This thesis describes the design and evaluation of robotic systems for medical image guided percutaneous needle interventions. Percutaneous needle interventions have become increasingly more common in the diagnosis and treatment of a variety of illnesses in the human population. Examples include biopsies, radiofrequency ablation, cryotherapy, abscess drainage, and brachytherapy, amongst others. The coupling of medical imaging to the insertion of a needle raises a number of difficulties for the physician, such as accurately aligning the needle to the planned trajectory in the image, realizing complex out-of-plane trajectories that are difficult to visualize and compensating for soft tissue motion. Robotics can be used to assist these procedures and simplify these challenges, potentially resulting in more accurate procedures, better clinical outcomes and greater patient eligibility. This thesis outlines the technical and clinical challenges typically faced during the design and evaluation of such needle insertion robots. Focus is given primarily to the aspects which differentiate needle insertion robots from other medical robots. A review of the state of the art is used to describe these challenges and to present some of the solutions that have been proposed to face them. On this basis, two such robotic systems, developed during this thesis, are described in detail, providing concrete examples of the variety of design constraints imposed in a medical image guided needle insertion setting. The first system, called PROSPER, is for ultrasound(US)-guided transperineal prostate interventions, in particular brachytherapy. It is mounted to the surgical table and a 3D transrectal US probe is rigidly connected to it, allowing one-time pre-operative calibration between the image and the robot coordinate spaces. The protocol developed for this system includes intra-operative US-US registration in order to compensate for prostate motion and deformation during insertion. This chapter exposes the challenges of a system that is not physically present in the imaging space and that takes into account the various constraints inherent to a soft tissue environment. The second system, called the LPR, is 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 robot is calibrated to the image intra-operatively using multi-modal fiducials embedded in the robot's structure. It is fully compatible with both imaging modalities in terms of image quality and space constraints. As opposed to the PROSPER robot, this chapter shows how the presence of the robot in the imaging space brings about a number of additional challenges that must be faced for its clinical acceptability. In the descriptions of both systems, emphasis is placed on the novel solutions put into place with the goal of providing a real clinical benefit to both patients and clinicians. Prototypes of each system were developed and evaluated on synthetic phantoms in terms of their pre-clinical compatibility and accuracy.
Design and evaluation of robotic systems for medical image guided percutaneous needle interventions