Needle Insertion Task Research Articles

Virtual Needle Insertion with Enhanced Haptic Feedback for Guidance and Needle-Tissue Interaction Forces.

Interventional radiologists mainly rely on visual feedback via imaging modalities to steer a needle toward a tumor during biopsy and ablation procedures. In the case of CT-guided procedures, there is a risk of exposure to hazardous X-ray-based ionizing radiation. Therefore, CT scans are usually not used continuously, which increases the chances of a misplacement of the needle and the need for reinsertion, leading to more tissue trauma. Interventionalists also encounter haptic feedback via needle-tissue interaction forces while steering a needle. These forces are useful but insufficient to clearly perceive and identify deep-tissue structures such as tumors. The objective of this paper was to investigate the effect of enhanced force feedback for sensing interaction forces and guiding the needle when applied individually and simultaneously during a virtual CT-guided needle insertion task. We also compared the enhanced haptic feedback to enhanced visual feedback. We hypothesized that enhancing the haptic feedback limits the time needed to reach the target accurately and reduces the number of CT scans, as the interventionalist depends more on real-time enhanced haptic feedback. To test the hypothesis, a simulation environment was developed to virtually steer a needle in five degrees of freedom (DoF) to reach a tumor target embedded in a liver model. Twelve participants performed in the experiment with different feedback conditions where we measured their performance in terms of the following: targeting accuracy, trajectory tracking, number of CT scans required, and the time needed to finish the task. The results suggest that the combination of enhanced haptic feedback for guidance and sensing needle-tissue interaction forces significantly reduce the number of scans and the duration required to finish the task by 32.1% and 46.9%, respectively, when compared to nonenhanced haptic feedback. The other feedback modalities significantly reduced the duration to finish the task by around 30% compared to nonenhanced haptic feedback.

Design and Evaluation of Haptic Guidance in Ultrasound-Based Needle-Insertion Procedures.

This article presents two haptic guidance systems designed to help a clinician keep an ultrasound probe steady when completing ultrasound-assisted needle insertion tasks. These procedures demand spatial reasoning and hand-eye coordination because the clinician must align a needle with the ultrasound probe and extrapolate the needle trajectory using only a 2D ultrasound image. Past research has shown that visual guidance helps the clinician align the needle, but does not help the clinician keep the ultrasound probe steady, sometimes resulting in a failed procedure. We created two separate haptic guidance systems to provide feedback if the user tilts the ultrasound probe away from the desired setpoint using (1) vibrotactile stimulation provided by a voice coil motor or (2) distributed tactile pressure provided by a pneumatic mechanism. Both systems significantly reduced probe deviation and correction time to errors during a needle insertion task. We also tested the two feedback systems in a more clinically relevant setup and showed that the perceptibility of the feedback was not affected by the addition of a sterile bag placed over the actuators and gloves worn by the user. These studies show that both types of haptic feedback are promising for helping the user keep the ultrasound probe steady during ultrasound-assisted needle insertion tasks. Survey results indicated that users preferred the pneumatic system over the vibrotactile system. Haptic feedback may improve user performance in ultrasound-based needle-insertion procedures and shows promise in training for needle-insertion tasks and other medical procedures where guidance is required.

Precision and Safety of Ultrasound-Guided versus Palpation-Guided Needle Placement on the Patellar Tendon: A Cadaveric Study.

For decades, needling interventions have been performed based on manual palpation and anatomic knowledge. The increasing use of real-time ultrasonography in clinical practice has improved the accuracy and safety of needling techniques. Although currently ultrasound-guided procedures are routinely used for patellar tendon pathology, e.g., during percutaneous electrolysis, the accuracy of these procedures is still unknown. This study used a cadaveric model to compare and evaluate both the accuracy and safety of ultrasound-guided and palpation-guided needling techniques for the patellar tendon. A total of five physical therapists performed a series of 20 needle insertion task each (n = 100), 10 insertions based on manual palpation (n = 50) and 10 insertions guided with ultrasound (n = 50) to place a needle along the interface between the patellar tendon and Hoffa's fat pad. All procedures were performed on cryopreserved knee specimens. Distance to the targeted tissue, time of the procedure, accurate rate of insertions, number of passes, and unintentional punctured structures between both applications (with and without ultrasound guiding) were compared. The results revealed higher accuracy (100% vs. 80%), a lower distance from needle to the targeted tissue (0.25 ± 0.65 vs. 2.5 ± 1.9 mm), longer surface of contact with the needle (15.5 ± 6.65 vs. 4.7 ± 7.5 mm), and a lower frequency of patellar tendon puncture (16% vs. 52%, p < 0.001) with the ultrasound-guided procedure as opposed to palpation-guided one. Nevertheless, the ultrasound-guided procedure took longer (54.8 ± 26.8 vs. 23.75 ± 15.4 s) and required more passes (2.55 ± 1.9 vs. 1.5 ± 0.95) to be conducted than the palpation-guided procedure (all, p < 0.001). According to these findings, the accuracy of invasive procedures applied on the patellar tendon is higher when conducted with ultrasound guidance than when conducted just on manual palpation or anatomical landmark. These results suggest that ultrasound could improve the clinical application of invasive procedures at the fat-patellar tendon interface. Due to the anatomical features of the targeted tissue, some procedures require this precision, so the use of ultrasound is recommended.

Precision of Ultrasound-Guided versus Anatomical Palpation-Guided Needle Placement of the Ulnar Nerve at the Cubital Tunnel: A Cadaveric Study.

Percutaneous electrical stimulation has been performed for years with only the assistance of anatomical landmarks. The development of real-time ultrasonography guidance has improved the precision and safety of these percutaneous interventions. Despite ultrasound-guided and palpation-guided procedures being performed routinely for targeting nerve tissues in the upper extremity, the precision and safety of these techniques are unknown. The aim of this cadaveric study was to determine and compare the precision and safety of ultrasound-guided versus palpation-guided needling procedure with and without the handpiece of the ulnar nerve on a cadaveric model. Five physical therapists performed a series of 20 needle insertion tasks each (n = 100), 10 palpation-guided (n = 50) and 10 ultrasound-guided (n = 50) on cryopreserved specimens. The purpose of the procedure was to place the needle in proximity to the ulnar nerve at the cubital tunnel. The distance to target, time performance, accurate rate, number of passes, and unintentional puncture of surrounding structures were compared. The ultrasound-guided procedure was associated with higher accuracy (66% vs. 96%), lower distance from needle to the target (0.48 ± 1.37 vs. 2.01 ± 2.41 mm), and a lower frequency of perineurium puncture (0% vs. 20%) when compared with the palpation-guided procedure. However, the ultrasound-guided procedure required more time (38.33 ± 23.19 vs. 24.57 ± 17.84 s) than the palpation-guided procedure (all, p < 0.001). Our results support the assumption that ultrasound guidance improves the accuracy of needling procedures on the ulnar nerve at the cubital tunnel when compared with palpation guidance.

Deep-LfD: Deep robot learning from demonstrations

<h2>Abstract</h2> Like other robot learning from demonstration (LfD) approaches, deep-LfD builds a task model from sample demonstrations. However, unlike conventional LfD, the deep-LfD model learns the relation between high dimensional visual sensory information and robot trajectory/path. This paper presents a dataset of successful needle insertion by da Vinci Research Kit into deformable objects based on which several deep-LfD models are built as a benchmark of models learning robot controller for the needle insertion task.

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.

Comparison of Augmented Reality Display Techniques to Support Medical Needle Insertion.

Augmented reality (AR) may be a useful technique to overcome issues of conventionally used navigation systems supporting medical needle insertions, like increased mental workload and complicated hand-eye coordination. Previous research primarily focused on the development of AR navigation systems designed for specific displaying devices, but differences between employed methods have not been investigated before. To this end, a user study involving a needle insertion task was conducted comparing different AR display techniques with a monitor-based approach as baseline condition for the visualization of navigation information. A video see-through stationary display, an optical see-through head-mounted display and a spatial AR projector-camera-system were investigated in this comparison. Results suggest advantages of using projected navigation information in terms of lower task completion time, lower angular deviation and affirmative subjective participant feedback. Techniques requiring the intermediate view on screens, i.e. the stationary display and the baseline condition, showed less favorable results. Thus, benefits of providing AR navigation information compared to a conventionally used method could be identified. Significant objective measures results, as well as an identification of advantages and disadvantages of individual display techniques contribute to the development and design of improved needle navigation systems.

Comparing touch-based and head-tracking navigation techniques in a virtual reality biopsy simulator

Recently, virtual reality (VR) technologies started gaining momentum in surgical simulation-based training by allowing clinicians to practice their skills before performing real procedures. The design of such simulators is usually focused on the primary operative tasks to be taught, but little attention is paid to secondary tasks that the user needs to perform, such as changing his/her point of view when manipulating the surgical instruments. More particularly, it is not clear how to design appropriate interaction techniques for those tasks, and how the fidelity of these interactions can impact the user’s performance on such systems. In this paper, we compare two viewpoint changing techniques having two different levels of interaction fidelity during needle insertion in a semi-immersive VR (SIVR) biopsy trainer. These techniques were designed based on observing clinicians performing actual biopsy procedures. The first technique is based on tracking the user’s head position (high interaction fidelity), while the second technique is touch-based with the user utilizing his/her non-dominant hand fingers to manipulate the point of view on a touch screen (moderate interaction fidelity). A user study was carried out to investigate the impact of the interaction fidelity of the viewpoint changing task (secondary task) on the user’s performance during the needle insertion task (main task). Twenty-one novice participants were asked to perform several trials of a needle insertion task while using the navigation techniques (within-subject design). Objective and subjective measures were recorded to compare the task performance (time to accomplish the task, precision of the tumor sampling, and errors) and user experience for both techniques. The results show that the touch-based viewpoint changing technique improves the users’ task completion performance during needle insertion while maintaining a similar level of needle manipulation accuracy as compared to the head-tracking technique. These results suggest that high interaction fidelity is not always necessary when designing surgical trainers. This also highlights the importance of designing appropriate interactions for secondary tasks because they can influence the user’s primary task performance in VR simulators.

Design and control of a novel magnetic resonance imaging-compatible breast intervention robot

Breast cancer is one of the most frequent cancers and a major cause of cancer death in women. In this article, the design and control of a novel magnetic resonance imaging-compatible breast intervention robot are proposed. The dimensions and tolerance of the robot system are considered, and a novel pitching mechanism is designed to achieve a dexterous operation in the limited space. The magnetic resonance imaging compatibility of the robot materials is tested. The nonmagnetic structure and compact Cartesian mechanism of the robot allow it to operate safely in a magnetic resonance imaging scanner. According to the robot’s structure, a kinematics analysis based on a coupled motions model is established. The workspace simulation analysis of the robot proves that it is suitable for the whole breast surgery. To control the needle insertion tasks, the overall control system in the form of “personal computer (PC) + single-chip micyoco (SCM)” is designed. Finally, the motion control experiment is carried out, and the robot positioning error is 0.37 mm, which proves that the breast intervention robot and its control system designed in this article can meet the requirements of breast intervention.

PIÑATA: Pinpoint insertion of intravenous needles via augmented reality training assistance

Conventional needle insertion training relies on medical dummies that simulate surface anatomy and internal structures such as veins or arteries. These dummies offer an interesting space to augment with useful information to assist training practices, namely, internal anatomical structures (subclavian artery and vein, internal jugular vein and carotid artery) along with target point, desired inclination, position and orientation of the needle. However, limited research has been conducted on Optical See-Through Augmented Reality (OST-AR) interfaces for training needle insertion, especially for central venous catheterization (CVC). In this work we introduce PIÑATA, an interactive tool to explore the benefits of OST-AR in CVC training using a dummy of the upper torso and neck; andexplore if PIÑATA complements conventional training practices.. Our design contribution also describes the observation and co-design sessions used to collect user requirements, usability aspects and user preferences. This was followed by a comparative study with 18 participants - attending specialists and medical residents - that performed needle insertion tasks for CVC with PIÑATAand the conventional training system. The performance was objectively measured by task completion time and number of needle insertion errors. A correlation was found between the task completion time in the two training methods, suggesting the concurrent validity of our OST-AR tool. An inherent difference in the task completion time (p =0.040) and in the number of errors (p = 0.036) between novices and experts proved the construct validity of the new tool. The qualitative answers of the participants also suggest its face and content validity, a high acceptability rate and a medium perceived workload. Finally, the result of semi-structured interviews with these 18 participants revealed that 14 of them considered that PIÑATA can complement the conventional training system, especially due to the visibility of the vessels inside the simulator. 13 agreed that OST-AR adoption in these scenarios is likely, particularly during early stages of training. Integration with ultrasound information was highlighted as necessary future work. In sum, the overall results show that the OST-AR tool proposed can complement the conventional training of CVC.

A Semi-Autonomous Stereotactic Brain Biopsy Robot With Enhanced Safety

In stereotactic brain biopsy, operating the needle accurately and taking the biopsy specimen safely are two major challenges for ensuring the success of the surgical procedure. Considering this fact, surgical robots offering high accuracy and precision have been developed for neurosurgery including brain biopsy. Typical brain biopsy robots are only commanded to adjust the needle's pose before inserting the needle manually by a neurosurgeon. In the literature, there exists no robotic system that is competent to complete the needle insertion task autonomously. To move a step forward, a novel biopsy module for brain biopsy is first designed and fabricated in this paper. The biopsy module can be automated to complete a series of tasks such as inserting the needle, generating and controlling the aspiration pressure for specimen acquisition, and rotating the cannula for side-cutting. The biopsy module is further integrated with a cost-effective and lightweight UR5 robot and an optical tracking system to improve the autonomy, leading to a stereotactic neuronavigation system. Kinematic relationships of the involved elements are established via a calibration process. A quadratic programming based approach equipped with a virtual potential field method is implemented to safely control the robot with joint-limit avoidance and obstacle avoidance capabilities. The experimentation of the brain biopsy robot is performed, demonstrating that the developed robotic system has potential applicability in the brain biopsy surgery.

Stiffness analysis and experimental validation of modular-type hybrid antagonistic tendon-driven joint systems

SUMMARYThis paper proposes a new antagonistic tendon-driven joint (TDJ) that exhibits higher stiffness and larger travel range than conventional types of TDJs. A detailed mathematical analysis of the stiffness of the proposed TDJ is conducted and compared to other TDJs. The effect of the tendon length is taken into consideration to establish a more precise and realistic stiffness model of the proposed TDJ. Thereafter, two hardware prototypes of the proposed TDJ design, developed in the form of a packaged modular structure that integrates two TDJs, are introduced. Using these prototypes, the stiffness characteristics of the proposed TDJs are verified through experimentation. Additionally, experimental results on the stiffness behavior during the mimicked needle insertion tasks are provided. Results show that the proposed TDJs present much higher stiffness than conventional ones and thus give a potential benefit to precision manipulation.

Compact Design of a Hydraulic Driving Robot for Intraoperative MRI-Guided Bilateral Stereotactic Neurosurgery

In this letter, we present an intraoperative magnetic resonance imaging (MRI)-guided robot for bilateral stereotactic procedures. Its compact design enables robot's operation within the constrained space of standard imaging head coil. magnetic resonance (MR) safe and high-performance hydraulic transmissions are incorporated. A maximum stiffness coefficient of 24.35 N/mm can be achieved with transmission fluid preloaded at 2 bar. Sufficient targeting accuracy (average within ≤1.73 mm) has been demonstrated in a simulated needle insertion task of deep brain stimulation. A novel MR-based wireless tracking technique is adopted. It is capable of offering real-time and continuous (30-40 Hz) three-dimensional (3-D) localization of robotic instrument under the proper MR tracking sequence. It outperforms the conventional method of using low-contrast passive fiducials that can only be revealed in the MR image domain. Two wireless tracking units/markers are integrated with the robot, which are two miniaturized coil circuits in size of 1.5 × 5 × 0.2 mm 3 , fabricated on flexible thin films. A navigation test was performed under the standard MRI settings in order to visualize the 3-D localization of the robotic instrument. MRI compatibility test was also carried out to prove the minimal interference to MR images of the presented hydraulic robotic platform.

Design and Evaluation of a Robotic Device for Automated Tail Vein Cannulations in Rodent Models.

Preclinical testing in rodent models is a ubiquitous part of modern biomedical research and commonly involves accessing the venous bloodstream for blood sampling and drug delivery. Manual tail vein cannulation is a time-consuming process and requires significant skill and training, particularly since improperly inserted needles can affect the experimental results and study outcomes. In this paper, we present a miniaturized, robotic medical device for automated, image-guided tail vein cannulations in rodent models. The device is composed of an actuated three degrees-of-freedom (DOFs) needle manipulator, three-dimensional (3D) near-infrared (NIR) stereo cameras, and an animal holding platform. Evaluating the system through a series of workspace simulations and free-space positioning tests, the device exhibited a sufficient work volume for the needle insertion task and submillimeter accuracy over the calibration targets. The results indicate that the device is capable of cannulating tail veins in rodent models as small as 0.3 mm in diameter, the smallest diameter vein required to target.

Virtual Reality simulator for dental anesthesia training in the inferior alveolar nerve block.

Objectives This study shows the development and validation of a dental anesthesia-training simulator, specifically for the inferior alveolar nerve block (IANB). The system developed provides the tactile sensation of inserting a real needle in a human patient, using Virtual Reality (VR) techniques and a haptic device that can provide a perceived force feedback in the needle insertion task during the anesthesia procedure.Material and Methods To simulate a realistic anesthesia procedure, a Carpule syringe was coupled to a haptic device. The Volere method was used to elicit requirements from users in the Dentistry area; Repeated Measures Two-Way ANOVA (Analysis of Variance), Tukey post-hoc test and averages for the results’ analysis. A questionnaire-based subjective evaluation method was applied to collect information about the simulator, and 26 people participated in the experiments (12 beginners, 12 at intermediate level, and 2 experts). The questionnaire included profile, preferences (number of viewpoints, texture of the objects, and haptic device handler), as well as visual (appearance, scale, and position of objects) and haptic aspects (motion space, tactile sensation, and motion reproduction).Results The visual aspect was considered appropriate and the haptic feedback must be improved, which the users can do by calibrating the virtual tissues’ resistance. The evaluation of visual aspects was influenced by the participants’ experience, according to ANOVA test (F=15.6, p=0.0002, with p<0.01). The user preferences were the simulator with two viewpoints, objects with texture based on images and the device with a syringe coupled to it.Conclusion The simulation was considered thoroughly satisfactory for the anesthesia training, considering the needle insertion task, which includes the correct insertion point and depth, as well as the perception of tissues resistances during the insertion.

Developing a Compact Robotic Needle Driver for MRI-Guided Breast Biopsy in Tight Environments

In this letter, we present the design and development of a new robotic system for MRI-guided breast biopsy. The robot's structure is nonmagnetic, therefore, it can safely operate from within the scanner's magnetic bore; it has a compact Cartesian mechanism that allows it perform needle insertion tasks from both frontal and lateral directions inside an open bore scanner. A combination of piezoelectric and pneumatic actuators drive the motion of the proposed three degrees-of-freedom robot. To control the needle's insertion, we present an adaptive position regulator that uses the feedback from multiple sensors and that is robust to external disturbances. A detailed experimental study is presented to validate the performance and magnetic properties of the new mechanical prototype.

Plenoptic Cameras in Surgical Robotics: Calibration, Registration, and Evaluation.

Three-dimensional sensing of changing surgical scenes would improve the function of surgical robots. This paper explores the requirements and utility of a new type of depth sensor, the plenoptic camera, for surgical robots. We present a metric calibration procedure for the plenoptic camera and the registration of its coordinate frame to the robot (hand-eye calibration). We also demonstrate the utility in robotic needle insertion and application of sutures in phantoms. The metric calibration accuracy is reported as 1.14 ± 0.80 mm for the plenoptic camera and 1.57 ± 0.90 mm for hand-eye calibration. The accuracy of needle insertion task is 1.79 ± 0.35 mm for the entire robotic system. Additionally, the accuracy of suture placement with the presented system is reported at 1.80 ± 0.43 mm. Finally, we report consistent suture spacing with only 0.11 mm standard deviation between inter-suture distances. The measured accuracy of less than 2 mm with consistent suture spacing is a promising result to provide repeatable leak-free suturing with a robotic tool and a plenoptic depth imager.

多自由度鉗子を搭載した深部脳外科小型手術支援システムの開発

In neurosurgery, precise and complicated surgical tasks are required to be performed in deep and narrow spaces in the brain, and such surgical tasks are difficult even for skilled surgeons. Many master-slave neurosurgical robots have been developed to assist surgeons; however, previously developed systems are rather bulky and do not have sufficient degrees of freedom (DOFs). Therefore, we are developing a new miniature master-slave neurosurgical robotic system targeted for tasks in deep and narrow spaces of the brain. This robot is equipped with multi-DOF robotic forceps for tasks in deep and narrow spaces. This paper describes the mechanical design and control method of the robot. As a preliminary experiment, a needle insertion task was performed using a model simulating a workspace, showing promising results.

Brace for variability in tool positioning: Modeling and simulation of 1 DoF needle insertion task under tool-braced condition

Erroneous human arm motion leads to inaccuracy in tool positioning which often affects the quality of many precision manipulation tasks. Variability in tool endpoints during mechanical interactions among humans, tools, and environments can be reduced by bracing strategies; therefore, such a cost-effective approach may increase accuracy and reproducibility in human arm movements and thus prove useful in improving performance of selected interactive tasks. Although a great number of works is found in the literature related to performance augmentation of braced robotic manipulators, only a few studies are found on bracing strategies for performing interactive tasks and on analogies to human manipulation. In this paper, a method for predicting bracing properties is proposed for single degree of freedom interactive task to improve performance. To reflect real workplace scenarios, models of the human impedance, the brace, and the contact of the interaction are represented and used to predict the quality of the executed task. The task execution model intended to predict real-life performance in both free arm and braced conditions are then used to estimate the brace properties to augment performance of the representative task.

Design, development, and evaluation of a master–slave surgical system for breast biopsy under continuous MRI

Magnetic Resonance Imaging (MRI) provides superior soft-tissue contrast in cancer diagnosis compared to other imaging modalities. However, the strong magnetic field inside the MRI bore along with limited scanner bore size poses significant challenges. Since current approaches in breast biopsy using MR images are primarily blind targeting approaches, it is necessary to develop an MRI-compatible robot that can avoid multiple needle insertions into the breast tissue. This MRI-compatible robotic system could potentially lead to improvement in the targeting accuracy and reduce sampling errors. A master–slave surgical system has been developed comprising a MRI-compatible slave robot which consists of one piezo motor and five pneumatic cylinders connected by long pneumatic transmission lines. The slave robot follows the configuration of the master robot, which provides an intuitive manipulation interface for the physician and operates inside the MRI bore to adjust the needle position and orientation and perform needle insertion tasks. Based on the MRI experiments using the slave robot, there was no significant distortion in the images, and hence the slave robot can be safely operated inside the MRI with minimal loss in signal-to-noise ratio (SNR). Ex vivo and in vivo experiments have been conducted to evaluate the performance of the master–slave surgical system.