@article {Fichtinger2008b, title = {Robotic assistance for ultrasound-guided prostate brachytherapy}, journal = {Medical Image Analysis}, volume = {12}, number = {5}, year = {2008}, month = {06/2008}, pages = {535}, publisher = {Queen{\textquoteright}s University; 25 Union Street;725 Goodwin Hall; Kingston; ON; Canada gabor@cs queensu ca}, abstract = {

We present a robotically assisted prostate brachytherapy system, test results in training phantoms, Phase-I clinical trials The system consists of a transrectal ultrasound (TRUS), 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, 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 pre-insertion transverse, rotational errors (measured with a Polaris optical tracker relative to the template{\textquoteright}s coordinate frame) were 0 25 mm (STD=0 17 mm), 0 75 degrees (STD=0 37 degrees) In phantoms,needle tip placement errors measured in TRUS were 1 04 mm (STD=0 50mm) A Phase-I clinical feasibility, safety trial has been successfully completed with the system We encountered needle tip positioning errors of a magnitude greater than 4mm in only 2 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, outcomes

}, keywords = {Brachytherapy, Computer-Assisted, Equipment Design, Equipment Failure Analysis, Humans, instrumentation, instrumentation/methods, Interventional, Male, Prostatic Neoplasms, Radiotherapy, radiotherapy/ultrasonography, Robotics, Ultrasonography}, doi = {10 1016/j media 2008 06 002}, url = {http://dx doi org/10 1016/j media 2008 06 002}, author = {Gabor Fichtinger and Jonathan Fiene and Christopher Kennedy and Gernot Kronreif and Iulian Iordachita and Danny Y Song and E. Clif Burdette and Peter Kazanzides} } @article {Krieger2007a, title = {Design and preliminary accuracy studies of an MRI-guided transrectal prostate intervention system}, journal = {Medical image computing and computer-assisted intervention (MICCAI)}, volume = {10}, number = {Pt 2}, year = {2007}, pages = {59{\textendash}67}, publisher = {Department of Mechanical Engineering, Johns Hopkins University, Baltimore, USA}, abstract = {

This paper reports a novel system for magnetic resonance imaging (MRI) guided transrectal prostate interventions, such as needle biopsy, fiducial marker placement, and therapy delivery The system utilizes a hybrid tracking method, comprised of passive fiducial tracking for initial registration, subsequent incremental motion measurement along the degrees of freedom using fiber-optical encoders, mechanical scales Targeting accuracy of the system is evaluated in prostate phantom experiments Achieved targeting accuracy, procedure times were found to compare favorably with existing systems using passive, active tracking methods Moreover, the portable design of the system using only standard MRI image sequences, minimal custom scanner interfacing allows the system to be easily used on different MRI scanners

}, keywords = {Algorithms, Artificial Intelligence, Automated, Biopsy, Computer-Assisted, Equipment Design, Equipment Failure Analysis, Humans, Image Enhancement, Image Interpretation, Imaging, instrumentation/methods, Interventional, Magnetic Resonance Imaging, Male, methods, Needle, pathology/surgery, Pattern Recognition, Pilot Projects, Prostatectomy, Prostatic Neoplasms, Rectum, Reproducibility of Results, Robotics, Sensitivity, Specificity, Three-Dimensional, User-Computer Interface}, author = {Axel Krieger and Csaba Csoma and Iulian Iordachita and Peter Guion and Anurag K. Singh and Gabor Fichtinger and Whitcomb, Louis L.} } @article {DiMaio2007, title = {Dynamic MRI scan plane control for passive tracking of instruments and devices}, journal = {Medical image computing and computer-assisted intervention (MICCAI)}, volume = {10}, number = {Pt 2}, year = {2007}, pages = {50{\textendash}58}, publisher = {Brigham, Women{\textquoteright}s Hospital, Harvard Medical School, Boston, MA, USA}, abstract = {

This paper describes a novel image-based method for tracking robotic mechanisms, interventional devices during Magnetic Resonance Image (MRI)-guided procedures It takes advantage of the multi-planar imaging capabilities of MRI to optimally image a set of localizing fiducials for passive motion tracking in the image coordinate frame The imaging system is servoed to adaptively position the scan plane based on automatic detection, localization of fiducial artifacts directly from the acquired image stream This closed-loop control system has been implemented using an open-source software framework, currently operates with GE MRI scanners Accuracy, performance were evaluated in experiments, the results of which are presented here

}, keywords = {Algorithms, Anatomy, Artificial Intelligence, Automated, Computer-Assisted, Cross-Sectional, Humans, Image Enhancement, Image Interpretation, Imaging, instrumentation/methods, Magnetic Resonance Imaging, methods, Pattern Recognition, Phantoms, Reproducibility of Results, Robotics, Sensitivity, Specificity, Surgery, Three-Dimensional, User-Computer Interface}, author = {Simon DiMaio and Eigil Samset and Gregory Fischer and Iulian Iordachita and Gabor Fichtinger and Ferenc Jolesz and Clare M Tempany} } @article {Jain2007, title = {Intra-operative 3D guidance in prostate brachytherapy using a non-isocentric C-arm}, journal = {Medical image computing and computer-assisted intervention (MICCAI)}, volume = {10}, number = {Pt 2}, year = {2007}, pages = {9{\textendash}17}, publisher = {Johns Hopkins University, USA}, abstract = {

Intra-operative guidance in Transrectal Ultrasound (TRUS) guided prostate brachytherapy requires localization of inserted radioactive seeds relative to the prostate Seeds were reconstructed using a typical C-arm, and exported to a commercial brachytherapy system for dosimetry analysis Technical obstacles for 3D reconstruction on a non-isocentric C-arm included pose-dependent C-arm calibration; distortion correction; pose estimation of C-arm images; seed reconstruction;, C-arm to TRUS registration In precision-machined hard phantoms with 40-100 seeds, we correctly reconstructed 99 8\% seeds with a mean 3D accuracy of 0 68 mm In soft tissue phantoms with 45-87 seeds, clinically realistic 15 degrees C-arm motion, we correctly reconstructed 100\% seeds with an accuracy of 1 3 mm The reconstructed 3D seed positions were then registered to the prostate segmented from TRUS In a Phase-1 clinical trial, so far on 4 patients with 66-84 seeds, we achieved intra-operative monitoring of seed distribution, dosimetry We optimized the 100\% prescribed iso-dose contour by inserting an average of 3 75 additional seeds, making intra-operative dosimetry possible on a typical C-arm, at negligible additional cost to the existing clinical installation

}, keywords = {Algorithms, Brachytherapy, Computer-Assisted, Equipment Design, Equipment Failure Analysis, Humans, Imaging, instrumentation/methods, Interventional, Intraoperative Care, Male, methods, Prostatic Neoplasms, Prosthesis Implantation, Radiographic Image Enhancement, Radiographic Image Interpretation, Radiography, radiography/radiotherapy, Radiotherapy, Reproducibility of Results, Sensitivity, Specificity, Three-Dimensional, Tomography, X-Ray Computed}, author = {Ameet K. Jain and Anton Degeut and Iulian Iordachita and Gouthami Chintalapani and Jack Blevins and Le Yi and Elwood Armour and E. Clif Burdette and Danny Y Song and Gabor Fichtinger} } @article {Fichtinger2007c, title = {Robotic assistance for ultrasound guided prostate brachytherapy}, journal = {Medical Image Computing and Computer-Assisted Intervention (MICCAI)}, volume = {4791}, year = {2007}, pages = {119{\textendash}127}, publisher = {The Johns Hopkins University, Baltimore, Maryland, USA gabor@cs jhu edu}, abstract = {

We present a robotically assisted prostate brachytherapy system, test results in training phantoms The system consists of a transrectal ultrasound (TRUS), a spatially co-registered robot 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, uses the same coordinate system Established clinical hardware, workflow, calibration are left intact In these experiments, we recorded the first insertion attempt without adjustment All clinically relevant locations were reached Non-parallel needle trajectories were achieved The pre-insertion transverse, rotational errors (measured with Polaris optical tracker relative to the template{\textquoteright}s coordinate frame) were 0 25mm (STD = 0 17mm), 0 75 degrees (STD = 0 37 degrees) The needle tip placement errors measured in TRUS were 1 04mm (STD = 0 50mm) The system is in Phase-I clinical feasibility, safety trials, under Institutional Review Board approval

}, keywords = {Brachytherapy, Computer-Assisted, Equipment Design, Equipment Failure Analysis, Humans, instrumentation/methods, Interventional, Male, Prostatic Neoplasms, Radiotherapy, Radiotherapy Planning, radiotherapy/ultrasonography, Robotics, Ultrasonography}, author = {Gabor Fichtinger and Jonathan Fiene and Christopher Kennedy and Gernot Kronreif and Iulian Iordachita and Danny Y Song and E. Clif Burdette and Peter Kazanzides} } @article {Fichtinger2005, title = {Image overlay for CT-guided needle insertions}, journal = {Journal of Computer Aided Surgery}, volume = {10}, number = {4}, year = {2005}, month = {Jul}, pages = {241{\textendash}255}, abstract = {

OBJECTIVE: We present a 2D image overlay device to assist needle placement on computed tomography (CT) scanners MATERIALS AND METHODS: The system consists of a flat display, a semitransparent mirror mounted on the gantry When the physician looks at the patient through the mirror, the CT image appears to be floating inside the body with correct size, position as if the physician had 2D {\textquoteright}X-ray vision{\textquoteright} The physician draws the optimal path on the CT image The composite image is rendered on the display, thus reflected in the mirror The reflected image is used to guide the physician in the procedure In this article, we describe the design, various embodiments of the 2D image overlay system, followed by the results of phantom, cadaver experiments in multiple clinical applications RESULTS: Multiple skeletal targets were successfully accessed with one insertion attempt Generally, successful access was recorded on liver targets when a clear path opened, but the number of attempts, accuracy showed variability because of occasional lack of access Soft tissue deformation further reduced the accuracy, consistency in comparison to skeletal targets CONCLUSION: The system demonstrated strong potential for reducing faulty needle insertion attempts, thereby reducing X-ray dose, patient discomfort

}, keywords = {Animals, Biopsy, Cadaver, Calibration, Computer-Assisted, Equipment Design, Humans, Image Processing, Imaging, instrumentation, Interventional, Needle, Phantoms, Radiography, Swine, Tomography, User-Computer Interface, X-Ray Computed}, doi = {10 1080/10929080500230486}, url = {http://dx doi org/10 1080/10929080500230486}, author = {Gabor Fichtinger and Anton Degeut and Gregory Fischer and Iulian Iordachita and Emese Balogh and Ken Masamune and Russell H. Taylor and Laura Fayad and Michelle de Oliveira and James Zinreich} } @article {Boctor2005, title = {Real-time quality control of tracked ultrasound}, journal = {Medical image computing and computer-assisted intervention (MICCAI)}, volume = {8}, number = {Pt 1}, year = {2005}, pages = {621{\textendash}630}, abstract = {

The overwhelming majority of intra-operative hazard situations in tracked ultrasound (US) systems are attributed to failure of registration between tracking, imaging coordinate frames We introduce a novel methodology for eal-time in-vivo quality control of tracked US systems, in order to capture registration failures during the clinical procedure In effect, we dynamically recalibrate the tracked US system for rotation, scale factor, and in-plane position offset up to a scale factor We detect any unexpected change in these parameters through capturing discrepancies in the resulting calibration matrix, thereby assuring quality (accuracy, consistency) of the tracked system No phantom is used for the recalibration We perform the task of quality control in the background, transparently to the clinical user while the subject is being scanned We present the concept, mathematical formulation, and experimental evaluation in-vitro This new method can play an important role in guaranteeing accurate, consistent, and reliable performance of tracked ultrasound

}, keywords = {Algorithms, Computer Systems, Computer-Assisted, Health Care, Humans, Image Enhancement, Image Interpretation, Interventional, methods, Quality Assurance, Quality Control, Reproducibility of Results, Sensitivity, Specificity, Surgery, Ultrasonography, User-Computer Interface}, author = {Emad Boctor and Iulian Iordachita and Gabor Fichtinger and Gregory D. Hager} }