Mirror-integrated ultrasound image-guided access

Abstract

Percutaneous Nephrolithotomy (PCNL), is a minimally invasive surgical procedure for removal of kidney stones typically >1cm. The procedure involves inserting a needle through the patient’s skin into the kidney which is being more commonly performed now using ultrasound (US) guidance. Existing US image-guided needle insertion employed in PCNL faces the challenge in terms of keeping the needle tip visible during the insertion process. We propose a needle insertion mechanism with mirror-integrated US imaging, which provides an intuitive and simple solution to monitor the needle insertion path. This is achieved by using acoustic mirror to change the direction of the US image plane while the needle goes through the spacing in the middle of the acoustic mirror so that the needle path aligns with the US image plane. Both the needle and the acoustic mirror are designed to be rotatable to provide the clinician with the flexibility to search for the optimal needle insertion orientation. According to the law of acoustic wave reflection, the needle should rotate two times the amount of the mirror to keep aligned with the US image plane. A synchronization mechanism consisting of belts and pulleys was designed to achieve this 2:1 rotation ratio. Needle-mirror synchronized rotation is tested using an image-processing-based method. In terms of imaging functionality, US images display point targets inside the gelatin phantom as well as the needle tip clearly. In the needle insertion experiment, a needle is inserted into the gelatin phantom to reach point targets, and results show insertion errors <3mm. Overall, our results demonstrate the potential of using the proposed US image-guided access mechanism in clinical scenarios.