Feasibility, safety and accuracy of a CT-guided robotic assistance for percutaneous needle placement in a swine liver model

AbstractEvaluate the feasibility, safety and accuracy of a CT-guided robotic assistance for percutaneous needle placement in the liver. Sixty-six fiducials were surgically inserted into the liver of ten swine and used as targets for needle insertions. All CT-scan acquisitions and robotically-assisted needle insertions were coordinated with breath motion using respiratory monitoring. Skin entry and target points were defined on planning CT-scan. Then, robotically-assisted insertions of 17G needles were performed either by experienced interventional radiologists or by a novice. Post-needle insertion CT-scans were acquired to assess accuracy (3D deviation, ie. distance from needle tip to predefined target) and safety. All needle insertions (43/43; median trajectory length = 83 mm (interquartile range [IQR] 72–105 mm) could be performed in one (n = 36) or two (n = 7) attempts (100% feasibility). Blinded evaluation showed an accuracy of 3.5 ± 1.3 mm. Accuracy did not differ between novice and experienced operators (3.7 ± 1.3 versus 3.4 ± 1.2 mm, P = 0.44). Neither trajectory angulation nor trajectory length significantly impacted accuracy. No complications were encountered. Needle insertion using the robotic device was shown feasible, safe and accurate in a swine liver model. Accuracy was influenced neither by the trajectory length nor by trajectory angulations nor by operator’s experience. A prospective human clinical trial is recruiting.

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Author Correction: Feasibility, safety and accuracy of a CT-guided robotic assistance for percutaneous needle placement in a swine liver model

Scientific Reports ◽

10.1038/s41598-021-87093-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Boris Guiu ◽

Thierry De Baère ◽

Guillaume Noel ◽

Maxime Ronot

Keyword(s):

Robotic Assistance ◽

Needle Placement ◽

Ct Guided ◽

Liver Model ◽

Swine Liver

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

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Needle placement accuracy in CT-guided robotic post mortem biopsy

Current Directions in Biomedical Engineering ◽

10.1515/cdbme-2020-0031 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Martin Gromniak ◽

Maximilian Neidhardt ◽

Axel Heinemann ◽

Klaus Püschel ◽

Alexander Schlaefer

Keyword(s):

Needle Biopsy ◽

Minimal Invasive ◽

Robotic Arm ◽

Limited Time ◽

Time Since Death ◽

Time Cost ◽

Needle Placement ◽

Manner Of Death ◽

Ct Guided ◽

Placement Accuracy

AbstractForensic autopsies include a thorough examination of the corpse to detect the source or alleged manner of death as well as to estimate the time since death. However, a full autopsy may be not feasible due to limited time, cost or ethical objections by relatives. Hence, we propose an automated minimal invasive needle biopsy system with a robotic arm, which does not require any online calibrations during a procedure. The proposed system can be easily integrated into the workflow of a forensic biopsy since the robot can be flexibly positioned relative to the corpse. With our proposed system, we performed needle insertions into wax phantoms and livers of two corpses and achieved an accuracy of 4.34 ± 1.27 mm and 10.81 ± 4.44 mm respectively.

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The impact of tumour regression in locally advanced carcinoma cervix during external beam radiotherapy and the need for adaptive planning

10.1055/s-0039-1685287 ◽

2016 ◽

Keyword(s):

Ct Scan ◽

Locally Advanced ◽

Target Volume ◽

Ct Images ◽

Tumour Regression ◽

Target Coverage ◽

Carcinoma Cervix ◽

Advanced Carcinoma ◽

The Impact ◽

Planning Ct

Aim: To study the impact of tumour regression occurring during IMRT for locally advanced carcinoma cervix and study dose distribution to target volume and OARs and hence the need for any replanning. Materials and Methods: 40 patients undergoing IM-IGRT and weekly chemotherapy were included in the study. After 36 Gy, a second planning CT-scan was done and target volume and OARs were recontoured. First plan (non-adaptive) was compared with second plan (adaptive plan) to evaluate whether it would still offer sufficient target coverage to the CTV and spare the OARs after having delivered 36 Gy. Finally new plan was created based on CT-images to investigate whether creating a new treatment plan would optimize target coverage and critical organ sparing. To measure the response of the primary tumour and pathologic nodes to EBRT, the differences in the volumes of the primary GTV and nodal GTV between the pretreatment and intratreatment CT images was calculated. Second intratreatment IMRT plans was generated, using the delineations of the intratreatment CT images. The first IMRT plan (based on the first CT-scan or non adaptive plan) was compared with second IMRT plan (based on the second CT-scan or adaptive plan). Results: 35% patients had regression in GTV in the range of 4.1% to 5%, 20% in the range of 1.1%-2%, 15% in the range of 2.1%-3% and 20% in the range of 6%-15%. There was significant mean decrease in GTV of 4.63 cc (p=0.000). There was a significant decrease in CTV on repeat CT done after 36 Gy by 23.31 cc (p=0.000) and in PTV by 23.31 cc (p=0.000). There was a statistically significant increase in CTV D98, CTV D95, CTV D50 and CTV D2 in repeat planning CT done after 36 Gy. There was no significant alteration in OARs doses. Conclusion: Despite tumour regression and increased target coverage in locally advanced carcinoma cervix after a delivery of 36 Gy there was no sparing of OARs. Primary advantage of adaptive RT seems to be in greater target coverage with non-significant normal tissue sparing.

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Robotic Assistance System for Cone-Beam Computed Tomography-Guided Percutaneous Needle Placement

CardioVascular and Interventional Radiology ◽

10.1007/s00270-021-02938-7 ◽

2021 ◽

Author(s):

Michael Kostrzewa ◽

Andreas Rothfuss ◽

Torben Pätz ◽

Markus Kühne ◽

Stefan O. Schoenberg ◽

...

Keyword(s):

Computed Tomography ◽

Target Lesion ◽

Robotic Arm ◽

Cone Beam ◽

Mean Deviation ◽

Robotic Assistance ◽

Needle Placement ◽

Image Guided ◽

Out Of Plane ◽

Tip Position

Abstract Purpose The study aimed to evaluate a new robotic assistance system (RAS) for needle placement in combination with a multi-axis C-arm angiography system for cone-beam computed tomography (CBCT) in a phantom setting. Materials and Methods The RAS consisted of a tool holder, dedicated planning software, and a mobile platform with a lightweight robotic arm to enable image-guided needle placement in conjunction with CBCT imaging. A CBCT scan of the phantom was performed to calibrate the robotic arm in the scan volume and to plan the different needle trajectories. The trajectory data were sent to the robot, which then positioned the tool holder along the trajectory. A 19G needle was then manually inserted into the phantom. During the control CBCT scan, the exact needle position was evaluated and any possible deviation from the target lesion measured. Results In total, 16 needle insertions targeting eight in- and out-of-plane sites were performed. Mean angular deviation from planned trajectory to actual needle trajectory was 1.12°. Mean deviation from target point and actual needle tip position was 2.74 mm, and mean deviation depth from the target lesion to the actual needle tip position was 2.14 mm. Mean time for needle placement was 361 s. Only differences in time required for needle placement between in- and out-of-plane trajectories (337 s vs. 380 s) were statistically significant (p = 0.0214). Conclusion Using this RAS for image-guided percutaneous needle placement with CBCT was precise and efficient in the phantom setting.

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Robotically Driven CT-guided Needle Insertion: Preliminary Results in Phantom and Animal Experiments

Radiology ◽

10.1148/radiol.2017162856 ◽

2017 ◽

Vol 285 (2) ◽

pp. 454-461 ◽

Cited By ~ 11

Author(s):

Takao Hiraki ◽

Tetsushi Kamegawa ◽

Takayuki Matsuno ◽

Jun Sakurai ◽

Yasuzo Kirita ◽

...

Keyword(s):

Animal Experiments ◽

Needle Insertion ◽

Ct Guided ◽

Preliminary Results

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Robot-to-image Registration with Geometric Marker for CT-guided Robotic Needle Insertion

10.1109/icra48506.2021.9561876 ◽

2021 ◽

Author(s):

Iori Ikeda ◽

Kai Sekine ◽

Ryosuke Tsumura ◽

Hiroyasu Iwata

Keyword(s):

Image Registration ◽

Needle Insertion ◽

Ct Guided

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A Robotized Needle Insertion Device for Percutaneous Procedures

Volume 7: 29th Mechanisms and Robotics Conference, Parts A and B ◽

10.1115/detc2005-84577 ◽

2005 ◽

Cited By ~ 1

Author(s):

Olivier Piccin ◽

Pierre Renaud ◽

Laurent Barbe´ ◽

Bernard Bayle ◽

Benjamin Maurin ◽

...

Keyword(s):

Ct Scan ◽

Medical Application ◽

Needle Insertion ◽

Computer Assisted ◽

The Novel ◽

Percutaneous Therapy ◽

Percutaneous Procedures ◽

Insertion Device ◽

Haptic Control ◽

Novel Design

In this paper, a new robotized needle insertion device is proposed for computer-assisted percutaneous therapy. The insertion device is integrated in a robotic system dedicated to gesture guidance in a Computed Tomography (CT) scan. The presented design fulfills the stringent requirements of such a medical application: compatibility with a CT-scan and haptic control by the practitioner are ensured as well as safety and sterilization. The novel design of the insertion device is first presented, outlining its main properties, before introducing preliminary experimental results.

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CT-guided needle placement in the central nervous system: results in 146 consecutive patients

American Journal of Roentgenology ◽

10.2214/ajr.143.4.861 ◽

1984 ◽

Vol 143 (4) ◽

pp. 861-868 ◽

Cited By ~ 15

Author(s):

CJ Moran ◽

TP Naidich ◽

JA Marchoski

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Needle Placement ◽

Ct Guided ◽

The Central Nervous System

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Fetal dose from proton pencil beam scanning craniospinal irradiation during pregnancy: a Monte Carlo study

Physics in Medicine and Biology ◽

10.1088/1361-6560/ac4b38 ◽

2022 ◽

Author(s):

Yeon Soo Yeom ◽

Keith Tchadwick Griffin ◽

Matthew M Mille ◽

Choonik Lee ◽

Shannon O'Reilly ◽

...

Keyword(s):

Monte Carlo ◽

Ct Scan ◽

Monte Carlo Study ◽

Whole Body ◽

Pencil Beam ◽

Pencil Beam Scanning ◽

Fetal Organ ◽

Organ Tissue ◽

Planning Ct ◽

Fetal Dose

Abstract Objective: We conducted a Monte Carlo study to comprehensively investigate the fetal dose resulting from proton pencil beam scanning (PBS) craniospinal irradiation (CSI) during pregnancy. Approach: The gestational-age dependent pregnant phantom series developed at the University of Florida (UF) were converted into DICOM-RT format (CT images and structures) and imported into a treatment planning system (TPS) (Eclipse v15.6) commissioned to a IBA PBS nozzle. A proton PBS CSI plan (prescribed dose: 36 Gy) was created on the phantoms. The TOPAS MC code was used to simulate the proton PBS CSI on the phantoms, for which MC beam properties at the nozzle exit (spot size, spot divergence, mean energy, and energy spread) were matched to IBA PBS nozzle beam measurement data. We calculated mean absorbed doses for 28 organs and tissues and whole body of the fetus at eight gestational ages (8, 10, 15, 20, 25, 30, 35, and 38 weeks). For contextual purposes, the fetal organ/tissue doses from the treatment planning CT scan of the mother’s head and torso were estimated using the National Cancer Institute dosimetry system for CT (NCICT, Version 3) considering a low-dose CT protocol (CTDIvol: 8.97 mGy). Main Results: The majority of the fetal organ/tissue doses from the proton PBS CSI treatment fell within a range of 3 to 6 mGy. The fetal organ/tissue doses for the 38-week phantom showed the largest variation with the doses ranging from 2.9 mGy (adrenals) to 8.2 mGy (eye lenses) while the smallest variation ranging from 3.2 mGy (oesophagus) to 4.4 mGy (brain) was observed for the doses for the 20-week phantom. The fetal whole-body dose ranged from 3.7 mGy (25 weeks) to 5.8 mGy (8 weeks). Most of the fetal doses from the planning CT scan fell within a range of 7 to 13 mGy, approximately 2-to-9 times lower than the fetal dose equivalents of the proton PBS CSI treatment (assuming a quality factor of 7). Significance: The fetal organ/tissue doses observed in the present work will be useful for one of the first clinically informative predictions on the magnitude of fetal dose during proton PBS CSI during pregnancy.

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