Risk Management for the Reliability of Robotic Assisted Treatment of Non-resectable Liver Tumors

Abstract

Hepatic cancers represent an important worldwide health issue where surgery alone in most cases is not a feasible therapeutic solution since most tumors are non-resectable. Despite targeted therapies showing positive results in other areas of cancer treatment, in the case of liver tumors, no low-risk delivery methods have been identified. Based on a risk assessment approach, this paper proposes a technical solution in the form of a robotic system capable of achieving a reliable delivery method for targeted treatment, focusing on the patient safety and therapeutic efficiency. The design of the robotic system starts from the definition of the design constraints with respect to the medical protocol. An analytical hierarchy process is used to prioritize the data correlated with the technical characteristics of a new robotic system, aiming to minimize risks associated with the medical procedure. In a four-phase quality function deployment, the technical solution is evaluated with respect to the quality characteristics, functions, subsystems, and components aiming to achieve a safe and reliable system with high therapeutic efficiency. The results lead to the concept of HeRo, a parallel robotic system for the reliable targeted treatment of non-resectable liver tumors.

Integration of Real-Time Image Fusion in the Robotic-Assisted Treatment of Hepatocellular Carcinoma

“…The targeted treatment of HCC (by means of brachytherapy or chemotherapy) may become a valid therapeutic method if the main challenges that the procedure imposes are addressed, namely, accuracy, safety and ergonomics. On the one hand, accuracy is arguably the most important factor in order to ensure patients’ safety; accurate delivery of the therapeutic agent depends both on the precision of the needle insertion and on the real-time information during the medical procedure [ 8 ], a fact that was also pointed out in [ 11 ]. On the other hand, the procedure ergonomics is important and has positive effects in diminishing the procedure time and decreasing personnel fatigue.…”

“…Furthermore, the possibility of robotic transrectal ultrasound-guided prostate biopsy has been investigated in [ 6 ], using a hands-free probe manipulator, mimicking the same four degrees of freedom that are used manually. Robotic systems (such as [ 7 , 8 ]) may also offer alternative solutions for the image guiding systems using US imaging since the position of the US probe (which is required for an adequate fusion and may be achieved e.g., with electromagnetic tracking [ 9 ]) is known via the kinematic models of the robots. In [ 8 ], the authors discuss the viability of robotic-assisted brachytherapy and intratumoral-targeted chemotherapy with respect to the technical challenges that the robotic system must overcome in order to ensure patient safety and procedure ergonomics.…”

“…Robotic systems (such as [7,8]) may also offer alternative solutions for the image guiding systems using US imaging since the position of the US probe (which is required for an adequate fusion and may be achieved e.g., with electromagnetic tracking [9]) is known via the kinematic models of the robots. In [8], the authors discuss the viability of robotic-assisted brachytherapy and intratumoral-targeted chemotherapy with respect to the technical challenges that the robotic system must overcome in order to ensure patient safety and procedure ergonomics. Although brachytherapy was used alone [10] or in combination with intratumoral chemotherapy [11] for liver cancers treatment, these therapeutic methods are not yet explored (to the authors best knowledge) for the robotic-assisted treatment of HCC.…”

On the flexible needle insertion into the human liver

“…Details of the forces during needle insertion into the liver are find in 14 , the real time collision detection for virtual surgery in 15 and the minimal hierarchical collision detection in 16 . Optimization is required to modify the needle trajectory in order to protect the liver 17 , 18 , to manage the tumor risk 19 , and to change the robot architecture 20 – 22 . The inverse sonification problem for capturing hardly detectable details in a medical image is treated in 23 , and the control in 24 – 27 .…”

Modeling of the Flexible Needle Insertion into the Human Liver

“…Details of the forces during needle insertion into the liver are find in [14], the real time collision detection for virtual surgery in [15] and the minimal hierarchical collision detection in [16]. Optimization is required to modify the needle trajectory in order to protect the liver [17,18], to manage the tumor risk [19], and to change the robot architecture [20][21][22]. The inverse sonification problem for capturing hardly detectable details in a medical image is treated in [23], and the control in [24][25][26][27].…”