@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} } @conference {Karim-Aghaloo2008, title = {Towards detecting surgical clips in 3D ultrasound for target localization in radiation therapy: a study on tissue phantoms}, booktitle = {International Conference of the IEEE Engineering in Medicine and Biology Society}, volume = {2008}, year = {2008}, pages = {5282{\textendash}5285}, publisher = {Department of Electrical, Computer Engineering, Queens University, Kingston, ON K7L3N6, Canada}, organization = {Department of Electrical, Computer Engineering, Queens University, Kingston, ON K7L3N6, Canada}, abstract = {

A study is performed to measure the visibility of small surgical clips in 3D ultrasound volumes of a phantom as the first step towards using such clips as fiducial markers in radiation therapy Visibility is calculated as the contrast to noise ratio of the echo from the clip to the background The appearance of a resonance tail is also calculated using a moment analysis Contrast is found to be high, mostly independent of material, size of the clip All clips are visible, but the length of the tail is found to be dependent on clip orientation to the ultrasound beam The consistent visibility of the clips suggests they are suitable as fiducial markers in ultrasound, the dependency of the resonance tail on orientation provides an opportunity to distinguish clips from other specular reflectors

}, keywords = {Computer-Assisted, Equipment Design, Equipment Failure Analysis, Humans, Image Enhancement, Imaging, instrumentation, instrumentation/methods, methods, Phantoms, Radiotherapy, Reproducibility of Results, Sensitivity, Specificity, Surgical Instruments, Three-Dimensional, Ultrasonography}, doi = {10 1109/IEMBS 2008 4650406}, url = {http://dx doi org/10 1109/IEMBS 2008 4650406}, author = {Zahra Karim-Aghaloo and Prasad Shrawane and Purang Abolmaesumi and Gabor Fichtinger and Robert Rohling} } @article {Fischer2007, title = {MRI image overlay: application to arthrography needle insertion}, journal = {Journal of Computer Aided Surgery}, volume = {12}, number = {1}, year = {2007}, month = {Jan}, pages = {2{\textendash}14}, publisher = {Engineering Research Center, Johns Hopkins University, Baltimore, Maryland, USA gfisch@jhu edu}, abstract = {

Magnetic Resonance Imaging (MRI) offers great potential for planning, guiding, monitoring, controlling interventions MR arthrography (MRAr) is the imaging gold standard for assessing small ligament, fibrocartilage injury in joints In contemporary practice, MRAr consists of two consecutive sessions: (1) an interventional session where a needle is driven to the joint space, MR contrast is injected under fluoroscopy or CT guidance;, (2) a diagnostic MRI imaging session to visualize the distribution of contrast inside the joint space, evaluate the condition of the joint Our approach to MRAr is to eliminate the separate radiologically guided needle insertion, contrast injection procedure by performing those tasks on conventional high-field closed MRI scanners We propose a 2D augmented reality image overlay device to guide needle insertion procedures This approach makes diagnostic high-field magnets available for interventions without a complex, expensive engineering entourage In preclinical trials, needle insertions have been performed in the joints of porcine, human cadavers using MR image overlay guidance; in all cases, insertions successfully reached the joint space on the first attempt

}, keywords = {Arthrography, Cartilage, Contrast Media, diagnosis, Humans, injuries, instrumentation, Joint Diseases, Ligaments, Magnetic Resonance Imaging, Needles}, doi = {10 1080/10929080601169930}, url = {http://dx doi org/10 1080/10929080601169930}, author = {Gregory Fischer and Anton Degeut and Csaba Csoma and Russell H. Taylor and Laura Fayad and John A Carrino and James Zinreich and Gabor Fichtinger} } @article {DiMaio2006b, title = {Robot-assisted needle placement in open-MRI: system architecture, integration and validation}, journal = {Studies in health technology and informatics}, volume = {119}, year = {2006}, pages = {126{\textendash}131}, publisher = {Brigham, Women{\textquoteright}s Hospital, Harvard Medical School, USA simond@bwh harvard edu}, abstract = {

This work describes an integrated system for planning, performing percutaneous procedures-such as prostate biopsy-with robotic assistance under MRI-guidance The physician interacts with a planning interface in order to specify the set of desired needle trajectories, based on anatomical structures, lesions observed in the patient{\textquoteright}s MR images All image-space coordinates are automatically computed, and used to position a needle guide by means of an MRI-compatible robotic manipulator, thus avoiding the limitations of the traditional fixed needle template Direct control of real-time imaging aids visualization of the needle as it is manually inserted through the guide Results from in-scanner phantom experiments are provided

}, keywords = {Biopsy, Computer Systems, diagnosis, Humans, instrumentation, Magnetic Resonance Imaging, Male, Needle, Prostatic Neoplasms, Robotics}, author = {Simon DiMaio and Steve Pieper and Kiyoyuki Chinzei and Nobuhiko Hata and Emese Balogh and Gabor Fichtinger and Clare M Tempany and Ron Kikinis} } @article {Fichtinger2006, title = {Robotically assisted prostate brachytherapy with transrectal ultrasound guidance{\textendash}Phantom experiments}, journal = {Brachytherapy}, volume = {5}, number = {1}, year = {2006}, pages = {14{\textendash}26}, publisher = {Engineering Research Center, The Johns Hopkins University, Baltimore, MD 21218-2682, USA gabor@cs jhu edu}, abstract = {

PURPOSE: To report the preliminary experimental results obtained with a robot-assisted transrectal ultrasound (TRUS)-guided prostate brachytherapy system METHODS AND MATERIALS: The system consists of a TRUS unit, a spatially coregistered needle insertion robot, and an FDA-approved treatment planning, image-registered implant system The robot receives each entry/target coordinate pair of the implant plan, inserts a preloaded needle, and then the seeds are deposited The needles/sources are tracked in TRUS, thus allowing the plan to be updated as the procedure progresses RESULTS: The first insertion attempt was recorded for each needle, without adjustment All clinically relevant locations were reached in a prostate phantom Nonparallel, parallel needle trajectories were demonstrated Based on TRUS, the average transverse placement error was 2 mm (worst case 2 5 mm, 80\% less than 2 mm), and the average sagittal error was 2 5 mm (worst case 5 0 mm, 70\% less than 2 5 mm) CONCLUSIONS: The concept, technical viability of robot-assisted brachytherapy were demonstrated in phantoms The kinematically decoupled robotic assistant device is inherently safe Overall performance was promising, but further optimization is necessary to prove the possibility of improved dosimetry

}, keywords = {Anatomic, Brachytherapy, Endosonography, Equipment Design, Humans, instrumentation, Male, methods, Models, Prostatic Neoplasms, radiotherapy/ultrasonography, Rectum, Robotics}, doi = {10 1016/j brachy 2005 10 003}, url = {http://dx doi org/10 1016/j brachy 2005 10 003}, author = {Gabor Fichtinger and E. Clif Burdette and Attila Tanacs and Alexandru Patriciu and Dumitru Mazilu and Whitcomb, Louis L. and Dan Stoianovici} } @article {Susil2006, title = {Transrectal prostate biopsy and fiducial marker placement in a standard 1 5T magnetic resonance imaging scanner}, journal = {The Journal of Urology}, volume = {175}, number = {1}, year = {2006}, month = {Jan}, pages = {113{\textendash}120}, publisher = {Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA}, abstract = {

PURPOSE: We investigated the accuracy, feasibility of a system that provides transrectal needle access to the prostate concurrent with 1 5 Tesla MRI which previously has not been possible MATERIALS AND METHODS: In 5 patients with previously diagnosed prostate cancer, MRI guided intraprostatic placement of gold fiducial markers (4 procedures),/or prostate biopsy (3 procedures) was performed using local anesthesia RESULTS: Mean procedure duration was 76 minutes, all patients tolerated the intervention well Procedure related adverse events included self-limited hematuria, hematochezia following 3 of 8 procedures (all resolved in less than 1 week) Mean needle placement accuracy was 1 9 mm for the fiducial marker placement studies, 1 8 mm for the biopsy procedures Mean fiducial marker placement accuracy was 4 8 mm, the mean fiducial marker placement accuracy transverse to the needle direction was 2 6 mm All patients who underwent the procedure were able to complete their course of radiotherapy without delay or complication CONCLUSIONS: While studies of clinical usefulness are warranted, transrectal 1 5 T MRI guided prostate biopsy, fiducial marker placement is feasible using this system, providing new opportunities for image guided diagnostic, therapeutic prostate interventions

}, keywords = {Biopsy, Equipment Design, Feasibility Studies, Humans, instrumentation, instrumentation/methods, Magnetic Resonance Imaging, Male, Needle, pathology, Prostate, Prostatic Neoplasms}, doi = {10 1016/S0022-5347(05)00065-0}, url = {http://dx doi org/10 1016/S0022-5347(05)00065-0}, author = {Robert Susil and Cynthia Menard and Axel Krieger and Jonathan Coleman and Kevin Camphausen and Peter Choyke and Gabor Fichtinger and Whitcomb, Louis L. and Norman Coleman and Ergin Atalar} } @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 {Cleary2005, title = {Precision placement of instruments for minimally invasive procedures using a "needle driver" robot}, journal = {international journal of medical robotics computer assisted surgery MRCAS}, volume = {1}, number = {2}, year = {2005}, month = {Jan}, pages = {40{\textendash}47}, abstract = {

Medical practice continues to move toward less invasive procedures Many of these procedures require the precision placement of a needle in the anatomy Over the past several years, our research team has been investigating the use of a robotic needle driver to assist the physician in this task This paper summarizes our work in this area The robotic system is briefly described, followed by a description of a clinical trial in spinal nerve blockade The robot was used under joystick control to place a 22 gauge needle in the spines of 10 patients using fluoroscopic imaging The results were equivalent to the current manual procedure We next describe our follow-up clinical application in lung biopsy for lung cancer screening under CT fluoroscopy The system concept is discussed, the results of a phantom study are presented A start-up company named ImageGuide has recently been formed to commercialize the robot Their revised robot design is presented, along with plans to install a ceiling-mounted version of the robot in the CT fluoroscopy suite at Georgetown University

}, keywords = {Biopsy, Cadaver, Equipment Design, Fluoroscopy, Humans, Imaging, instrumentation, instrumentation/methods, Lung, Lung Neoplasms, methods, Minimally Invasive, Needles, Nerve Block, pathology, pathology/radiography, Phantoms, Randomized Controlled Trials as Topic, Robotics, Spinal Nerves, Surgical Procedures, Tomography, X-Ray Computed}, doi = {10 1002/rcs 40}, url = {http://dx doi org/10 1002/rcs 40}, author = {Kevin Cleary and Vance Watson and David Lindisch and Russell H. Taylor and Gabor Fichtinger and Sheng Xu and Charles White and John Donlon and Michael Taylor and Alexandru Patriciu and Dumitru Mazilu and Dan Stoianovici} } @article {Boctor2003b, title = {Virtual remote center of motion control for needle placement robots}, journal = {Journal of Computer Aided Surgery}, volume = {9}, number = {5}, year = {2003}, pages = {175{\textendash}183}, abstract = {

OBJECTIVE: We present an algorithm that enables percutaneous needle-placement procedures to be performed with unencoded, unregistered, minimally calibrated robots while removing the constraint of placing the needle tip on a mechanically enforced Remote Center of Motion (RCM) MATERIALS AND METHODS: The algorithm requires only online tracking of the surgical tool, a five-degree-of-freedom (5-DOF) robot comprising three prismatic DOF, two rotational DOF An incremental adaptive motion control cycle guides the needle to the insertion point, also orients it to align with the target-entry-point line The robot executes RCM motion without having a physically constrained fulcrum point RESULTS: The proof-of-concept prototype system achieved 0 78 mm translation accuracy, 1 4 degrees rotational accuracy (this is within the tracker accuracy) within 17 iterative steps (0 5-1 s) CONCLUSION: This research enables robotic assistant systems for image-guided percutaneous procedures to be prototyped/constructed more quickly, less expensively than has been previously possible Since the clinical utility of such systems is clear, has been demonstrated in the literature, our work may help promote widespread clinical adoption of this technology by lowering system cost, complexity

}, keywords = {Algorithms, Computer-Assisted, Equipment Design, Imaging, instrumentation, Needles, Robotics, Surgery, Three-Dimensional}, doi = {10 1080/10929080500097661}, url = {http://dx doi org/10 1080/10929080500097661}, author = {Emad Boctor and Robert Webster and Herve Mathieu and Allison Okamura and Gabor Fichtinger} } @article {Masamune2001, title = {System for robotically assisted percutaneous procedures with computed tomography guidance}, journal = {Journal of Computer Aided Surgery}, volume = {6}, number = {6}, year = {2001}, pages = {370{\textendash}383}, abstract = {

We present the prototype of an image-guided robotic system for accurate, consistent placement of percutaneous needles in soft-tissue targets under CT guidance inside the gantry of a CT scanner The couch-mounted system consists of a seven-degrees-of-freedom passive mounting arm, a remote center-of-motion robot, and a motorized needle-insertion device Single-image-based coregistration of the robot, image space is achieved by stereotactic localization using a miniature version of the BRW head frame built into the radiolucent needle driver The surgeon plans, controls the intervention in the scanner room on a desktop computer that receives DICOM images from the scanner The system does not need calibration, employs pure image-based registration, and does not utilize any vendor-specific hardware or software features In the open air, where there is no needle-tissue interaction, we systematically achieved an accuracy better than 1 mm in hitting targets at 5-8 cm from the fulcrum point In the phantom, the orientation accuracy was 0 6 degrees, and the distance between the needle tip, the target was 1 04 mm Experiments indicated that this robotic system is suitable for a variety of percutaneous clinical applications

}, keywords = {Biopsy, Computer-Assisted, Humans, Image Processing, Imaging, instrumentation, instrumentation/methods, Needle, Phantoms, Robotics, Surgery, Tomography, User-Computer Interface, X-Ray Computed}, doi = {10 1002/igs 10024}, url = {http://dx doi org/10 1002/igs 10024}, author = {Ken Masamune and Gabor Fichtinger and Alexandru Patriciu and Robert Susil and Russell H. Taylor and Louis Kavoussi and James Anderson and Ichiro Sakuma and Takeyoshi Dohi and Dan Stoianovici} }