We report the development of a robot for radiological percutaneous interventions using uniplanar fluoroscopy, biplanar fluoroscopy, or computed tomography (CT) for needle biopsy, radio frequency ablation, cryotherapy, and other needle procedures. AcuBot is a compact six-degree-of-freedom robot for manipulating a needle or other slender surgical instrument in the confined space of the imager without inducing image artifacts. Its distinctive characteristic is its decoupled motion capability correlated to the positioning, orientation, and instrument insertion steps of the percutaneous intervention. This approach allows each step of the intervention to be performed using a separate mechanism of the robot. One major advantage of this kinematic approach is patient safety. The first feasibility experiment performed with the robot, a cadaver study of perispinal blocks under biplanar fluoroscopy, is presented. The main expected application of this system is to CT-based procedures. AcuBot has received Food and Drug Administration clearance (IDE G010331/S1), and a clinical trial of using the robot for perispinal nerve and facet blocks is presently underway at Georgetown University, Washington, DC.

This paper reports on technology developments aimed at improving the state of the art for image-guided minimally invasive spine procedures. Back pain is a major health problem with serious economic consequences. Minimally invasive procedures to treat back pain are rapidly growing in popularity due to improvements in technique and the substantially reduced trauma to the patient versus open spinal surgery. Image guidance is an enabling technology for minimally invasive procedures, but technical problems remain that may limit the wider applicability of these techniques. The paper begins with a discussion of low back pain and the potential shortcomings of open back surgery. The advantages of minimally invasive procedures are enumerated, followed by a list of technical problems that must be overcome to enable the more widespread dissemination of these techniques. The technical problems include improved intraoperative imaging, fusion of images from multiple modalities, the visualization of oblique paths, percutaneous spine tracking, mechanical instrument guidance, and software architectures for technology integration. Technical developments to address some of these problems are discussed next. The discussion includes intraoperative computerized tomography (CT) imaging, magnetic resonance imaging (MRI)/CT image registration, three-dimensional (3-D) visualization, optical localization, and robotics for percutaneous instrument placement. Finally, the paper concludes by presenting several representative clinical applications: biopsy, vertebroplasty, nerve and facet blocks, and shunt placement. The program presented here is a first step to developing the physician-assist systems of the future, which will incorporate visualization, tracking, and robotics to enable the precision placement and manipulation of instruments with minimal trauma to the patient.

Gives an overview of our program plan in robotically assisted spine procedures and details an initial cadaver study. Low back pain is a common medical problem, and minimally invasive procedures such as nerve blocks are rapidly growing in popularity as a potential method of treatment. To assist the physician in needle placement during these procedures, we have investigated using a needle-driver robot developed at the Johns Hopkins Urology Robotics Laboratory. Robotic systems such as these have great potential as physician-assisting devices for improving the precision of needle placement and enabling the development of the next generation of precision guidance systems for interventional techniques.