Curvilinear catheter implantation in HDR prostate brachytherapy: feasibility study.

BACKGROUND: High-dose-rate (HDR) brachytherapy (BT) has been acknowledged as a widely utilized treatment for patients with intermediate- and high-risk prostate cancer, despite its side effects such as edema, incontinence, and impotence. Nevertheless, the treatment is consistently limited by the potential danger of excessive irradiation to organs-at-risk (OARs) like the urethra, bladder, and rectum. PURPOSE: This study aims to introduce curvilinear catheter implantation in the prostate gland for HDR treatment. The objective is to improve the radiation dose distribution by offering access channels conformal to the prostate anatomy. This approach seeks to minimize toxicity to nearby OARs while utilizing a reduced number of needles, potentially leading to improved clinical outcomes. METHODS: Curvilinear catheters were first pre-planned for an anonymized patient using Oncentra treatment planning system (TPS) and hybrid inverse planning optimization (HIPO) algorithm. The trajectories of the catheters were then analyzed using MATLAB to extract their radius of curvature. Tendon-driven active needles were then used to implant curvilinear catheters inside an anthropomorphic phantom. RESULTS: Proposed curvilinear catheter implantation resulted in significant improvement in terms of dosimetric constraints to the OARs and coverage to the prostate. Tendon-driven active needles were shown to be capable of realizing the required pre-planned curvatures inside prostate. It was shown that the active needle can realize a desired radius of curvature and a desired trajectory with an average accuracy of 9.1 ± 8.6  and 1.27 ± 0.50 mm in air and inside a tissue-mimicking phantom, respectively. CONCLUSION: This work demonstrates the feasibility of using tendon-driven active curvilinear catheter implantation in prostate to improve the outcomes of HDR-BT via improved radiation dose distribution to the prostate and reduced toxicity to the OARs.

A mechanics-based model for a tendon-driven active needle navigating inside a multiple-layer tissue.

Percutaneous minimally invasive procedures such brachytherapy and biopsy require a flexible active needle for precise movement inside tissue and accurate placement at target positions for higher success rates for diagnosis and treatment, respectively. In a previous work, we presented a tendon-driven active needle to navigate inside tissue. This work presents a new model to predict the deflection of the tendon-driven needle while steering in a multiple-layer soft tissue. A multi-layer phantom tissue with different localized stiffness was developed for needle insertion tests followed by indentation tests to identify its mechanical properties. Using a robot that inserts and actively bends the tendon-driven needle inside the soft tissue while simultaneously tracking the needle through ultrasound imaging, various experiments were conducted for model validation. The proposed model was verified by comparing the simulation results to the empirical data. The results demonstrated the accuracy of the model in predicting the tendon-driven needle deflection in multiple-layer (different stiffness) soft tissue.

Teleoperated and Automated Control of a Robotic Tool for Targeted Prostate Biopsy.

This work presents a robotic tool with bidirectional manipulation and control capabilities for targeted prostate biopsy interventions. Targeted prostate biopsy is an effective image-guided technique that results in detection of significant cancer with fewer cores and lower number of unnecessary biopsies compared to systematic biopsy. The robotic tool comprises of a compliant flexure section fabricated on a nitinol tube that enables bidirectional bending via actuation of two internal tendons, and a biopsy mechanism for extraction of tissue samples. The kinematic and static models of the compliant flexure section, as well as teleoperated and automated control of the robotic tool are presented and validated with experiments. It was shown that the controller can force the tip of the robotic tool to follow sinusoidal set-point positions with reasonable accuracy in air and inside a phantom tissue. Finally, the capability of the robotic tool to bend, reach targeted positions inside a phantom tissue, and extract a biopsy sample is evaluated.

Modeling and Operator Control of a Robotic Tool for Bidirectional Manipulation in Targeted Prostate Biopsy.

This work introduces design, manipulation, and operator control of a bidirectional robotic tool for minimally invasive targeted prostate biopsy. The robotic tool is purposed to be used as a compliant flexure section of active biopsy needles. The design of the robotic tool comprises of a flexure section fabricated on a nitinol tube that enables bidirectional bending via actuation of two internal tendons. The statics of the flexure section is presented and validated with experimental data. Finally, the capability of the robotic tool to reach targeted positions inside prostate gland is evaluated.

Integrating robot-assisted ultrasound tracking and 3D needle shape prediction for real-time tracking of the needle tip in needle steering procedures.

BACKGROUND: Needle insertions have been used in several minimally invasive procedures for diagnostic and therapeutic purposes. Real-time position of the needle tip is an important information in needle steering systems. METHODS: This work introduces a robot-assisted ultrasound tracking (R-AUST) system integrated with a needle shape prediction method to provide 3D position of the needle tip. The tracking system is evaluated in phantom and ex vivo beef liver tissues. RESULTS: An average error of 0.60 mm was found for needle insertion tests inside the phantom tissue. The R-AUST integrated with shape prediction in the beef liver tissue was able to track the needle tip with an average and maximum error of 0.37 and 0.67 mm, respectively. The average error reported in this work is within the mean allowable needle placement error (<2.7 mm) in targeted procedures. CONCLUSIONS: Integration of R-AUST tracking method with needle shape prediction results in a reasonably accurate real-time tracking suitable for ultrasound-guided needle insertions.

Steering a Tendon-Driven Needle in High-Dose-Rate Prostate Brachytherapy for Patients with Pubic Arch Interference.

High-dose-rate brachytherapy (HDR BT) is a radiation therapy that places radioactive sources at cancerous tissue using needles. HDR BT offers better dose conformality and sparing of clinical structures, lower operator dependency, and fewer acute irritative symptoms compared to the other form of BT (low-dose-rate (LDR)). However, use of HDR BT is limited for patients with pubic arch interference, where the transperineal path to the prostate is blocked. This study aims to introduce a tendon-driven needle that can bend inside tissue to reach desired positions inside prostate. Initial experiments in a phantom tissue showed the feasibility of the needle to get around the pubic arch for placement at hard-to-reach target positions.