In pathology and legal medicine, the histopathological and microbiological analysis of tissue samples from infected deceased is a valuable information for developing treatment strategies during a pandemic such as COVID-19. However, a conventional autopsy carries the risk of disease transmission and may be rejected by relatives. We propose minimally invasive biopsy with robot assistance under CT guidance to minimize the risk of disease transmission during tissue sampling and to improve accuracy. A flexible robotic system for biopsy sampling is presented, which is applied to human corpses placed inside protective body bags. An automatic planning and decision system estimates optimal insertion point. Heat maps projected onto the segmented skin visualize the distance and angle of insertions and estimate the minimum cost of a puncture while avoiding bone collisions. Further, we test multiple insertion paths concerning feasibility and collisions. A custom end effector is designed for inserting needles and extracting tissue samples under robotic guidance. Our robotic post-mortem biopsy (RPMB) system is evaluated in a study during the COVID-19 pandemic on 20 corpses and 10 tissue targets, 5 of them being infected with SARS-CoV-2. The mean planning time including robot path planning is 5.72±1.67 s. Mean needle placement accuracy is 7.19±4.22 mm.
Optical tracking systems are widely used, for example, to navigate medical interventions. Typically, they require the presence of known geometrical structures, the placement of artificial markers, or a prominent texture on the target’s surface. In this work, we propose a 6D tracking approach employing volumetric optical coherence tomography (OCT) images. OCT has a micrometer-scale resolution and employs near-infrared light to penetrate few millimeters into, for example, tissue. Thereby, it provides sub-surface information which we use to track arbitrary targets, even with poorly structured surfaces, without requiring markers. Our proposed system can shift the OCT’s field-of-view in space and uses an adaptive correlation filter to estimate the motion at multiple locations on the target. This allows one to estimate the target’s position and orientation. We show that our approach is able to track translational motion with root-mean-squared errors below 0.25 mm and in-plane rotations with errors below 0.3°. For out-of-plane rotations, our prototypical system can achieve errors around 0.6°.
Forensic 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.
Modern optical coherence tomography (OCT) devices provide volumetric images with micrometer-scale spatial resolution and a temporal resolution beyond video rate. In this work, we analyze an OCT-based prototypical tracking system which processes 831 volumes per second, estimates translational motion, and automatically adjusts the field-of-view, which has a size of few millimeters, to follow a sample even along larger distances. The adjustment is realized by two galvo mirrors and a motorized reference arm, such that no mechanical movement of the scanning setup is necessary. Without requiring a marker or any other knowledge about the sample, we demonstrate that reliable tracking of velocities up to 25 mm s −1 is possible with mean tracking errors in the order of 0.25 mm. Further, we report successful tracking of lateral velocities up to 70 mm s −1 with errors below 0.3 mm.
Collaborative robotic needle insertions have the potential to improve placement accuracy and safety, e.g., during epidural anesthesia. Epidural anesthesia provides effective regional pain management but can lead to serious complications, such as nerve injury or cerebrospinal fluid leakage. Robotic assistance might prevent inadvertent puncture by providing haptic feedback to the physician. Haptic feedback can be realized on the basis of force measurements at the needle. However, contact should be avoided for delicate structures. We propose a proximity-based method to provide feedback prior to contact. We measure the distance to boundary layers, visualize the proximity for the operator and further feedback it as a haptic resistance. We compare our approach to haptic feedback based on needle forces and visual feedback without haptics. Participants are asked to realize needle insertions with each of the three feedback modes. We use phantoms that mimic the structures punctured during epidural anesthesia. We show that visual feedback improves needle placement, but only proximity-based haptic feedback reduces accidental puncture. The puncture rate is 62% for force-based haptic feedback, 60% for visual feedback and 6% for proximity-based haptic feedback. Final needle placement inside the epidural space is achieved in 38%, 70% and 96% for force-based haptic, visual and proximity-based haptic feedback, respectively. Our results suggest that proximity-based haptic feedback could improve needle placement safety in the context of epidural anesthesia.
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