Steerable needles are novel medical devices capa-ble of following curved paths through tissue, enabling them to avoid anatomical obstacles and steer to hard-to-reach sites in tissue, including targets in the lung for lung cancer diagnosis. Steerable needles are typically deployed into tissue from an insertion surface, and selecting the insertion site is critical for procedure success as it determines which paths the needle can take to its target. Prior motion planners for steerable needles typically only plan from a specific start pose to the target. We introduce a new resolution-optimal steerable needle motion planner that efficiently finds plans from an insertion surface to a target position, handling additional degrees of freedom at both the start and the target. Our algorithm systematically builds a search tree consisting of needle motion primitives backward from the target towards the insertion surface, which allows it to provide an optimality guarantee up to the resolution of the primitives. The algorithm finds higher-quality plans faster than prior state-of-the-art motion planners, as demonstrated in anatomical scenario simulations in the lung.

Steerable needles are minimally invasive devices that enable novel medical procedures by following curved paths to avoid critical anatomical obstacles. We introduce a new start pose robustness metric for steerable needle motion plans. A steerable needle deployment typically consists of a physician manually placing a steerable needle at a precomputed start pose on the surface of tissue and handing off control to a robot, which then autonomously steers the needle through the tissue to the target. The handoff between humans and robots is critical for procedure success, as even small deviations from a planned start pose change the steerable needle's reachable workspace. Our metric is based on a novel geometric method to efficiently compute how far the physician can deviate from the planned start pose in both position and orientation such that the steerable needle can still reach the target. We evaluate our metric through simulation in liver and lung scenarios. Our evaluation shows that our metric can be applied to plans computed by different steerable needle motion planners and that it can be used to efficiently select plans with large safe start regions.

Bronchoscopy is currently the least invasive method for definitively diagnosing lung cancer, which kills more people in the United States than any other form of cancer. Successfully diagnosing suspicious lung nodules requires accurate localization of the bronchoscope relative to a planned biopsy site in the airways. This task is challenging because the lung deforms intraoperatively due to respiratory motion, the airways lack photometric features, and the anatomy's appearance is repetitive. In this paper, we introduce a real-time camera-based method for accurately localizing a bronchoscope with respect to a planned needle insertion pose. Our approach uses deep learning and accounts for deformations and overcomes limitations of global pose estimation by estimating pose relative to anatomical landmarks. Specifically, our learned model considers airway bifurcations along the airway wall as landmarks because they are distinct geometric features that do not vary significantly with respiratory motion. We evaluate our method in a simulated dataset of lungs undergoing respiratory motion. The results show that our method generalizes across patients and localizes the bronchoscope with accuracy sufficient to access the smallest clinically-relevant nodules across all levels of respiratory deformation, even in challenging distal airways. Our method could enable physicians to perform more accurate biopsies and serve as a key building block toward accurate autonomous robotic bronchoscopy.

Steerable needles are medical devices with the ability to follow curvilinear paths to reach targets while circumventing obstacles. In the deployment process, a human operator typically places the steerable needle at its start position on a tissue surface and then hands off control to the automation that steers the needle to the target. Due to uncertainty in the placement of the needle by the human operator, choosing a start position that is robust to deviations is crucial since some start positions may make it impossible for the steerable needle to safely reach the target. We introduce a method to efficiently evaluate steerable needle motion plans such that they are safe to variation in the start position. This method can be applied to many steerable needle planners and requires that the needle's orientation angle at insertion can be robotically controlled. Specifically, we introduce a method that builds a funnel around a given plan to determine a safe insertion surface corresponding to insertion points from which it is guaranteed that a collision-free motion plan to the goal can be computed. We use this technique to evaluate multiple feasible plans and select the one that maximizes the size of the safe insertion surface. We evaluate our method through simulation in a lung biopsy scenario and show that the method is able to quickly find needle plans with a large safe insertion surface.

Steerable needles that are able to follow curvilinear trajectories and steer around anatomical obstacles are a promising solution for many interventional procedures. In the lung, these needles can be deployed from the tip of a conventional bronchoscope to reach lung lesions for diagnosis. The reach of such a device depends on several design parameters including the bronchoscope diameter, the angle of the piercing device relative to the medial axis of the airway, and the needle's minimum radius of curvature while steering. Assessing the effect of these parameters on the overall system's clinical utility is important in informing future design choices and understanding the capabilities and limitations of the system. In this paper, we analyze the effect of various settings for these three robot parameters on the percentage of the lung that the robot can reach. We combine Monte Carlo random sampling of piercing configurations with a Rapidly-exploring Random Trees based steerable needle motion planner in simulated human lung environments to asymptotically accurately estimate the volume of sites in the lung reachable by the robot. We highlight the importance of each parameter on the overall system's reachable workspace in an effort to motivate future device innovation and highlight design trade-offs.