Prospects in Percutaneous Ablative Targeting: Comparison of a Computer-Assisted Navigation System and the AcuBot Robotic System

Abstract

Aim: Precise targeting is essential for adequate treatment of lesions during image-guided therapy. The aim of this study was to compare the performance of two emerging image-guided targeting technologies in a phantom model. Materials and Methods: A computer-assisted navigation system and AcuBot were tested using three operators: an interventional radiologist and two endourologists. Fiducials were placed in an anatomic gelatin phantom and targeted by both systems. The images were reconstructed and analyzed using a specialized software package (Amira; Visage Imaging, Carlsbad, CA). Accuracy was assessed by measuring proximity of the tip of the needle to the fiducial on computed-tomography-guided imaging. Accuracy and time to target were quantified and compared. Results: The mean distance from the desired target for AcuBot was 1.2 mm (range: 0.39-2.82). The mean distance from the desired target for the navigation system was 5.8 mm (range: 1.8-11.9). The AcuBot was significantly more accurate than the navigation system ( p < 0.0001). The mean time from target acquisition to needle placement was 37 seconds (range: 15-75) for the AcuBot and 108 seconds (range: 45-315) for the navigation system ( p ¼ 0.001). Conclusion: Emerging technologies hold promise for increased accuracy during percutaneous targeted procedures. Both the AcuBot and the computer-assisted navigation system were accurate and efficient in a phantom targeting model. AcuBot was significantly more accurate, faster, and less user dependent than the navigation system. Further studies in animal and clinical studies are warranted to further advance this promising technology.

New technology in ureteroscopy and percutaneous nephrolithotomy

“…4) [(www.clearguidemedical.com/news) 30 August 2015]. The company is a Johns-Hopkins University spin-off, trying to commercialize products of previous projects [7,8]. Until now, there are no publications in urology.…”

Comparison of CT Fluoroscopy-Guided Manual and CT-Guided Robotic Positioning System for In Vivo Needle Placements in Swine Liver

“…It has also been suggested that the use of robotic assistance during needle placement can help minimize the radiation exposure to operators and patients during CT or fluoroscopy guided interventional procedures [17; 20–27]. At the same time, the use of robotic guidance may also reduce the number of needle adjustments required to reach a target, thereby reducing patient complications such as bleeding[28]. …”

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

“…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].…”

“…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.…”