Needle Bending Research Articles

PO0213: Evaluating Needle Bending and Tracking Requirements for Improved Needle Placement in Interstitial Gynecologic Brachytherapy

PO0213: Evaluating Needle Bending and Tracking Requirements for Improved Needle Placement in Interstitial Gynecologic Brachytherapy

A mechanics-based model for predicting flexible needle bending with large curvature in soft tissue

Percutaneous insertion is one of the most common minimally invasive procedures. Compared with traditional straight rigid needles, bevel-tipped flexible needle can generate curved trajectories to avoid obstacles and sensitive organs. However, the nonlinear large deflection problem challenges the bending prediction of the needle, which dramatically influences the surgical success rate. This paper analyzed the mechanism of needle-tissue interaction, and established a mechanics-based model of the needle bending during an insertion. And then, a discretization of the bending model was adopted to accurately predict the large bending of the needle in soft tissue. Insertion experiments were conducted to validate the bending prediction model. The results showed that the large needle bending was predicted with the mean/RMSE/maximumu error of 0.42 mm / 0.26 mm / 1.08 mm, which was clinically acceptable. This proved the rationality and accuracy of the proposed model.

A Comparison between Kinematic Models for Robotic Needle Insertion with Application into Transperineal Prostate Biopsy

Transperineal prostate biopsy is the most reliable technique for detecting prostate cancer, and robot-assisted needle insertion has the potential to improve the accuracy of this procedure. Modeling the interaction between a bevel-tip needle and the tissue, considering tissue heterogeneity, needle bending, and tissue/organ deformation and movement is a required step to enable robotic needle insertion. Even if several models exist, they have never been compared on experimental grounds. Based on this motivation, this paper proposes an experimental comparison for kinematic models of needle insertion, considering different needle insertion speeds and different degrees of tissue stiffness. The experimental comparison considers automated insertions of needles into transparent silicone phantoms under stereo-image guidance. The comparison evaluates the accuracy of existing models in predicting needle deformation.

Considering Anatomic Features When Retrieving a Separated Needle: A Case Report Using CT Navigation Within the Infratemporal Fossa

Needle separation is an unfortunate complication encountered during local anesthetic administration in dentistry. Attributing factors have been thought to be related to needle gauge, pre-injection needle bending, needle deflection, redirection, and depth of penetration. Various methods have been described for FB identification and retrieval. We present a case of a separated hypodermic needle in the infratemporal fossa after a posterior superior alveolar (PSA) nerve block. We describe the use of computed tomography (CT) navigation system with an expanded armamentarium of guided instrumentation. Utilization of our method can efficiently aid in the localization and removal of foreign bodies in the maxillofacial region.

Measurement of needle and armature dynamics in a gasoline direct injector by high-speed neutron imaging

In modern spark ignition engines, precise delivery of fuel with gasoline direct injection has become increasingly important in the effort to meet ever stricter efficiency and emissions regulations. Use of multiple small close-coupled injections has become more common in attempt to precisely control fuel distribution in the cylinder, but these strategies are hindered by nonlinear injection effects due to operation in the ballistic region of the solenoid-operated valve and due to armature bounce at the end of injection. Understanding the internal dynamics of the injector is crucial to minimizing and controlling non-linearity and shot-to-shot variation, but the experimental techniques available to date are capable only of tracking the position of either the top of the needle (via laser sensors or by monitoring current and voltage in the solenoid coil) or the bottom of the needle (via transparent nozzles or high-speed x-ray imaging). A complete picture of the axial and radial motion of valve needle has until now remained elusive. In this work, we present high-speed ensemble neutron transmission imaging of an entire 8-hole gasoline direct injector operating at 200 bar, allowing for both visualization and quantification of the actuation dynamics including lift and wobble of the valve ball, oscillation and bending of the valve needle, lift, rocking, and bounce of the armature, compression of the springs, and radial swelling of the solenoid during energization. Because neutrons offer high penetration through the metal injector while also being sensitive to the 1H nuclei in fuel molecules, it is also possible to simultaneously see the fluid dynamics of the injection process, including filling of the sac volume, emanation of the spray through the nozzle holes and into the downstream gas, and the formation and evolution of fuel films on the tip of the injector and the walls of the spray container.

Device malfunctions with use of EUS–guided fine-needle biopsy devices: Analysis of the MAUDE database

ABSTRACT Background The safety of endoscopic ultrasound–guided tissue acquisition through fine-needle biopsy devices is well-established in clinical trials. The real-world experience of using these devices is not known. The authors analyzed the postmarketing surveillance data from the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database to answer this question. Methods The Food and Drug Administration MAUDE database from January 2012 to June 2022 was accessed to evaluate for device malfunctions and patient-related adverse consequences of these malfunctions. Results There were 344 device-related issues. Most issues were due to detachment or breakage of the device (n = 185 [53.7%]). Seventy-six of the breakages (40.8%) occurred during the procedure, whereas 89 cases (47.8%) occurred while removing the needle from the endoscope. The most common site of tissue biopsy at the time of needle breakage was the pancreas (44 [23.8%]). The common patient-related adverse events were retained foreign body (n = 50 [14.5%]) followed by bleeding (16, 4.6%). Six patients (3.4%) required a second intervention for removal of the retained foreign bodies including surgery in 2 cases. The device breakage damaged the endoscope in 3 cases (1.7%), and there was 1 case of needlestick injury to the nurse. Conclusion The fine-needle biopsy devices can be associated with needle breakage and bending; these adverse events were not previously reported. Needle breakages can result in a retained foreign body that may require additional procedures including surgery. These real-world findings from the MAUDE database may inform clinical decisions and help improve clinical outcomes.

A prospective survey on trephine biopsy of bone and bone marrow: an experience with 274 Indian patients’ biopsies

Trephine bone marrow biopsy is an effective technique for diagnosing hematological malignancies in patients of different ages. During trephine biopsy, bone marrow cores are obtained for detailed morphological evaluation to look for any abnormality and arrive at a diagnosis. The primary goal of this work is to perform a survey on Indian patients of various ages for the trephine bone marrow biopsy process. In the present study, data related to 274 trephine biopsy samples from 300 patients were acquired at the Post Graduate Institute of Medical Education and Research (PGIMER) in Chandigarh, India. Pain was found to be the sole major procedure-related complication, and patients reported no/less pain in 41 BMB (14.96%) patients, moderate pain in 82 (29.92%) cases, and unbearable pain in 151 (55.1%) BMB cases. In addition, the patients were evaluated by the authors and hematologist as non-anxious for the procedure in 34 (12.4%), anxious in 92 (33.57%), and very/highly anxious in 148 (56%) cases. The bone texture of the patients significantly affected the needle bending, number of repetitions required, and size of the bone marrow sample. This demonstrates the need for improvement in the biopsy procedure. To this end, a survey was conducted to assess the numerous difficulties and diagnostic outcomes throughout the trephine biopsy process.

Flexible Needle Bending Model for Spinal Injection Procedures.

An in situ needle manipulation technique used by physicians when performing spinal injections is modeled to study its effect on needle shape and needle tip position. A mechanics-based model is proposed and solved using finite element method. A test setup is presented to mimic the needle manipulation motion. Tissue phantoms made from plastisol as well as porcine skeletal muscle samples are used to evaluate the model accuracy against medical images. The effect of different compression models as well as model parameters on model accuracy is studied, and the effect of needle-tissue interaction on the needle remote center of motion is examined. With the correct combination of compression model and model parameters, the model simulation is able to predict needle tip position within submillimeter accuracy.

GPP10 Presentation Time: 10:10 AM: Using 3D Printed Vaginal Individualized Applicator (VIA) to Simplify Needle Insertion, Guide Needle Distribution and Optimize Dosimetry for Gynecologic Interstitial and Cervix Hybrid Brachytherapy

<h3>Purpose</h3> Optimally placing interstitial needles either as part of hybrid procedures for the treatment of cervical cancer or for interstitial only gynecologic brachytherapy requires time and expertise. Individualized templates to guide needles to dosimetrically beneficial positions could simplify interstitial and hybrid procedures, decrease procedure time, improve needle distribution and optimize dosimetry. <h3>Materials and Methods</h3> We developed a novel approach using 3D printed Vaginal Individualized Applicator (VIA) templates that contain internal channels that guide interstitial needles from the vaginal introitus to the desired locations within the tumor. The use of 3D printing allows for curved and angled needle trajectories allowing needle distribution to be individualized based on patient and tumor anatomy, such as having a narrow vaginal applicator with needle paths to cover a much wider tumor diameter. The channel directions and needle depths are based on a pre-planning approach. Following a pre-procedure MRI, CTV contours are drawn and converted to a Computer Aided Design (CAD) format. Within the 3D design software, a simple 25 mm diameter cylinder is used to start. Needle paths are manually designed to cover the target following a set of basic rules, which include needle spacing and bending angles. The cylinder with curved needle paths is intended to be slid over the tandem after insertion, or used on its own with a needle in the central location (Figure 1A). The resulting design is 3D printed with biocompatible materials and sterilized pre-procedure. Depending on the printing options (in-house printer or external vendor), the process takes from one week to 24 hours, thereby enabling fraction-to-fraction modifications. <h3>Results</h3> We have created and used clinically 3D printed VIA templates for both hybrid cervix brachytherapy for patients with narrow vaginal canals and for interstitial only gynecologic brachytherapy. The VIA design allows for dwell times within the needles and also within the cylinder component. By allowing the placement of needles from the vaginal introitus, the VIA increases the ease and simultaneously decreases the complexity of optimally placing interstitial needles within the region of the tumor. This design approach also allows additional needles to be placed through available potential channels, if found to be needed, following 3D imaging with CT or MRI, without removing any of the applicator (Figure 1B). For hybrid procedures (n=7), use of the VIA decreased procedure time by 45% (from 33.1 to 18.3 minutes) and improved or maintained excellent dosimetry with an average CTV V100% of 93.4% vs. 90.9% for other hybrid applicators. Similarly, in using the VIA for interstitial-only cases (n=1), we found that needle placement was reduced by 30 minutes or 33% quicker than standard interstitial procedures with similar dosimetry (CTV V100% 95.4 % for VIA vs. 93.4%). <h3>Conclusions</h3> Our team developed a novel 3D printed VIA template that significantly facilitates gynecologic interstitial and cervix hybrid brachytherapy by simplifying the placement of needles, decreasing procedure time and optimizing dosimetry. The clinical data above demonstrates the benefits of this approach for patients with narrow vaginal canals that do not accommodate commercial hybrid applicators. The VIA can easily be designed to facilitate interstitial gynecologic brachytherapy for multiple clinical situations.

A robotic puncture system with optical and mechanical feedback under respiratory motion.

Puncture robot can improve the accuracy and efficiency of puncture surgery, such as thoracoabdominal and liver puncture. However, as soft tissue is deformed and shifted under respiratory motion and during the puncture process, the needle is pulled, resulting in the needle's bending and deformation, which increases the risks and sufferings of the patient, a robotic puncture system with optical and mechanical feedback is necessary. Therefore, this paper proposes a multi-information sensing 'guide-clamp' end effector for puncture surgery to accurately detect the posture and force on the puncture needle in real time. And gravity bias method with trajectory planning and the compensational controlling model are also proposed to offset the interference of self-weight and achieve zero force following. This system is evaluated by the experiments of robot controlling and human tissue simulation and the results prove the excellent robustness of the system, which meet the clinical requirement.

Concurrently bendable and rotatable continuum tubular robot for omnidirectional multi-core transurethral prostate biopsy.

A transurethral prostate biopsy device is proposed in this paper, which can shoot a biopsy needle at different angles to take samples from multiple locations within the prostate. Firstly, the traditional prostate biopsy methods, including transrectal prostate biopsy and transperineal prostate biopsy, are introduced and compared. Then, the working principles of the new prostate biopsy procedure are illustrated. The designs of the needle bending system and the flexible needle are presented, and a proofs-of-concept study of the robotic biopsy device is demonstrated. Design parameters, material selection, and control unit are introduced. Experiments are carried out to test and demonstrate the functions of the prototype. Theoretical and measured bending angles are compared and analyzed. The bending system can effectively bend the biopsy needle to any angle between 15 and 45°. The penetration force of the biopsy needle decreases with the increase of the bending angle. The range of rotation of the bending system on one hemisphere is ±25°. Together with the translational motion, the biopsy needle can reach any point within the workspace. Finally, a phantom test and a cadaver experiment were carried out to simulate biopsy.

Percutaneous nephrolithotomy - the puncture.

To determine what importance is given to the puncture and assistive technologies in percutaneous nephrolithotomy (PNL) in the current urological literature. PubMed was searched for English publications and reviews for the keywords: 'percutaneous nephrolithotomy', 'percutaneous nephrostomy', 'puncture'. The search was limited to the last 5 years, January 2016 until February 2021. Based on 183 abstracts, 121 publications were selected, read, and reviewed. References, older or seminal papers were read and cited if they contributed to a better understanding. A total of 198 references form the basis of this narrative review. The puncture is frequently referred to as the most crucial part of PNL. In contrast, the influence of the puncture on the failure rate of PNL and the specific puncture-related complications seems to be low in the single-digit percentage range. However, there are no universally accepted definitions and standards measuring the quality of puncture. Consequently, the impact of the puncture on general PNL complications, on stone scores predicting success rates and on learning curves evaluating surgeons' performance have not been systematically studied. Assistive technologies rely on fluoroscopy and ultrasonography, the latter of which is becoming the preferred imaging modality for monitoring the entire procedure. Needle bending, a problem relevant to all puncture techniques, is not addressed in the urological literature. The importance attached to puncture in PNL in the current urological literature is subjectively high but objectively low. Some basics of puncture are not well understood in urology. Disciplines other than urology are more actively involved in the development of puncture techniques.

Research on Force Analysis and Path Planning of Flexible Needle Puncture Bending Modelling

Through the force analysis of the flexible needle puncture process, the corresponding mechanical model is established, and the main factors that cause the flexible needle bending deformation are analysed, and the bending model of the flexible needle puncture process is initially established. By discretizing the bending model, combined with experimental verification, a relatively complete bending model is obtained. Based on the RRT algorithm, the goal guidance algorithm, the optimal path selection algorithm, etc. are proposed, combined with the bending model of the flexible needle, and an improved RRT algorithm suitable for the flexible needle insertion method is established. Through simulation analysis and combined with experimental verification, it is concluded that path planning based on the improved RRT algorithm can bypass important human organs and soft tissues more flexibly, accurately puncture the target position, and achieve relatively safe surgery.

Temperature compensation of the fiber-optic based system for the shape reconstruction of a minimally invasive surgical needle

This paper presents the methodology for temperature compensation of a system for shape reconstruction of a minimally invasive surgical needle. The system is based on four optical fibers glued along the needle at 90∘ from each other and connected to the optical backscattering reflectometry interrogator. The interrogator measures backscattered light from four fibers, which shifts as a response to temperature or strain variations. During minimally invasive surgery the fibers sense both the strain change (due to the needle bending) and the temperature change (due to the difference between the temperature of the environment and the human body). Shape reconstruction is based on the strain measurements, so the temperature readings need to be compensated. The methodology of compensation is based on the two pairs of opposite fibers, which measure the same temperature change and opposite strain. The spectral shifts of the opposite fibers are added to find only the temperature component and the result is subtracted from the whole spectral shift to find the strain change detected by each fiber. This method has been validated by repeated constant insertion into a temperature-varying phantom. The algorithm has succeeded in the extraction of the strain component, which found to be the same in all trials despite the changing temperature.

Physical, chemical, mechanical, and micromorphological characterization of dental needles.

BackgroundIn anesthetic techniques, touching bones can cause needle bending. Theoretically, a needle should support such deflection without fracturing. However, it is possible that a needle may fracture depending on the quality and type of needle used. This study evaluated the physical, chemical, and micromorphological characteristics of long and short dental anesthetic needles, as well as the mechanical properties of flexural load and bending resistance when needles are subjected to different bending angles.MethodsLong and short needles (30G, Jets, Misawa, Selekto, Terumo, Unoject and 27G, Dencojet, Injex, Jets, Misawa, Procare, Setoject XL, Terumo) were evaluated. Scanning electron microscopy was used to evaluate the needle bevels and energy-dispersive X-ray spectroscopy was used for the chemical analysis of needle compositions. Flexural loading and bending strength assessments were performed using a universal testing machine by bending the needles (n = 5) to angles of 30°, 60°, or 90°, or until fracture occurred.ResultsThe Injex 27G, Jets 27G, and Septoject XL 27G needles were all less than 30 mm in length. There were small percentage variations in the chemical compositions of the needles. Superior smoothness was observed for the Unoject 30G needle, which exhibited the highest fracture resistance at 60°. The Jets 30G needle exhibited greater resistance to fractures at 90°. The Procare 27G needle exhibited the highest load resistance to bending, followed by the Septoject XL 27G needle, and both needles were tied for the lowest fracture resistance. No needle fractured when bent to 30° or at less than three bends to 60° or 90°.ConclusionsGreater needle resistance to bending increases the probability of early fracturing. Thinner and shorter needles are more resistant than longer and thicker needles. Performing a single bend does not result in any significant risk of fracture or obliterate the lumen, allowing for the continued passage of anesthetic liquid.

A technique to prevent needle bending when closing posterior trunk defects: A video demonstration

The inherent dermal thickness and relative lack of elasticity of the posterior trunk can make closures challenging and can result in needle bending.1 Bent needles may produce an uncontrollable trajectory that may damage adjacent tissue and require immediate suture replacement, thereby increasing surgical time and material waste. We present an efficient back closure technique that will maintain the natural shape of the needle.

Survey of Interventional Pain Physicians on Bending Spinal Needles for Chronic Pain Procedures

Background: Interventional pain procedures involve placement of fine-gauge spinal needles, which practitioners will frequently bend to facilitate both driving the needle through tissue, and to increase accuracy of placement at a specific spinal structure or nerve target. This bend is commonly performed by hand, leaving the proceduralist at risk for fingerstick injury, and the patient at risk of site contamination. However, few case studies have been published, and there are almost no data on physician preference or practice. Objectives: The purpose of this study was to survey interventional pain physicians on their practice of spinal needle manipulation before performing lumbar medial branch nerve blocks. Specific aims were to assess the prevalence of manual needle bending, and to determine possible associations with practitioner experience, clinical environment, and fingerstick injury. Study Design: A survey. Setting: Annual 2018 American Society for Interventional Pain Physicians conference in Orlando, Florida. Methods: A convenience sample of participants were screened for eligibility and asked to voluntarily participate in a de-identified IRB-approved survey (IRB201703055). The survey consisted of 5 questions, 2 with binary answer choices and the remaining 3 with multiple answer choices. Data were collected on an iPad via Qualtrics software. Data were analyzed by descriptive statistics (counts, percentages). Results: Of 480 interventional pain physician attendees at the conference, 154 (32.1%) completed the survey. The majority (114/154; 74%) reported ‘always’ bending the distal tip of spinal needles, and a further 21 (14%) reported ‘sometimes’; 19 (12%) said they do not bend their needles. Only 25 (18%) respondents used an instrument to bend their needles; 112 (82%) bend their needles by hand. Eight respondents (6%) reported a fingerstick injury while bending a spinal needle, one while using an instrument, and 7 during a manual bend. Approximately half of respondents had been practicing for greater than 15 years; 78% work in a private practice environment. Limitations: Due to the setting, the recruitment method presents the possibility of selection bias. Furthermore, although the response rate may appear low, it is higher than similarly performed studies. Conclusions: Spinal needle manipulation is common prior to performing interventional pain procedures, and most spinal needle manipulations are performed by hand. Rate of fingerstick injury was low in this sample, but cannot be evaluated without comparative data. Factors to be considered in a subsequent study are the effects of needle bend variability relative to practitioner experience and alternative means of needle manipulation. Key words: Interventional pain procedures, spinal needles, facet joint injections, needle bending, fingerstick injuries

Personalized needle modification for CT-guided percutaneous infrazygomatic radiofrequency ablation of the maxillary nerve through the foramen rotundum in order to treat V2 trigeminal neuralgia.

Background: The computed tomography (CT)-guided radiofrequency ablation (RFA) of the maxillary nerve (V2) via foramen rotundum (FR) approach has been reported to offer the highest rates of pain relief in V2 trigeminal neuralgia (TN). However, the access to FR may be obstructed by the greater wing of the sphenoid bone.Objectives: We report on an optimized CT-guided percutaneous infrazygomatic of maxillary nerve through the foramen rotundum (FR) to treat V2 trigeminal neuralgia (TN) using personalized RFA needles based on patient’s individual CT-image parameters.Patients and methods: 176 patients with isolated V2 TN were included. If the entry of the percutaneous needle into the FR canal was blocked by the greater wing of the sphenoid bone, straight RFA needles was bent at the tip with an angle α (the angle between the straight line from the external opening of FR to the skin entry point and the long axis of the FR canal). The maxillary nerve RFA was performed after confirmation with electrophysiological tests. Pain relief in the V2 territory and TN recurrence rate were followed for up to 60 months.Results: Fifty-two patients (29.55%) required needle bending. The maxillary nerve thermal RFA resulted in analgesia in the V2 territory without affecting the V1 or V3 zone. TN recurrence rate at 6, 12, 24, 36, 48 and 60 months was 2.55%, 7.64%, 17.20%, 24.41%, 30.28% and 33.77%, respectively.Conclusion: The personalized needle modification technique for maxillary nerve RFA through FR is safe and effective to treat V2 TN.

Mechanics of tissue rupture during needle insertion in transverse isotropic soft tissue

During robot-assisted percutaneous puncture surgery, a bevel-tipped needle is inserted into a fiber-structured soft tissue, which has transverse isotropic mechanical properties. Tissue rupture may lead to needle bending and insertion error. Therefore, analysis of the mechanics of rupture events in transverse isotropic space is essential for the precise control of needle motion. We analyzed the needle stiffness force and the cutting force, both related to rupture events, which are caused by contact deformation and tissue cutting, respectively. A modified model based on a homogeneous elastic half-space contact force model was used to describe the variation in the stiffness force of the needle. An energy-based maximum stiffness force model was proposed to predict the surface rupture for a needle that is inserted at different orientations. A model for the cutting force was presented based on a solid mechanics theory of unidirectional fiber-reinforced composite material to analyze the effect of the needle tip pose on the cutting force. Experiments on porcine muscle confirmed that the stiffness force and the cutting force were clearly influenced by the insertion orientation angle. The developed models could predict the stiffness force and the cutting force during needle insertion into the transverse isotropic tissue. This method provides a foundation for predicting needle deflection in the transverse isotropic space. Graphical abstract Force modeling for needle insertion in transverse isotropic soft tissue.

Evaluation of robot-assisted MRI-guided prostate biopsy: needle path analysis during clinical trials

While the interaction between a needle and the surrounding tissue is known to cause a significant targeting error in prostate biopsy leading to false-negative results, few studies have demonstrated how it impacts in the actual procedure. We performed a pilot study on robot-assisted MRI-guided prostate biopsy with an emphasis on the in-depth analysis of the needle-tissue interaction in vivo. The data were acquired during in-bore transperineal prostate biopsies in patients using a 4 degrees-of-freedom (DoF) MRI-compatible robot. The anatomical structures in the pelvic area and the needle path were reconstructed from MR images, and quantitatively analyzed. We analyzed each structure individually and also proposed a mathematical model to investigate the influence of those structures in the targeting error using the mixed-model regression. The median targeting error in 188 insertions (27 patients) was 6.3 mm. Both the individual anatomical structure analysis and the mixed-model analysis showed that the deviation resulted from the contact between the needle and the skin as the main source of error. On contrary, needle bending inside the tissue (expressed as needle curvature) did not vary among insertions with targeting errors above and below the average. The analysis indicated that insertions crossing the bulbospongiosus presented a targeting error lower than the average. The mixed-model analysis demonstrated that the distance between the needle guide and the patient skin, the deviation at the entry point, and the path length inside the pelvic diaphragm had a statistically significant contribution to the targeting error (p < 0.05). Our results indicate that the errors associated with the elastic contact between the needle and the skin were more prominent than the needle bending along the insertion. Our findings will help to improve the preoperative planning of transperineal prostate biopsies.