Accurate Needle Insertion Research Articles

Developing a method to plan robotic straight needle insertion using a probability-based assessment of puncture occurrence

Needle-based treatments for cancer require accurate placement of the needle tip into the target tissue. However, it is often difficult to insert a needle accurately because of the cancer displacement caused by organ deformation. Therefore, developing a planning method based on a numerical simulation that analyzes organ deformation is important for accurate needle insertion. However, predicting the puncture conditions, including the force applied to the needle is not trivial owing to marked variations in the experimental data. The purpose of this research is to develop a novel method for predicting a robust path for straight needle insertion with various puncture points. The method is based on the probabilities of the various puncture conditions and evaluates the expected accuracy of needle placement. First, a probability-based puncture condition was established and the expected accuracy of needle placement was defined. We also performed in vitro needle insertion experiments using a porcine liver. Significant variations in puncture force were observed. Accordingly, we established a probability distribution for the tissue stress caused by the puncture. An in vitro experiment was performed to measure needle placement accuracy using the optimized path. Experimental results show that the proposed method achieves a mean accuracy of 1.5 mm.

Critical Organs Sparing for Preserving Erectile Function by Non-Template Based Permanent Prostate Brachytherapy

Current transperineal prostate brachytherapy technique results in needles passing through the penile bulb and neurovascular bundles (NVB), with resulting traumatic injury and potential for dysfunction. With the emergence of robotic technology, accurate angled needle insertion without reliance on a template becomes feasible. Our goals were to develop a non-template based permanent prostate brachytherapy treatment planning system (TPS) and demonstrate its usage on designing treatment plans which avoids needles passing through critical organs for erectile function such as penile bulb and NVB.

Development and Preliminary Evaluation of a Motorized Needle Guide Template for MRI-Guided Targeted Prostate Biopsy

To overcome the problems of limited needle insertion accuracy and human error in the use of a conventional needle guide template in magnetic resonance imaging (MRI)-guided prostate intervention, we developed a motorized MRI-compatible needle guide template that resembles a transrectal ultrasound-guided prostate template. The motorized template allows automated, gapless needle guidance in a 3T MRI scanner with minimal changes in the current clinical procedure. To evaluate the impact of the motorized template on MRI, signal-to-noise ratio and distortion were measured under various system configurations. A maximum of 44% signal-to-noise ratio decrease was found when the ultrasonic motors were running, and a maximum of 0.4% image distortion was observed due to the presence of the motorized template. To measure needle insertion accuracy, we performed four sets of five random target needle insertions mimicking four biopsy procedures, which resulted in an average in-plane targeting error of 0.94 mm with a standard deviation of 0.34 mm. The evaluation studies indicated that the presence and operation of the motorized template in the MRI bore create insignificant image degradation, and provide submillimeter targeting accuracy. The automated needle guide that is directly controlled by navigation software eliminates human error so that the safety of the procedure can be improved.

A 45° Set Square Method for Accurate Needle Insertion in Ultrasound-guided Internal Jugular Venous Catheterization

Until now, there was no standardized method for insertion of introducer needle in ultrasound-guided internal jugular venous catheterization (IJVC). The needle insertion site and angle have been determined on the basis of the performer's experience. We designed a new standardized approach (called 45° set square method) that determines the site and the angle of needle insertion during ultrasound-guided IJVC to improve first-attempt success rate and reduce complications. The purpose of this study was to investigate the clinical usefulness of the novel 45° set square method for IJVC by ultrasound guidance in the Emergency Department (ED).

Needle steering for robot-assisted insertion into soft tissue: A survey

Needle insertion is a common surgical procedure used in diagnosis and treatment. The needle steering technologies make continuous developments in theoretical and practical aspects along with the in-depth research on needle insertion. It is necessary to summarize and analyze the existing results to promote the future development of theories and applications of needle insertion. Thus, a survey of the state of the art of research is presented on algorithms of needle steering techniques, the surgical robots and devices. Based on the analysis of the needle insertion procedure, the concept of needle steering is defined as a kinematics problem, which is to place the needle at the target and avoid the obstacles. The needle steering techniques, including the artificial potential field method and the nonholonomic model, are introduced to control the needles for improving the accuracy. Based on the quasi-static thinking, the virtual spring model and the cantilever-beam model are developed to calculate the amount of needle deflection and generate the needle path. The phantoms instead of the real tissue are used to verify the models mentioned in most of the experimentations. For the desired needle trajectories, the image-guided robotic devices and some novel needles are presented to achieve the needle steering. Finally, the challenges are provided involving the controllability of the long flexible needle and the properties of soft tissue. The results and investigations can be used for further study on the precision and accuracy of needle insertion.

Enhanced Targeting in Breast Tissue Using a Robotic Tissue Preloading-Based Needle Insertion System

The use of minimally invasive procedures for breast tumor diagnosis and treatment, such as needle biopsy and radiofrequency ablation (RFA), is steadily increasing. Accurate needle insertion requires solving the problems of tissue deformation and target displacement. In this study, we developed a robotic needle insertion method to improve the precision of diagnostic biopsy and RFA treatment. The mechanical probe was designed to reduce tissue displacement by pressing the breast tissue before needle insertion: a technique that is known as preloading. We focused on the needle insertion phase and evaluated the insertion accuracy achieved. Using a numerical simulation model and an actual hog breast, we compared tissue preloaded needle insertion with normal needle insertion. The data obtained with both test systems showed that targeting errors were greatly reduced using preloading-based needle insertion, as compared with normal needle insertion. The procedure is expected to offer a safe and effective alternative to the traditional methods of needle insertion for breast tissue biopsy or RFA. Our study also revealed the relationship between insertion accuracy and preloading probe force.

Effects of insertion speed and trocar stiffness on the accuracy of needle position for brachytherapy

In prostate brachytherapy, accurate positioning of the needle tip to place radioactive seeds at its target site is critical for successful radiation treatment. During the procedure, needle deflection leads to seed misplacement and suboptimal radiation dose to cancerous cells. In practice, radiation oncologists commonly use high-speed hand needle insertion to minimize displacement of the prostate as well as the needle deflection. Effects of speed during needle insertion and stiffness of trocar (a solid rod inside the hollow cannula) on needle deflection are studied. Needle insertion experiments into phantom were performed using a 2(2) factorial design (2 parameters at 2 levels), with each condition having replicates. Analysis of the deflection data included calculating the average, standard deviation, and analysis of variance (ANOVA) to find significant single and two-way interaction factors. The stiffer tungsten carbide trocar is effective in reducing the average and standard deviation of needle deflection. The fast insertion speed together with the stiffer trocar generated the smallest average and standard deviation for needle deflection for almost all cases. The combination of stiff tungsten carbide trocar and fast needle insertion speed are important to decreasing needle deflection. The knowledge gained from this study can be used to improve the accuracy of needle insertion during brachytherapy procedures.

Navigated targeting of liver lesions: pitfalls of electromagnetic tracking

One of the major challenges related to percutaneous radiofrequency ablation (RFA) of liver tumors is the exact placement of the instrument within the lesion. Previous studies have shown the benefit of computer-assisted needle insertion based on optical tracking of both the instrument and internal fiducials used for registration. However, the concept has not been accepted for clinical use. This may in part be attributed to the line-of-sight constraint imposed by optical tracking systems which results in the use of needles thick enough to avoid bending. Electromagnetic (EM) tracking systems allow the localization of medical instruments without line-of-sight requirements, but are known to be less robust to the influence of metallic and/or ferromagnetic objects. In this paper, we apply a previously introduced fiducial-based system for navigated needle insertion with an EM tracking system and assess the overall targeting error using a static phantom in two different settings: in a non-metallic environment (REF) and on a CT stretcher (CT). While accurate needle insertion could be achieved in the reference environment (REF: 2.6±0.7 mm), targeting errors dropped drastically in the presence of metal (CT: 10.4±6.1 mm). For accurate and robust computer-assisted needle insertion, EM field distortions should thus either be avoided by assuring a suitable environment or by using methods for shielding or error compensation.

Precision grid and hand motion for accurate needle insertion in brachytherapy

In prostate brachytherapy, a grid is used to guide a needle tip toward a preplanned location within the tissue. During insertion, the needle deflects en route resulting in target misplacement. In this paper, 18-gauge needle insertion experiments into phantom were performed to test effects of three parameters, which include the clearance between the grid hole and needle, the thickness of the grid, and the needle insertion speed. Measurement apparatus that consisted of two datum surfaces and digital depth gauge was developed to quantify needle deflections. The gauge repeatability and reproducibility (GR&R) test was performed on the measurement apparatus, and it proved to be capable of measuring a 2 mm tolerance from the target. Replicated experiments were performed on a 2(3) factorial design (three parameters at two levels) and analysis included averages and standard deviation along with an analysis of variance (ANOVA) to find significant single and two-way interaction factors. Results showed that grid with tight clearance hole and slow needle speed increased precision and accuracy of needle insertion. The tight grid was vital to enhance precision and accuracy of needle insertion for both slow and fast insertion speed; additionally, at slow speed the tight, thick grid improved needle precision and accuracy. In summary, the tight grid is important, regardless of speed. The grid design, which shows the capability to reduce the needle deflection in brachytherapy procedures, can potentially be implemented in the brachytherapy procedure.

力覚提示を伴う高品質な穿刺シミュレーションのためのマルチレート・オンラインリメッシュ法

Recently, there are growing needs for fast and accurate needle insertion simulations with realistic sensations. However, it takes large computation time to realize such simulations. Our goal is to construct a needle insertion training system for trainee doctors to practice the needle insertion operations. In this paper, we propose a multi-rate online remesh method to achieve a real time and accurate needle insertion simulation. In this approach, tetrahedral volume mesh that located near the needle is rapidly subdivided by binary bisection algorithm. And then, accurate friction force of the needle is calculated from relative velocities between the needle and nodes of subdivided small tetrahedra.

Tactile Feedback Comparison of Manual, Hammer, and Rotary Powered Needle Insertion Accuracy for Bone Marrow Biopsy and Other Procedures

AbstractAbstract 4752 Introduction:For decades, clinicians have performed bone marrow sampling procedures by manually twisting and pushing auger-like devices into bones, with variable and less than ideal results. For the clinician, the bone marrow biopsy is generally a blind procedure during needle advancement without any dynamic visual reference, except the external view of the patient and the device. The clinician is required to feel the tissue levels, including bone of widely diverse densities, communicated via the needle to the hand. The procedure is relatively straightforward but substantial skill and experience are required by the operator to complete the procedure quickly, safely and effectively, with minimal pain to the patient. With the introduction of rotary power to access the intraosseous space, the question of needle tip control has been open to debate. Some clinicians question whether the ease of insertion with a rotary-powered device would lead to perforation of the opposite cortex of the bone and/or damage adjacent tissues. Objectives:The investigators sought to study the relative precision of anatomical placement of the needle tip in bones using only tactile feedback. The objective was to determine if clinicians were able to correctly place the needle tip into a specific target area of simulated bone more often and in less time when using rotary powered intraosseous devices than when using manually inserted devices, or hammer-assisted insertion devices, when relying primarily on tactile feedback to determine correct depth of penetration. Better tactile feedback with the rotary power would allow clinicians to accurately predict the level of control over needle placement. Additionally, needles inserted with rotary power would cause less damage to simulated bone than those inserted with manual or hammer-assisted techniques. Methods:Three different FDA-cleared 11 gauge stainless steel needle types were compared in a randomized prospective study test blocks of artificial bone. The needle types were Manual inserted (Manual), Hammer-assisted (Hammer), and Rotary-powered inserted (Power). Test blocks were specifically designed of three different thicknesses each simulating the characteristics of human bone. Eleven clinicians participated in the study. Following each insertion, the participant was asked to rate his/her confidence level of insertion accuracy on a scale of 0 to 10. Position of the needle tip was assessed by fluoroscopic confirmation. Each participant also inserted each needle type into a simulated osteoporotic bone model (raw chicken egg). The ability to insert the needle into the osteoporotic model without damage was based on visual assessment. Data were analyzed using SPSS for Windows. Results:Each of the 11 participants used each of the three needle types (Manual, Hammer, and Power) on each of the three different simulated bone types, for a total of 9 insertions each. Total number of insertions for the study was 99 (9×11). Mean insertion times were Manual: 20.7 ± 10.1 seconds, Hammer: 12.7 ± 5.9 seconds, and Power: 8.7 ± 2.8 seconds. Differences were statistically significant (p<0.001). Insertion success by devices, defined as correct placement of the needle tip to a specific target depth, was Manual: 48.5%, Hammer: 69.7%, Power: 97.0%. Differences were statistically significant (p<0.001). On a scale of 0 to 10, mean insertion certainty levels, defined as the clinicians perception of needle tip placement into the correct location, by devices were Manual: 48% certainty, Hammer: 61% certainty, and Power: 91% certainty. All certainty comparisons between devices were statistically significant (p<0.05). Using a raw egg to simulate osteoporotic bone, insertion rates without damage were Manual: 19.2%, Hammer: 36.4%, and Power: 100%. Differences were statistically significant (p<0.001). Conclusions:Correct placement of a bone biopsy needle into a precise target area using tactile feedback only was markedly better and faster when using a rotary powered needle than when using a Manually inserted or a Hammer assisted device. The operator's impression of correct needle placement correlated with actual control of needle placement. Damage to fragile bone models was negligible with the Powered device compared to marked damage from the Manual and Hammer devices. These findings may have far reaching clinical applications when determining the best method for performing bone marrow biopsies. Disclosures:Miller:Vidacare Corporation: Employment, Equity Ownership, Patents & Royalties. Bolleter:Vidacare Corporation: Consultancy, Employment, Equity Ownership, Patents & Royalties. Philbeck:Vidacare Corporation: Employment. Montez:Vidacare Corporation: Employment.

413: Tactile Feedback Comparison of Three Types of Intraosseous Access Devices for Needle Insertion Accuracy

413: Tactile Feedback Comparison of Three Types of Intraosseous Access Devices for Needle Insertion Accuracy

Development of an integrated needle insertion system with image guidance and deformation simulation

Objective The purpose of our work was to develop an integrated system with image guidance and deformation simulation for the purpose of accurate needle insertion. Methods We designed an ultrasound-guided needle insertion manipulator and physical model to simulate liver deformation. We carried out an in vivo experiment using a porcine liver to verify the effectiveness of our manipulator and model. Results The results of the in vivo experiment showed that the needle insertion manipulator accurately positions the needle tip into the target. The experimental results also showed that the liver model accurately reproduces the nonlinear increase of force upon the needle during insertion. Discussion Based on these results, it is suggested that the needle insertion manipulator and the physical liver model developed and validated in this work are effective for accurate needle insertion.

Teleoperated master–slave needle insertion

Accuracy of needle tip placement and needle tracking in soft tissue are of particular importance in many medical procedures. In recent years, developing autonomous and teleoperated systems for needle insertion has become an active area of research. In this study, needle insertion was performed using a master-slave set-up with multi-degrees of freedom. The effect of force feedback on the accuracy of needle insertion was investigated. In addition, this study compared autonomous, teleoperated and semi-autonomous needle insertion. The results of this study show that incorporation of force feedback can improve teleoperated needle insertion. However, autonomous and semi-autonomous needle insertions, which use feedback from a deflection model, provide significantly better performance. Development of a haptic master-slave needle insertion system, which is capable of performing some autonomous tasks based on feedback from tissue deformation and needle deflection models, can improve the performance of autonomous robotics-based insertions as well as non-autonomous teleoperated manual insertions.

Effectiveness of real‐time virtual sonography‐guided radiofrequency ablation treatment for patients with hepatocellular carcinomas

Real-time virtual sonography (RVS) can synchronize B-mode ultrasound (US) images with multiplanar reconstruction (MPR)-computed tomography (CT) images on the same screen in real time. The purpose of this study was to evaluate the effectiveness of RVS for radiofrequency ablation therapy (RFA) of hepatocellular carcinomas (HCC) in which it was difficult to identify contours or margins by B-mode US. Sixty-three consecutive patients with a solitary HCC of less than 3.5 cm in diameter were enrolled in this study. Thirty-nine patients with HCC clearly detectable by B-mode US underwent conventional RFA, while the remaining 24 with obscure tumor lesions underwent RVS-guided RFA. A follow-up study of RFA treatment was performed every 3 months using enhanced CT imaging of the arterial and portal phase (at least 24 months). The accuracy of needle insertion was confirmed by measuring the gap between the needle insertion line and the center of the tumor from MPR-CT images. The local recurrence rate of the RVS-guided RFA group was similar to that of the conventional RFA group (8.3% vs 7.7%), despite the difficulty of detecting tumor lesions in the former group. The mean gap between the needle insertion line and the center of the tumor was 1.6 mm (0-3.2 mm) in eight patients treated with RVS-guided RFA. RVS-guided RFA can be useful for treating HCC that are difficult to detect by B-mode US.

Needle insertion into soft tissue: A survey

Needle insertion in soft tissue has attracted considerable attention in recent years due to its application in minimally invasive percutaneous procedures such as biopsies and brachytherapy. This paper presents a survey of the current state of research on needle insertion in soft tissue. It examines the topic from several aspects, e.g. modeling needle insertion forces, modeling tissue deformation and needle deflection during insertion, robot-assisted needle insertion, and the effect of different trajectories on tissue deformation. All studies show that the axial force of a needle during insertion in soft tissue is the summation of different forces distributed along the needle shaft such as stiffness force, frictional force and cutting force. Some studies have modeled these forces. The force data in some procedures is used for identifying tissue layers as the needle is inserted or for path planning. Needle deflection and tissue deformation are major problems for accurate needle insertion and attempts have been made to model them. Using current models several insertion techniques have been developed which are briefly reviewed in this paper.

Cadaver Evaluation of EMG Needle Insertion Techniques Used to Target Muscles of the Thorax

Measure the accuracy of needle insertion in thoracic muscles of human cadavers. Evaluate the effectiveness of known EMG techniques for sampling thoracic innervated muscles. The evaluation of thoracic radiculopathies requires accurate electrodiagnostic techniques for evaluating the thoracic myotomes. An American Board of Electrodiagnostic Medicine certified physician placed needles into pertinent muscles of the thorax and an anatomist serving as a blinded dissector recorded the path and accuracy of needle. Needle examination of thoracic muscles was as accurate as limb needle examination. No notable risks are noted in multifidus sampling. However, in the cadaver, some risks were noted in association with placements in the intercostal muscles. The target muscle was reliably sampled, but the rib or vertebral level was difficult to landmark in the cadaver. Needle examination of the thoracic multifidus and intercostals is reliable, although further confirmation is needed to accurately verify the appropriate vertebral or rib level being sampled.

Control of soft tissue deformation during robotic needle insertion

Accurate needle insertion into soft, inhomogeneous tissue is of practical interest because of its importance in percutaneous therapies. In procedures that involve multiple needle insertions such as transrectal ultrasound‐guided prostate brachytherapy, it is important to reduce tissue deformation before puncture and during needle insertion. In order to reduce this deformation, we have studied the effect of different trajectories for a 2‐DOF (degrees of freedom) robot performing needle insertion in soft tissue. To obtain an optimum trajectory, we have compared tissue indentation and frictional forces for different trajectories. According to the results of our experiments, infinitesimal force per tissue displacement is a useful parameter for online trajectory update. In addition, the results show that axial rotation can reduce tissue indentation before puncture and frictional forces after puncture. Our proposed position/force controller is shown to provide considerable improvement in performance with regard to minimizing tissue deformation before puncture.

Sci‐PM Fri ‐ 04: A three‐dimensional micro‐ultrasound image‐guided and robotically assisted needle positioning system

Biomedical research using small animals often requires interventional procedures such as biopsies and injections. When performed inaccurately, these procedures can produce poor results, jeopardizing the study. A needle‐positioning robot for three‐dimensional micro‐ultrasound guided interventions was developed to improve the accuracy of needle insertion. The robot has three degrees of freedom for positioning the needle in three dimensions. Two rotational joints are used to control orientation (roll and pitch), while another joint linearly translates the needle to perform insertion. The three axes intersect at a single point, producing a remote centre of motion (RCM) that acts as a fulcrum for the three‐dimensional orientation of the needle. The RCM corresponds to the insertion point of the needle into the animal. The robot was calibrated to ensure that the three axes intersected at a single point, and that the needle tip was positioned at the RCM. The calibration was performed using a high‐resolution digital camera to find the centre of rotation about the pitch and roll axes separately. The position of the needle was adjusted until it was aligned with the RCM. Calibration results indicate that the distance from the needle to the pitch and roll axes are 24±30 μm and 18±15 μm, respectively. The pitch and roll axes are separated by 11±3 μm. The calibration procedure allowed us to detect and correct manufacturing and design errors. The expected maximum needle positioning error computed from the calibration is 32 μm when the needle tip is moved to the boundary of the workspace.