A Robotic System for Real-time Tumor Manipulation During Image guided Breast Biopsy

Breast biopsy guided by imaging techniques is widely used to evaluate suspicious masses within the breast. Current procedure allows the physician to determine location and extent of a tumor in the patient breast before inserting the needle. There are several problems with this procedure: Complex interaction dynamics between needle and breast tissue will likely displace the tumor from its original position necessitating multiple insertions, causing surgeons’ fatigue, patient’s discomfort, and compromising integrity of the tissue specimen. We present a new concept for real-time manipulation of a tumor using a robotic system that monitors the image of the tumor to generate appropriate external force to position the tumor at a desired location. The objective is to demonstrate that it is possible to manipulate a tumor in real-time by applying controlled external force in an automated way such that the tumor does not deviate from the path of the needle. We have demonstrated efficacy of this approach on breast phantoms. The robotic system consists of an ultrasound probe for image acquisition, a guiding mechanism for automatic probe orientation, image processing algorithm for extracting tumor position and PID (proportional-integral-derivative) controlled actuators for tumor manipulation. We have successfully tested this system for accessing mobile lesions during multiple needle insertion trials. This approach has the potential to reduce the number of attempts a surgeon makes to capture the desired tissue specimen, minimize tissue damage, improve speed of biopsy, and reduce patient discomfort.

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New real-time MR image-guided surgical robotic system for minimally invasive precision surgery

International Journal of Computer Assisted Radiology and Surgery ◽

10.1007/s11548-007-0146-9 ◽

2008 ◽

Vol 2 (6) ◽

pp. 317-325 ◽

Cited By ~ 32

Author(s):

M. Hashizume ◽

T. Yasunaga ◽

K. Tanoue ◽

S. Ieiri ◽

K. Konishi ◽

...

Keyword(s):

Minimally Invasive ◽

Real Time ◽

Robotic System ◽

Mr Image ◽

Image Guided

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A breast analytics dashboard to allow near-real-time visualization of quality assurance data.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.186 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 186-186

Author(s):

Mia Alyce Levy ◽

Jeremy Warner ◽

Neal Sanders ◽

Pam Carney ◽

Joy Pratt ◽

...

Keyword(s):

Quality Assurance ◽

Real Time ◽

Clinical Data ◽

Breast Biopsy ◽

Pilot Project ◽

Quality Reporting ◽

Image Guided ◽

Time Period ◽

National Quality ◽

Clinical Systems

186 Background: Quality metrics for internal use (e.g. quality improvement; quality assurance [QA/QI] activities) and external use (e.g. accreditation; national quality reporting) are currently primarily obtained through retrospective manual data abstraction on subsets of patients, at a majority of cancer centers. Real-time QA/QI of all patients is attractive but requires collection of electronic data from disparate clinical systems that are rarely fully interoperable. We developed a dashboard to aggregate relevant clinical information in near real-time for QA/QI visualizations. Methods: Tableau® software was used to visualize data from multiple clinical systems at Vanderbilt University Medical Center (VUMC). Custom extract, transform, and load (ETL) processes were developed to collect radiology, pathology, professional billing, and clinical data on a daily basis. An integrated dashboard was developed through an iterative process involving physicians, nurses, and software engineers. As a pilot project, data from all patients with an image-guided breast biopsy obtained at VUMC from 2009-2013 was visualized. Results: 4177 biopsies were included in the visualized cohort as of June 2014. 3,210 (77%) of the biopsies were preceded by a BiRADS 4 or 5 mammogram. The annual biopsy rate increased by 51% over the time period. Despite this increase in volume, the median number of weekdays from BiRADS 4 or 5 mammogram to image-guided biopsy was stable at 5 days over the time period. Prior diagnosis status, lesion class, procedure type, and imaging exam type were also included in the dashboard. Conclusions: This pilot project demonstrates the ability to visualize near real-time clinical data for QA/QI purposes. Tableau® is interactive, so that certain patterns (e.g. the distribution of number of days from screening mammogram to biopsy) can be explored at a granular level. This functionality also allows the user to investigate why 23% of patients had no apparent imaging before biopsy. Based on a perceived pattern of delayed biopsy in certain outliers, QI efforts at VUMC are underway to ensure timely biopsy. Interactive visual dashboards such as the one described present opportunities to rapidly cycle QA findings into QI actions.

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397 Intra-tumor immunotherapy injections utilizing image guidance in interventional radiology: clinical trial experience at a tertiary care cancer center

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-sitc2020.0397 ◽

2020 ◽

Vol 8 (Suppl 3) ◽

pp. A422-A422

Author(s):

Ravi Murthy ◽

Rahul Sheth ◽

Alda Tam ◽

Sanjay Gupta ◽

Vivek Subbiah ◽

...

Keyword(s):

Clinical Trials ◽

Interventional Radiology ◽

Real Time ◽

Image Guidance ◽

Tertiary Care ◽

Cancer Center ◽

Imaging Guidance ◽

Image Guided ◽

Real Time Image ◽

Time Image

BackgroundImage guided intra-tumor administration of investigational immunotherapeutic agents represents an expanding field of interest. We present a retrospective review of the safety, feasibility & technical nuances of real-time image guidance for injection & biopsy across a spectrum of extracranial solid malignancies utilizing the discipline of Interventional Radiology.MethodsPatients who were enrolled in image guided intratumoral immunotherapy injection (ITITI) clinical trials over a 6 year period (2013–19) at a single tertiary care cancer center were included in this analysis. Malignancy, location, imaging guidance utilized for ITITI & biopsy for injected (adscopal) & non-injected (abscopal) lesions were determined and categorized. Peri-procedural adverse events were noted.Results262 pts (146 female, 61 yrs median) participating in 29 immunotherapeutic clinical trials (TLR & STING agonists, gene therapy, anti CD-40, viral/bacterial/metabolic oncolytics) met study criteria. Malignancies included melanoma 88, sarcoma 32, colorectal 29, breast 23, lung 17, head & neck 15, ovarian 8, neuroendocrine 7, pancreatic adenocarcinoma 6, 3 each (cholangioCA, endometrial, bladder, GI tract), 2 each (RCC, thymicCA, lymphoma, merkel cell, prostate) & others 1 each (CUP, GIST, dermatofibrosarcoma, DSRT, neuroblastoma, thyroid). All 169 & 93 patients received the intended 1371 ITITI in parietal (abdominal/chest wall, extremity, neck, pelvis) or visceral (liver, lung, peritoneum, adrenal) locations respectively; 83 patients received lymph node injections within either location. Imaging guidance was US in 68% of the cohort (US 161, CT+US 19); CT was used in 30% (81) & MRI in 1 patient. Median diameter of the ITITI lesion was 32 mm (8–230 mm). Median volume of the ITITI therapeutic material/session was 2 ml (1–6.9 ml). Lesions were accessed using a coaxial technique. ITITI delivery needles used at operator preference & tailored to lesion characteristics were either a 21G/22G Chiba, 21G Profusion (Cook Medical), 22G Morrison (AprioMed), 25G hypodermic (BD) & 18G Quadrafuse (Rex Medical). 2840 core biopsies (>18G Tru-cut core, Mission, Bard Medical) were performed in 237 patients during 690 procedures; biopsy sessions were often concurrent & of the ITITI site. 137 patients also underwent biopsy of a non-ITITI site (89 parietal location). Dimensions of the non-ITITI lesion were median 10 mm (7–113 mm); US image guidance was used in 97 patients (72%) to obtain a total of 1257, >18G Tru-core samples. 1.3% of injections resulted in SAE (NCI CTC AE >3) and 0.5% of 4097 biopsies developed major complications (SIR Criteria); both categories were manageable.ConclusionsUtilizing real time image guidance, ITITI to the administration of a myriad of investigational immunotherapeutic agents with concomitant biopsy procedures to date are associated with a high technical success rate & favorable safety profile.AcknowledgementsJoshua Hein, Mara Castaneda, Jyotsna Pera, Yunfang Jiang,Shuang Liu, Holly Liu and Anna LuiTrial RegistrationN/AEthics ApprovalThe study was approved by Institution’s Ethics Board, approval number 2020-0536: A retrospective study to determine the safety, feasibility and technical challenges of real-time image guidance for intra-tumor injection and biopsy across multiple solid tumors.Consent2020-0536 Waiver of Informed ConsentReferenceSheth RA, Murthy R, Hong DS, et al. Assessment of image-guided intratumoral delivery of immunotherapeutics in patients with cancer. JAMA Netw Open 2020;3(7):e207911. doi:10.1001/jamanetworkopen.2020.7911

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Understanding Patient Anxiety and Pain During Initial Image-guided Breast Biopsy

Journal of Breast Imaging ◽

10.1093/jbi/wbaa072 ◽

2020 ◽

Vol 2 (6) ◽

pp. 583-589

Author(s):

Santo Maimone ◽

Andrey P Morozov ◽

Annamaria Wilhelm ◽

Inna Robrahn ◽

Tedra D Whitcomb ◽

...

Keyword(s):

Breast Biopsy ◽

Procedural Pain ◽

Patient Anxiety ◽

Initial Image ◽

Image Guided ◽

Pain Scores ◽

Multiple Biopsies ◽

Lower Pain ◽

Malignant Lesions ◽

Positive Correlations

Abstract Objective Image-guided breast biopsies are safe, efficient, and reliable. However, patients are often anxious about these procedures, particularly those who have never undergone a prior biopsy. Methods This prospective IRB-approved study surveyed 163 patients undergoing their first breast biopsy. Participants provided informed consent and completed a short written survey prior to and immediately after their procedure. Level of anxiety as well as anticipated and actual levels of pain prior to and following the procedure were assessed using a 0–10-point Likert scale. Correlation, bivariate, and regression analyses were performed. Results Regarding the biopsy experience, 133/163 (81.6%) of patients reported it as better than expected. Anxiety decreased significantly from a prebiopsy mean score of 5.52 to a postbiopsy mean score of 2.25 (P < 0.001). Average and greatest pain experienced during the procedure had mean scores of 2.03 and 2.77, respectively, both significantly lower compared to preprocedural expectation (mean 4.53) (P < 0.001). Lower pain scores were reported in US-guided procedures compared to stereotactic- and MRI-guided biopsies (P < 0.001). No significant differences in pain scores were seen in those undergoing single versus multiple biopsies, or when benign, elevated-risk, or malignant lesions were sampled. Positive correlations were seen with prebiopsy anxiety levels and procedural pain as well as with anticipated pain and actual procedural pain. Conclusion Image-guided biopsies are often better tolerated by patients than anticipated. We stress the benefit of conveying this information to patients prior to biopsy, as decreased anxiety correlates with lower levels of pain experienced during the procedure.

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Real-time motion tracking in image-guided oral implantology

International Journal of Medical Robotics and Computer Assisted Surgery ◽

10.1002/rcs.215 ◽

2008 ◽

Vol 4 (4) ◽

pp. 339-347 ◽

Cited By ~ 9

Author(s):

Xiaojun Chen ◽

Yanping Lin ◽

Yiqun Wu ◽

Chengtao Wang

Keyword(s):

Real Time ◽

Motion Tracking ◽

Image Guided ◽

Time Motion ◽

Oral Implantology

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First Demonstration of Combined kV/MV Image-Guided Real-Time Dynamic Multileaf-Collimator Target Tracking

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2009.02.012 ◽

2009 ◽

Vol 74 (3) ◽

pp. 859-867 ◽

Cited By ~ 93

Author(s):

Byungchul Cho ◽

Per R. Poulsen ◽

Alex Sloutsky ◽

Amit Sawant ◽

Paul J. Keall

Keyword(s):

Target Tracking ◽

Real Time ◽

Multileaf Collimator ◽

Time Dynamic ◽

Image Guided

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Intraductal Papilloma Without Atypia on Image- Guided Breast Biopsy: Upgrade Rates to Carcinoma at Surgical Excision

Breast Care ◽

10.1159/000489096 ◽

2018 ◽

Vol 13 (5) ◽

pp. 364-368 ◽

Cited By ~ 4

Author(s):

Doris Leithner ◽

Benjamin Kaltenbach ◽

Petra Hödl ◽

Volker Möbus ◽

Volker Brandenbusch ◽

...

Keyword(s):

Needle Biopsy ◽

Breast Biopsy ◽

Ductal Carcinoma ◽

Statistical Tests ◽

Menopausal Status ◽

Surgical Excision ◽

Lesion Size ◽

Intraductal Papilloma ◽

Image Guided ◽

Institutional Review

Background: The management of intraductal papilloma without atypia (IDP) in breast needle biopsy remains controversial. This study investigates the upgrade rate of IDP to carcinoma and clinical and radiologic features predictive of an upgrade. Methods: Patients with a diagnosis of IDP on image-guided (mammography, ultrasound, magnetic resonance imaging) core needle or vacuum-assisted biopsy and surgical excision of this lesion at a certified breast center between 2007 and 2017 were included in this institutional review board-approved retrospective study. Appropriate statistical tests were performed to assess clinical and radiologic characteristics associated with an upgrade to malignancy at excision. Results: For 60 women with 62 surgically removed IDPs, the upgrade rate to malignancy was 16.1% (10 upgrades, 4 invasive ductal carcinoma, 6 ductal carcinoma in situ). IDPs with upgrade to carcinoma showed a significantly greater distance to the nipple (63.5 vs. 36.8 mm; p = 0.012). No significant associations were found between upgrade to carcinoma and age, menopausal status, lesion size, microcalcifications, BI-RADS descriptors, initial BI-RADS category, and biopsy modality. Conclusion: The upgrade rate at excision for IDPs diagnosed with needle biopsy was higher than expected according to some guideline recommendations. Observation only might not be appropriate for all patients with IDP, particularly for those with peripheral IDP.

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