Abstract
This manuscript discusses a prototype image-guided robotic system that is currently under development at The Johns Hopkins University. This system is intended to allow percutaneous delivery of surgical devices as well as therapeutic agents to soft tissue and bone lesions. The proposed system has many potential applications including the treatment of liver cancer, which is an attractive application of the technology.
The purpose of the system is to allow more accurate and precise delivery of therapeutic modalities than can be achieved freehand by the physician. This will allow the treatment of lesions that are smaller than 2 cm in diameter which is not possible with current freehand percutaneous techniques. The system will also allow rapid re-targeting for multiple lesions and optimal therapy distribution over a treatment volume through delivery of a precise pattern of treatment, both of which are difficult to accomplish manually. Moreover, we hope to stimulate development of novel therapies which can take full advantage of the substantially improved accuracy in placing a therapy delivery device within the volume of the organ of interest. The system has the potential to replace major surgery thereby reducing the associated morbidity and mortality as well as reduce the cost of treatment. Additionally, the minimally invasive procedure allows treatment of those patients for whom surgery is contraindicated.
In vitro phantom studies show that the system is capable of placing small “treatment” spheres (representing brachytherapy seeds) with a mean accuracy of 0.52 mm with a 99% confidence interval of [0.38 mm–0.66 mm] for the mean estimate. The maximum error encountered with these studies was 0.9 mm. These studies encourage us to move forward toward in vivo studies.
While we are focusing on the liver in this manuscript, the technology can be used in other soft tissue systems, such as the kidney [1], with minor modifications. In this manuscript, we discuss the design and testing considerations of the prototype system as well as briefly discussing planned future improvements to the system.
This is a preview of subscription content, log in via an institution to check access.
Preview
Unable to display preview. Download preview PDF.
References
A Bzostek, et al., “An Automated System for Precise Percutaneous Access of the Renal Collecting System,” presented at The First Joint Conference of CVRMed II and MRCAS Grenoble, France, 1997.
J. R. Wands and H. E. Blum, “Primary Hepatocellular Carcinoma,” The New England Journal of Medicine, vol. 325, pp. 729–731, 1991.
S. O. Stuver and D. Trichopoulos, “Liver Cancer,” Cancer Surveys, vol. 19, pp 99–124 1994.
C. C. Boring, et al., “Cancer Statistics, 1994,” Cancer Journal for Clinicians, vol 44 pp 7–26, 1994.
P. D. Schneider and J. P. McGahan, “Percutaneous Approaches to Liver Neoplasms,” in Minimally Invasive Surgery, J. G. Hunter and J. Sackier, Eds. New York: McGraw Hill, 1993, pp. 255–263.
T. Levraghi, A. Salmi, and L. Bolondi, “Small hepatocellular carcinoma: percutaneous alcohol injection — results in 23 patients,” Radiology, vol. 168, pp. 1313–1317, 1988.
R. Holt, R. Naunta, and T. Lee, “Intraoperative interstitial radiation therapy for hepatic metastases from colorectal carcinomas,” Amer. J. of Surgery, vol. 54, pp. 231–233, 1988.
J. Hahl, R. Haapiainen, and J. Ovaska, “Laser-induced hyperthermia in the treatment of liver tumors,” Lasers Surg Med, vol. 10, pp. 319–321, 1990.
J. McGahan, P. Browning, and J. Brock, “Hepatic ablation using radiofrequency electrocautery,” Investigational Radiology, vol. 25, pp. 267–270, 1990.
J. H. Anderson, et al., “Image-Guided Percutaneous Robotic Assisted Therapy,” presented at Annual Fall Meeting of the Biomedical Engineering Society, The Pennsylvania State University, 1996.
J. A. Seibert, G. T. Barnes, and R. G. Gould, “Specification, Acceptance Testing and Quality Control of Diagnostic X-ray Imaging Equipment,” in Medical Physics Monograph No. 20. Woodbury, NY: American Institute of Physics, Inc., 1991.
J. M. Boone, et al., “Analysis and correction of imperfections in the image intensifier-TV-digitizer imaging chain,” Medical Physics, vol. 18, pp. 236–242, 1991.
B. Schueler and X. Hu, “Correction of image intensifier distortion for three-dimensional x-ray angiography,” presented at SPIE Medical Imaging 1995 — Physics of Medical Imaging, San Diego, CA, 1995.
S. Schreiner, et al., “Accuracy Assessment of a clinical biplane fluoroscope for three-dimensional measurements and targeting,” presented at SPIE Conference on Medical Imaging, Newport Beach, CA, 1997.
A. Rougee, et al., “Geometrical Calibration of X-ray Imaging Chains for Three-Dimensional Reconstruction,” Computerized Medical Imaging and Graphics, vol. 17, pp. 295–300, 1993.
R. Y. Tsai, “A versatile camera calibration technique for high-accuracy 3D machine vision metrology using off-the-shelf TV cameras and lenses,” IEEE Transactions on Robotics and Automation, vol. 3, pp. 323–344, 1987.
R. Y. Tsai and R. K. Lenz, “A new technique for fully autonomous and efficient 3D robotics hand/eye calibration,” IEEE Trans. on Robotics and Automation, vol. 5, pp. 345–358, 1989.
W. C. Hunter and E. A. Zerhouni, “Imaging Distinct Points in Left Ventricular Myocardium to Study Regional Wall Deformation,” in Medical Radiology Innovations in Diagnostic Radiology, J. H. Anderson, Ed. Berlin, Germany: Springer-Verlag, 1989, pp. 169–190.
P. Potamianos, B.L. Davies, and R.D. Hibbard, “Intra-operative Registration for Percutaneous Surgery,” Proceedings of the 2nd Annual Symposium on MRCAS, Baltimore, MD, pp.156–164, 1995.
R. H. Taylor, et. al, “A Telerobotic Assistant for Laparoscopic Surgery,” IEEE Engineering in Medicine and Biology Magazine, vol. 14, pp. 279–287, 1995.
Author information
Authors and Affiliations
Editor information
Rights and permissions
Copyright information
© 1997 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Schreiner, S., Anderson, J.H., Taylor, R.H., Funda, J., Bzostek, A., Barnes, A.C. (1997). A system for percutaneous delivery of treatment with a fluoroscopically-guided robot. In: Troccaz, J., Grimson, E., Mösges, R. (eds) CVRMed-MRCAS'97. CVRMed MRCAS 1997 1997. Lecture Notes in Computer Science, vol 1205. Springer, Berlin, Heidelberg. https://doi.org/10.1007/BFb0029300
Download citation
DOI: https://doi.org/10.1007/BFb0029300
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-62734-0
Online ISBN: 978-3-540-68499-2
eBook Packages: Springer Book Archive