Rationale and Objectives
Our research team has developed a magnetic resonance imaging (MRI)-compatible robot for long bone biopsy. The robot is intended to enable a new workflow for bone biopsy in pediatrics under MRI imaging. Our long-term objectives are to minimize trauma and eliminate radiation exposure when diagnosing children with bone cancers and bone infections. This article presents our robotic systems, phantom accuracy studies, and workflow analysis.
Materials and Methods
This section describes several aspects of our work including the envisioned clinical workflow, the MRI-compatible robot, and the experimental setup. The workflow consists of five steps and is intended to enable the entire procedure to be completed in the MRI suite. The MRI-compatible robot is MR Safe, has 3 degrees of freedom, and a remote center of motion mechanism for orienting a needle guide. The accuracy study was done in a Siemens Aera 1.5T scanner with a long bone phantom. Four targeting holes were drilled in the phantom.
Results
Each target was approached twice at slightly oblique angles using the robot needle guide for a total of eight attempts. A workflow analysis showed the average time for each targeting attempt was 32 minutes, including robot setup time. The average 3D targeting error was 1.39 mm with a standard deviation of 0.40 mm. All of the targets were successfully reached.
Conclusion
The results showed the ability of the robotic system in assisting the radiologist to precisely target a bone phantom in the MRI environment. The robot system has several potential advantages for clinical application, including the ability to work at the MRI isocenter and serve as a steady and precise guide.
Introduction
This paper describes our work in developing a magnetic resonance imaging (MRI)-compatible robot for long bone biopsy in pediatrics. The robot is intended to enable a novel clinical workflow for image-guided bone biopsy with the goals of minimizing trauma and eliminating radiation exposure in children with bone cancers and bone infections.
Bone pain is a common complaint in children. It can be caused by benign etiologies such as bone infection or malignant etiologies such as bone tumor. Typically, pediatric patients present with symptoms including pain, tenderness, or reluctance to bear weight or use the affected limb. Fevers can be seen in patients with both infections and cancers. Conventional radiographs may be normal, especially early in the course of a disease. MRI is often used to aid in the diagnosis due to its improved soft tissue, marrow, and joint space resolution. The MRI appearance of infectious and neoplastic bone pathology can overlap and sometimes may be indistinguishable. However, clinical management and treatment of these etiologies is quite different.
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Related Work
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Table 1
Categories of Related MRI-compatible Robots
Category Type Subcategory References Clinical application Needle-based procedures Rehabilitation Mounting method Patient-mounted Bed-mounted Actuation method Pneumatic/hydraulic Piezoelectric motor MR classification: ASTM F2503 MR Conditional MR Safe
ASTM, American Society for Testing and Materials; MR, magnetic resonance; MRI, magnetic resonance imaging.
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Clinical Application
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Mounting Method
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Actuation Method
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MR Classification
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Materials and Methods
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Clinical Workflow
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MRI-compatible Robot
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Experimental Setup: Targeting Accuracy
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Results
Workflow Results
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Table 2
Time Required for Each Targeting Attempt (All Numbers in Minutes, First Four Rows Are Estimates, Last Five Rows Are From DICOM Time Stamps)
Experiment 1 2 Average Standard Deviation Test 1 2 3 4 1 2 3 4 Robot and mockup mounting on MR table (approx.) 5 5 5 0 Robot cable connection and robot homing (approx.) 6 6 6 0 Robot positioning with RCM at skin entry point (approx.) 5 5 5 0 MR coil placement (approx.) 3 3 3 0 MRI scan for registration 3.78 3.78 2.27 2.27 3.80 3.78 3.78 3.78 3.41 0.70 Image-robot registration 3.05 3.25 3.50 3.38 3.77 3.52 3.35 3.57 3.42 0.22 Robotic orientation of needle guide on target and setting the depth of needle insertion 0.72 1.13 0.65 0.80 0.65 0.87 1.17 1.00 0.87 0.21 Manual needle insertion (approx.) 2.50 2.50 2.50 2.50 2.50 2.50 2.50 2.50 2.50 0 MRI scan for targeting error measurement 2.85 2.77 2.28 2.30 3.78 3.78 3.78 3.78 3.17 0.67 Total time 31.90 32.43 30.20 30.25 33.50 33.45 33.58 33.63 32.37 1.46
MR, magnetic resonance; MRI, magnetic resonance imaging, RCM, remote center of motion.
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Targeting Experiment Results
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Table 3
Results From Eight Targeting Trials
Target Trial Target Depth (mm) Needle Insertion Angle (Deg) 2D Error (mm)] 3D Error (mm) Medial-lateral Superior-inferior 1 1 27.34 18.86 −11.22 1.17 1.25 2 21.69 28.60 2.74 0.67 0.69 2 1 30.14 −6.52 16.97 1.50 1.68 2 26.23 −7.06 −6.55 1.31 1.51 3 1 26.74 18.92 −10.43 1.35 1.35 2 22.20 −10.10 7.72 0.69 1.01 4 1 28.02 6.72 2.88 1.58 1.71 2 26.29 −4.40 9.81 1.72 1.89 Max 1.72 1.89 Average (accuracy) 1.25 1.39 SD (precision) 0.39 0.40
SD, standard deviation.
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Conclusions
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Acknowledgments
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