Sang-Eun Song

Development of a pneumatic robot for MRI-guided transperineal prostate biopsy and brachytherapy: New approaches

Magnetic Resonance Imaging (MRI) guided prostate biopsy and brachytherapy has been introduced in order to enhance the cancer detection and treatment. For the accurate needle positioning, a number of robotic assistants have been developed. However, problems exist due to the strong magnetic field and limited workspace. Pneumatically actuated robots have shown the minimum distraction in the environment but the confined workspace limits optimal robot design and thus controllability is often poor. To overcome the problem, a simple external damping mechanism using timing belts was sought and a 1-DOF mechanism test result indicated sufficient positioning accuracy. Based on the damping mechanism and modular system design approach, a new workspace-optimized 4-DOF parallel robot was developed for the MRI-guided prostate biopsy and brachytherapy. A preliminary evaluation of the robot was conducted using previously developed pneumatic controller and satisfying results were obtained.

Development and Evaluation of an Actuated MRI-Compatible Robotic System for MRI-Guided Prostate Intervention

This paper reports the design, development, and magnetic resonance imaging (MRI) compatibility evaluation of an actuated transrectal prostate robot for MRI-guided needle intervention in the prostate. The robot performs actuated needle MRI guidance with the goals of providing 1) MRI compatibility; 2) MRI-guided needle placement with accuracy sufficient for targeting clinically significant prostate cancer foci; 3) reducing interventional procedure times (thus increasing patient comfort and reducing opportunity for needle targeting error due to patient motion); 4) enabling real-time MRI monitoring of interventional procedures; and 5) reducing the opportunities for error that arise in manually actuated needle placement. The design of the robot, employing piezoceramic-motor actuated needle guide positioning and manual needle insertion, is reported. Results of an MRI compatibility study show no reduction of MRI signal-to-noise ratio (SNR) with the disabled motors. Enabling the motors reduces the SNR by 80% without radio frequency (RF) shielding, but the SNR is only reduced by 40-60% with RF shielding. The addition of RF shielding is shown to significantly reduce image SNR degradation caused by the presence of the robotic device. An accuracy study of MRI-guided biopsy needle placements in a prostate phantom is reported. The study shows an average in-plane targeting error of 2.4 mm with a maximum error of 3.7 mm. These data indicate that the systems needle targeting accuracy is similar to that obtained with a previously reported manually actuated system, and is sufficient to reliably sample clinically significant prostate cancer foci under MRI guidance.

Transperineal In-Bore 3-T MR Imaging–guided Prostate Biopsy: A Prospective Clinical Observational Study

PURPOSE To determine the detection rate, clinical relevance, Gleason grade, and location of prostate cancer ( PCa prostate cancer ) diagnosed with and the safety of an in-bore transperineal 3-T magnetic resonance (MR) imaging-guided prostate biopsy in a clinically heterogeneous patient population. MATERIALS AND METHODS This prospective retrospectively analyzed study was HIPAA compliant and institutional review board approved, and informed consent was obtained. Eighty-seven men (mean age, 66.2 years ± 6.9) underwent multiparametric endorectal prostate MR imaging at 3 T and transperineal MR imaging-guided biopsy. Three subgroups of patients with at least one lesion suspicious for cancer were included: men with no prior PCa prostate cancer diagnosis, men with PCa prostate cancer who were undergoing active surveillance, and men with treated PCa prostate cancer and suspected recurrence. Exclusion criteria were prior prostatectomy and/or contraindication to 3-T MR imaging. The transperineal MR imaging-guided biopsy was performed in a 70-cm wide-bore 3-T device. Overall patient biopsy outcomes, cancer detection rates, Gleason grade, and location for each subgroup were evaluated and statistically compared by using χ(2) and one-way analysis of variance followed by Tukey honestly significant difference post hoc comparisons. RESULTS Ninety biopsy procedures were performed with no serious adverse events, with a mean of 3.7 targets sampled per gland. Cancer was detected in 51 (56.7%) men: 48.1% (25 of 52) with no prior PCa prostate cancer , 61.5% (eight of 13) under active surveillance, and 72.0% (18 of 25) in whom recurrence was suspected. Gleason pattern 4 or higher was diagnosed in 78.1% (25 of 32) in the no prior PCa prostate cancer and active surveillance groups. Gleason scores were not assigned in the suspected recurrence group. MR targets located in the anterior prostate had the highest cancer yield (40 of 64, 62.5%) compared with those for the other parts of the prostate (P < .001). CONCLUSION In-bore 3-T transperineal MR imaging-guided biopsy, with a mean of 3.7 targets per gland, allowed detection of many clinically relevant cancers, many of which were located anteriorly.

Soft robotic sleeve supports heart function

A soft robotic sleeve modeled on the structure of the human heart assists cardiovascular function in an ex vivo and in vivo porcine model of heart failure. Robots have a change of heart Ventricular assist devices help failing hearts function by pumping blood but require monitoring and anticoagulant therapy to prevent blood clot formation. Roche et al. created a soft robotic device with material properties similar to those of native heart tissue that sits snugly around the heart and provides ventricular assistance without ever contacting blood. The robotic sleeve uses compressed air to power artificial silicone muscles that compress and twist, mimicking the movements of the normal human heart. The authors show that the artificial muscles could be selectively activated to twist, compress, or simultaneously perform both actions on one side or both sides of the heart. The device increased cardiac ejection volume in vitro and when implanted in adult pigs during drug-induced cardiac arrest. There is much interest in form-fitting, low-modulus, implantable devices or soft robots that can mimic or assist in complex biological functions such as the contraction of heart muscle. We present a soft robotic sleeve that is implanted around the heart and actively compresses and twists to act as a cardiac ventricular assist device. The sleeve does not contact blood, obviating the need for anticoagulation therapy or blood thinners, and reduces complications with current ventricular assist devices, such as clotting and infection. Our approach used a biologically inspired design to orient individual contracting elements or actuators in a layered helical and circumferential fashion, mimicking the orientation of the outer two muscle layers of the mammalian heart. The resulting implantable soft robot mimicked the form and function of the native heart, with a stiffness value of the same order of magnitude as that of the heart tissue. We demonstrated feasibility of this soft sleeve device for supporting heart function in a porcine model of acute heart failure. The soft robotic sleeve can be customized to patient-specific needs and may have the potential to act as a bridge to transplant for patients with heart failure.

Preclinical evaluation of an MRI-compatible pneumatic robot for angulated needle placement in transperineal prostate interventions

PurposeTo evaluate the targeting accuracy of a small profile MRI-compatible pneumatic robot for needle placement that can angulate a needle insertion path into a large accessible target volume.MethodsWe extended our MRI-compatible pneumatic robot for needle placement to utilize its four degrees-of-freedom (4-DOF) mechanism with two parallel triangular structures and support transperineal prostate biopsies in a closed-bore magnetic resonance imaging (MRI) scanner. The robot is designed to guide a needle toward a lesion so that a radiologist can manually insert it in the bore. The robot is integrated with navigation software that allows an operator to plan angulated needle insertion by selecting a target and an entry point. The targeting error was evaluated while the angle between the needle insertion path and the static magnetic field was between −5.7° and 5.7° horizontally and between −5.7° and 4.3° vertically in the MRI scanner after sterilizing and draping the device.ResultsThe robot positioned the needle for angulated insertion as specified on the navigation software with overall targeting error of 0.8 ± 0.5mm along the horizontal axis and 0.8 ± 0.8mm along the vertical axis. The two-dimensional root-mean-square targeting error on the axial slices as containing the targets was 1.4mm.ConclusionsOur preclinical evaluation demonstrated that the MRI-compatible pneumatic robot for needle placement with the capability to angulate the needle insertion path provides targeting accuracy feasible for clinical MRI-guided prostate interventions. The clinical feasibility has to be established in a clinical study.

3T MR-guided in-bore transperineal prostate biopsy: A comparison of robotic and manual needle-guidance templates

To demonstrate the utility of a robotic needle‐guidance template device as compared to a manual template for in‐bore 3T transperineal magnetic resonance imaging (MRI)‐guided prostate biopsy.

Accuracy study of a robotic system for MRI-guided prostate needle placement

Accurate needle placement is the first concern in percutaneous MRI‐guided prostate interventions. In this phantom study, different sources contributing to the overall needle placement error of a MRI‐guided robot for prostate biopsy have been identified, quantified and minimized to the possible extent.

Development and Preliminary Evaluation of a Motorized Needle Guide Template for MRI-Guided Targeted Prostate Biopsy

To overcome the problems of limited needle insertion accuracy and human error in the use of a conventional needle guide template in magnetic resonance imaging (MRI)-guided prostate intervention, we developed a motorized MRI-compatible needle guide template that resembles a transrectal ultrasound-guided prostate template. The motorized template allows automated, gapless needle guidance in a 3T MRI scanner with minimal changes in the current clinical procedure. To evaluate the impact of the motorized template on MRI, signal-to-noise ratio and distortion were measured under various system configurations. A maximum of 44% signal-to-noise ratio decrease was found when the ultrasonic motors were running, and a maximum of 0.4% image distortion was observed due to the presence of the motorized template. To measure needle insertion accuracy, we performed four sets of five random target needle insertions mimicking four biopsy procedures, which resulted in an average in-plane targeting error of 0.94 mm with a standard deviation of 0.34 mm. The evaluation studies indicated that the presence and operation of the motorized template in the MRI bore create insignificant image degradation, and provide submillimeter targeting accuracy. The automated needle guide that is directly controlled by navigation software eliminates human error so that the safety of the procedure can be improved.

Development and preliminary evaluation of an actuated MRI-compatible robotic device for MRI-guided prostate intervention

This paper reports the design, development, and magnetic resonance imaging (MRI) compatibility evaluation of an actuated transrectal prostate robot for MRI-guided intervention. The robot employs an actuated needle guide with the goal of reducing interventional procedure times and increasing needle placement accuracy. The design of the robot, employing piezo-ceramic-motor actuated needle guide positioning and manual needle insertion, is reported. Results of a MRI compatibility study show no reduction of MRI image signal-to-noise-ratio (SNR) with the motors disabled and a 40% to 60% reduction in SNR with the motors enabled. The addition of radio-frequency (RF) shielding is shown to significantly reduce image SNR degradation due to the presence of the robotic device.

HyBAR: hybrid bone-attached robot for joint arthroplasty

A number of small bone‐attached surgical robots have been introduced to overcome some disadvantages of large stand‐alone surgical robots. In orthopaedics, increasing demand on minimally invasive joint replacement surgery has also been encouraging small surgical robot developments. Among various technical aspects of such an approach, optimal miniaturization that maintains structural strength for high speed bone removal was investigated.