonstrated the feasibility of MRN after injection of microparticle aggregates through a dedicated injector. This work is an important step leading to MRN-based selective embolization techniques in humans.

Adherence to guidelines in requesting Oncotype DX in a publicly funded health care system

Background

Oncotype dx [odx (Genomic Health, Redwood City, CA, U.S.A.)] is an approved prognostic tool for women with node-negative, hormone receptor-positive, her2-negative breast cancer. Because of cost, optimal use of this test is crucial, especially in a publicly funded health care system. We evaluated adherence with our provincial guidelines for odx requests, the management of patients with an intermediate recurrence score (rs), and the cost impact of odx.

Methods

This retrospective study included 201 consecutive patients with an odx request from two university institutions in Quebec between May 2012 and December 2014. Concordance with provincial guidelines was estimated, with its 95% confidence interval (ci). For patients with an intermediate rs, factors influencing the final treatment decision were assessed. The cost impact of odx was derived from the proportion of patients for whom chemotherapy was not recommended.

Results

In 93.0% of patients (95% ci: 89.5% to 96.6%), odx was ordered according to guidelines. The concordance was similar in both institutions (92.7%; 95% ci: 88.1% to 97.3%; and 93.6%; 95% ci: 88.2% to 99.0%). In 112 (55.7%), 78 (38.8%), and 9 (4.5%) patients, the rs suggested low, intermediate, and high risk respectively. In the intermediate-risk group, most patients (n = 58, 74.4%) did not receive chemotherapy, mainly because of patient preference and the absence of a clear proven benefit. Savings of CA$100,000 for the study period (2.5 years) were estimated to be associated with odx use.

Conclusions

In our experience, the use of odx was concordant with published recommendations and had a positive cost impact.

A Wireless Fiber Photometry System Based on a High-Precision CMOS Biosensor With Embedded Continuous-Time Modulation

Fluorescence biophotometry measurements require wide dynamic range (DR) and high-sensitivity laboratory apparatus. Indeed, it is often very challenging to accurately resolve the small fluorescence variations in presence of noise and high-background tissue autofluorescence. There is a great need for smaller detectors combining high linearity, high sensitivity, and high-energy efficiency. This paper presents a new biophotometry sensor merging two individual building blocks, namely a low-noise sensing front-end and a order continuous-time modulator (CTSDM), into a single module for enabling high-sensitivity and high energy-efficiency photo-sensing. In particular, a differential CMOS photodetector associated with a differential capacitive transimpedance amplifier-based sensing front-end is merged with an incremental order 1-bit CTSDM to achieve a large DR, low hardware complexity, and high-energy efficiency. The sensor leverages a hardware sharing strategy to simplify the implementation and reduce power consumption. The proposed CMOS biosensor is integrated within a miniature wireless head mountable prototype for enabling biophotometry with a single implantable fiber in the brain of live mice. The proposed biophotometry sensor is implemented in a 0.18- CMOS technology, consuming from a 1.8- supply voltage, while achieving a peak dynamic range of over a 50- input bandwidth, a sensitivity of 24 mV/nW, and a minimum detectable current of 2.46- at a 20- sampling rate.

Biohybrid actuators for robotics: A review of devices actuated by living cells

Actuation is essential for artificial machines to interact with their surrounding environment and to accomplish the functions for which they are designed. Over the past few decades, there has been considerable progress in developing new actuation technologies. However, controlled motion still represents a considerable bottleneck for many applications and hampers the development of advanced robots, especially at small length scales. Nature has solved this problem using molecular motors that, through living cells, are assembled into multiscale ensembles with integrated control systems. These systems can scale force production from piconewtons up to kilonewtons. By leveraging the performance of living cells and tissues and directly interfacing them with artificial components, it should be possible to exploit the intricacy and metabolic efficiency of biological actuation within artificial machines. We provide a survey of important advances in this biohybrid actuation paradigm.

Assessment of the Accuracy of Optical Shape Sensing for Needle Tracking Interventions

Accurate needle guidance is essential for a number of magnetic resonance imaging (MRI)-guided percutaneous procedures, such as radiofrequency ablation (RFA) of metastatic liver tumors. A promising technology to obtain real-time tracking of the shape and tip of a needle is by using high-frequency (up to 20 kHz) fiber Bragg grating (FBG) sensors embedded in optical fibers, which are insensitive to external magnetic fields. We fabricated an MRI-compatible needle designed for percutaneous procedures with a series of FBG sensors which would be tracked in an image-guidance system, allowing to display the needle shape within a navigation image. A series of phantom experiments demonstrated needle tip tracking errors of 1.05 ± 0.08 mm for a needle deflection up to 16.82 mm on a ground-truth model and showed nearly similar accuracy to electromagnetic (EM) tracking (i.e., 0.89 ± 0.09 mm). We demonstrated feasibility of the FBG-based tracking system for MRI-guided interventions with differences under 1 mm between tracking systems. This study establishes the needle tracking accuracy of FBG needle tracking for image-guided procedures.

Abstract P2-05-30: OncotypeDX® for breast cancer: A multigene assay that makes a difference?

Objective: OncotypeDX® (ODX) is a multigene diagnostic assay that can estimate the 10 year-risk of distant recurrence in women with hormone receptor positive (HR+) and node negative (N–) early breast cancer. The testreports a Recurrence Score® (RS) and three risk group categories have been described: low-risk (&lt;18), intermediate-risk (18-30) and high-risk (≥31). It helps the oncologist in the adjuvant chemotherapy decision process and globally leads to a reduction in the recommendation for chemotherapy use. This test is expensive and represents an economic burden in a publicly funded province. Nonetheless, its use has been approved over other gene expression profiling like Mammaprint® based on the evidence of its prognostic and predictive ability. We evaluated the adequacy of the requests for the ODX in an academic setting after the introduction in May 2012 of a reference framework for its use in Québec, Canada and the impact on chemotherapy recommendation. The costs generated by the test were also determined. Methods: We included all patients with an ODX request from two University Centers, CICM and CHUS, and estimated the concordance with the current provincial guideline for which an ODX may be ordered (invasive breast cancer HR+/Her2–/N- that is T1b with unfavorable characteristics or T1c or T2). For the intermediate-risk group, the factors influencing the final decision to use systemic chemotherapy were analysed. The projected cost-effectiveness of the ODX was derived from the proportion of patients (pts) for which the chemotherapy was not recommended. Results: Between May 2012 and December 2014, a total of 201 pts, 123 pts from CICM and 78 from CHUS, had an ODX done. In 93,0% (95%CI, 89,5-96,6) of pts, ODX was ordered correctly with respect to the guideline. There was no statistical differences between both sites (CICM: 92,7% [95%CI, 97,3-88,1]; CHUS 93,6% [95%CI, 88,2-99,0]). A total of 9 pts had high-risk RS (4,5%), 78 pts had intermediate-risk RS (38,8%) and 112 pts had low-risk RS (55,7%). Chemotherapy was recommended for 31 pts (18,2%) instead of an estimated 58,0% prior to the use of ODX according to previous reports published. In the intermediate-risk group, the majority of pts (74,4%) did not receive chemotherapy. The patient's preference and the absence of a proven benefit were the main reasons for withholding chemotherapy in this group. The additional cost associated with the use of the ODX was compensated with the reduction of the adjuvant systemic chemotherapy prescribed and its derived expenses (chemotherapy cost, nursing time and hospitalisations) and savings of 100 K were observed. Conclusions: In early breast cancer HR+ and N-, the use of ODX in two University Hospitals is concordant with published recommendations. ODX use is cost effective. This benefice does not take into account the psychological burden that comes with the decision to use adjuvant chemotherapy; neither does it evaluate potential long term complications. The widespread use of ODX must be looked at critically in face of other emerging gene signature tests like Endopredict® and PAM50®. As for the predictive ability of the ODX for adjuvant chemotherapy, one can question the strength of the actual evidence and argue if it confers this test an advantage over other multigene assays.

Citation Format: Martel S, Prady C, Simon R, Matte C. OncotypeDX® for breast cancer: A multigene assay that makes a difference? [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-05-30.

Magneto-aerotactic bacteria deliver drug-containing nanoliposomes to tumour hypoxic regions

Oxygen-depleted hypoxic regions in the tumour are generally resistant to therapies. Although nanocarriers have been used to deliver drugs, the targeting ratios have been very low. Here, we show that the magneto-aerotactic migration behaviour of magnetotactic bacteria, Magnetococcus marinus strain MC-1 (ref. 4), can be used to transport drug-loaded nanoliposomes into hypoxic regions of the tumour. In their natural environment, MC-1 cells, each containing a chain of magnetic iron-oxide nanocrystals, tend to swim along local magnetic field lines and towards low oxygen concentrations based on a two-state aerotactic sensing system. We show that when MC-1 cells bearing covalently bound drug-containing nanoliposomes were injected near the tumour in severe combined immunodeficient beige mice and magnetically guided, up to 55% of MC-1 cells penetrated into hypoxic regions of HCT116 colorectal xenografts. Approximately 70 drug-loaded nanoliposomes were attached to each MC-1 cell. Our results suggest that harnessing swarms of microorganisms exhibiting magneto-aerotactic behaviour can significantly improve the therapeutic index of various nanocarriers in tumour hypoxic regions.

Fundamental Principles and Issues of High-speed Piezoactuated Three-legged Motion for Miniature Robots Designed for Nanometer-scale Operations

One of the important aspects in the development of high-throughput platforms based on a fleet of scientific instruments in the form of miniature wireless robots designed for fast operations at the nanometer-scale, is the conception of an embedded locomotion system capable of fast displacements between two successive locations while being accurate enough to position the robot within the range of the embedded instrument, typically within a few tenths of nanometers. This paper describes not only the fundamental principles of the locomotion method and mechanisms but the main constraints, challenges, and environmental conditions that must be taken into account in the implementation of such a system. Preliminary experimental results show the validity of this approach.

Switching between Magnetotactic and Aerotactic Displacement Controls to Enhance the Efficacy of MC-1 Magneto-Aerotactic Bacteria as Cancer-Fighting Nanorobots

The delivery of drug molecules to tumor hypoxic areas could yield optimal therapeutic outcomes. This suggests that effective cancer-fighting micro- or nanorobots would require more integrated functionalities than just the development of directional propelling constructs which have so far been the main general emphasis in medical micro- and nanorobotic research. Development of artificial agents that would be most effective in targeting hypoxic regions may prove to be a very challenging task considering present technological constraints. Self-propelled, sensory-based and directionally-controlled agents in the form of Magnetotactic Bacteria (MTB) of the MC-1 strain have been investigated as effective therapeutic nanorobots in cancer therapy. Following computer-based magnetotactic guidance to reach the tumor area, the microaerophilic response of drug-loaded MC-1 cells could be exploited in the tumoral interstitial fluid microenvironments. Accordingly, their swimming paths would be guided by a decreasing oxygen concentration towards the hypoxic regions. However, the implementation of such a targeting strategy calls for a method to switch from a computer-assisted magnetotactic displacement control to an autonomous aerotactic displacement control. In this way, the MC-1 cells will navigate to tumoral regions and, once there, target hypoxic areas through their microaerophilic behavior. Here we show not only how the magnitude of the magnetic field can be used for this purpose but how the findings could help determine the specifications of a future compatible interventional platform within known technological and medical constraints.

Vessel-based registration of an optical shape sensing catheter for MR navigation

PURPOSE

Magnetic resonance navigation (MRN), achieved with an upgraded MRI scanner, aims to guide therapeutic nanoparticles from their release in the hepatic vascular network to embolize highly vascularized liver tumors. Visualizing the catheter in real-time within the arterial network is important for selective embolization within the MR gantry. To achieve this, a new MR-compatible catheter tracking technology based on optical shape sensing is used.

METHODS

This paper proposes a vessel-based registration pipeline to co-align this novel catheter tracking technology to the patient's diagnostic MR angiography (MRA) with 3D roadmapping. The method first extracts the 3D hepatic arteries from a diagnostic MRA based on concurrent deformable models, creating a detailed representation of the patient's internal anatomy. Once the optical shape sensing fibers, inserted in a double-lumen catheter, is guided into the hepatic arteries, the 3D centerline of the catheter is inferred and updated in real-time using strain measurements derived from fiber Bragg gratings sensors. Using both centerlines, a diffeomorphic registration based on a spectral representation of the high-level geometrical primitives is applied.

RESULTS

Results show promise in registration accuracy in five phantom models created from stereolithography of patient-specific vascular anatomies, with maximum target registration errors below 2 mm. Furthermore, registration accuracy with the shape sensing tracking technology remains insensitive to the magnetic field of the MR magnet.

CONCLUSIONS

This study demonstrates that an accurate registration procedure of a shape sensing catheter with diagnostic imaging is feasible.

Swimming microorganisms acting as nanorobots versus artificial nanorobotic agents: A perspective view from an historical retrospective on the future of medical nanorobotics in the largest known three-dimensional biomicrofluidic networks

The vascular system in each human can be described as a 3D biomicrofluidic network providing a pathway close to approximately 100 000 km in length. Such network can be exploited to target any parts inside the human body with further accessibility through physiological spaces such as the interstitial microenvironments. This fact has triggered research initiatives towards the development of new medical tools in the form of microscopic robotic agents designed for surgical, therapeutic, imaging, or diagnostic applications. To push the technology further towards medical applications, nanotechnology including nanomedicine has been integrated with principles of robotics. This new field of research is known as medical nanorobotics. It has been particularly creative in recent years to make what was and often still considered science-fiction to offer concrete implementations with the potential to enhance significantly many actual medical practices. In such a global effort, two main strategic trends have emerged where artificial and synthetic implementations presently compete with swimming microorganisms being harnessed to act as medical nanorobotic agents. Recognizing the potentials of each approach, efforts to combine both towards the implementation of hybrid nanorobotic agents where functionalities are implemented using both artificial/synthetic and microorganism-based entities have also been initiated. Here, through the main eras of progressive developments in this field, the evolutionary path being described from some of the main historical achievements to recent technological innovations is extrapolated in an attempt to provide a perspective view on the future of medical nanorobotics capable of targeting any parts of the human body accessible through the vascular network.

A prototype of injector to control and to detect the release of magnetic beads within the constraints of multibifurcation magnetic resonance navigation procedures

PURPOSE

An injector equipped with a bead capture and a bead detection system is presented. In the context of magnetic resonance navigation (MRN), in which MRI gradients are used to steer intravascular therapeutic carriers, fast and reliable injection is essential. In this paper, we present a prototype of injector to control and to detect the release of magnetic beads.

METHODS

The injector relies on two distinct subsystems: (1) the capture subsystem, which creates local magnetic force to stop the flow of magnetic beads; and (2) the detection subsystem, which detects flowing beads and generates a trigger signal to start MRI gradient pulses. Both systems rely on small microcoils wound on the tubing.

RESULTS

Five-turn microcoils show the best compromise between size and performance. Less than 5 mW of power is required to capture 0.8-mm beads moving in a flow above 5 mL min^-1 or when a gradient above 200 mT m^-1 is applied. The detection system is not sensitive to noise and detects every 0.8-mm bead in flow rates up to 14 mL m^-1 .

CONCLUSION

The prototype of injector shows performance above the requirements inherent to magnetic resonance navigation. This system is a step toward in vivo multibifurcation MRN. Magn Reson Med 77:444-452, 2017. © 2016 Wiley Periodicals, Inc.

Three-dimensional reconstruction of a vascular network by dynamic tracking of magnetite nanoparticles

PURPOSE

Visualization of small blood vessels feeding tumor sites provides important information on the tumors and their microenvironment. This information plays an important role in targeted drug therapies using magnetic gradients. However, capabilities of current clinical imaging modalities may be insufficient to resolve complex microvascular networks. The purpose of this study is to map the vascular network, 3D, based on the magnetic susceptibility contrast.

METHODS

Magnetic particles induce an inhomogeneity in the MRI's magnetic field in an order much larger than their real size. This is an approach to compensate the spatial resolution insufficiency of a clinical MR scanner. Micron-sized agglomerations of magnetite nanoparticles were injected in a 3D phantom vascular network, and a fast multislice, multiacquisition MR sequence was applied to track the agglomerations along their trajectories. The experiment was performed twice for two different imaging planes: coronal and transversal. The susceptibility artifact in the images indicated the presence and the position of the agglomerations. The calculated positions through multiple images were assembled to build up the 3D distribution of the vascular network.

RESULTS

The calculated points were compared with the centerline of the channels, extracted from the 3D reference image, to determine the absolute measurement error. The mean error was measured to be approximately half of the pixel's size. It was found that the positioning error on the axis perpendicular to the imaging slice was nearly twice as high as on the imaging plane axes due to the slice thickness. In order to compensate for the lack of resolution on the perpendicular axis, the reconstruction was performed using a combination of coronal and transversal data. The combination of the coordinates led to a significant decrease in the mean measurement error at each segment in the vascular network (p < 0.001).

CONCLUSIONS

A method for 3D reconstruction of a microvascular network based on the susceptibility contrast in MRI and using a clinical scanner and a commercial receiver coil was proposed. The method presents a novel approach for reconstruction of vascular networks using the susceptibility effect. The proposed method may be applied to resolve vascular networks at a micrometric scale.

SN-38 active loading in poly(lactic-co-glycolic acid) nanoparticles and assessment of their anticancer properties on COLO-205 human colon adenocarcinoma cells

SN-38 is a highly effective drug against many cancers. The development of an optimal delivery system for SN-38 is extremely challenging due to its low solubility and labile lactone ring. Herein, SN-38 encapsulated in poly(D,L-lactide-co-glycolide) nanoparticles (NPs) is introduced to enhance its solubility, stability and cellular uptake. SN-38-loaded NPs prepared by spontaneous emulsification solvent diffusion (SESD) method had an average diameter of 310 nm, a zeta potential of -9.69 mV and a loading efficiency of 71%. They were able to protect the active lactone ring of SN-38 against inactivation under physiological condition. A colorectal adenocarcinoma cell line (COLO-205) was used to assess the NPs effects on cytotoxicity and cellular uptake. Result showed a significant decreased cell proliferation and cell apoptosis. These results suggest that these SN-38-loaded NPs can be an effective delivery system for the treatment of colon cancer and potentially for other types of cancers.

Covalent binding of nanoliposomes to the surface of magnetotactic bacteria for the synthesis of self-propelled therapeutic agents

The targeted and effective delivery of therapeutic agents remains an unmet goal in the field of controlled release systems. Magnetococcus marinus MC-1 magnetotactic bacteria (MTB) are investigated as potential therapeutic carriers. By combining directional magnetotaxis-microaerophilic control of these self-propelled agents, a larger amount of therapeutics can be delivered surpassing the diffusion limits of large drug molecules toward hard-to-treat hypoxic regions in solid tumors. The potential benefits of these carriers emphasize the need to develop an adequate method to attach therapeutic cargos, such as drug-loaded nanoliposomes, without substantially affecting the cell's ability to act as delivery agents. In this study, we report on a strategy for the attachment of liposomes to MTB (MTB-LP) through carbodiimide chemistry. The attachment efficacy, motility, and magnetic response of the MTB-LP were investigated. Results confirm that a substantial number of nanoliposomes (∼70) are efficiently linked with MTB without compromising functionality and motility. Cytotoxicity assays using three different cell types (J774, NIH/3T3, and Colo205) reveal that liposomal attachments to MTB formulation improve the biocompatibility of MTB, whereas attachment does not interfere with liposomal uptake.

Three-dimensional remote aggregation and steering of magnetotactic bacteria microrobots for drug delivery applications

Magnetotactic bacteria (MTB) can be viewed as self-propelled natural microrobots. These bacterial microrobots can be remotely controlled using magnetic fields due to their internal chain of iron-oxide nanoparticles acting like a compass needle. This internal chain enables them to adopt a magnetotactic behavior that can be exploited to perform a variety of microscale tasks from microassembly and micro-manufacturing to the delivery through microvascular networks of therapeutic agents to tumors. To effectively support these applications, three-dimensional (3D) aggregations of MTB become essential in order to manipulate and guide the bacteria effectively in the human microvasculature to deliver a predefined dose of therapeutics. To achieve such aggregations in a 3D volume, time-varying magnetic field sequences were developed enabling us to simulate in time the existence of a magnetic monopole. This article presents and compares three different time-varying magnetic field sequences generated by three orthogonal pairs of electromagnets able to generate such 3D aggregations of MTB.