Needle Placement Robots

Laboratory for Percutaneous Surgery The Perk Lab

Copyright Gabor Fichtinger, 2008

In-Scanner Robotic Interventions

When robot and patient meet in an imaging scanner in an intervention
Coordinates

Imager:

CT,MRI, US, X-ray

Planning & control computer

Patient Robot

Physician

Digital images

Laboratory for Percutaneous Surgery The Perk Lab

Copyright Gabor Fichtinger, 2008

Serial Linkages
Where all joints move in synch
custom-developed (Neuromate)

Pros: Can move virtually anywhere Lots of different motions Smooth motion Cons: Hard to constrain Safety concerns Complex control Ugly math Aggregating errors Must do everything to do anything anything

Industry robots and derivatives (PUMA SCARA, etc)

Laboratory for Percutaneous Surgery The Perk Lab

Copyright Gabor Fichtinger, 2008

Floor-mounted NeuroMateTM system

System used for brain biopsies Contact-based registration with fiducials

Laboratory for Percutaneous Surgery The Perk Lab Copyright Gabor Fichtinger, 2008

Decoupled Linkages
Where joints can move selectively
1
3D translation move needle to entry

2
2D Rotation orient needle

3
0D/1D/2D Insertion drive needle

Pros: Cons:

CAN BE INHERENTLY SAFE Separates steps of surgery Easy to constrain Simpler control Simpler Math Curbed error aggregation Limited types of motions Limited trajectory Ragged motion
Taylor et al, IEEE TRA, 2001
Laboratory for Percutaneous Surgery The Perk Lab Copyright Gabor Fichtinger, 2008

Example: 3DOF RCM-PAKY

7-DOF passive arm Needle

Joysticks and safety switches

Locking arm 2-DOF RCM 1-DOF needle injector

Amplifier box

Table side robot mount

Stoianovici et al, MICCAI-1997, MICCAI-1998, MICCAI-1998

Laboratory for Percutaneous Surgery The Perk Lab

Copyright Gabor Fichtinger, 2008

CT-Guided Prostate Biopsy

Fichtinger et al. Acad Rad, 2002

Laboratory for Percutaneous Surgery The Perk Lab Copyright Gabor Fichtinger, 2008

Single-slice Registration to CT
P1 P2 P7 P6

P3

P4

P5

P1 | P1 P2 |= d12 L c = L* d23/(d12+d23) c P2 d23= | P2 P3 | P3 Image plane

Laboratory for Percutaneous Surgery The Perk Lab Copyright Gabor Fichtinger, 2008

Closed form: fast and computationally robust

Susil et al. MICCAI 1999 Masamune et al. JCAS 2001 Lee et al. J. MedPhys 2002

Slicer-based Treatment Planning

Credit: A. Tanacs
Laboratory for Percutaneous Surgery The Perk Lab Copyright Gabor Fichtinger, 2008

Slicer-based Treatment Planning

Credit: A. Tanacs
Laboratory for Percutaneous Surgery The Perk Lab Copyright Gabor Fichtinger, 2008

CT-Guided Kidney Biopsy

Robot registered to CT from a single image using stereotactic frame on the end-effector

PLAY VIDEO
Credit: D. Stoianovici, L. Kavoussi, A. Patriciu, S. Solomon (JHU Bayview)

Laboratory for Percutaneous Surgery The Perk Lab

Copyright Gabor Fichtinger, 2008

Intra-Cranial Hemorrhage Removal

Anatomic rendering Path planning & robot control Robot CT gantry

Vitre a CT table CT computer & DICOM server DICOM images

Patient

Blind spots Collision 3DOF insufficient

view from inferior

view from superior

Credit: Ellis, Fichtinger, et al.

Copyright Gabor Fichtinger, 2008

Laboratory for Percutaneous Surgery The Perk Lab

CT-Guided Lung Biopsy

Robot registered to CT using the scanners alignment laser

PLAY VIDEO
Patriciu et al, MICCAI 2001

Laboratory for Percutaneous Surgery The Perk Lab

Copyright Gabor Fichtinger, 2008

CT-Guided Biopsy Sandwich Robot (by Kronreif et al.)

Credit: Gernot Kronreif, Joachim Kettenbach, Martin Frst, Martin Kornfeld, Wolfgang Ptacek, Michael Vogele, ARC Seibersdorf Research GmbH, Austria
Kettenbach et al. Invest Radiol. 2005 Apr;40(4):219-28.; Kettenbach et al. Eur Radiol. 2005 Apr;15(4):765-71
Laboratory for Percutaneous Surgery The Perk Lab Copyright Gabor Fichtinger, 2008

Accubot

Stoianovici et al, IEEE Transactions on Robotics and Automation. Oct 2003

Laboratory for Percutaneous Surgery The Perk Lab Copyright Gabor Fichtinger, 2008

CTF-Guided Lung Biopsy

3D CT Volume CT Fluoroscopy

Frame Grabber

Register real-time CTF to CT Then compensate with robot

Xu et al. SPIE 2004
Laboratory for Percutaneous Surgery The Perk Lab Copyright Gabor Fichtinger, 2008

Light Puncturing Robot for biopsies (TIMC, by Troccaz et al.)

Body mounted CT/MR compatible No trajectory limitation Embedded fiducial localization Pneumatic actuation Accuracy ~1.5mm

Laboratory for Percutaneous Surgery The Perk Lab

Copyright Gabor Fichtinger, 2008

Bone-mounted MARS system

M. Shoham, Technion and Mazor Surgical Technologies, Israel.

Laboratory for Percutaneous Surgery The Perk Lab Copyright Gabor Fichtinger, 2008

Robotic positioning: MARS drill CT drill

start goal

guide robot surgeon patient

Copyright L. Joskowicz, 2009

plan

Laboratory for Percutaneous Surgery The Perk Lab

Copyright Gabor Fichtinger, 2008

MARS: pedicle screw insertion

Copyright L. Joskowicz, 2009

Laboratory for Percutaneous Surgery The Perk Lab

Copyright Gabor Fichtinger, 2008

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MARS: Execution

Copyright L. Joskowicz, 2009

Laboratory for Percutaneous Surgery The Perk Lab

Copyright Gabor Fichtinger, 2008

MARS: Clinical setup

4,000 screw to date

Copyright L. Joskowicz, 2009

Laboratory for Percutaneous Surgery The Perk Lab

Copyright Gabor Fichtinger, 2008

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