Ureteroscopy is a minimally invasive procedure for diagnosis and treatment of urinary tract pathology. Ergonomic and visualization challenges as well as radiation exposure are limitations to conventional ureteroscopy. Therefore, we have developed a robotic system to “power drive” a flexible ureteroscope with 3D tip tracking and pre-operative image overlay. The proposed system was evaluated using a kidney phantom registered to pre-operative MR images. Initial experiments show the potential of the device to provide additional assistance, precision, and guidance during urology procedures.
In laparoscopic surgery, live video provides visualization of the exposed organ surfaces in the surgical field, but is
unable to show internal structures beneath those surfaces. The laparoscopic ultrasound is often used to visualize the
internal structures, but its use is limited to intermittent confirmation because of the need for an extra hand to maneuver
the ultrasound probe. Other limitations of using ultrasound are the difficulty of interpretation and the need for an extra
port. The size of the ultrasound transducer may also be too large for its usage in small children. In this paper, we report
on an augmented reality (AR) visualization system that features continuous hands-free volumetric ultrasound scanning
of the surgical anatomy and video imaging from a stereoscopic laparoscope. The acquisition of volumetric ultrasound
image is realized by precisely controlling a back-and-forth movement of an ultrasound transducer mounted on a linear
slider. Furthermore, the ultrasound volume is refreshed several times per minute. This scanner will sit outside of the
body in the envisioned use scenario and could be even integrated into the operating table. An overlay of the maximum
intensity projection (MIP) of ultrasound volume on the laparoscopic stereo video through geometric transformations
features an AR visualization system particularly suitable for children, because ultrasound is radiation-free and provides
higher-quality images in small patients. The proposed AR representation promises to be better than the AR
representation using ultrasound slice data.
The exploration of natural orifice transluminal endoscopic surgery (NOTES) has brought considerable interest in
magnetic anchoring of intracorporeal tools. Magnetic anchoring and guidance system (MAGS) is the concept of
anchoring miniature in-vivo tools and device to the parietal peritoneum by coupling with an external magnetic holder
module placed on the skin surface. MAGS has been shown to be effective in anchoring passive tools such as in-vivo
cameras or tissue retractors. The strength of the magnetic field and magnet configurations employed depends on the size,
shape and weight of the in-vivo tools, the coupling distance between internal and external modules, and physiological
concerns such as tool interaction and tissue ischemia. This paper presents our effort to develop a better understanding of
the coupling dynamic between a small in-vivo robot designed for tissue manipulation, and an external MAGS handle
used to position the in-vivo robot. An electromagnetic simulation software (Vizimag 3.19) was used to simulate
coupling forces between a two-magnet configuration of the MAGS handle. A prototype model of the in-vivo robot and a
two-magnet configuration of a MAGS handle were fabricated. Based on this study, we were able to identify an optimal
design solution for a MAGS module given the mechanical constraints of the internal module design.
Numerous studies have demonstrated the efficacy of interstitial ablative approaches for the treatment of renal and hepatic
tumors. Despite these promising results, current systems remain highly dependent on operator skill, and cannot treat
many tumors because there is little control of the size and shape of the zone of necrosis, and no control over ablator
trajectory within tissue once insertion has taken place. Additionally, tissue deformation and target motion make it
extremely difficult to accurately place the ablator device into the target. Irregularly shaped target volumes typically
require multiple insertions and several sequential thermal ablation procedures. This study demonstrated feasibility of
spatially tracked image-guided conformal ultrasound (US) ablation for percutaneous directional ablation of diseased
tissue. Tissue was prepared by suturing the liver within a pig belly and 1mm BBs placed to serve as needle targets. The
image guided system used integrated electromagnetic tracking and cone-beam CT (CBCT) with conformable needlebased
high-intensity US ablation in the interventional suite. Tomographic images from cone beam CT were transferred
electronically to the image-guided tracking system (IGSTK). Paired-point registration was used to register the target
specimen to CT images and enable navigation. Path planning is done by selecting the target BB on the GUI of the realtime
tracking system and determining skin entry location until an optimal path is selected. Power was applied to create
the desired ablation extent within 7-10 minutes at a thermal dose (>300eqm43). The system was successfully used to
place the US ablator in planned target locations within ex-vivo kidney and liver through percutaneous access. Targeting
accuracy was 3-4 mm. Sectioned specimens demonstrated uniform ablation within the planned target zone. Subsequent
experiments were conducted for multiple ablator positions based upon treatment planning simulations. Ablation zones in
liver were 73cc, 84cc, and 140cc for 3, 4, and 5 placements, respectively. These experiments demonstrate the feasibility
of combining real-time spatially tracked image guidance with directional interstitial ultrasound ablation. Interstitial
ultrasound ablation delivered on multiple needles permit the size and shape of the ablation zone to be "sculpted" by
modifying the angle and intensity of the active US elements in the array. This paper summarizes the design and
development of the first system incorporating thermal treatment planning and integration of a novel interstitial acoustic
ablation device with integrated 3D electromagnetic tracking and guidance strategy.
Quantitative CT for volumetric analysis of medical images is increasingly being proposed for monitoring
patient response during chemotherapy trials. An integrated MATLAB GUI has been developed for an
oncology trial at Georgetown University Hospital. This GUI allows for the calculation and visualization of
the volume of a lesion. The GUI provides an estimate of the volume of the tumor using a semi-automatic
segmentation technique. This software package features a fixed parameter adaptive filter from the ITK toolkit
and a tumor segmentation algorithm to reduce inter-user variability and to facilitate rapid volume
measurements. The system also displays a 3D rendering of the segmented tumor, allowing the end user to
have not only a quantitative measure of the tumor volume, but a qualitative view as well. As an initial
validation test, several clinical cases were hand-segmented, and then compared against the results from the
tool, showing good agreement.
Small mammals, namely mice and rats, play an important role in biomedical research. Imaging, in
conjunction with accurate therapeutic agent delivery, has tremendous value in small animal research since it
enables serial, non-destructive testing of animals and facilitates the study of biomarkers of disease
progression. The small size of organs in mice lends some difficulty to accurate biopsies and therapeutic agent
delivery. Image guidance with the use of robotic devices should enable more accurate and repeatable targeting
for biopsies and delivery of therapeutic agents, as well as the ability to acquire tissue from a pre-specified
location based on image anatomy. This paper presents our work in integrating a robotic needle guide device,
specialized stereotaxic mouse holder, and magnetic resonance imaging, with a long-term goal of performing
accurate and repeatable targeting in anesthetized mice studies.
Accurate needle placement is a common need in the medical environment. While the use
of small diameter needles for clinical applications such as biopsy, anesthesia and
cholangiography is preferred over the use of larger diameter needles, precision placement
can often be challenging, particularly for needles with a bevel tip. This is due to
deflection of the needle shaft caused by asymmetry of the needle tip. Factors such as the
needle shaft material, bevel design, and properties of the tissue penetrated determine the
nature and extent to which a needle bends. In recent years, several models have been
developed to characterize the bending of the needle, which provides a method of
determining the trajectory of the needle through tissue. This paper explores the use of a
nonholonomic model to characterize needle bending while providing added capabilities
of path planning, obstacle avoidance, and path correction for lung biopsy procedures. We
used a ballistic gel media phantom and a robotic needle placement device to
experimentally assess the accuracy of simulated needle paths based on the nonholonomic
model. Two sets of experiments were conducted, one for a single bend profile of the
needle and the second set of tests for double bending of the needle. The tests provided an
average error between the simulated path and the actual path of 0.8 mm for the single
bend profile and 0.9 mm for the double bend profile tests over a 110 mm long insertion
distance. The maximum error was 7.4 mm and 6.9 mm for the single and double bend
profile tests respectively. The nonholonomic model is therefore shown to provide a
reasonable prediction of needle bending.
When choosing an Electromagnetic Tracking System (EMTS) for image-guided procedures, it is desirable for the
system to be usable for different procedures and environments. Several factors influence this choice. To date,
the only factors that have been studied extensively, are the accuracy and the susceptibility of electromagnetic
tracking systems to distortions caused by ferromagnetic materials. In this paper we provide a holistic overview
of the factors that should be taken into account when choosing an EMTS. These factors include: the system's
refresh rate, the number of sensors that need to be tracked, the size of the navigated region, system interaction
with the environment, can the sensors be embedded into the tools and provide the desired transformation
data, and tracking accuracy and robustness. We evaluate the Aurora EMTS (Northern Digital Inc., Waterloo,
Ontario, Canada) and the 3D Guidance EMTS with the flat-panel and the short-range field generators (Ascension
Technology Corp., Burlington, Vermont, USA) in three clinical environments. We show that these systems are
applicable to specific procedures or in specific environments, but that, no single system is currently optimal for
all environments and procedures we evaluated.
The goal of this project is to develop a robotic system to assist the physician in minimally invasive ultrasound
interventions. In current practice, the physician must manually hold the ultrasound probe in one hand and manipulate the
needle with the other hand, which can be challenging, particularly when trying to target small lesions. To assist the
physician, the robot should not only be capable of providing the spatial movement needed, but also be able to control the
contact force between the ultrasound probe and patient. To meet these requirements, we are developing a prototype
system based on a six degree of freedom parallel robot. The system will provide high bandwidth, precision motion, and
force control. In this paper we report on our progress to date, including the development of a PC-based control system
and the results of our initial experiments.
Vertebroplasty is a minimally invasive procedure in which bone cement is pumped into a fractured vertebral
body that has been weakened by osteoporosis, long-term steroid use, or cancer. In this therapy, a trocar (large
bore hollow needle) is inserted through the pedicle of the vertebral body which is a narrow passage and requires
great skill on the part of the physician to avoid going outside of the pathway. In clinical practice, this procedure
is typically done using 2D X-ray fluoroscopy. To investigate the feasibility of providing 3D image guidance, we
developed an image-guided system based on electromagnetic tracking and our open source software platform
the Image-Guided Surgery Toolkit (IGSTK). The system includes path planning, interactive 3D navigation, and
dynamic referencing. This paper will describe the system and our initial evaluation.
The development of image-guided interventions requires validation studies to evaluate
new protocols. So far, these validation studies have been limited to animal models and to
software and physical phantoms that simulate respiratory motion but cannot
accommodate needle punctures in a realistic manner. We have built a computer-controlled
pump that drives an anthropomorphic respiratory phantom for simulating
natural breathing patterns. This pump consists of a power supply, a motion controller
with servo amplifier, linear actuator, and custom fabricated pump assembly. By
generating several sample waveforms, we were able to simulate typical breathing
patterns. Using this pump, we were able to produce chest wall movements similar to
typical chest wall movements observed in humans. This system has potential applications
for evaluating new respiratory compensation algorithms and may facilitate improved
testing of image-guided protocols under realistic interventional conditions.
This paper proposes an assessment protocol that incorporates both hardware and analysis methods for evaluation of
electromagnetic tracker accuracy in different clinical environments. The susceptibility of electromagnetic tracker
measurement accuracy is both highly dependent on nearby ferromagnetic interference sources and non-isotropic. These
inherent limitations combined with the various hardware components and assessment techniques used within different
studies makes the direct comparison of measurement accuracy between studies difficult. This paper presents a multicenter
study to evaluate electromagnetic devices in different clinical environments using a common hardware phantom
and assessment techniques so that results are directly comparable. Measurement accuracy has been shown to be in the
range of 0.79-6.67mm within a 180mm3 sub-volume of the Aurora measurement space in five different clinical
environments.
Electromagnetic trackers have found inroads into medical applications as a tool for navigation in recent years. Their susceptibility to interference from both electromagnetic and ferromagnetic sources have prompted several accuracy assessment studies in past years. To the best of our knowledge, this is the first accuracy study conducted to characterize measurement accuracy of an NDI AURORA electromagnetic tracker within a CyberKnife radiosurgery suite. CyberKnife is a frameless, stereotactic radiosurgery device used to ablate tumors within the brain, spine and in recent years, the chest and abdomen. This paper uses a data collection protocol to collect uniformly distributed data points within a subset of the AURORA measurement volume in a CyberKnife suite. The key aim of the study is to determine the extent to which large metal components of the CyberKnife stereotactic radiosurgery device and robot mount contribute to overall system performance for the AURORA electromagnetic device. A secondary goal of the work is to determine the variation in accuracy and device behavior with the presence of ionizing radiation when the LINAC is turned on.
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