Does needle rotation improve lesion targeting?

Badaan, Shadie; Petrisor, Doru; Kim, Chunwoo; Mozer, Pierre; Mazilu, Dumitru; Gruionu, Lucian Gheorghe; Patriciu, Alex; Cleary, Kevin; Stoianovici, Dan

doi:10.1002/rcs.381

Cited by 58 publications

(30 citation statements)

References 29 publications

(39 reference statements)

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“…With specialized hardware adjustment in Acubo-RND, the dependency on novice can be reduced leading to lower placement error. According to other studies with PPI-BT robots, sub-millimeter precision is possible [10,32,33].…”

Section: Discussionmentioning

confidence: 92%

“…Some of these brachytherapy-specific devices can insert needles at a continuum of locations and angles, emulating the degrees of freedom provided by freehand techniques, but can also place the tip of a needle with millimeter accuracy. However, the majority of current brachytherapy robot prototypes focus on PPI-BT [27,28,29,30,31], including the Acubot-RND [10,32,33], which is a needle insertion robot with applications to PPI-BT. Fig.…”

Section: Background and Related Workmentioning

confidence: 99%

“…Needle rotation was not used in this experiment. However, it has been shown that needle rotation improves targeting accuracy [33]. The RND has a needle release mechanism which enables the user to command it to release the needle at anytime during the procedure.…”

Section: Hardware Specificationsmentioning

confidence: 99%

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Initial experiments toward automated robotic implantation of skew-line needle arrangements for HDR brachytherapy

Garg¹,

Siauw²,

Berenson³

et al. 2012

2012 IEEE International Conference on Automation Science and Engineering (CASE)

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Abstract-One of the goals of automation is to increase the reliability and quality of a given process. This study aims to automate high dose rate brachytherapy (HDR-BT), a radiation therapy that places radioactive sources at the site of the tumor using needles. Although HDR-BT has a high rate of clinical success in curing prostate cancer, it also has several side effects related to needle and dose trauma. A new planning algorithm from previous work optimizes needle arrangements using skewlines (non-parallel, non-intersecting lines). This paper presents initial experiments towards an automated system for implanting skew-line needle arrangements computed from a planning system. We describe the interface, calibration and integration of the robotic hardware with the planning system, and present experiments using our robotic system to implant needles into anatomically-correct tissue phantoms. Results suggest that this system can achieve HDR-BT treatment objectives with reduced trauma to organs and low demands on operator skill, thus making the procedure repeatable at lower cost. We believe that in the future, robotic HDR-BT will result in improved treatment quality with reduced dependence on physician skill.

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Section: Discussionmentioning

confidence: 92%

Section: Background and Related Workmentioning

confidence: 99%

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Initial experiments toward automated robotic implantation of skew-line needle arrangements for HDR brachytherapy

Garg¹,

Siauw²,

Berenson³

et al. 2012

2012 IEEE International Conference on Automation Science and Engineering (CASE)

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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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“…Breath holding techniques are often used during percutaneous liver interventions to approach static conditions, but require a substantial amount of patient cooperation. In addition, lesion displacements may originate from the puncture event itself (2), as a result of the insertion forces acting on the complex set of interconnected and sliding tissue structures. In many cases, e.g.…”

Section: Introductionmentioning

confidence: 99%