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This review systematically examines the recent research from the past decade on diverse path-planning algorithms tailored for stereotactic neurosurgery applications. Our comprehensive investigation involved a thorough search of scholarly papers from Google Scholar, PubMed, IEEE Xplore, and Scopus, utilizing stringent inclusion and exclusion criteria. The screening and selection process was meticulously conducted by a multidisciplinary team comprising three medical students, robotic experts with specialized knowledge in path-planning techniques and medical robotics, and a board-certified neurosurgeon. Each selected paper was reviewed in detail, and the findings were synthesized and reported in this review. The paper is organized around three different types of intervention tools: straight needles, steerable needles, and concentric tube robots. We provide an in-depth analysis of various path-planning algorithms applicable to both single and multi-target scenarios. Multi-target planning techniques are only discussed for straight tools as there is no published work on multi-target planning for steerable needles and concentric tube robots. Additionally, we discuss the imaging modalities employed, the critical anatomical structures considered during path planning, and the current status of research regarding its translation to clinical human studies. To the best of our knowledge and as a conclusion from this systematic review, this is the first review paper published in the last decade that reports various path-planning techniques for different types of tools for minimally invasive neurosurgical applications. Furthermore, this review outlines future trends and identifies existing technology gaps within the field. By highlighting these aspects, we aim to provide a comprehensive overview that can guide future research and development in path planning for stereotactic neurosurgery, ultimately contributing to the advancement of safer and more effective neurosurgical procedures.
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Algoritmos , Procedimientos Quirúrgicos Mínimamente Invasivos , Procedimientos Neuroquirúrgicos , Técnicas Estereotáxicas , Humanos , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Técnicas Estereotáxicas/instrumentación , Robótica/métodos , Cirugía Asistida por Computador/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/instrumentaciónRESUMEN
Magnetic resonance (MR) conditional actuators and encoders are the key components for MR-guided robotic systems. In this article, we present the modeling and control of our MR-safe pneumatic radial inflow motor and encoder. A comprehensive model is developed that considers the primary dynamic elements of the system, including: 1) motor dynamics, 2) pneumatic transmission line dynamics, and 3) valve dynamics. After model validation, we present a simplified third order model that facilitates design of a first order sliding mode controller (TO-SMC). Finally, the motor hardware is tested in a 7T MRI. No image distortion or artifacts were observed. We posit the MR-safe motor and dynamic model will lower the entry barriers for researchers interested in MR-guided robots and promote wider adoption of MR-guided robotic systems.
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AIMS: Assess the potential benefits of using PedBotLab, a clinic based robotic ankle platform with integrated video game software, to improve ankle active and passive range of motion, strength, selective motor control, gait efficiency, and balance. METHODS: Ten participants with static neurological injuries and independent ambulation participated in a 10-week pilot study (Pro00013680) to assess feasibility and efficacy of PedBotLab as a therapeutic device twice weekly. Isometric ankle strength, passive and active ankle range of motion, plantarflexor spasticity, selective motor control of the lower extremity, balance, and gait speed were measured pre- and post-trial. RESULTS: Statistically significant improvements were seen in flexibility, active range of motion, and strength in multiple planes of ankle motion. Ankle dorsiflexion with knee flexion and knee extension demonstrated statistically significant results in all outcome measures. No significant changes were observed in gait speed outcomes. CONCLUSIONS: The use of PedbotLab can lead to improvements in ankle strength, flexibility, and active range of motion for children with static neurological injuries. Future studies aim to evaluate the effect on gait quality and work toward developing a home-based device.
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Terapia por Ejercicio , Rango del Movimiento Articular , Robótica , Juegos de Video , Humanos , Niño , Masculino , Proyectos Piloto , Femenino , Rango del Movimiento Articular/fisiología , Terapia por Ejercicio/métodos , Adolescente , Fuerza Muscular/fisiología , Equilibrio Postural/fisiología , Tobillo/fisiopatología , Articulación del Tobillo/fisiopatología , Enfermedades del Sistema Nervioso/rehabilitación , Enfermedades del Sistema Nervioso/fisiopatologíaRESUMEN
Child growth measurements are critical vital signs to track, with every individual child growth curve potentially revealing a story about a child's health and well-being. Simply put, every baby born requires basic building blocks to grow and thrive: proper nutrition, love and care, and medical health. To ensure that every child who is missing one of these vital aspects is identified, growth is traditionally measured at birth and each well-child visit. While the blue and pink growth curves appear omnipresent in pediatric clinics, it is surprising to realize that their use only became standard of care in 1977 when the National Center for Health Statistics (NCHS) adopted the growth curve as a clinical tool for health. Behind this practice lies a socioeconomically, culturally, and politically complex interplay of individuals and institutions around the world. In this review, we highlight the often forgotten past, current state of practice, and future potential of this powerful clinical tool: the growth reference chart, with a particular focus on clinical genetics practice. The goal of this article is to understand ongoing work in the field of anthropometry (the scientific study of human measurements) and its direct impact on modern pediatric and genetic patient care.
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Desarrollo Infantil , Estado Nutricional , Lactante , Recién Nacido , Niño , Humanos , AntropometríaRESUMEN
BACKGROUND: Annotated data are foundational to applications of supervised machine learning. However, there seems to be a lack of common language used in the field of surgical data science. The aim of this study is to review the process of annotation and semantics used in the creation of SPM for minimally invasive surgery videos. METHODS: For this systematic review, we reviewed articles indexed in the MEDLINE database from January 2000 until March 2022. We selected articles using surgical video annotations to describe a surgical process model in the field of minimally invasive surgery. We excluded studies focusing on instrument detection or recognition of anatomical areas only. The risk of bias was evaluated with the Newcastle Ottawa Quality assessment tool. Data from the studies were visually presented in table using the SPIDER tool. RESULTS: Of the 2806 articles identified, 34 were selected for review. Twenty-two were in the field of digestive surgery, six in ophthalmologic surgery only, one in neurosurgery, three in gynecologic surgery, and two in mixed fields. Thirty-one studies (88.2%) were dedicated to phase, step, or action recognition and mainly relied on a very simple formalization (29, 85.2%). Clinical information in the datasets was lacking for studies using available public datasets. The process of annotation for surgical process model was lacking and poorly described, and description of the surgical procedures was highly variable between studies. CONCLUSION: Surgical video annotation lacks a rigorous and reproducible framework. This leads to difficulties in sharing videos between institutions and hospitals because of the different languages used. There is a need to develop and use common ontology to improve libraries of annotated surgical videos.
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Procedimientos Quirúrgicos Ginecológicos , Procedimientos Quirúrgicos Mínimamente Invasivos , Humanos , Femenino , Procedimientos Quirúrgicos Mínimamente Invasivos/métodosRESUMEN
OBJECTIVES: Our previous published studies have focused on safety and effectiveness of using therapeutic ultrasound (TUS) for treatment of type 2 diabetes mellitus (T2DM) in preclinical models. Here we present a set of simulation studies to explore potential ultrasound application schemes that would be feasible in a clinical setting. METHODS: Using the multiphysics modeling tool OnScale, we created two-dimensional (2D) models of the human abdomen from CT images captured from one normal weight adolescent patient, and one obese adolescent patient. Based on our previous studies, the frequency of our TUS was 1 MHz delivered from a planar unfocused transducer. We tested five different insonation angles, as well as four ultrasound intensities combined with four different duty factors and five durations of application to explore how these variables effect the peak pressure and temperature delivered to the pancreas as well as surrounding tissue in the model. RESULTS: We determined that ultrasound applied directly from the anterior of the patient abdomen at 5 W/cm2 delivered consistent acoustic pressures to the pancreas at the levels which we have previously found to be effective at inducing an insulin release from preclinical models. CONCLUSIONS: Our modeling work indicates that it may be feasible to non-invasively apply TUS in clinical treatment of T2DM.
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Cavidad Abdominal , Diabetes Mellitus Tipo 2 , Obesidad Infantil , Humanos , Adolescente , Insulina/uso terapéutico , Páncreas/diagnóstico por imagenRESUMEN
BACKGROUND: Current methods of burn estimation can lead to incorrect estimates of the total body surface area (TBSA) burned, especially among injured children. Inaccurate estimation of burn size can impact initial management, including unnecessary transfer to burn centres and fluid overload during resuscitation. To address these challenges, we developed a smartphone application (EasyTBSA) that calculates the TBSA of a burn using a body-part by body-part approach. The aims of this study were to assess the accuracy of the EasyTBSA application and compare its performance to three established methods of burn size estimation (Lund-Browder Chart, Rule of Nines and Rule of Palms). METHODS: Twenty-four healthcare providers used each method to estimate burn sizes on moulaged manikins. The manikins represented different ages (infant, child and adult) with different TBSA burns (small <20%, medium 20%-49% and large >49%). We calculated the accuracy of each method as the difference between the user-estimated and actual TBSA. The true value of the complete body surface area of the manikins was obtained by three-dimensional scans. We used multivariable modelling to control for manikin size and method. RESULTS: Among all age groups and burn sizes, the EasyTBSA application had the greatest accuracy for burn size estimation (-0.01%, SD 3.59%) followed by the Rule of Palms (3.92%, SD 10.71%), the Lund-Browder Chart (4.42%, SD 5.52%) and the Rule of Nines (5.05%, SD 6.87%). CONCLUSIONS: The EasyTBSA application may improve the estimation of TBSA compared with existing methods.
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Quemaduras , Niño , Adulto , Lactante , Humanos , Superficie Corporal , Quemaduras/terapia , Unidades de Quemados , Resucitación/métodos , Personal de SaludRESUMEN
We have developed an MRI-safe needle guidance toolkit for MRI-guided interventions intended to enable accurate positioning for needle-based procedures. The toolkit allows intuitive and accurate needle angulation and entry point positioning according to an MRI-based plan, using a flexible, patterned silicone 2D grid. The toolkit automatically matches the grid on MRI planning images with a physical silicon grid placed conformally on the patient's skin and provides the Interventional Radiologist an easy-to-use guide showing the needle entry point on the silicon grid as well as needle angle information. The radiologist can use this guide along with a 2-degree-of-freedom (rotation and angulation relative to the entry point) hand-held needle guide to place the needle into the anatomy of interest. The initial application that we are considering for this toolkit is arthrography, a diagnostic procedure to evaluate the joint space condition. However, this toolkit could be used for any needle-based and percutaneous procedures such as MRI-guided biopsy and facet joint injection. For matching the images, we adopt a transformation parameter estimation technique using the phase-only correlation method in the frequency domain. We investigated the robustness of this method against rotation, displacement, and Rician noise. The algorithm was able to successfully match all the dataset images. We also investigated the accuracy of identifying the entry point from registered template images as a prerequisite for a future targeting study. Application of the template matching algorithm to locate the needle entry points within the MRI dataset resulted in an average entry point location estimation accuracy of 0.12 ±0.2 mm. This promising result motivates a more detailed assessment of this algorithm in the future including a targeting study on a silicon phantom with embedded plastic targets to investigate the end-to-end accuracy of this automatic template matching algorithm in the interventional MRI room.
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Imagen por Resonancia Magnética , Silicio , Humanos , Imagen por Resonancia Magnética/métodos , Agujas , Algoritmos , Biopsia Guiada por Imagen/métodos , Fantasmas de ImagenRESUMEN
Magnetic resonance imaging (MRI) can provide high-quality 3-D visualization of target anatomy, surrounding tissue, and instrumentation, but there are significant challenges in harnessing it for effectively guiding interventional procedures. Challenges include the strong static magnetic field, rapidly switching magnetic field gradients, high-power radio frequency pulses, sensitivity to electrical noise, and constrained space to operate within the bore of the scanner. MRI has a number of advantages over other medical imaging modalities, including no ionizing radiation, excellent soft-tissue contrast that allows for visualization of tumors and other features that are not readily visible by other modalities, true 3-D imaging capabilities, including the ability to image arbitrary scan plane geometry or perform volumetric imaging, and capability for multimodality sensing, including diffusion, dynamic contrast, blood flow, blood oxygenation, temperature, and tracking of biomarkers. The use of robotic assistants within the MRI bore, alongside the patient during imaging, enables intraoperative MR imaging (iMRI) to guide a surgical intervention in a closed-loop fashion that can include tracking of tissue deformation and target motion, localization of instrumentation, and monitoring of therapy delivery. With the ever-expanding clinical use of MRI, MRI-compatible robotic systems have been heralded as a new approach to assist interventional procedures to allow physicians to treat patients more accurately and effectively. Deploying robotic systems inside the bore synergizes the visual capability of MRI and the manipulation capability of robotic assistance, resulting in a closed-loop surgery architecture. This article details the challenges and history of robotic systems intended to operate in an MRI environment and outlines promising clinical applications and associated state-of-the-art MRI-compatible robotic systems and technology for making this possible.
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PURPOSE: This pilot study assesses the feasibility of using PedBotHome to promote adherence to a home exercise program, the ability of the device to withstand frequent use, and changes in participant ankle mobility.PedBotHome is a robotic ankle device with integrated video game software designed to improve ankle mobility in children with cerebral palsy. METHODS: Eight participants enrolled in a 28-day trial of PedBotHome. Ankle strength, range of motion, and plantar flexor spasticity were measured pre- and posttrial. Performance was monitored remotely, and game settings were modified weekly by physical therapists. RESULTS: Four participants met the study goal of 20 days of use. There were statistically significant improvements in ankle strength, spasticity, and range of motion. CONCLUSIONS: PedBotHome is a feasible device to engage children with static neurological injuries in ankle home exercise. This pilot study expands the paradigm for future innovative home-based robotic rehabilitation.
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Procedimientos Quirúrgicos Robotizados , Juegos de Video , Tobillo , Articulación del Tobillo , Niño , Terapia por Ejercicio , Humanos , Espasticidad Muscular , Proyectos PilotoRESUMEN
INTRODUCTION: This paper reports the system integration and cadaveric assessment of a body-mounted robotic system for MRI-guided lumbar spine injections. The system is developed to enable MR-guided interventions in closed bore magnet and avoid problems due to patient movement during cannula guidance. MATERIAL AND METHODS: The robot is comprised by a lightweight and compact structure so that it can be mounted directly onto the lower back of a patient using straps. Therefore, it can minimize the influence of patient movement by moving with the patient. The MR-Conditional robot is integrated with an image-guided surgical planning workstation. A dedicated clinical workflow is created for the robot-assisted procedure to improve the conventional freehand MRI-guided procedure. RESULTS: Cadaver studies were performed with both freehand and robot-assisted approaches to validate the feasibility of the clinical workflow and to assess the positioning accuracy of the robotic system. The experiment results demonstrate that the root mean square (RMS) error of the target position to be 2.57 ± 1.09 mm and of the insertion angle to be 2.17 ± 0.89°. CONCLUSION: The robot-assisted approach is able to provide more accurate and reproducible cannula placements than the freehand procedure, as well as to reduce the number of insertion attempts.
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Procedimientos Quirúrgicos Robotizados , Robótica , Cadáver , Humanos , Inyecciones Espinales , Imagen por Resonancia MagnéticaRESUMEN
The COVID-19 pandemic has affected life for everyone, and hospitals, in particular have been hard hit. In this study, we describe our efforts to develop personal protective equipment at a children's hospital early in the pandemic. We convened an innovation working group to organize our efforts and respond to the rapidly changing situation. We describe our work in four areas: (1) plexiglass shields for the emergency department, (2) face shields for clinical providers, (3) breath shields for ophthalmology, and (4) flip-up safety glasses for nurses. The hospital's supply chain is now caught up with addressing many pandemic-related shortages. Nevertheless, through our multidisciplinary approach to reacting to the pandemic's urgent needs, we demonstrated agility to bring stakeholders together to maximize the use of scarce resources and build resiliency. We believe this method can be rapidly replicated as future needs arise.
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Ingeniería Biomédica/instrumentación , COVID-19/prevención & control , Hospitales Pediátricos , Invenciones , Equipo de Protección Personal , Servicio de Urgencia en Hospital , Diseño de Equipo , Humanos , Pandemias , SARS-CoV-2RESUMEN
Non-invasive fetal electrocardiography (ECG) is a promising method for evaluating fetal cardiac electrical activity. Despite advances in fetal ECG technology, its ability to provide reliable, interpretable results in a typical outpatient fetal cardiology setting remains unclear. We sought to determine the feasibility of measuring standard ECG intervals in an outpatient fetal cardiology practice using an abdominal fetal ECG device that employs blind source separation with reference, an innovative signal-processing technique for fetal ECG extraction. Women scheduled for clinically indicated outpatient fetal echocardiogram underwent 10 min of fetal ECG acquisition from the maternal abdomen using specialized gel electrodes. A bedside laptop computer performed fetal ECG extraction, allowing real-time visualization of fetal and maternal ECG signals. Offline post-processing of 1 min of recorded data yielded fetal P-wave duration, PR interval, QRS duration, RR interval, QT interval, and QTc. Fifty-five fetuses were studied with gestational age 18-37 weeks, including 13 with abnormal fetal echocardiogram findings and three sets of twins. Interpretable results were obtained in 91% of fetuses, including 85% during the vernix period and 100% of twin fetuses. PR interval and RR interval of 18-24 week gestation fetuses were significantly shorter than those with gestational age 25-31 and 32-37 weeks. Of the six fetuses with abnormal rhythms on fetal echocardiogram, fetal ECG tracing was interpretable in five and matched the rhythm noted on fetal echocardiogram. Abdominal fetal ECG acquisition is feasible for arrhythmia detection and ECG interval calculation in a routine clinical setting.
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Arritmias Cardíacas/diagnóstico , Electrocardiografía/métodos , Frecuencia Cardíaca Fetal , Diagnóstico Prenatal/métodos , Adulto , Instituciones de Atención Ambulatoria , Electrocardiografía/instrumentación , Estudios de Factibilidad , Femenino , Edad Gestacional , Humanos , Persona de Mediana Edad , Embarazo , Adulto JovenRESUMEN
OBJECTIVE: Ultrasound imaging requires trained personnel. Advances in robotics and data transmission create the possibility of telesonography. This review introduces clinicians to current technical work in and potential applications of this developing capability. CONCLUSION: Telesonography offers advantages in hazardous or remote environments. Robotically assisted ultrasound can reduce stress injuries in sonographers and has potential utility during robotic surgery and interventional procedures.
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Robótica/instrumentación , Robótica/métodos , Telerradiología/instrumentación , Telerradiología/métodos , Ultrasonografía/instrumentación , Ultrasonografía/métodos , Diseño de Equipo , Análisis de Falla de Equipo , Humanos , Sistemas Hombre-Máquina , Evaluación de la Tecnología BiomédicaRESUMEN
In minimally invasive surgery methods such as laparoscopic surgery, surgical instruments are introduced through small incisions to minimize patient trauma and recovery times. To reduce the number of incisions, new techniques such as natural orifice transluminal endoscopic surgery (NOTES) have been proposed. Compared to laparoscopic surgery, the NOTES approach, which requires new technology and improved instruments, presents some unique challenges. Robotic NOTES (R-NOTES) could be an enabling technology for these procedures. In this paper, we first review relevant work in R-NOTES. We then present our work and the system architecture for an R-NOTES prototype system incorporating wireless command and control. The system was tested twice in swine animal studies.
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Cirugía Endoscópica por Orificios Naturales/instrumentación , Procedimientos Quirúrgicos Robotizados/instrumentación , Robótica/instrumentación , Análisis de Sistemas , Animales , Modelos Animales de Enfermedad , Diseño de Equipo , Seguridad de Equipos , Humanos , Laparoscopía/instrumentación , Laparoscopía/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Cirugía Endoscópica por Orificios Naturales/métodos , Procedimientos Quirúrgicos Robotizados/métodos , PorcinosRESUMEN
Ultrasound imaging is frequently used in medicine. The quality of ultrasound images is often dependent on the skill of the sonographer. Several researchers have proposed robotic systems to aid in ultrasound image acquisition. In this paper we first provide a short overview of robot-assisted ultrasound imaging (US). We categorize robot-assisted US imaging systems into three approaches: autonomous US imaging, teleoperated US imaging, and human-robot cooperation. For each approach several systems are introduced and briefly discussed. We then describe a compact six degree of freedom parallel mechanism telerobotic system for ultrasound imaging developed by our research team. The long-term goal of this work is to enable remote ultrasound scanning through teleoperation. This parallel mechanism allows for both translation and rotation of an ultrasound probe mounted on the top plate along with force control. Our experimental results confirmed good mechanical system performance with a positioning error of < 1 mm. Phantom experiments by a radiologist showed promising results with good image quality.
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Fantasmas de Imagen , Robótica/instrumentación , Ultrasonografía Intervencional/instrumentación , Interfaz Usuario-Computador , Diseño de Equipo , Seguridad de Equipos , Humanos , Robótica/métodos , Ultrasonografía Intervencional/métodosRESUMEN
BACKGROUND: Conventional laparoscopes provide a flat representation of the three-dimensional (3D) operating field and are incapable of visualizing internal structures located beneath visible organ surfaces. Computed tomography (CT) and magnetic resonance (MR) images are difficult to fuse in real time with laparoscopic views due to the deformable nature of soft-tissue organs. Utilizing emerging camera technology, we have developed a real-time stereoscopic augmented-reality (AR) system for laparoscopic surgery by merging live laparoscopic ultrasound (LUS) with stereoscopic video. The system creates two new visual cues: (1) perception of true depth with improved understanding of 3D spatial relationships among anatomical structures, and (2) visualization of critical internal structures along with a more comprehensive visualization of the operating field. METHODS: The stereoscopic AR system has been designed for near-term clinical translation with seamless integration into the existing surgical workflow. It is composed of a stereoscopic vision system, a LUS system, and an optical tracker. Specialized software processes streams of imaging data from the tracked devices and registers those in real time. The resulting two ultrasound-augmented video streams (one for the left and one for the right eye) give a live stereoscopic AR view of the operating field. The team conducted a series of stereoscopic AR interrogations of the liver, gallbladder, biliary tree, and kidneys in two swine. RESULTS: The preclinical studies demonstrated the feasibility of the stereoscopic AR system during in vivo procedures. Major internal structures could be easily identified. The system exhibited unobservable latency with acceptable image-to-video registration accuracy. CONCLUSIONS: We presented the first in vivo use of a complete system with stereoscopic AR visualization capability. This new capability introduces new visual cues and enhances visualization of the surgical anatomy. The system shows promise to improve the precision and expand the capacity of minimally invasive laparoscopic surgeries.
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Percepción de Profundidad , Imagenología Tridimensional , Laparoscopía/métodos , Iluminación , Cirugía Asistida por Computador/métodos , Animales , Laparoscopios , Modelos Animales , Fantasmas de Imagen , Porcinos , Ultrasonografía Intervencional , Grabación en VideoRESUMEN
OBJECTIVE: Use of medical devices in the magnetic resonance environment is regulated by standards that include the ASTM-F2213 magnetically induced torque. This standard prescribes five tests. However, none can be directly applied to measure very low torques of slender lightweight devices such as needles. METHODS: We present a variant of an ASTM torsional spring method that makes a "spring" of 2 strings that suspend the needle by its ends. The magnetically induced torque on the needle causes it to rotate. The strings tilt and lift the needle. At equilibrium, the magnetically induced potential energy is balanced by the gravitational potential energy of the lift. Static equilibrium allows calculating the torque from the needle rotation angle, which is measured. Moreover, a maximum rotation angle corresponds to the maximum acceptable magnetically induced torque, under the most conservative ASTM acceptability criterion. A simple apparatus using the 2-string method is shown, it can be 3D printed, and the design files are shared. RESULTS: The analytical methods were tested against a numeric dynamic model, showing perfect concordance. The method was then tested experimentally in 1.5T and 3T MRI with commercial biopsy needles. Numeric test errors were immeasurably small. Torques between 0.0001 Nm and 0.0018 Nm were measured in MRI with 7.7% maximum difference between tests. The cost to make the apparatus is 58USD and design files are shared. CONCLUSION: The apparatus is simple and inexpensive and provides good accuracy as well. SIGNIFICANCE: The 2-string method provides a solution to measure very low torques in the MRI.
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Imagen por Resonancia Magnética , Torque , Imagen por Resonancia Magnética/métodos , Rotación , Espectroscopía de Resonancia MagnéticaRESUMEN
Purpose: The purpose of this paper is to investigate the geometrical design and path planning of Concentric tube robots (CTR) for intracerebral hemorrhage (ICH) evacuation, with a focus on minimizing the risk of damaging white matter tracts and cerebral arteries. Methods: To achieve our objective, we propose a parametrization method describing a general class of CTR geometric designs. We present mathematical models that describe the CTR design constraints and provide the calculation of a path risk value. We then use a genetic algorithm to determine the optimal tube geometry for targeting within the brain. Results: Our results show that a multi-tube CTR design can significantly reduce the risk of damaging critical brain structures compared to the conventional straight tube design. However, there is no significant relationship between the path risk value and the number and shape of the additional inner curved tubes. Conclusion: Considering the challenges of CTR hardware design, fabrication, and control, we conclude that the most practical geometry for a CTR path in ICH treatment is a straight outer tube followed by a planar curved inner tube. These findings have important implications for the development of safe and effective CTRs for ICH evacuation by enabling dexterous manipulation to minimize damage to critical brain structures.
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PURPOSE: Bone biopsies are currently conducted under computed tomography (CT) guidance using a battery-powered drill to obtain tissue samples for diagnosis of suspicious bone lesions. However, this procedure is suboptimal as images produced under CT lack soft tissue discrimination and involve ionizing radiation. Therefore, our team developed an MRI-safe pneumatic drill to translate this clinical workflow into the MR environment, which can improve target visualization and eliminate radiation exposure. We compare drill times and quality of samples between the 2 drills using animal bones. METHODS: Five porcine spare rib bones were obtained from a butcher shop. Each bone was drilled twice using the Arrow OnControl battery-powered drill and twice using our pneumatically actuated drill. For this study, we used an 11-gauge bone biopsy needle set with an internal core capturing thread. A stopwatch recorded the overall time of drilling for each specimen obtained. RESULTS: All 20 samples collected contained a high-quality inner core and cortex. The total average time for drilling with the pneumatic drill was 8.5 s (+ / - 2.5 s) and 7.1 s (+ / - 1.4 s) with the standard battery-powered drill. CONCLUSION: Both drills worked well and were able to obtain comparable specimens. The pneumatic drill took slightly longer, 1.39 s on average, but this extra time would not be significant in clinical practice. We plan to use the pneumatic drill to enable MRI-safe bone biopsy for musculoskeletal lesions. Biopsy under MRI would provide excellent lesion visualization with no ionizing radiation.