We present a study in human-centered automation that has potential to reduce patient side effects from high dose rate brachytherapy (HDR-BT). To efficiently deliver radiation to the prostate while minimizing trauma to sensitive structures such as the penile bulb, we modified the Acubot-RND 7-axis robot to guide insertion of diamond-tip needles into desired skew-line geometric arrangements. We extend and integrate two algorithms: Needle Planning with Integer Programming (NPIP) and Inverse Planning with Integer Programming (IPIP) to compute skew-line needle and dose plans. We performed three physical experiments with anatomically correct phantom models to study performance: two with the robot and one control experiment with an expert human physician (coauthor Hsu) without the robot. All were able to achieve needle arrangements that meet the RTOG-0321 clinical dose objectives with zero trauma to the penile bulb. We analyze systematic and random errors in needle placement; total RMS error for the robot system operating without feedback ranged from 2.6 to 4.3 mm, which is comparable to the RMS error of 2.7 mm obtained in an earlier study for PPI-BT treatment using a robot with 3D ultrasound feedback.

The paper presents a new robot for manipulating a transrectal ultrasound probe for image-guided intervention of the prostate, the TRUS robot. The robot positions and orients the probe for image scanning and needle targeting of the prostate. Image slices and their respective position are mapped three-dimensionally to render volumetric images. The robot is designed to accommodate the constraints of the clinical prostate intervention. The robot includes all 4 degrees-of-freedom that are available in manual handling of the probe. In-vitro studies on pelvic mockups verify 3D imaging capabilities. The robot is clinically used in robot-assisted laparoscopic radical prostatectomy for providing intraoperative ultrasound-based navigation for the surgeon.

Needle steering is a commonly used technique in the medical field as it enables physicians to more precisely reach the target tissue. In this paper we describe our interest in needle steering for lung biopsy and the significance of this technique. There has been much interest in modeling needle steering in recent years and this paper builds upon that work. We describe our Matlab implementation and present simulation results. We also show our experimental results based on a robotic needle driver and X-Ray imaging in the interventional suite. The experimental results showed good agreement with the simulation results.

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 provides a broad overview of medical robot systems used in surgery. After introducing basic concepts of computer-integrated surgery, surgical CAD/CAM, and surgical assistants, it discusses some of the major design issues particular to medical robots. It then illustrates these issues and the broader themes introduced earlier with examples of current surgical CAD/CAM and surgical assistant systems. Finally, it provides a brief synopsis of current research challenges and closes with a few thoughts on the research/industry/clinician teamwork that is essential for progress in the field.

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.