Haytham Elhawary

The case for MR-compatible robotics: a review of the state of the art

The numerous imaging capabilities of magnetic resonance imaging (MRI) coupled with its lack of ionizing radiation has made it a desirable modality for real‐time guidance of interventional procedures. The combination of these abilities with the advantages granted by robotic systems to perform accurate and precise positioning of tools has driven the recent development of MR‐compatible interventional and assistive devices.

MRI signal intensity based B-spline nonrigid registration for pre- and intraoperative imaging during prostate brachytherapy

To apply an intensity‐based nonrigid registration algorithm to MRI‐guided prostate brachytherapy clinical data and to assess its accuracy.

A review of magnetic resonance imaging compatible manipulators in surgery.

Abstract Developments in magnetic resonance imaging (MRI), coupled with parallel progress in the field of computer-assisted surgery, mean that an ideal environment has been created for the development of MRI-compatible robotic systems and manipulators, capable of enhancing many types of surgical procedure. However, MRI does impose severe restrictions on mechatronic devices to be used in or around the scanners. In this article a review of the developments in the field of MRI-compatible surgical manipulators over the last decade is presented. The manipulators developed make use of different methods of actuation, but they can be reduced to four main groups: actuation transmitted through hydraulics, pneumatic actuators, ultrasonic motors based on the piezoceramic principle and remote manual actuation. Progress has been made concerning material selection, position sensing, and different actuation techniques, and design strategies have been implemented to overcome the multiple restrictions imposed by the MRI environment. Most systems lack the clinical validation needed to continue on to commercial products.

The feasibility of MR-Image guided prostate biopsy using piezoceramic motors inside or near to the magnet isocentre

The excellent soft tissue contrast of Magnetic Resonance Imaging (MRI) has encouraged the development of MRI compatible systems capable of combining the advantages of robotic manipulators with high quality anatomical images. Continuing this development, a new five DOF prostate biopsy manipulator has been designed for use inside a closed 1.5T MRI scanner. Space constraints in the bore and the current trend to restrict field strength exposure for operators indicate that a master-slave configuration is ideal for controlling the robotic system from outside the bore. This system has been designed to work with piezoceramic motors and optical encoders placed inside or near the field of view of the scanner, using real time image guidance for targeting biopsies to specific lesions in the prostate. MRI tests have been performed to prove the feasibility of this concept and a one DOF proof-of-concept test rig implementing closed loop position control has been tested and is presented here. A first prototype of the slave manipulator has been designed and manufactured incorporating this new technology.

Intraoperative Real-Time Querying of White Matter Tracts During Frameless Stereotactic Neuronavigation

BACKGROUND: Brain surgery faces important challenges when trying to achieve maximum tumor resection while avoiding postoperative neurological deficits. OBJECTIVE: For surgeons to have optimal intraoperative information concerning white matter (WM) anatomy, we developed a platform that allows the intraoperative real-time querying of tractography data sets during frameless stereotactic neuronavigation. METHODS: Structural magnetic resonance imaging, functional magnetic resonance imaging, and diffusion tensor imaging were performed on 5 patients before they underwent lesion resection using neuronavigation. During the procedure, the tracked surgical tool tip position was transferred from the navigation system to the 3-dimensional Slicer software package, which used this position to seed the WM tracts around the tool tip location, rendering a geometric visualization of these tracts on the preoperative images previously loaded onto the navigation system. The clinical feasibility of this approach was evaluated in 5 cases of lesion resection. In addition, system performance was evaluated by measuring the latency between surgical tool tracking and visualization of the seeded WM tracts. RESULTS: Lesion resection was performed successfully in all 5 patients. The seeded WM tracts close to the lesion and other critical structures, as defined by the functional and structural images, were interactively visualized during the intervention to determine their spatial relationships relative to the lesion and critical cortical areas. Latency between tracking and visualization of tracts was less than a second for a fiducial radius size of 4 to 5 mm. CONCLUSION: Interactive tractography can provide an intuitive way to inspect critical WM tracts in the vicinity of the surgical region, allowing the surgeon to have increased intraoperative WM information to execute the planned surgical resection.

Multimodality Non-rigid Image Registration for Planning, Targeting and Monitoring During CT-Guided Percutaneous Liver Tumor Cryoablation

RATIONALE AND OBJECTIVES The aim of this study was to develop non-rigid image registration between preprocedure contrast-enhanced magnetic resonance (MR) images and intraprocedure unenhanced computed tomographic (CT) images, to enhance tumor visualization and localization during CT imaging-guided liver tumor cryoablation procedures. MATERIALS AND METHODS A non-rigid registration technique was evaluated with different preprocessing steps and algorithm parameters and compared to a standard rigid registration approach. The Dice similarity coefficient, target registration error, 95th-percentile Hausdorff distance, and total registration time (minutes) were compared using a two-sided Students t test. The entire registration method was then applied during five CT imaging-guided liver cryoablation cases with the intraprocedural CT data transmitted directly from the CT scanner, with both accuracy and registration time evaluated. RESULTS Selected optimal parameters for registration were a section thickness of 5 mm, cropping the field of view to 66% of its original size, manual segmentation of the liver, B-spline control grid of 5 × 5 × 5, and spatial sampling of 50,000 pixels. A mean 95th-percentile Hausdorff distance of 3.3 mm (a 2.5 times improvement compared to rigid registration, P < .05), a mean Dice similarity coefficient of 0.97 (a 13% increase), and a mean target registration error of 4.1 mm (a 2.7 times reduction) were measured. During the cryoablation procedure, registration between the preprocedure MR and the planning intraprocedure CT imaging took a mean time of 10.6 minutes, MR to targeting CT image took 4 minutes, and MR to monitoring CT imaging took 4.3 minutes. Mean registration accuracy was <3.4 mm. CONCLUSIONS Non-rigid registration allowed improved visualization of the tumor during interventional planning, targeting, and evaluation of tumor coverage by the ice ball. Future work is focused on reducing segmentation time to make the method more clinically acceptable.

A Modular Approach to MRI-Compatible Robotics

The objective of the research described in this article is to create individual MR-compatible modules consisting of 1-DoF stages complete with actuators and position encoders for implementation of the closed-loop position control. These modules can connect together to form multi-DoF assemblies that can be located inside the scanner bore near to the patient anatomy that requires the intervention. This avoids the problems associated with remote actuation and transmission mechanisms, considerably reducing the size of the manipulator. As most robots consist of kinematic chains of 1-DoF stages, these modules would be suitable for a wide range of interventions, and their design can be optimized for the procedure for which they are applied to.

System for 3-D Real-Time Tracking of MRI-Compatible Devices by Image Processing

Real-time processing of MRIs is reported as a method of 3D tracking of mechanical devices within the field of view using passive microcoil fiducials. The specific implementation described makes use of two scan planes for full 3D tracking of a 5-DOF manipulator arm used for prostate biopsy under image guidance. Real-time tracking was observed with a maximum update rate of 0.42 frames per second for a maximum probe velocity of 10 mm/s. The localization of fiducials had a mean error of 0.36 (plusmn0.17) mm (p < 0.02), leading to a mean error in the needle tip position of 2.6 (plusmn0.3) mm (p < 0.05).

Robotic System for Transrectal Biopsy of the Prostate: Real-Time Guidance Under MRI

In this paper, to harness the possibility of real-time guidance of MRI, a robotic system has been developed to perform transrectal prostate biopsy inside a 1.5-T closed bore scanner. A specially developed MR pulse sequence is capable of tracking the needle location in real time while dynamically updating the scan planes to always include the needle and target.

Haptic Needle Unit for MR-Guided Biopsy and Its Control

MRI provides high-resolution anatomical images and is ideal for certain image-guided interventions. Due to the physical separation between the patient region of interest and the workspace accessible by the clinician, direct force feedback from the target anatomy is missing during the interventions. This paper demonstrates the use of a master-slave haptic device for magnetic resonance-guided biopsy, using a novel haptic control scheme based upon a neural network speed model. Results have shown the feasibility of the proposed hardware design and control scheme.