computer assisted medical interventions -...

Computer Assisted Medical Interventions

Force control, collaborative manipulation and telemanipulation

Project : Robot-Assisted Procedures in Interventional Radiology

Bernard BAYLE

Joint courseUniversity of Strasbourg, University of Houston, Telecom Paris Tech

2008–2009

Interventional Radiology (IR) procedures

A long list of minimally invasive image guided procedures

Balloon angioplasty, biliary drainage and stenting, central venousaccess, chemoembolization, cryoablation, infection and abscessdrainage, needle biopsy, radiofrequency ablation, thrombolysis,urinary tract obstruction, vertebroplasty, . . .

Interventional Radiology : access

Percutaneous access : focus on procedures with needles orprobes

Catheters : angioplasty, drainage, stenting, venous access, . . .

Needles : biopsies, injections, radiofrequency ablation,cryoablation, vertebroplasty, . . .

Interventional Radiology : manual procedureschedule

Treatment schedule

1 Diagnosis and intervention planning


Treatment schedule


2 Entry point registration


Treatment schedule



3 Patient preparation : sterilization, anaesthesia, etc.


Treatment schedule




4 Incision at the entry point


Treatment schedule




4 Incision at the entry point

5 Insertion, treatment and needle removal

Imaging for IR

CT MRI

X

Availability ++

Price ++

Variety of targets -

Imaging quality -

Radiations ++

US

US

Imaging for IR

CT MRI

X

Radiations - -

Availability +

Price +

Imaging quality -

Variety of targets –

US

X

Imaging for IR

CT MRI

X

Imaging quality ++

Radiations - -

Availability -

Variety of targets ++

Price - -

US

CT

Imaging for IR

CT MRI

X

Availability - -

Price - -

Radiations ++

Imaging quality ++

Variety of targets ++

US

MRI

Needle insertion

Haptics

Basic requirement in the absence of real-time imaging

Nonlinear, non homogeneous, patient variability

Forces up to 6 − 10 N (max. ≃ 20 N bones)

0 2 4 6 8 10 12 14 16 18−6

−4

−2

0

2

Time (s)

For

ce (

N)

Why robots for IR ?

CT MRI

XUS

US

Why robots for IR ?

CT MRI

X

Motions

in the image plane

Realtime image

guidance

US

US

Why robots for IR ?

CT MRI

XUS

CT

Why robots for IR ?

CT MRI

X

X-rays protection

Planning

Registration

force feedbackNecessary

imagingLimited realtime

US

CT

Why robots for IR ?

CT MRI

XUS

MRI

Why robots for IR ?

CT MRI

X

OperatorGuidance modality ?

guidanceRealtime image

Tunnel access

Registration/planning

US

MRI

Project : Robotic Specifications

Step 1

Definition on the medical task : general case, limitations,incompatibilities ?

Step 2

Definition of the robotic task.

Step 3

Robotic specifications for this task.

Step 1 : Medical Specifications

image acquisition

registration needle/image

incision and local insertion

image acquisition

orientation correction (needle bevel, bending)

image acquisition

needle insertion

image acquisition (checking)

. . .

medical treatment

needle removal

Step 2 : Robotic task

image acquisition

registration needle (or robot)/image

entry point position and needle orientation computation

insertion

image acquisition (checking)

. . .

medical treatment

needle removal

Step 3 : Robotic Specifications

automatic robot and/or tool registration in the imaging device

positioning device with 5 or 6 DOF (insertion decoupling ?)

operator interaction to be chosen : automatic, collaborativemanipulation, telemanipulation

force feedback

position measurement with/without model

Step 4 : Your Solution

Existing systems

Table mounted systems

Existing systems

Table mounted systems Patient mounted systems

Telerobotic needle insertion system for CT

Features

Teleoperation : staff protection

Automatic registration tool/image

Perceptual feedback (force, vision)

Ergonomics

Issues

Technology

Planing, control, image registration

Safety, sterilization

Performances

CT-Bot positioning unit [IEEE Trans. Biomed Eng.2008]

Features Constraints Solution

SafetyMotion Patient-mounted robot.compensationFailsafebehavior

Quick removal of the robot from its base.Joints locked in case of power failure. Releaseof the needle.

Environmentalcompatibility

CT-scancompatibility

No metal in the CT-plane to avoid image ar-tifacts.

Sterilization Protective bags, autoclavable distal parts, andone use parts.

Mechanicalfeatures

Dimensions ≃ 200 mm side cube (remaining space in thescanner ring for a stout patient).

Weight < 3 kg for the patient comfort.Mobility 5 DOF according to physicians requirements ;

optional DOF for the needle self rotation (tra-jectory bending).

Angularlimits

−10 to 65 deg in the CT-plane, ±25 deg inthe orthogonal plane, to give access to variousorgans under various incidences.

Accuracy 5 mm max position error at the tip of a 200mm long needle (≃ 10 mm for a manual pro-cedure).

Forces 20 N max. force along the axis of the needle

CT-Bot positioning unit [IEEE Trans. Biomed Eng. 2008]

CT-Bot insertion unit [IJRR special issue 2009]

Specifications

Needle insertion and bevel orientation

Needle manipulation and release

Adapted the CT-Bot platform (small/stroke)

X-rays compatible

Force measurement


1. Casing (CT-Bot platform)

Flexible shaft

3. Actuator for the grasp/releaseof the needle

Connecting rod

2. Transmission and actuatorfor translational displacement

Needle

130

mm

150

mm

1. Casing

3. Grasping device

Driving mechanism

Insertion mechanism

2. Carriage B

Compression latch

4. Force sensor

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