Journal of Medical Robotics Research

Robotic-assisted steered needles aim to accurately control the deflection of the flexible needle’s tip to achieve accurate path following. In doing so, they can decrease trauma to the patient, by avoiding sensitive regions while increasing placement accuracy. This class of needle presents more complicated kinematics compared to straight needles, which can be exploited to produce specific motion profiles via careful controller design and tuning. Motion profiles can be optimized to minimize certain conditions such as maximum tissue deformation and target migration, which was the goal of the formalized cyclic, low-level controller for a Programmable Bevel-tip Needle (PBN) presented in this work. PBNs are composed of a number of interlocked segments that are able to slide with respect to one another. Producing a controlled, desired offset of the tip geometry leads to the corresponding desired curvature of the PBN, and hence desired path trajectory of the system. Here, we propose a cyclical actuation strategy, where the tip configuration is achieved over a number of reciprocal motion cycles, which we hypothesize will reduce tissue deformation during the insertion process. A series of in vitro, planar needle insertion experiments are performed in order to compare the cyclic controller performance with the previously used direct push controller, in terms of targeting accuracy and tissue deformation. It is found that there is no significant difference between the target tracking performance of the controllers, but a significant decrease in axial tissue deformation when using the cyclic controller.

Steerable needles hold the promise of improving the accuracy of both therapies and biopsies as they are able to steer to a target location around obstructions, correct for disturbances, and account for movement of internal organs. However, their ability to make late-insertion corrections has always been limited by the lower bound on the attainable radius of curvature. This paper presents a new class of steerable needle insertion where the objective is to first control the direction of tissue fracture with an inner stylet and later follow with the hollow needle. This method is shown to be able to achieve radius of curvature as low as 6.9mm across a range of tissue stiffnesses and the radius of curvature is controllable from the lower bound up to a near infinite radius of curvature based on the stylet/needle step size. The approach of “fracture-directed” steerable needles indicates the promise of the technique for providing a tissue-agnostic method of achieving high steerability that can account for variability in tissues during a typical procedure and achieve radii of curvature unattainable through current bevel-tipped techniques. A variety of inner stylet geometries are investigated using tissue phantoms with multiple stiffnesses and discrete-step kinematic models of motion are derived heuristically from the experiments. The key finding presented is that it is the geometry of the stylet and the tuning of the bending stiffnesses of both the stylet and the tube, relative to the stiffness of the tissue, that allow for such small radius of curvature even in very soft tissues.

Prostate cancer is one of the leading causes of death in men. Prostate interventions using magnetic resonance imaging (MRI) benefits from high tissue contrast if compared to other imaging modalities. The Minimally Invasive Robotics In An MRI environment (MIRIAM) robot is an MRI-compatible system able to steer different types of needles towards a point of interest using MRI guidance. However, clinicians can be reluctant to give the robot total control of the intervention. This work integrates a haptic device in the MIRIAM system to allow input from the clinician during the insertion. A shared control architecture is achieved by letting the clinician control the insertion depth via the haptic device, while the robotic system controls the needle orientation. The clinician receives haptic feedback based on the insertion depth and tissue characteristics. Four control laws relating the motion of the master robot (haptic device) to the motion of the slave robot (MIRIAM robot) are presented and evaluated. Quantitative and qualitative results from 20 human subjects demonstrate that the squared-velocity control law is the most suitable option for our application. Additionally, a pre-operative target localization algorithm is presented in order to provide the robot with the target location. The target localization and reconstruction algorithm are validated in phantom and patient images with an average dice similarity coefficient (DSC) of 0.78. The complete system is validated through experiments by inserting a needle towards a target within the MRI scanner. Four human subjects perform the experiment achieving an average targeting error of 3.4mm.

Long flexible needles used in percutaneous procedures such as biopsy and brachytherapy deflect during insertion, thus reducing needle tip placement accuracy. This paper presents a surgeon-in-the-loop system to automatically steer the needle during manual insertion and compensate for needle deflection using an event-triggered controller. A reduced-order kinematic bicycle model incorporating needle tip measurement data from ultrasound images is used to determine steering actions required to minimize needle deflection. To this end, an analytic solution to the reduced-order bicycle model, which is shown to be more computationally efficient than a discrete-step implementation of the same model, is derived and utilized for needle tip trajectory prediction. These needle tip trajectory predictions are used online to optimize the insertion depths (event-trigger points) for steering actions such that needle deflection is minimized. The use of the analytic model and the event-triggered controller also allows for limiting the number and extent of needle rotations (to reduce tissue trauma) in a constrained optimization framework. The system was tested experimentally in three different ex-vivo tissue phantoms with a surgeon-in-the-loop needle insertion device. The proposed needle steering controller was shown to keep the average needle deflection within 0.47 $\pm$ 0.21mm at the final insertion depth of 120mm.

Because fine needles can easily be deflected, accurate needle insertion is often difficult. Lower abdominal insertion is particularly difficult because of less imaging feedback; thus, an approach for allowing a straight insertion path by minimizing deflection is beneficial in cases of lower abdominal insertion. Although insertion with axial rotation can minimize deflection, the rotational insertion may cause tissue damage. Therefore, we established a novel insertion method for minimizing both deflection and tissue damage by combining rotation and vibration. Using layered tissues, we evaluated the effect of a combination of rotation and vibration in terms of deflection and tissue damage, which were measured by the insertion force and torque, and the area of the hole created by the needle using histological tissue sections to measure tissue damage. The experimental results demonstrated that insertion with unidirectional rotation is risky in terms of tissue wind-up, while insertion with bidirectional rotation can decrease deflection and avoid wind-up. We also found that insertion with vibration can decrease the insertion force and torque. Therefore, insertion with a combination of bidirectional rotation and vibration can minimize needle deflection and tissue damage, including the insertion force and torque and the hole area.