Automatic Brachytherapy Seed Placement Under MRI Guidance

Patriciu, Alexandru; Petrisor, Doru; Müntener, Michael; Mazilu, Dumitru; Schär, Michael; Stoianovici, Dan

doi:10.1109/tbme.2007.900816

Cited by 96 publications

(71 citation statements)

References 31 publications

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“…Another potential benefit may be reduced exposure of the operating crew to toxic dose by handling the sources remotely. To this end, Patriciu et al (2007) demonstrated remotely actuated seed handling and insertion in training phantoms. This system was designed for use with MRI in a fetal patient position, with no apparent provision for its adaptation to standard clinical practice under TRUS guidance in lithotomy position.…”

Section: Introductionmentioning

confidence: 99%

Robotic assistance for ultrasound-guided prostate brachytherapy

Fichtinger

Fiene

Kennedy

et al. 2008

Medical Image Analysis

108

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We present a robotically assisted prostate brachytherapy system and test results in training phantoms and Phase-I clinical trials. The system consists of a transrectal ultrasound (TRUS) and a spatially co-registered robot, fully integrated with an FDA-approved commercial treatment planning system. The salient feature of the system is a small parallel robot affixed to the mounting posts of the template. The robot replaces the template interchangeably, using the same coordinate system. Established clinical hardware, workflow and calibration remain intact. In all phantom experiments, we recorded the first insertion attempt without adjustment. All clinically relevant locations in the prostate were reached. Non-parallel needle trajectories were achieved. The preinsertion transverse and rotational errors (measured with a Polaris optical tracker relative to the template's coordinate frame) were 0.25mm (STD=0.17mm) and 0.75° (STD=0.37°). In phantoms, needle tip placement errors measured in TRUS were 1.04mm (STD=0.50mm). A Phase-I clinical feasibility and safety trial has been successfully completed with the system. We encountered needle tip positioning errors of a magnitude greater than 4mm in only 2 out of 179 robotically guided needles, in contrast to manual template guidance where errors of this magnitude are much more common. Further clinical trials are necessary to determine whether the apparent benefits of the robotic assistant will lead to improvements in clinical efficacy and outcomes.

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Section: Introductionmentioning

confidence: 99%

Robotic assistance for ultrasound-guided prostate brachytherapy

Fichtinger

Fiene

Kennedy

et al. 2008

Medical Image Analysis

108

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“…An ever-growing body of literature demonstrates the integration of robotic manipulators and intraoperative imaging, real-time or intermittent with the procedure, using x-ray fluoroscopy, ultrasound (US) or Magnetic Resonance Imaging (MRI) [1]. Examples of demonstrated image-guided and robot assisted procedures includes applications in urology [2], cardiac ablation with fluoroscopy guided Sensei robotic catheter system (Hansen medical, USA) [3], and MRI-guided procedure like the resection of brain tumor with the NeuroArm [4], breast biopsy [5] and brachytherapy [6]. In these works the operator inspects visually the imaging information and maneuvers the robotic manipulator.…”

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confidence: 99%

A Framework for Integrating Real-Time MRI With Robot Control: Application to Simulated Transapical Cardiac Interventions

Navkar

Deng

Shah

et al. 2013

IEEE Trans. Biomed. Eng.

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Abstract-The advent of intraoperative real-time image guidance has led to the emergence of new surgical interventional paradigms including image-guided robot assistance. Most often the use of an intraoperative imaging modality is limited to visual perception of the area of procedure. In this work, we propose a framework for performing robot-assisted interventions with real-time Magnetic Resonance Imaging (rtMRI) guidance. The described computational core of this framework, processes onthe-fly rtMRI, integrates the processed information with robot control and renders it on the human-machine interfaces. This information is rendered on a visualization and force-feedback interface for enhanced perception of a dynamic area of procedure and for assisting the operator in the safe and accurate maneuvering of a robotic manipulator. The framework was experimentally tested by applying it to a simulated Transapical Aortic Valve Implantation with a virtual robotic manipulator. rtMRI data was processed on-the-fly in a rolling-window scheme and together with a multi-threaded and multi-hardware implementation, the core delivered appropriate speed of 20Hz for visualization and 1000Hz for force-feedback. The experimental results demonstrate significant improvement in the simulated task by both decreasing the duration of the procedure by half and increasing safety in the presence of cardiac and breathing motion by reducing the duration or incidents the operator collides with the tissue.

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“…Several of these devices can potentially insert skew-line needles, but they focus on PPI-BT and are not fully integrated with needle planners [36], [37], [38], [39], [40] The Acubot-RND was designed for PPI-BT and is operated by a manual joystick [13], [41], [42]. In this study, we modify the Acubot-RND with an interface to our needle planning software.…”

Section: Background and Related Workmentioning

confidence: 99%

Robot-Guided Open-Loop Insertion of Skew-Line Needle Arrangements for High Dose Rate Brachytherapy

Garg

Siauw

Berenson

et al. 2013

IEEE Trans. Automat. Sci. Eng.

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Abstract-We present a study in human-centered automation that has potential to reduce patient side effects from high dose rate brachytherapy (HDR-BT). To efficiently deliver radiation to the prostate while minimizing trauma to sensitive structures such as the penile bulb, we modified the Acubot-RND 7-axis robot to guide insertion of diamond-tip needles into desired skew-line geometric arrangements. We extend and integrate two algorithms: Needle Planning with Integer Programming (NPIP) and Inverse Planning with Integer Programming (IPIP) to compute skew-line needle and dose plans. We performed three physical experiments with anatomically-correct phantom models to study performance: two with the robot and one control experiment with an expert human physician (co-author Hsu) without the robot. All were able to achieve needle arrangements that meet the RTOG-0321 clinical dose objectives with zero trauma to the penile bulb. We analyze systematic and random errors in needle placement; total RMS error for the robot system operating without feedback ranged from 2.6 mm to 4.3 mm, which is comparable to the RMS error of 2.7 mm obtained in an earlier study for PPI-BT treatment using a robot with 3D ultrasound feedback.Note to Practitioners Brachytherapy treats cancer by delivering radioactive sources proximal to cancer sites via needles. Current methods use standardized fixed mechanical templates that force needles into parallel arrangements that may prevent needles from reaching prostate volumes blocked by the pubic arch and often require needles to puncture sensitive organs. Skew-line (non-parallel) arrangements of needles can reach targets under the pubic arch and avoid sensitive organs. However these arrangements cannot be achieved with standard templates, motivating the use of automation. We present a human-centered automation system that integrates state-of-the- Left: The current clinical approach to prostate high dose rate brachytherapy (HDR-BT) uses parallel needles guided by a mechanical template. This approach may prevent needles from reaching prostate volumes blocked by the pubic arch and often require needles to puncture sensitive organs (which can produce long-term side-effects). Right: Skew-line needle arrangements facilitated by robot guidance can avoid puncture by reaching under the pubic arch and can minimize trauma to sensitive organs such as the penile bulb which can produce side effects such as incontinence and impotence.art needle and dose planning algorithms with a modified needle insertion robot. Results suggest that the robot can achieve precision and accuracy comparable to that of expert human physician. This approach has applications to brachytherapy treatment for other organs and to other needle procedures such as biopsy and anesthetic injection.

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Automatic Brachytherapy Seed Placement Under MRI Guidance

Cited by 96 publications

References 31 publications

Robotic assistance for ultrasound-guided prostate brachytherapy

Robotic assistance for ultrasound-guided prostate brachytherapy

A Framework for Integrating Real-Time MRI With Robot Control: Application to Simulated Transapical Cardiac Interventions

Robot-Guided Open-Loop Insertion of Skew-Line Needle Arrangements for High Dose Rate Brachytherapy

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