Percutaneous Needle Procedures Research Articles

Needle Tip Tracking in 2D Ultrasound Based on Improved Compressive Tracking and Adaptive Kalman Filter

Ultrasound (US) is commonly used in percutaneous needle procedures for real-time guidance. Accurate and robust automatic needle tracking is highly desirable to address the influence of noise and artifacts in US images. This letter presents a tracking approach which combines an improved compressive tracking (ICT) algorithm and a modified Sage-Husa adaptive Kalman filter (SHAKF) to achieve real-time needle tip tracking under 2D US. Estimated needle insertion velocity is used to improve the tracking performance while the high US pixel intensity of the needle tip is used to correct drift. A simplified SHAKF is then implemented to adaptively estimate the statistical characteristics of the noise in the compressive tracking results. An innovation threshold is proposed to improve the response speed of the filter while a normalized cross correlation based method is used to improve the tracking robustness. The proposed tracking approach has been evaluated in in-plane and out-of-plane motions under different insertion speeds and angles in both phantom and tissue experiments. Compared with the original compressive tracking, ICT+Kalman filter, and the template matching algorithm, our proposed approach demonstrates highly accurate tracking performance and high robustness in all cases.

Design of a Percutaneous MRI-Guided Needle Robot With Soft Fluid-Driven Actuator

Percutaneous ablation is a standard therapy for most cases of hepatocellular carcinoma (HCC), which is a general type of primary liver cancer. Magnetic resonance imaging (MRI) offers high-contrast images of soft tissue to monitor the ablation procedure. However, the success of MRI-guided ablation still depends on precise intra-tumor probe placement and skin insertion positioning, both of which require highly experienced operators, and can induce inter-operator variability in ablation results. In this letter, we present a semi-automated robotic system for MRI-guided percutaneous needle procedures. The compact and lightweight design enables the direct fixture of robot on the patient body and simultaneous needle targeting at multiple locations with several robots. Accurate (0.89 ± 0.31 mm) needle navigation is achieved by incorporating soft fluid-driven actuators with feedback control and stiffness modulation capabilities. The 3D location of the needle guide is reconfirmed by wireless MR tracking coils. The performance of the robotic platform, such as stiffness, needle positioning accuracy and frequency response was experimentally evaluated. Negligible interference to MR imaging was also validated by an MR compatibility test.

Visual needle tip tracking in 2D US guided robotic interventions

Percutaneous needle procedures are among the most frequently performed minimally invasive surgical procedure. For tracking the needle tip in the tissue, 2D ultrasound (US) imaging is commonly used; however, the low resolution of the images creates a challenge for tracking. This paper describes a robotic system that can perform US image guided biopsies by tracking the needle and the target simultaneously. It uses a template-based visual tracking method for small and deformable targets. During the experiments, a needle was inserted into realistic phantoms using a 5-DOF robot. The 2D US probe was held by a robotic arm that was servoed along the needle path. The 3D shape of the needle was estimated using the 2D transverse US images, which was used to align the needle axis with the 2D imaging plane. The accuracy of the visual needle tip tracking was evaluated using an optical tracking system, and a computed tomography scanner was used to determine the accuracy of the 3D needle shape estimation method. Target reaching accuracies were measured using an electromagnetic tracking system. The results of the experiments showed that the proposed system can track the needle tip in 2D US guided needle procedures in real-time with a sub-millimeter positional error.

Percutaneous pleural drainage in patients taking clopidogrel: real danger or phantom fear?

Despite being categorized as a procedure associated with a low risk of iatrogenic hemorrhage, percutaneous pleural drainage in patients taking the ubiquitous antiplatelet agent clopidogrel is still commonly perceived as a risky proposition. There is mounting evidence, however, in support of the safety of percutaneous needle procedures in persons receiving this medication. Establishing that these pleural interventions can be performed safely without clopidogrel interruption would be of great clinical significance, especially in those taking it for recent cardiac stenting and therefore in danger of stent thrombosis should antiplatelet therapy (APT) be withheld. The purpose of the present review is to summarize the available data from published studies and series of thoracentesis and chest tube insertion in patients exposed to clopidogrel. Also incorporated into this review are relevant investigations from the thoracic surgery and interventional radiology experience, which contribute indirect evidence and help shape the context for interpreting the safety data reported in the pleural literature. At the end, an attempt is made to synthesize the current knowledge on this topic into conclusions for guiding practice.

Development and 3D Spatial Calibration of a Parallel Robot for Percutaneous Needle Procedures with 2D Ultrasound Guidance

Robotic systems are being applied to medical interventions as they increase the operational accuracy. The proposed autonomous and ultrasound guided 5-DOF parallel robot can achieve such accuracy for needle biopsies, which particularly demand precise needle positioning and insertion. In this paper, the robot’s mechanical design, system identifications, and the design of its controller are explained. A torque computed controller with gravity compensation and friction models, yielding a 0.678[Formula: see text]mm RMS position error for the needle tip, was used. A novel method was used for 3D space calibration of the images for detecting the volume of interest in the biopsy procedure by a multipoint crosswire phantom with parallel threads. The calibration technique had a validation RMS error of 0.03[Formula: see text]mm.

Design and Validation of a CT- and MRI-Guided Robot for Percutaneous Needle Procedures

This paper describes the design and evaluation of the second generation of a robotic system called the light puncture robot for thoracic and abdominopelvic interventional radiology procedures under CT and MRI guidance. It is mounted on the patient's body and positions and inserts the needle according to the trajectory and target chosen by the radiologist in the image. The mechanical design is described in detail along with its forward and inverse kinematics. The robot can be segmented and registered fully automatically in both imaging modalities. Phantom experiments in the CT scanner and preliminary feasibility experiments in the MRI are described, showing a targeting accuracy of 3.3 ± 1.7  mm in gelatin for depths ranging from 30 to 90  mm and needle orientations of –13˚ to +15˚ about normal from the patient's skin. A detailed error analysis is discussed along with potential improvements in the system. The potential clinical advantages of the system include higher targeting accuracy for complex dual obliquity trajectories, the need for fewer images, and improved accessibility to MRI-guided interventions.

Modelling and characterisation of a ultrasound-actuated needle for improved visibility in ultrasound-guided regional anaesthesia and tissue biopsy

Clear needle visualisation is recognised as an unmet need for ultrasound guided percutaneous needle procedures including regional anaesthesia and tissue biopsy. With inadequate needle visibility, these procedures may result in serious complications or a failed operation. This paper reports analysis of the modal behaviour of a previously proposed ultrasound-actuated needle configuration, which may overcome this problem by improving needle visibility in colour Doppler imaging. It uses a piezoelectric transducer to actuate longitudinal resonant modes in needles (outer diameter 0.8–1.2mm, length>65mm). The factors that affect the needle’s vibration mode are identified, including the needle length, the transducer’s resonance frequency and the gripping position. Their effects are investigated using finite element modelling, with the conclusions validated experimentally. The actuated needle was inserted into porcine tissue up to 30mm depth and its visibility was observed under colour Doppler imaging. The piezoelectric transducer is able to generate longitudinal vibration with peak-to-peak amplitude up to 4μm at the needle tip with an actuating voltage of 20Vpp. Actuated in longitudinal vibration modes (distal mode at 27.6kHz and transducer mode at 42.2kHz) with a drive amplitude of 12–14Vpp, a 120mm needle is delineated as a coloured line in colour Doppler images, with both needle tip and shaft visualised. The improved needle visibility is maintained while the needle is advanced into the tissue, thus allowing tracking of the needle position in real time. Moreover, the needle tip is highlighted by strong coloured artefacts around the actuated needle generated by its flexural vibration. A limitation of the technique is that the transducer mode requires needles of specific lengths so that the needle’s resonance frequency matches the transducer. This may restrict the choice of needle lengths in clinical applications.

C-arm cone beam computed tomography needle path overlay for image-guided procedures of the spine and pelvis

The aim of this study is to report our early clinical experience using C-arm cone beam computed tomography with fluoroscopic overlay for image guidance during percutaneous needle procedures of the spine and pelvis. Twelve consecutive patients (four female and eight male patients; mean age, 64years; range, 47-74years; SD ± 7.6years) who underwent percutaneous biopsy of the spine and pelvis for suspected metastasis (n = 12), spondylodiscitis (n = 6), abscess (n = 5) or bone tumour (n = 1) were prospectively included between March 2009 and November 2010. The procedures were performed on the Allura Xper FD20/20 (Philips, Best, the Netherlands) using cone beam computed tomography (XperCT) with the C-arm combined with fluoroscopic overlay for needle guidance. Based on an initial XperCT, entry and target points were defined using dedicated guidance software (XperGuide). The needle path was visualised in various reconstructed planes and could be adjusted when considered necessary. For percutaneous interventions, the entry view (overlay of entry and target point in the bull's eye fashion), the progression view (perpendicular to the entry view) as well as two additional views could automatically be piloted to with the C-arm system. Needle navigation was supported by a biopsy guidance device (Seestar, Radi, Uppsala, Sweden). Correct needle positioning was confirmed with a second XperCT acquisition. Technical success was defined as any target point reached via the planned needle trajectory with a distance of final needle tip within 5mm of the planned target point in any direction. In all 12 patients, target areas could be defined based on XperCT data. In 11 of 12 (92%) cases, the target point was successfully reached on the planned trajectory with a mean error of 2.8mm (range, 0.5-9.4mm; SD, 2.4mm). No peri- or post-interventional complications occurred. XperCT-guided interventions with the XperGuide system seem a safe and reliable tool for percutaneous needle interventions of the spine and pelvis. The advantage of the technique when compared to CT- or fluoroscopy-guided interventions needs to be determined in a comparative study of a larger scale.

Outbreak of Invasive Methicillin-ResistantStaphylococcus aureusInfection Associated With Acupuncture and Joint Injection

To describe an outbreak of invasive methicillin-resistant Staphylococcus aureus (MRSA) infection after percutaneous needle procedures (acupuncture and joint injection) performed by a single medical practitioner. A medical practitioner's office and 4 hospitals in Perth, Western Australia. Eight individuals who developed invasive MRSA infection after acupuncture or joint injection performed by the medical practitioner. We performed a prospective and retrospective outbreak investigation, including MRSA colonization surveillance, environmental sampling for MRSA, and detailed molecular typing of MRSA isolates. We performed an infection control audit of the medical practitioner's premises and practices and administered MRSA decolonization therapy to the medical practitioner. Eight cases of invasive MRSA infection were identified. Seven cases occurred as a cluster in May 2004; another case (identified retrospectively) occurred approximately 15 months earlier in February 2003. The primary sites of infection were the neck, shoulder, lower back, and hip: 5 patients had septic arthritis and bursitis, and 3 had pyomyositis; 3 patients had bacteremia, including 1 patient with possible endocarditis. The medical practitioner was found to be colonized with the same MRSA clone [ST22-MRSA-IV (EMRSA-15)] at 2 time points: shortly after the first case of infection in March 2003 and again in May 2004. After the medical practitioner's premises and practices were audited and he himself received MRSA decolonization therapy, no further cases were identified. This outbreak most likely resulted from a breakdown in sterile technique during percutaneous needle procedures, resulting in the transmission of MRSA from the medical practitioner to the patients. This report demonstrates the importance of surveillance and molecular typing in the identification and control of outbreaks of MRSA infection.

5423193 Low-maintenance system for maintaining a cargo in a refrigerated condition over an extended duration: Claterbos John K; Fulton Stephen C Warrenton, OR, 97146, United States

Clear needle visualisation is recognised as an unmet need for ultrasound guided percutaneous needle procedures including regional anaesthesia and tissue biopsy. With inadequate needle visibility, these procedures may result in serious complications or a failed operation. This paper reports analysis of the modal behaviour of a previously proposed ultrasound-actuated needle configuration, which may overcome this problem by improving needle visibility in colour Doppler imaging. It uses a piezoelectric transducer to actuate longitudinal resonant modes in needles (outer diameter 0.8–1.2 mm, length > 65 mm). The factors that affect the needle’s vibration mode are identified, including the needle length, the transducer’s resonance frequency and the gripping position. Their effects are investigated using finite element modelling, with the conclusions validated experimentally. The actuated needle was inserted into porcine tissue up to 30 mm depth and its visibility was observed under colour Doppler imaging. The piezoelectric transducer is able to generate longitudinal vibration with peak-to-peak amplitude up to 4 μm at the needle tip with an actuating voltage of 20 Vpp. Actuated in longitudinal vibration modes (distal mode at 27.6 kHz and transducer mode at 42.2 kHz) with a drive amplitude of 12–14 Vpp, a 120 mm needle is delineated as a coloured line in colour Doppler images, with both needle tip and shaft visualised. The improved needle visibility is maintained while the needle is advanced into the tissue, thus allowing tracking of the needle position in real time. Moreover, the needle tip is highlighted by strong coloured artefacts around the actuated needle generated by its flexural vibration. A limitation of the technique is that the transducer mode requires needles of specific lengths so that the needle’s resonance frequency matches the transducer. This may restrict the choice of needle lengths in clinical applications.