Abstract

Biopsies for personalized cancer care can be performed with cone beam computed tomography (CBCT) guidance, but manual needle manipulation remains an issue due to X-ray exposure to physicians. Modern CBCT scanners integrate today real-time imaging and software assistance for needle planning. In this paper, these available features are exploited to design a novel device offering an intermediate level of assistance between simple passive mechanical devices of limited efficiency, and advanced robotic devices requiring adapted procedure workflows. Our resulting system is built to limit its impact on the current manual practice. It is patient-mounted and provides remote control of needle orientation and insertion. A multilayer phantom is specifically developed to reproduce interactions between the needle and soft abdominal tissues. It is used to experimentally evaluate the device added value by comparing assisted versus manual needle insertions. The device is shown to help reducing X-ray exposure by a factor 4, without impacting the accuracy obtained manually.

References

1.
Cancer Research UK
,
2015
, “
Worldwide Cancer Mortality Statistics
,”
Cancer Research UK
,
London, UK
.
2.
Tam
,
A. L.
,
Lim
,
H. J.
,
Wistuba
,
I. I.
,
Tamrazi
,
A.
,
Kuo
,
M. D.
,
Ziv
,
E.
,
Wong
,
S.
,
Shih
,
A. J.
,
Webster
,
R. J.
,
Fischer
,
G. S.
,
Nagrath
,
S.
,
Davis
,
S. E.
,
White
,
S. B.
, and
Ahrar
,
K.
,
2016
, “
Image-Guided Biopsy in the Era of Personalized Cancer Care: Proceedings From the Society of Interventional Radiology Research Consensus Panel
,”
J. Vasc. Intervent. Radiol.
,
27
(
1
), pp.
8
19
.10.1016/j.jvir.2015.10.019
3.
Cherukuri
,
A. R.
,
Lubner
,
M. G.
,
Zea
,
R.
,
Hinshaw
,
J. L.
,
Lubner
,
S. J.
,
Matkowskyj
,
K. A.
,
Foltz
,
M. L.
, and
Pickhardt
,
P. J.
,
2019
, “
Tissue Sampling in the Era of Precision Medicine: Comparison of Percutaneous Biopsies Performed for Clinical Trials or Tumor Genomics Versus Routine Clinical Care
,”
Abdom. Radiol.
,
44
(
6
), pp.
2074
2080
.10.1007/s00261-018-1702-1
4.
Dalag
,
L.
,
Fergus
,
J. K.
, and
Zangan
,
S. M.
,
2019
, “
Lung and Abdominal Biopsies in the Age of Precision Medicine
,”
Semin. Intervent. Radiol.
,
36
(
03
), pp.
255
263
.10.1055/s-0039-1693121
5.
Pron
,
G.
,
Mocarski
,
E.
,
Bennett
,
J.
,
Vilos
,
G.
,
Common
,
A.
,
Zaidi
,
M.
,
Sniderman
,
K.
,
Asch
,
M.
,
Kozak
,
R.
,
Simons
,
M.
,
Tran
,
C.
, and
Kachura
,
J.
,
2003
, “
Tolerance, Hospital Stay, and Recovery After Uterine Artery Embolization for Fibroids: The Ontario Uterine Fibroid Embolization Trial
,”
J. Vasc. Intervent. Radiol.
,
14
(
10
), pp.
1243
1250
.10.1097/01.RVI.0000092664.72261.F9
6.
Racadio
,
J.
,
Babic
,
D.
,
Homan
,
R.
,
Rampton
,
J.
,
Patel
,
M.
,
J.M
,
R.
, and
N.D
,
J.
,
2007
, “
Live 3D Guidance in the Interventional Radiology Suite
,”
Am. J. Roentgenol.
,
189
(
6
), pp.
W357
W364
.10.2214/AJR.07.2469
7.
Braak
,
S.
,
van Strijen
,
M.
,
van Es
,
H.
,
R
,
N.
, and
van Heesewijk
,
J.
,
2011
, “
Effective Dose During Needle Interventions: Cone-Beam CT Guidance Compared With Conventional CT Guidance
,”
J. Vasc. Intervent. Radiol.
,
22
(
4
), pp.
455
461
.10.1016/j.jvir.2011.02.011
8.
Braak
,
S.
,
van Strijen
,
M.
,
van Leersum
,
M.
,
van Es
,
H.
, and
van Heesewijk
,
J.
,
2010
, “
Real-Time 3D Fluoroscopy Guidance During Needle Interventions: Technique, Accuracy and Feasibility
,”
Am. J. Roentgenol.
,
194
(
5
), pp.
W445
W451
.10.2214/AJR.09.3647
9.
Busser
,
W.
,
Braak
,
S.
,
Futterer
,
J.
,
van Strijen
,
M. J.
,
Y.L
,
H.
,
de Lange
,
F.
, and
Schultze Kool
,
L.
,
2013
, “
Cone Beam CT Guidance Provides Superior Accuracy for Complex Needle Paths Compared With CT Guidance
,”
Brit. Inst. Radiol.
,
86
(
1030
), pp.
1
6
.10.1259/bjr.20130310
10.
Philips Healthcare,
2019
,
XperGuide, Live 3D Needle Guidance
,
Philips Healthcare
,
Eindhoven, The Netherlands
.
11.
Kulkarni
,
P.
,
Sikander
,
S.
,
Biswas
,
P.
,
Frawley
,
S.
, and
Song
,
S.-E.
,
2019
, “
Review of Robotic Needle Guide Systems for Percutaneous Intervention
,”
Ann. Biomed. Eng.
,
47
(
12
), pp.
2489
2513
. July,10.1007/s10439-019-02319-9
12.
Kroes
,
M.
,
Busser
,
W.
,
de Lange
,
F.
,
Hoogeven
,
Y.
,
Schultze Kool
,
L.
, and
N.L
,
N.
,
2011
, “
Hand Dose Assessment in Combined Cone-Beam CT and Real-Time Fluoroscopy Guided Needle Puncture Procedures Using Needle Guidance Devices
,”
European Congress of Radiology
, Vienna, Austria, Mar. 3–7.https://www.semanticscholar.org/paper/Hand-dose-assessment-in-combined-cone-beam-CT-and-Kroes-Busser/37e6abc0b5fc22711910f9f07565839f3ab512b2
13.
Kroes
,
M.
,
Busser
,
M.
,
Futterer
,
J.
,
Arntz
,
M.
,
Janssen
,
C.
,
Hoogevee
,
Y.
,
de Lange
,
F.
, and
Schultze Kool
,
L.
,
2013
, “
Assessment of Needle Guidance Devices for Their Potential to Reduce Fluoroscopy Time and Operator Hand Dose During c-Arm Cone-Beam Computed Tomography-Guided Needle Interventions
,”
J. Vasc. Intervent. Radiol.
,
24
(
6
), pp.
901
906
.10.1016/j.jvir.2013.02.037
14.
Tovar-Arriaga
,
S.
,
Tita
,
R.
,
Pedraza-Ortega
,
J.
,
Gorrostieta
,
E.
, and
Kalender
,
W.
,
2011
, “
Development of a Robotic FD-CT-Guided Navigation System for Needle Placement - Preliminary Accuracy Tests
,”
Int. J. Medical Rob. Comput. Assisted Surg.
,
7
(
2
), pp.
225
236
.10.1002/rcs.393
15.
Schulz
,
B.
,
Eichler
,
K.
,
Siebenhandl
,
P.
,
Gruber-Rouh
,
T.
,
Czerny
,
C.
,
Vogl
,
T.
, and
Zangos
,
S.
,
2013
, “
Accuracy and Speed of Robotic Assisted Needle Interventions Using a Modern Cone Beam Computed Tomography Intervention Suite: A Phantom Study
,”
Eur. Radiol.
,
23
(
1
), pp.
198
204
.10.1007/s00330-012-2585-0
16.
Pfeil
,
A.
,
Barbé
,
L.
,
Wach
,
B.
,
R.L
,
C.
,
Gangi
,
A.
, and
Renaud
,
P.
,
2018
, “
Observations and Experiments for the Definition of a New Robotic Device Dedicated to ct, Cbct and Mri-Guided Percutaneous Procedures
,”
IEEE Engineering in Medicine and Biology Conference
, Honolulu, HI, July 18–21, pp.
1708
1712
.10.1109/EMBC.2018.8512682
17.
Hungr
,
N.
,
Bricault
,
I.
,
Cinquin
,
P.
, and
Fouard
,
C.
,
2016
, “
Design and Validation of a CT- and MRI-Guided Robot for Percutaneous Needle Procedures
,”
IEEE Trans. Rob.
,
32
(
4
), pp.
973
987
.10.1109/TRO.2016.2588884
18.
Stoianovici
,
D.
,
Jun
,
C.
,
Lim
,
S.
,
Li
,
P.
,
Petrisor
,
D.
,
Fricke
,
S.
,
Sharma
,
K.
, and
Cleary
,
K.
,
2018
, “
Multi-Imager Compatible, MR-Safe, Remote Center of Motion Needle-Guide Robot
,”
IEEE Trans. Biomed. Eng.
,
65
(
1
), pp.
165
177
.10.1109/TBME.2017.2697766
19.
Official Journal of the European Union
,
2010
, “
Directive 2010/63/EU of the European Parliament and of the Council of 22 September 2010 on the Protection of Animals Used for Scientific Purposes Text With EEA Relevance
,”
Ph.D. thesis
.https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2010:276:0033:0079:en:PDF
20.
Braak
,
S. J.
,
2012
, “Cone-Beam CT Guidance in Interventional Radiology,”
Ph.D. thesis
,
Utrecht University
,
Utrecht, The Netherlands
.https://dspace.library.uu.nl/handle/1874/256016
21.
Abi-Jaoudeh
,
N.
,
Fisher
,
T.
,
Jacobus
,
J.
,
Skopec
,
M.
,
Radaelli
,
A.
,
Van Der Bom
,
I. M.
,
Wesley
,
R.
, and
Wood
,
B. J.
,
2016
, “
Prospective Randomized Trial for Image-Guided Biopsy Using Cone-Beam CT Navigation Compared With Conventional CT
,”
J. Vasc. Intervent. Radiol.
,
27
(
9
), pp.
1342
1349
.10.1016/j.jvir.2016.05.034
22.
Schullian
,
P.
,
Widmann
,
G.
,
Lang
,
T. B.
,
Knoflach
,
M.
, and
Bale
,
R.
,
2011
, “
Accuracy and Diagnostic Yield of CT-Guided Stereotactic Liver Biopsy of Primary and Secondary Liver Tumors
,”
Comput. Aided Surg.
,
16
(
4
), pp.
181
187
.10.3109/10929088.2011.578367
23.
Maurin
,
B.
,
Barbé
,
L.
,
Bayle
,
B.
,
Zanne
,
P.
,
Gangloff
,
J.
,
de Mathelin
,
M.
,
Gangi
,
A.
,
Soler
,
L.
, and
Forgione
,
A.
,
2004
, “
In Vivo Study of Forces During Needle Insertions
,”
Proceedings of the Medical Robotics, Navigation and Visualisation Scientific Workshop
, Remagen, Germany, Mar. 11–12, pp.
415
422
.http://eavr.u-strasbg.fr/~bernard/publications/download/mrnv2004.pdf
24.
Mendoza
,
E.
, and
Whitney
,
J. P.
,
2019
, “
A Testbed for Haptic and Magnetic Resonance Imaging-Guided Percutaneous Needle Biopsy
,”
IEEE Rob. Autom. Lett.
,
4
(
4
), pp.
3177
3183
.10.1109/LRA.2019.2925558
25.
Christoforou
,
2013
, “
A Novel, General-Purpose, MR-Compatible, Manually Actuated Robotic Manipulation System for Minimally Invasive Interventions Under Direct MRI Guidance
,”
Int. J. Med. Rob. Comput. Assisted Surg.
, 10(1), pp.
22
34
.10.1002/rcs.1504
26.
El Bannan
,
K.
,
Chronik
,
B. A.
, and
Salisbury
,
S. P.
,
2015
, “
Development of an MRI-Compatible, Compact, Rotary-Linear Piezoworm Actuator
,”
ASME J. Med Devices
,
9
(
1
), p.
014501
.10.1115/1.4028943
27.
Comber
,
D. B.
,
Slightam
,
J. E.
,
Gervasi
,
V. R.
,
Neimat
,
J. S.
, and
Barth
,
E. J.
,
2016
, “
Design, Additive Manufacture, and Control of a Pneumatic MR-Compatible Needle Driver
,”
IEEE Trans. Rob.
,
32
(
1
), pp.
138
149
.10.1109/TRO.2015.2504981
28.
Maurin
,
B.
,
Bayle
,
B.
,
Gangloff
,
J.
,
Zanne
,
P.
,
Mathelin
,
M. D.
, and
Piccin
,
O.
,
2006
, “
A Robotized Positioning Platform Guided by Computed Tomography: Practical Issues and Evaluation
,” Proceedings IEEE International Conference on Robotics and Automation (
ICRA 2006
), Orlando, FL, May 15–19, pp.
251
256
.10.1109/ROBOT.2006.1641192
29.
Walsh
,
C.
,
Hanumara
,
N.
,
Slocum
,
A.
,
Shepard
,
J.
, and
Gupta
,
R.
,
2008
, “
A Patient-Mounted, Telerobotic Tool for CT-Guided Percutaneous Interventions
,”
ASME J. Med. Devices
,
2
(1), p. 011007.10.1115/1.2902854
30.
Monfaredi
,
R.
,
Wilson
,
E.
,
Sze
,
R.
,
Sharma
,
K.
,
Azizi
,
B.
,
Iordachita
,
I.
, and
Cleary
,
K.
,
2015
, “
Shoulder-Mounted Robot for MRI-Guided Arthrography: Accuracy and Mounting Study
,” 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (
EMBC
), Milan, Italy, Aug. 25–29, pp.
3643
3646
.10.1109/EMBC.2015.7319182
31.
Ben-David
,
E.
,
Shochat
,
M.
,
Roth
,
I.
,
Nissenbaum
,
I.
,
Sosna
,
J.
, and
Goldberg
,
S. N.
,
2018
, “
Evaluation of a CT-Guided Robotic System for Precise Percutaneous Needle Insertion
,”
J. Vasc. Intervent. Radiol. JVIR
,
29
(
10
), pp.
1440
1446
.10.1016/j.jvir.2018.01.002
32.
Leschka
,
S. C.
,
Babic
,
D.
,
El Shikh
,
S.
,
Wossmann
,
C.
,
Schumacher
,
M.
, and
Taschner
,
C. A.
,
2012
, “
C-Arm Cone Beam Computed Tomography Needle Path Overlay for Image-Guided Procedures of the Spine and Pelvis
,”
Neuroradiology
,
54
(
3
), pp.
215
223
.10.1007/s00234-011-0866-y
33.
Bruyas
,
A.
,
Geiskopf
,
F.
, and
Renaud
,
P.
,
2015
, “
Toward Unibody Robotic Structures With Integrated Functions Using Multimaterial Additive Manufacturing: Case Study of an Mri-Compatible Interventional Device
,” IEEE/RSJ International Conference on Intelligent Robots and Systems (
IROS
), Hamburg, Germany, Sept. 28–Oct. 2, pp.
1744
1750
.10.1109/IROS.2015.7353603
34.
Bruyas
,
A.
,
Geiskopf
,
F.
, and
Renaud
,
P.
,
2015
, “
Design and Modeling of a Large Amplitude Compliant Revolute Joint: The Helical Shape Compliant Joint
,”
ASME J. Mech. Des.
,
137
(
8
), p.
085003
.10.1115/1.4030650
35.
Pfeil
,
A.
,
Barbé
,
L.
,
Wach
,
B.
,
Bruyas
,
A.
,
Geiskopf
,
F.
,
Nierenberger
,
M.
, and
Renaud
,
P.
,
2018
, “
A 3D-Printed Needle Driver Based on Auxetic Structure and Inchworm Kinematics
,”
ASME
Paper No. DETC2018-85371.10.1115/DETC2018-85371
36.
Lefebvre
,
P. M.
,
Koon
,
K. T. V.
,
Brusseau
,
E.
,
Nicolle
,
S.
,
Palieme
,
J.-F.
,
Lambert
,
S. A.
, and
Grenier
,
D.
,
2016
, “
Comparison of Viscoelastic Property Characterization of Plastisol Phantoms With Magnetic Resonance Elastography and High-Frequency Rheometry
,”
Annual International Conference of the IEEE Engineering in Medicine and Biology Society
, Orlando, FL, Aug. 16–20, pp.
1216
1219
.10.1109/EMBC.2016.7590924
37.
Wang
,
Y.
,
Tai
,
B. L.
,
Yu
,
H.
, and
Shih
,
A. J.
,
2014
, “
Silicone-Based Tissue-Mimicking Phantom for Needle Insertion Simulation
,”
ASME J. Med. Devices
, 8(2), p.
021001
.10.1115/1.4026508
38.
Sparks
,
J. L.
,
Vavalle
,
N. A.
,
Kasting
,
K. E.
,
Long
,
B.
,
Tanaka
,
M. L.
,
Sanger
,
P. A.
,
Schnell
,
K.
, and
Conner-Kerr
,
T. A.
,
2015
, “
Use of Silicone Materials to Simulate Tissue Biomechanics as Related to Deep Tissue Injury
,”
Adv. Skin Wound Care
,
28
(
2
), pp.
59
68
.10.1097/01.ASW.0000460127.47415.6e
39.
Barbé
,
L.
,
Bayle
,
B.
,
de Mathelin
,
M.
, and
Gangi
,
A.
,
2007
, “
In vivo Model Estimation and Haptic Characterization of Needle Insertions
,”
Int. J. Rob. Res.
,
26
(
11–12
), pp.
1283
1301
.10.1177/0278364907082666
40.
Maurin
,
B.
,
Barbé
,
L.
,
Bayle
,
B.
,
Zanne
,
P.
,
Gangloff
,
J.
,
De Mathelin
,
M.
,
Gangi
,
A.
,
Soler
,
L.
, and
Forgione
,
A.
,
2004
, “
In Vivo Study of Forces During Needle Insertions
,”
Perspective in Image-Guided Surgery
,
World Scientific
,
Munich, Germany
, pp.
415
422
. http://eavr.u-strasbg.fr/~bernard/publications/download/mrnv2004.pdf
41.
Heerink
,
W. J.
,
Ruiter
,
S. J. S.
,
Pennings
,
J. P.
,
Lansdorp
,
B.
,
Vliegenthart
,
R.
,
Oudkerk
,
M.
, and
de Jong
,
K. P.
,
2019
, “
Robotic Versus Freehand Needle Positioning in CT-Guided Ablation of Livert Tumors
,”
Radiology
,
290
(
3
), pp.
826
832
.10.1148/radiol.2018181698
42.
Elayaperumal
,
S.
,
Bae
,
J.
,
Christensen
,
D.
,
Cutkosky
,
M.
,
Daniel
,
B.
,
Black
,
R.
,
Costa
,
J.
,
Faridian
,
F.
, and
Moslehi
,
B.
,
2013
, “
MR-Compatible Biopsy Needle With Enhanced Tip Force Sensing
,”
IEEE World Haptics
, Daejeon, Korea, Apr. 14–17.10.1109/WHC.2013.6548393
43.
Schneegans
,
H.
,
Rubbert
,
L.
,
Rivera
,
J.
,
Fifanski
,
S.
,
Renaud
,
P.
,
Henein
,
S.
, and
Baur
,
C.
,
2019
, “
Fiber Optic Fabry-Perot Interferometry for a Biopsy Needle With Tip Force Sensing
,”
IEEE/RSJ International Conference on Intelligent Robots and Systems
, Macau, China, Nov. 3–8.
44.
Gayral
,
T.
,
Rubbert
,
L.
, and
Renaud
,
P.
,
2019
, “
Modeling and Identification for the Design of a Rotary Soft Actuator Based on Wren Mechanism
,”
IEEE/RSJ International Conference on Intelligent Robots and Systems
, Macau, China, Nov. 3–8, pp.
7447
7453
.10.1109/IROS40897.2019.8967741
You do not currently have access to this content.