MRI image overlay: Application to arthrography needle insertion

Magnetic Resonance Imaging (MRI) offers great potential for planning, guiding, monitoring and controlling interventions. MR arthrography (MRAr) is the imaging gold standard for assessing small ligament and fibrocartilage injury in joints. In contemporary practice, MRAr consists of two consecutive sessions: (1) an interventional session where a needle is driven to the joint space and MR contrast is injected under fluoroscopy or CT guidance; and (2) a diagnostic MRI imaging session to visualize the distribution of contrast inside the joint space and evaluate the condition of the joint. Our approach to MRAr is to eliminate the separate radiologically guided needle insertion and contrast injection procedure by performing those tasks on conventional high-field closed MRI scanners. We propose a 2D augmented reality image overlay device to guide needle insertion procedures. This approach makes diagnostic high-field magnets available for interventions without a complex and expensive engineering entourage. In preclinical trials, needle insertions have been performed in the joints of porcine and human cadavers using MR image overlay guidance; in all cases, insertions successfully reached the joint space on the first attempt.

MRI-Compatible Pneumatic Robot for Transperineal Prostate Needle Placement

Magnetic resonance imaging (MRI) can provide high-quality 3-D visualization of prostate and surrounding tissue, thus granting potential to be a superior medical imaging modality for guiding and monitoring prostatic interventions. However, the benefits cannot be readily harnessed for interventional procedures due to difficulties that surround the use of high-field (1.5T or greater) MRI. The inability to use conventional mechatronics and the confined physical space makes it extremely challenging to access the patient. We have designed a robotic assistant system that overcomes these difficulties and promises safe and reliable intraprostatic needle placement inside closed high-field MRI scanners. MRI compatibility of the robot has been evaluated under 3T MRI using standard prostate imaging sequences and average SNR loss is limited to 5%. Needle alignment accuracy of the robot under servo pneumatic control is better than 0.94 mm rms per axis. The complete system workflow has been evaluated in phantom studies with accurate visualization and targeting of five out of five 1 cm targets. The paper explains the robot mechanism and controller design, the system integration, and presents results of preliminary evaluation of the system.

Pneumatically Operated MRI-Compatible Needle Placement Robot for Prostate Interventions

Magnetic Resonance Imaging (MRI) has potential to be a superior medical imaging modality for guiding and monitoring prostatic interventions. The strong magnetic field prevents the use of conventional mechatronics and the confined physical space makes it extremely challenging to access the patient. We have designed a robotic assistant system that overcomes these difficulties and promises safe and reliable intra-prostatic needle placement inside closed high-field MRI scanners. The robot performs needle insertion under real-time 3T MR image guidance; workspace requirements, MR compatibility, and workflow have been evaluated on phantoms. The paper explains the robot mechanism and controller design and presents results of preliminary evaluation of the system.

MRI compatibility of robot actuation techniques--a comparative study

This paper reports an experimental evaluation of the following three different MRI-compatible actuators: a Shinsei ultrasonic motor a Nanomotion ultrasonic motor and a pneumatic cylinder actuator. We report the results of a study comparing the effect of these actuators on the signal to noise ratio (SNR) of MRJ images under a variety of experimental conditions. Evaluation was performed with the controller inside and outside the scanner room and with both 1.5T and 3T MRI scanners. Pneumatic cylinders function with no loss of SNR with controller both inside and outside of the scanner room. The Nanomotion motor performs with moderate loss of SNR when moving during imaging. The Shinsei is unsuitable for motion during imaging. All may be used when motion is appropriately interleaved with imaging cycles.

Design and preliminary accuracy studies of an MRI-guided transrectal prostate intervention system

This paper reports a novel system for magnetic resonance imaging (MRI) guided transrectal prostate interventions, such as needle biopsy, fiducial marker placement, and therapy delivery. The system utilizes a hybrid tracking method, comprised of passive fiducial tracking for initial registration and subsequent incremental motion measurement along the degrees of freedom using fiber-optical encoders and mechanical scales. Targeting accuracy of the system is evaluated in prostate phantom experiments. Achieved targeting accuracy and procedure times were found to compare favorably with existing systems using passive and active tracking methods. Moreover, the portable design of the system using only standard MRI image sequences and minimal custom scanner interfacing allows the system to be easily used on different MRI scanners.

Validation system of MR image overlay and other needle insertion techniques

In order to develop accurate and effective augmented reality (AR) systems used in MR and CT guided needle placement procedures, a comparative validation environment is necessary. Clinical equipment is prohibitively expensive and often inadequate for precise measurement. Therefore, we have developed a laboratory validation system for measuring operator performance using different assistance techniques. Electromagnetically tracked needles are registered with the preoperative plan to measure placement accuracy and the insertion path. The validation system provides an independent measure of accuracy that can be applied to varying methods of assistance ranging from augmented reality guidance methods to tracked navigation systems and autonomous robots. In preliminary studies, this validation system is used to evaluate the performance of the image overlay, bi-plane laser guide, and traditional freehand techniques.

Dissociation of ionizing groups in the binding cleft inversely controls the endo- and exopeptidase activities of cathepsin B

Negatively charged reactants are sensitive reactivity probes of the active site of cysteine proteases (Halász, P., and Polgár, L. (1977) Eur. J. Biochem. 79, 491-494). Thus, the thiolate-imidazolium ion pair of papain reacts at an enhanced rate with iodoacetate due to a favorable interaction between the positive imidazolium ion of the ion pair and the negative carboxylate of the alkylating agent. We have found that cathepsin B, the closely related lysosomal cysteine protease, also shows enhanced reactivity toward iodoacetate, indicating the presence of the catalytically competent thiolate-imidazolium ion pair in this enzyme. However, the pH dependence of the reaction is different. Papain exhibits a simple bell-shaped curve, whereas cathepsin B exhibits a complex pH dependence which is controlled by an ionizing group with a pKa of about 5.5. This finding indicates the existence of two reactive forms associated with the active site of cathepsin B: a high reactivity form below pH 5.5 and a low reactivity form above pH 5.5. The former accounts for the exopeptidase (peptidyl dipeptidase) activity of the enzyme and the latter for the endopeptidase activity, measured with the highly specific substrate benzyloxycarbonyl-Arg-Arg-2-naphthylamide. As seen from active site models, cathepsin B, in contrast to papain, contains a triad of charged groups near the thiolate-imidazolium ion pair which is composed of Glu-131, Arg-162, and Glu-205. A net negative charge above pH 5.5 and the positive charge of Arg-162 below pH 5.5 may control the exo- and endopeptidase activities, as well as the alkylation with iodoacetate. This can be mediated through electrostatic interactions with the charged reactants and, possibly, also by causing a conformational change in the geometry of the thiolate-imidazolium ion pair.

Proteinase from germinating bean cotyledons. Evidence for involvement of a thiol group in catalysis

To degrade storage proteins germinating seeds synthesize proteinases de novo that can be inhibited by thiol-blocking reagents [Baumgartner & Chrispeels (1977) Eur. J. Biochem. 77, 223-233]. We have elaborated a procedure for isolation of such a proteinase from the cotyledons of Phaseolus vulgaris. The purification procedure involved fractionation of the cotyledon homogenate with acetone and with (NH4)2SO4 and successive chromatographies on DEAE-cellulose, activated thiol-Sepharose Sepharose and Sephacryl S-200. The purified enzyme has an Mr of 23,400, proved to be highly specific for the asparagine side chain and blocking of its thiol group resulted in loss of the catalytic activity. The chemical properties of the thiol group of the bean enzyme were investigated by acylation with t-butyloxycarbonyl-L-asparagine p-nitro-phenyl ester and by alkylations with iodoacetamide and iodoacetate. Deviations from normal pH-rate profile were observed, which indicated that the thiol group is not a simple functional group, but constitutes a part of an interactive system at the active site. The pKa value for acylation and the magnitude of the rate constant for alkylation with iodoacetate revealed that the bean proteinase possesses some properties not shared by papain and the other cysteine proteinases studied to date.