Accurate Needle Insertion Research Articles

Study of Tissue Damage Induced by Insertion of Composite-Coated Needle

Medical interventions have significantly progressed in developing minimally invasive techniques like percutaneous procedures. These procedures include biopsy and internal radiation therapy, where a needle or needle-like medical device is inserted through the skin to access a target inside the body. Ensuring accurate needle insertion and minimizing tissue-damage or cracks are critical in these procedures. This research aims to examine the coated needle effect on the force required to insert the needle (i.e., insertion force) and on tissue-damage during needle insertion into the bovine kidney. Reducing the needle insertion force, which is influenced by needle surface friction, generally results in a reduction in tissue-damage. Surgical needles were coated with a composite material, combining Polytetrafluoroethylene, Polydopamine, and Activated Carbon. Force measurement during needle insertion and a histological study to determine tissue-damage were conducted to evaluate the effectiveness of the coating. The insertion force was reduced by 49 % in the case of the coated needles. Furthermore, a histological analysis comparing tissue-damage resulting from coated and uncoated needles revealed an average 39 % reduction in tissue-damage with the use of coated needles. The results of this study demonstrate the potential of coated needles to enhance needle insertion and safety during percutaneous procedures.

The Advances and Utility of Artificial Intelligence and Robotics in Regional Anesthesia: An Overview of Recent Developments.

The integration of artificial intelligence (AI) and robotics in regional anesthesia has brought about transformative changes in acute pain management for surgical procedures. This review explores the evolving landscape of AI and robotics applications in regional anesthesia, outlining their potential benefits, challenges, and ethical considerations. AI-driven pain assessment, real-time guidance for needle placement during nerve blocks, and predictive modeling solutions for nerve blocks have the potential to enhance procedural precision and improve patient outcomes. Robotic technology aids in accurate needle insertion, reducing complications and improving pain relief. This review also highlights the ethical and safety considerations surrounding AI implementation, emphasizing data security and professional training. While challenges such as costs and regulatory hurdles exist, ongoing research and clinical trials demonstrate the practical utility of these technologies. In conclusion, AI and robotics have the potential to reshape regional anesthesia practice, ultimately improving patient care and procedural accuracy in pain management.

In Situ Flexible Needle Adjustment Towards MRI-Guided Spinal Injections Based on Finite Element Simulation.

This paper investigates the possibility of robotically performing in situ needle manipulations to correct the needle tip position in the setting of robot-assisted, MRI-guided spinal injections, where real time MRI images cannot be effectively used to guide the needle. Open-loop control of the needle tip is derived from finite element simulation, and the proposed method is tested with ex vivo animal muscle tissues and validated by cone beam computed tomography. Preliminary results have shown promise of performing needle tip correction in situ to improve needle insertion accuracy when real-time feedback is not readily available.

A Cadaveric Study of a Safe and Accurate Electromyographic Needle Approach to the Rhomboid Major.

This study aimed to investigate a safe and accurate electromyographic needle insertion site of the rhomboid major (RM) muscle using cadaver dissection. Dissection of the trapezius and rhomboid major muscles around the scapula was performed in 18 scapulae from nine fresh cadavers. The point (point A) at which the lateral margin of the lower trapezius muscle crossed the medial border of the scapula and the distal insertion point (point DI) of the rhomboid major muscle to the medial scapula were determined. The midpoint (point M) between points A and DI was also determined. The distance from the inferior angle of the scapula to each point was measured. The length of the medial scapula was 12.9 ± 1.2 cm from the root of the scapular spine to the inferior angle of the scapula. Points A, DI, and M were located at a mean distance of 8.4 ± 0.7, 1.8 ± 0.4, and 5.1 ± 0.5 cm proximal to the inferior angle of the scapula, respectively. Needle electromyographic examination of the rhomboid major muscle can be performed safely and accurately using the lower part of the rhomboid major muscle, as investigated in this anatomical study.

Point-of-care ultrasound in musculoskeletal field.

The musculoskeletal field is relatively new in point-of-care ultrasound (POCUS), a modality that has been gaining significance with the evolution of ultrasound (US) equipment and high-frequency probes. Images have become progressively clearer over the past decade, making it possible to diagnose many pathological conditions without exposure to radiation. Ultrasonography reveals many soft tissue pathologies that cannot be visualized using plain radiographs, which have historically been the first choice for the evaluation of musculoskeletal disorders. US saves money and time compared to magnetic resonance imaging (MRI). Although it is difficult to diagnose a disorder inside bone, its surface can be visualized very clearly, and it is also possible to visualize cartilage. Furthermore, with POCUS, it is possible to confirm a disorder and the continuity of the fibrous structures of muscles, tendons, and ligaments. In addition, the understanding of pathological conditions of motor disturbances, such as nerve or muscle/tendon injury, nerve paralysis, adhesions of the tendons, and joint instability, is deepened by observing the movement of these structures. Peripheral nerves, even small branches, can be visualized, and pathological conditions can be pinpointed by observing the nerve morphology, continuity, and relationship with the surrounding tissues. Children can be examined in a safe, relaxed environment, without leaving their parents. In addition, US is significantly different from other modalities in that it can be used for both diagnosis and treatment. Being able to visualize target sites improves safety and route accuracy of needle insertion for injection or puncture. Musculoskeletal POCUS is indispensable in routine medical care and is a technique that medical residents should acquire.

Needle path planning in semiautonomous and teleoperated robot-assisted epidural anaesthesia procedure: A proof of concept.

Epidural anaesthesia is a Percutaneous Procedure (PP) which plays a crucial role in surgical procedures, where accurate needle insertion is still challenging. The objective of this work is to present a Tuohy needle path planning, which allows an anaesthesiologist to drive semiautonomously, with the assistance of a teleoperated robot, the tip of the needle during this PP. We capture, analysed and modelled the anaesthetist hands' motion during the execution of this procedure, by synthetising, programing and simulating a parametrised and normalised kinematic constrains dependent on an insertion variable in a virtual robot. Two preoperative path planning models were obtained, which provide a teleoperated robot with kinematic constraints to semiautonomously drive a Tuohy needle in the epidural anaesthesia procedure. A semiautonomous robot can assist in the execution of this PP using the kinematic constraints obtained from the study of the movement of a specialist's hands.

Curve Fitting-Based Dynamic Path Planning and Tracking Control for Flexible Needle Insertion

Needle insertion is widely used in modern clinical practice, and flexible needles enable surgeons to adjust the needle insertion path to avoid obstacles and compensate for target drift. To increase the accuracy and safety of the needle insertion procedure, a path planning and tracking control method for flexible needle steering in dynamic environment is proposed in this paper. The path planning method is based on the artificial potential field algorithm and curve fitting algorithm, after several feasible paths with variant curvatures is obtained, they are furtherly optimized based on path length, obstacle clearance and control effort to select the best one. Simulations show that the proposed path planning method performs better than the current constant curvature method and the rapidly-exploring random tree (RRT) based method. By finely tuning the initial planned path, an intraoperative path replanning method is proposed, which are used to compensate for the drift of target and obstacles. Then to ensure the needle is inserted along the planned path, a tracking control method is adopted based on fuzzy logic algorithm. With the proposed intraoperative path planning and tracking control method, the robustness and accuracy of needle insertion in congested environment can be improved, and experiments also show that our proposed method achieves satisfactory insertion safety and targeting accuracy in dynamic environment. The obtained accuracy of 1.57 mm is sufficient for most clinical needle insertion applications.

Optimal placement for needle electromyography of the supinator muscle: Cadaveric studies.

The existing methods for needle electromyography are confusing as to which is the safest and most effective. Our aim was to identify the optimal and safest needle electromyographic insertion site in the supinator muscle. We performed a two-step cadaveric dissection of the supinator muscle and related neurovascular structures. The study was performed using 18 upper limbs of 9 fresh adult cadavers (step 1) and 14 upper limbs of 7 fresh adult cadavers (step 2). In step 1, an imaginary line connecting the radial head (RH) and midpoint of the dorsal wrist (RW line) was drawn, and the distance from the RH to the point where the RW line and posterior interosseous nerve (PIN) intersect (L_CROSS) was measured on the RW line. In step 2, the needle was inserted 30 mm distal to the RH according to the results of step 1. After injection with India ink, dissection was performed to measure the distance between the needle insertion site and PIN (L_CROSS_Inj) on the RW line. The median L_CROSS was 51.4 (35.5-65.6) mm. Needle insertion spared the PIN in all cases during step 2, and the needle was inserted into the supinator muscle in all cases. The median L_CROSS_Inj was 27.4 (13.2-39.8) mm. A safe and accurate needle insertion site for the supinator muscle is approximately 30 to 40 mm distal to the RH along the RW line.

Efficacy of Shadow-Based Needle Positioning System in Performing CT Image-Guided Percutaneous Biopsy of Lung Lesions: Our Initial Experience.

Context Computerized tomography (CT) is widely used for various interventions and there is a need for an effective navigation tool, for best outcomes. Aim The study was performed to evaluate the efficacy of light- and shadow-based needle positioning assistance device, an innovative navigation tool over the conventional freehand technique, in performing CT image-guided percutaneous interventions. Settings and Design This randomized control trial was performed among patients undergoing CT-guided percutaneous intervention for lung pathologies. Methodology A total of 60 participants were randomized into an intervention group and a control group. The accuracy of needle insertion and other efficacy parameters were assessed for both groups. Post needle placement, CT images were used to evaluate the study endpoints. Statistical Analysis Statistical analysis was performed using SPSS ver. 20 software. Results The mean needle positioning accuracy was 2.1 mm in the experimental group compared with 7.2 mm in the control group freehand procedures. The average time to position the needle at the desired target location was 2.5 minutes in the assisted procedure as compared with 5.3 minutes in the freehand procedure ( p < 0.05). The total number of check scans required to position the needle was 1.3 for assisted procedures and 1.9 for freehand procedures. Conclusion The use of shadow-based assistance device for CT-guided interventions is proven to be efficient and safer with high needle positioning accuracy.

Mixed Reality Needle Guidance Application on Smartglasses Without Pre-procedural CT Image Import with Manually Matching Coordinate Systems.

To develop and assess the accuracy of a mixed reality (MR) needle guidance application on smartglasses. An MR needle guidance application on HoloLens2, without pre-procedural CT image reconstruction or import by manually matching the spatial and MR coordinate systems, was developed. First, the accuracy of the target locations in the image overlay at 63 points arranged on a 45 × 35 × 21cm box and needle angles from 0° to 80°, placed using the MR application, was verified. The needle placement errors from 12 different entry points in a phantom by seven operators (four physicians and three non-physicians) were compared using a linear mixed model between the MR guidance and conventional methods using protractors. The average errors of the target locations and needle angles placed using the MR application were 5.9 ± 2.6mm and 2.3 ± 1.7°, respectively. The average needle insertion error using the MR guidance was slightly smaller compared to that using the conventional method (8.4 ± 4.0mm vs. 9.6 ± 5.1mm, p = 0.091), particularly in the out-of-plane approach (9.6 ± 3.5mm vs. 12.3 ± 4.6mm, p = 0.003). The procedural time was longer with MR guidance than with the conventional method (412 ± 134s vs. 219 ± 66s, p < 0.001). MR needle guidance without pre-procedural CT image import is feasible when matching coordinate systems, and the accuracy of needle insertion is slightly better than that of the conventional method.

Robotic Cytology using Extra-Fine Needles : -Proposal of Puncture Control Strategy for Increasing Collection Amount.

Fine needle aspiration cytology requires accurate needle insertion into a tumor and sufficient amount collection of samples, which highly depends on the skill of the physician. The advantage of the diagnosis is to minimize the tissue damage with the fine needle, while, when the amount of the sample sucked from the lesion is not enough for the definite diagnosis, the procedure has to be repeated until satisfying them. Although numerous research reported a robot-assisted insertion method to improve the accuracy of needle placement with fine needles, there was less research to address the efficient tissue collection. Ideally, the amount of the samples can be satisfied for the diagnosis even if an extra-fine needle (e.g. 25-gauge) is used. This paper proposes a novel needle insertion method for increasing the amount of the tissue sample with the extra-fine needle. The proposed insertion method comprises the round-trip insertion motion and trajectory rerouting with the nature of the bevel-tipped needle. The phantom study's result showed the equivalency of the aspiration amount between a physician's manual procedure with a 22-gauge needle and the proposed method with a 25-gauge needle (4.5 ± 1.0 mg vs 5.1 ± 0.7 mg). The results suggested that the proposed robotic aspiration method can increase the sampling amount with the extra-fine needle in the fine needle aspiration cytology.

MR compatibility, safety and accuracy of the redesigned UMC Utrecht single needle implant device

Purpose. The Utrecht single needle implant device (SNID) was redesigned to increase needle insertion velocity. The purpose of this study is to evaluate the magnetic resonance compatibility, safety and accuracy of the implant device preparing its application in a patient study to investigate the feasibility of inserting a brachytherapy needle into the prostate to a defined tumor target point. Methods. Several experiments were performed to evaluate the mechanical and radiofrequency safety of the needle system, the magnetic field perturbation, the calibration of the implant device in the MR coordinate system, functioning of the implant device during imaging and accuracy of needle insertion. Results. Endurance experiments showed the mechanical safety of the needle system. Magnetic field perturbation was acceptable with induced image distortions smaller than 0.5 mm for clinical MR sequences. Calibration of the implant device in the MR coordinate system was reproducible with average error (mean±standard deviation) of 0.2 ± 0.4 mm, 0.1 ± 0.3 mm and 0.6 ± 0.6 mm in the x, y- and z- direction, respectively. The RF safety measurement showed for clinical MR imaging sequences maximum temperature rises of 0.2 °C at the entry and tip points of the needle. Simultaneous functioning of the implant device and imaging is possible albeit with some intensity band artifacts in the fast field echo images. Finally, phantom measurements showed deviations amounting 2.5–3.6 mm measured as target-to-needle distance at a depth of 12 cm. Conclusions. This preclinical evaluation showed that the MR compatibility, safety and accuracy of the redesigned UMC Utrecht SNID allow its application in a patient study on the feasibility of inserting a brachytherapy needle into the prostate to a defined tumor target point.

A novel multi-DoF surgical robotic system for brachytherapy on liver tumor: Design and control

PurposeRadioactive seed implantation is an effective invasive treatment method for malignant liver tumors in hepatocellular carcinomas. However, challenges of the manual procedure may degrade the efficacy of the technique, such as the high accuracy requirement and radiation exposure to the surgeons. This paper aims to develop a robotic system and its control methods for assisting surgeons on the treatment.MethodWe present an interventional robotic system, which consists of a 5 Degree-of-Freedom (DoF) positioning robotic arm (a 3-DoF translational joint and a 2-DoF revolute joint) and a needle actuator used for needle insertion and radioactive seeds implantation. Control strategy is designed for the system to ensure the safety of the motion. In the designed framework, an artificial potential field (APF)-based motion planning and an ultrasound (US) image-based contacting methods are proposed for the control.ResultExperiments were performed to evaluate position and orientation accuracy as well as validate the motion planning procedure of the system. The mean and standard deviation of targeting error is 0.69 mm and 0.33 mm, respectively. Needle placement accuracy is 1.10 mm by mean. The feasibility of the control strategy, including path planning and the contacting methods, is demonstrated by simulation and experiments based on an abdominal phantom.ConclusionThis paper presents a robotic system with force and US image feedback in assisting surgeons performing brachytherapy on liver tumors. The proposed robotic system is capable of executing an accurate needle insertion task with by optical tracking. The proposed methods improve the safety of the robot’s motion and automate the process of US probe contacting under the feedback of US-image.

A novel manipulator with needle insertion forces feedback for robot-assisted lumbar puncture.

The use of lumbar puncture for paediatric diagnosis and treatment, such as cerebrospinal fluid sampling and intracranial pressure measurements, is steadily increasing. However, the standard 'blind' technique makes it difficult to attain accurate needle insertion. In this study, we developed a robot-assisted system to improve the precision of needle insertion during lumbar puncture. The manipulator can perform orientation, insertion and rotation of the needle as well as linear motion at targeted locations. We focused on accurately sensing the puncture forces during the needle insertion phase and evaluated the piercing force perception of the operator. The main features of the robot, such as backdrivable joints, physical human-robot cooperation, actuation system with low friction and remote centre of motion mechanism, can enhance overall safety. Experimental results using a lumbar puncture phantom proved that the manipulator could position the needle tip at targeted locations with good accuracy. The data obtained from the test system also showed that the loss of resistance and peak forces for stiff tissues were accurately perceived by the operator.

Surgical navigation system for brachytherapy based on mixed reality using a novel stereo registration method

In this study, we present a novel mixed reality navigation system to facilitate brachytherapy, which is an effective method for curing cancer. The accuracy of needle positioning is a vital problem in brachytherapy that can influence the treatment effect. The purpose of the developed system is to help doctors more quickly and easily position the needles and improve seed accuracy in brachytherapy surgery. Based on mixed reality and a multi-information fusion method, a successful fusion of medical images and a preoperative plan for real patients was achieved, allowing doctors to gain an intuitive understanding of the tumor. Image recognition and pose estimation were used to track the needle punctures in real time and perform registration processes. After global registration using an iterative closest-point algorithm with a pattern tracker, medical images and volume renderings of organs, needles and seeds were aligned with the patient. Based on a phantom experiment, the average needle location error was 0.961 mm, and the angle error was 1.861°. The accuracy of needle insertion was 1.586 mm, and the angle error was 2.429°. This research presents the design and validation of a surgical navigation system for thoracoabdominal brachytherapy based on mixed reality. The proposed system was validated through both phantom and animal experiments. The results indicated that the proposed system achieves clinically acceptable accuracy and can aid doctors in performing surgery based on a visualized plan.

Needle artifact characteristics and insertion accuracy using a 1.2 T open MRI scanner: A phantom study

PurposeTo evaluate the characteristics of needle artifacts and the accuracy of needle insertion using a 1.2 Tesla open magnetic resonance imaging (MRI) system in a phantom. Materials and methodsFirst, the apparent width of the needle on the MRI and the needle tip position error of 16- and 18-gauge MRI-compatible introducer needles and a 17-gauge cryoneedle were examined with different needle angles (0°, 30°, 45°, 60°, and 90°) to the main magnetic field (B0), sequence types (balanced steady-state acquisition with rewound gradient echo [BASG] and T2-weighted fast spin echo [FSE] sequence), and frequency encoding directions. Second, the accuracy of needle insertion was evaluated after 10 MRI fluoroscopy-guided insertions in a phantom. ResultsThe apparent needle widths was larger when the angle of the needle axis relative to B0 was larger. The needles appeared larger on BASG than on T2-weighted FSE images, with the largest apparent widths of 16-, 17-, and 18-gauge needles of 14.3, 11.6, and 11.0mm, respectively. The apparent needle tip position was always more distal than the actual position on BASG images, with the largest longitudinal error of 4.0mm. Meanwhile, the 16- and 18-gauge needle tips appeared more proximal on T2-weighted FSE images with right-to-left frequency encoding direction. The mean accuracy of MRI fluoroscopy-guided needle insertion was 3.1mm. ConclusionThese experiments clarify the characteristics of needle artifacts in a 1.2 Tesla open MRI. With this system, the MRI fluoroscopy-guided needle insertion demonstrated an acceptable accuracy for clinical use.

Multi-Bevel Needle Design Enabling Accurate Insertion in Biopsy for Cancer Diagnosis.

To obtain definitive cancer diagnosis for suspicious lesions, accurate needle deployment and adequate tissue sampling in needle biopsy are essential. However, the single-bevel needles in current biopsy devices often induce deflection during insertion, potentially causing lesion missampling/undersampling and cancer misdiagnosis. This study aims to reveal the biopsy needle design criteria enabling both low deflection and adequate tissue sampling. A novel model capable of predicting needle deflection and tissue deformation was first established to understand needle-tissue interaction with different needle tip geometries. Experiments of needle deflection and ex-vivo tissue biopsy were conducted for model validation. The developed model showed a reasonably good prediction on the correlation of needle tip type vs. the resultant needle deflection and tissue sampling length. A new multi-bevel needle with the tissue separation point below the needle groove face has demonstrated to be an effective design with an 87% reduction in deflection magnitude and equivalently long tissue sampling length compared to the current single-bevel needle. This study has revealed two critical design criteria for biopsy needles: 1) multiple bevel faces at the needle tip can generate forces to balance bending moments during insertion to enable a low needle deflection and 2) the tissue separation point should be below the needle groove face to ensure long tissue sampling length. The developed methodologies and findings in this study serve as proof-of-concept and can be utilized to investigate various biopsy procedures to improve cancer diagnostic accuracy as well as other procedures requiring accurate needle insertion.

Smartphone Augmented Reality CT-Based Platform for Needle Insertion Guidance: A Phantom Study.

To develop and assess the accuracy of an augmented reality (AR) needle guidance smartphone application. A needle guidance AR smartphone application was developed using Unity and Vuforia SDK platforms, enabling real-time displays of planned and actual needle trajectories. To assess the application's accuracy in a phantom, eleven operators (including interventional radiologists, non-interventional radiology physicians, and non-physicians) performed single-pass needle insertions using AR guidance (n = 8) and CT-guided freehand (n = 8). Placement errors were measured on post-placement CT scans. Two interventional radiologists then used AR guidance (n = 3) and CT-guided freehand (n = 3) to navigate needles to within 5mm of targets with intermediate CT scans permitted to mimic clinical use. The total time and number of intermediate CT scans required for successful navigation were recorded. In the first experiment, the average operator insertion error for AR-guided needles was 78% less than that for CT-guided freehand (2.69 ± 2.61mm vs. 12.51 ± 8.39mm, respectively, p < 0.001). In the task-based experiment, interventional radiologists achieved successful needle insertions on each first attempt when using AR guidance, thereby eliminating the need for intraoperative CT scans. This contrasted with 2 ± 0.9 intermediate CT scans when using CT-guided freehand. Additionally, average procedural times were reduced from 13.1 ± 6.6min with CT-guided freehand to 4.5 ± 1.3min with AR guidance, reflecting a 66% reduction. All operators exhibited superior needle insertion accuracy when using the smartphone-based AR guidance application compared to CT-guided freehand. This AR platform can potentially facilitate percutaneous biopsies and ablations by improving needle insertion accuracy, expediting procedural times, and reducing radiation exposures.

Magnetic resonance and ultrasound image-guided navigation system using a needle manipulator.

Image guidance is crucial for percutaneous tumor ablations, enabling accurate needle-like applicator placement into target tumors while avoiding tissues that are sensitive to injury and/or correcting needle deflection. Although ultrasound (US) is widely used for image guidance, magnetic resonance (MR) is preferable due to its superior soft tissue contrast. The objective of this study was to develop and evaluate an MR and US multi-modal image-guided navigation system with a needle manipulator to enable US-guided applicator placement during MR imaging (MRI)-guided percutaneous tumor ablation. The MRI-compatible needle manipulator with US probe was installed adjacent to a 3 Tesla MRI scanner patient table. Coordinate systems for the MR image, patient table, manipulator, and US probe were all registered using an optical tracking sensor. The patient was initially scanned in the MRI scanner bore for planning and then moved outside the bore for treatment. Needle insertion was guided by real-time US imaging fused with the reformatted static MR image to enhance soft tissue contrast. Feasibility, targeting accuracy, and MR compatibility of the system were evaluated using a bovine liver and agar phantoms. Targeting error for 50 needle insertions was 1.6±0.6mm (mean±standard deviation). The experiment confirmed that fused MR and US images provided real-time needle localization against static MR images with soft tissue contrast. The proposed MR and US multi-modal image-guided navigation system using a needle manipulator enabled accurate needle insertion by taking advantage of static MR and real-time US images simultaneously. Real-time visualization helped determine needle depth, tissue monitoring surrounding the needle path, target organ shifts, and needle deviation from the path.

Shoulder-mounted Robot for MRI-Guided Arthrography: Clinically Optimized System.

This paper introduces our compact and lightweight patient-mounted MRI-compatible 4 degree-of-freedom (DOF) robot with an improved transmission system for MRI-guided arthrography procedures. This robot could make the traditional two-stage arthrography procedure (fluoroscopy-guided needle insertion followed by a diagnostic MRI scan) simpler by converting it to a one-stage procedure but more accurate with an optimized system. The new transmission system is proposed, using different mechanical components, to result in higher accuracy of needle insertion. The results of a recent accuracy study are reported. Experimental results show that the new system has an error of 1.7 mm in positioning the needle tip at a depth of 50 mm, which indicates high accuracy.