Corrections to "Micropositioning and Control of an Underactuated Platform for Microscopic Applications".

[This corrects the article PMC5110010.].

State of the Art and Future Opportunities in MRI-Guided Robot-Assisted Surgery and Interventions.

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.

Active Stiffness Tuning of a Spring-based Continuum Robot for MRI-Guided Neurosurgery.

Deep intracranial tumor removal can be achieved if the neurosurgical robot has sufficient flexibility and stability. Towards achieving this goal, we have developed a spring-based continuum robot, namely a Minimally Invasive Neurosurgical Intracranial Robot (MINIR-II) with novel tendon routing and tunable stiffness for use in a magnetic resonance imaging (MRI) environment. The robot consists of a pair of springs in parallel, i.e., an inner inter-connected spring that promotes flexibility with decoupled segment motion and an outer spring that maintains its smooth curved shape during its interaction with the tissue. We propose a shape memory alloy (SMA) spring backbone that provides local stiffness control and a tendon routing configuration that enables independent segment locking. In this work, we also present a detailed local stiffness analysis of the SMA backbone and model the relationship between the resistive force at the robot tip and the tension in the tendon. We also demonstrate through experiments, the validity of our local stiffness model of the SMA backbone and the correlation between the tendon tension and the resistive force. We also performed MRI compatibility studies of the 3-segment MINIR-II robot by attaching it to a robotic platform that consists of SMA spring actuators with integrated water cooling modules.

MEMS-Based Flexible Force Sensor for Tri-Axial Catheter Contact Force Measurement.

Atrial fibrillation (AFib) is a significant healthcare problem caused by the uneven and rapid discharge of electrical signals from pulmonary veins (PVs). The technique of radiofrequency (RF) ablation can block these abnormal electrical signals by ablating myocardial sleeves inside PVs. Catheter contact force measurement during RF ablation can reduce the rate of AFib recurrence, since it helps to determine effective contact of the catheter with the tissue, thereby resulting in effective power delivery for ablation. This paper presents the development of a three-dimensional (3D) force sensor to provide the real-time measurement of tri-axial catheter contact force. The 3D force sensor consists of a plastic cubic bead and five flexible force sensors. Each flexible force sensor was made of a PEDOT:PSS strain gauge and a PDMS bump on a flexible PDMS substrate. Calibration results show that the fabricated sensor has a linear response in the force range required for RF ablation. To evaluate its working performance, the fabricated sensor was pressed against gelatin tissue by a micromanipulator and also integrated on a catheter tip to test it within deionized water flow. Both experiments simulated the ventricular environment and proved the validity of applying the 3D force sensor in RF ablation.

New Actuation Mechanism for Actively Cooled SMA Springs in a Neurosurgical Robot.

The paper presents the use of shape memory alloy (SMA) spring actuators with real-time cooling to control the motion of the MINIR-II robot. A new actuation mechanism involving the passage of water as the cooling medium and air as the medium to drive out the water has been developed to facilitate real-time control of the springs. Control parameters, such as current, water flow rates, SMA pre-displacement, and gauge pressure of the compressed air, are identified from the SMA thermal model and from the actuation mechanism. In depth modeling and characterization have been performed regarding these parameters to optimize the robot motion speed. Forced water cooling has also been compared with forced air cooling and proved to be the superior method to achieve higher robot speed. An improved robot design and an MRI-compatible experimental platform have been developed for the implementation of the actuation mechanism.

Development of a Meso-Scale SMA-Based Torsion Actuator for Image-Guided Procedures.

This paper presents the design, modeling, and control of a meso-scale torsion actuator based on shape memory alloy (SMA) for image-guided surgical procedures. Developing a miniature torsion actuator is challenging, but it opens the possibility of significantly enhancing the robot agility and maneuverability. The proposed torsion actuator is bi-directionally actuated by a pair of antagonistic SMA torsion springs through alternate Joule heating and natural cooling. The torsion actuator is integrated into a surgical robot prototype to demonstrate its working performance in the humid environment under C-Arm CT image guidance.

Toward the Development of a Flexible Mesoscale MRI-compatible Neurosurgical Continuum Robot.

Brain tumor, be it primary or metastatic, is usually life threatening for a person of any age. Primary surgical resection which is one of the most effective ways of treating brain tumors can have tremendously increased success rate if the appropriate imaging modality is used for complete tumor resection. Magnetic resonance imaging (MRI) is the imaging modality of choice for brain tumor imaging because of its excellent soft-tissue contrast. MRI combined with continuum soft robotics has immense potential to be the next major technological breakthrough in the field of brain cancer diagnosis and therapy. In this work, we present the design, kinematic, and force analysis of a flexible spring-based minimally invasive neurosurgical intracranial robot (MINIR-II). It is comprised of an inter-connected inner spring and an outer spring and is connected to actively cooled shape memory alloy spring actuators via tendon driven mechanism. Our robot has three serially connected 2-DoF segments which can be independently controlled due to the central tendon routing configuration. The kinematic and force analysis of the robot and the independent segment control were verified by experiments. Robot motion under forced cooling of SMA springs was evaluated as well as the MRI compatibility of the robot and its motion capability in brainlike gelatin environment.

Modeling and characterization of shape memory alloy springs with water cooling strategy in a neurosurgical robot.

Since shape memory alloy (SMA) has high power density and is magnetic resonance imaging (MRI) compatible, it has been chosen as the actuator for the meso-scale minimally invasive neurosurgical intracranial robot (MINIR-II) that is envisioned to be operated under continuous MRI guidance. We have devised a water cooling strategy to improve its actuation frequency by threading a silicone tube through the spring coils to form a compact cooling module-integrated actuator. To create active bi-directional motion in each robot joint, we configured the SMA springs in an antagonistic way. We modeled the antagonistic SMA spring behavior and provided the detailed steps to simulate its motion for a complete cycle. We investigated heat transfer during the resistive heating and water cooling processes. Characterization experiments were performed to determine the parameters used in both models, which were then verified by comparing the experimental and simulated data. The actuation frequency of the antagonistic SMAs was evaluated for several motion amplitudes and we could achieve a maximum actuation frequency of 0.143 Hz for a sinusoidal trajectory with 2 mm amplitude. Lastly, we developed a robotic system to implement the actuators on the MINIR-II to move its end segment back and forth for approximately ±25°.

Micropositioning and Control of an Underactuated Platform for Microscopic Applications.

For automation of biological experiments at the micro-scale, highly precise manipulator equipped with a microscope is required. However, current micropositioning stages have several limitations, such as: 1) manual operation, 2) lack of rotational capability, 3) incompatibility with a microscope, and 4) small range of motion (RoM). This research aims to develop a microscope compatible XYθ micropositioning stage with large RoM for phenotyping multiple biological samples rapidly for various microscopic applications. An underactuated planar mechanism, kinematic analysis, and control of the XYθ stage are presented in this paper. The planar mechanism consists of two piezoelectric linear actuators for translational motion capability and two passive revolute joints at the tip of each linear actuator for rotational capability. Based on the kinematic analysis of the stage, controllability and control strategy of the underactuated stage is described. Finally, the feasibility of the micropositioning stage for a general positioning and orienting task is verified by both simulation and tissue core experiments.

Design and fabrication of a flexible MEMS-based electromechanical sensor array for breast cancer diagnosis.

The use of flexible micro-electro-mechanical systems (MEMS) based device provides a unique opportunity in bio-medical robotics such as characterization of normal and malignant tissues. This paper reports on design and development of a flexible MEMS-based sensor array integrating mechanical and electrical sensors on the same platform to enable the study of the change in electro-mechanical properties of the benign and cancerous breast tissues. In this work, we present the analysis for the electrical characterization of the tissue specimens and also demonstrate the feasibility of using the sensor for mechanical characterization of the tissue specimens. Eight strain gauges acting as mechanical sensors were fabricated using poly(3,4-ethylenedioxythiophene) poly(styrenesulfonate) (PEDOT:PSS) conducting polymer on poly(dimethylsiloxane) (PDMS) as the substrate material. Eight electrical sensors were fabricated using SU-8 pillars on gold (Au) pads which were patterned on the strain gauges separated by a thin insulator (SiO2 1.0µm). These pillars were coated with gold to make it conducting. The electromechanical sensors are integrated on the same substrate. The sensor array covers 180µm × 180µm area and the size of the complete device is 20mm in diameter. The diameter of each breast tissue core used in the present study was 1mm and the thickness was 8µm. The region of interest was 200µm × 200µm. Microindentation technique was used to characterize the mechanical properties of the breast tissues. The sensor is integrated with conducting SU-8 pillars to study the electrical property of the tissue. Through electro-mechanical characterization studies using this MEMS-based sensor, we were able to measure the accuracy of the fabricated device and ascertain the difference between benign and cancer breast tissue specimens.

Robot-Guided Atomic Force Microscopy for Mechano-Visual Phenotyping of Cancer Specimens.

Atomic force microscopy (AFM) and other forms of scanning probe microscopy have been successfully used to assess biomechanical and bioelectrical characteristics of individual cells. When extending such approaches to heterogeneous tissue, there exists the added challenge of traversing the tissue while directing the probe to the exact location of the targeted biological components under study. Such maneuvers are extremely challenging owing to the relatively small field of view, limited availability of reliable visual cues, and lack of context. In this study we designed a system that leverages the visual topology of the serial tissue sections of interest to help guide robotic control of the AFM stage to provide the requisite navigational support. The process begins by mapping the whole-slide image of a stained specimen with a well-matched, consecutive section of unstained section of tissue in a piecewise fashion. The morphological characteristics and localization of any biomarkers in the stained section can be used to position the AFM probe in the unstained tissue at regions of interest where the AFM measurements are acquired. This general approach can be utilized in various forms of microscopy for navigation assistance in tissue specimens.

Design, development, and evaluation of an MRI-guided SMA spring-actuated neurosurgical robot.

In this paper, we present our work on the development of a magnetic resonance imaging (MRI)-compatible Minimally Invasive Neurosurgical Intracranial Robot (MINIR) comprising of shape memory alloy (SMA) spring actuators and tendon-sheath mechanism. We present the detailed modeling and analysis along with experimental results of the characterization of SMA spring actuators. Furthermore, to demonstrate image-feedback control, we used the images obtained from a camera to control the motion of the robot so that eventually continuous MR images could be used in the future to control the robot motion. Since the image tracking algorithm may fail in some situations, we also developed a temperature feedback control scheme which served as a backup controller for the robot. Experimental results demonstrated that both image feedback and temperature feedback can be used to control the motion of MINIR. A series of MRI compatibility tests were performed on the robot and the experimental results demonstrated that the robot is MRI compatible and no significant visual image distortion was observed in the MR images during robot operation.

Towards an Automated MEMS-based Characterization of Benign and Cancerous Breast Tissue using Bioimpedance Measurements.

Micro-Electro-Mechanical-Systems (MEMS) are desirable for use within medical diagnostics because of their capacity to manipulate and analyze biological materials at the microscale. Biosensors can be incorporated into portable lab-on-a-chip devices to quickly and reliably perform diagnostics procedure on laboratory and clinical samples. In this paper, electrical impedance-based measurements were used to distinguish between benign and cancerous breast tissues using microchips in a real-time and label-free manner. Two different microchips having inter-digited electrodes (10 µm width with 10 µm spacing and 10 µm width with 30 µm spacing) were used for measuring the impedance of breast tissues. The system employs Agilent E4980A precision impedance analyzer. The impedance magnitude and phase were collected over a frequency range of 100 Hz to 2 MHz. The benign group and cancer group showed clearly distinguishable impedance properties. At 200 kHz, the difference in impedance of benign and cancerous breast tissue was significantly higher (3110 Ω) in the case of microchips having 10 µm spacing compared to microchip having 30 µm spacing (568 Ω).

Pulse width modulation-based temperature tracking for feedback control of a shape memory alloy actuator.

This work presents a temperature-feedback approach to control the radius of curvature of an arc-shaped shape memory alloy (SMA) wire. The nonlinear properties of the SMA such as phase transformation and its dependence on temperature and stress make SMA actuators difficult to control. Tracking a desired trajectory is more challenging than controlling just the position of the SMA actuator since the desired path is continuously changing. Consequently, tracking the desired strain directly or tracking the parameters such as temperature and electrical resistance that are related to strain with a model is a challenging task. Temperature-feedback is an attractive approach when direct measurement of strain is not practical. Pulse width modulation (PWM) is an effective method for SMA actuation and it can be used along with a compensator to control the temperature of the SMA. Using the constitutive model of the SMA, the desired temperature profile can be obtained for a given strain trajectory. A PWM-based nonlinear PID controller with a feed-forward heat transfer model is proposed to use temperature-feedback for tracking a desired temperature trajectory. The proposed controller is used during the heating phase of the SMA actuator. The controller proves to be effective in tracking step-wise and continuous trajectories.

MEMS based Low Cost Piezoresistive Microcantilever Force Sensor and Sensor Module.

In the present work, we report fabrication and characterization of a low-cost MEMS based piezoresistive micro-force sensor with SU-8 tip using laboratory made silicon-on-insulator (SOI) substrate. To prepare SOI wafer, silicon film (0.8 µm thick) was deposited on an oxidized silicon wafer using RF magnetron sputtering technique. The films were deposited in Argon (Ar) ambient without external substrate heating. The material characteristics of the sputtered deposited silicon film and silicon film annealed at different temperatures (400-1050°C) were studied using atomic force microscopy (AFM) and X-ray diffraction (XRD) techniques. The residual stress of the films was measured as a function of annealing temperature. The stress of the as-deposited films was observed to be compressive and annealing the film above 1050°C resulted in a tensile stress. The stress of the film decreased gradually with increase in annealing temperature. The fabricated cantilevers were 130 µm in length, 40 µm wide and 1.0 µm thick. A series of force-displacement curves were obtained using fabricated microcantilever with commercial AFM setup and the data were analyzed to get the spring constant and the sensitivity of the fabricated microcantilever. The measured spring constant and sensitivity of the sensor was 0.1488N/m and 2.7mV/N. The microcantilever force sensor was integrated with an electronic module that detects the change in resistance of the sensor with respect to the applied force and displays it on the computer screen.

Design, Development, and Evaluation of a Master-Slave Surgical System for Breast Biopsy under Continuous MRI.

Magnetic Resonance Imaging (MRI) provides superior soft-tissue contrast in cancer diagnosis compared to other imaging modalities. However, the strong magnetic field inside the MRI bore along with limited scanner bore size poses significant challenges. Since current approaches in breast biopsy using MR images is primarily a blind targeting approach, it is necessary to develop a MRI-compatible robot that can avoid multiple needle insertions into the breast tissue. This MRI-compatible robotic system could potentially lead to improvement in the targeting accuracy and reduce sampling errors. A master-slave surgical system has been developed comprising of a MRI-compatible slave robot which consists of one piezo motor and five pneumatic cylinders connected by long pneumatic transmission lines. The slave robot follows the configuration of the master robot, which provides an intuitive manipulation interface for the physician and operates inside the MRI bore to adjust the needle position and orientation and perform needle insertion task. Based on the MRI experiments using the slave robot, there was no significant distortion in the images and hence the slave robot can be safely operated inside the MRI with minimal loss in signal-to-noise ratio (SNR). Ex vivo and in vivo experiments have been conducted to evaluate the performance of the master-slave surgical system.

Preclinical Evaluation of a Novel Steerable Robotic Neuroendoscope Tool.

BACKGROUND AND OBJECTIVES: To improve the outcomes of minimally invasive, endoscopic, intracranial procedures, steerable robotic tools have been developed but still require thorough evaluation before use in a clinical setting. This paper compares a novel steerable robotic neuroendoscope tool against a standard rigid tool. METHODS: Seventeen participants, 8 nonmedical and 9 medical (neurosurgery residents and fellows), were recruited. The evaluation trial consisted of a task that was completed using either a rigid tool or the steerable tool, followed by the completion of a qualitative survey. Target reach time and tool movement volume (TMV) were recorded for each trial and analyzed. The tools were evaluated within a realistic phantom model of the brain. RESULTS: Preclinical evaluation of both tools showed that average target reach time for the steerable tool among medical personnel (15.0 seconds) was longer than that of the rigid tool (5.9 seconds). However, the average TMV for the steerable tool (0.178 cm 3 ) was much lower than that of the rigid tool (0.501 cm 3 ) for medical personnel, decreasing the TMV by 64.47%. CONCLUSION: The steerable tool required more training and practice in comparison with the standard rigid tool, but it decreased the overall endoscope movement volume, which is a source of parenchymal injury associated with endoscopic procedures.

A Semi-Automated Positioning System for contact-mode Atomic Force Microscopy (AFM).

Contact mode Atomic Force Microscopy (CM-AFM) is popularly used by the biophysics community to study mechanical properties of cells cultured in petri dishes, or tissue sections fixed on microscope slides. While cells are fairly easy to locate, sampling in spatially heterogeneous tissue specimens is laborious and time-consuming at higher magnifications. Furthermore, tissue registration across multiple magnifications for AFM-based experiments is a challenging problem, suggesting the need to automate the process of AFM indentation on tissue. In this work, we have developed an image-guided micropositioning system to align the AFM probe and human breast-tissue cores in an automated manner across multiple magnifications. Our setup improves efficiency of the AFM indentation experiments considerably. Note to Practitioners: Human breast tissue is by nature heterogeneous, and in the samples we studied, epithelial tissue is formed by groups of functional breast epithelial cells that are surrounded by stromal tissue in a complex intertwined way. Therefore sampling a specific cell type on an unstained specimen is very difficult. To aid us, we use digital stained images of the same tissue annotated by a certified pathologist to identify the region of interest (ROI) at a coarse magnification and an image-guided positioning system to place the unstained tissue near the AFM probe tip. Using our setup, we could considerably reduce AFM operating time and we believe that our setup is a viable supplement to commercial AFM stages with limited X-Y range.

Towards comprehensive evaluation of the FLEXotendon glove-III: a case series evaluation in pediatric clinical cases and able-bodied adults.

Injuries involving the nervous system, such as a brachial plexus palsy or traumatic brain injury, can lead to impairment in the functionality of the hand. Assistive robotics have been proposed as a possible method to improve patient outcomes in rehabilitation. The work presented here evaluates the FLEXotendon Glove-III, a 5 degree-of-freedom, voice-controlled, tendon-driven soft robotic hand exoskeleton, with two human subjects with hand impairments and four able-bodied subjects. The FLEXotendon Glove-III was evaluated on four unimpaired subjects, in conjunction with EMG sensor data, to determine the quantitative performance of the glove in applied pinch force, perturbation resistance, and exertion reduction. The exoskeleton system was also evaluated on two subjects with hand impairments, using two standardized hand function tests, the Jebsen-Taylor Hand Function Test and the Toronto Rehabilitation Institute Hand Function Test. The subjects were also presented with three qualitative questionnaires, the Capabilities of Upper Extremities Questionnaire, the Quebec User Evaluation of Satisfaction with Assistive Technology, and the Orthotics Prosthetics User Survey-Satisfaction module. From the previous design, minor design changes were made to the exoskeleton. The quick connect system was redesigned for improved performance, the number of motors was reduced to decrease overall footprint, and the entire system was placed into a compact acrylic case that can be placed into a backpack for increased portability.

Telerobotic Transcatheter Delivery System for Mitral Valve Implant.

Mitral regurgitation (MR) is the most common type of valvular heart disease, affecting over 2% of the world population, and the gold-standard treatment is surgical mitral valve repair/replacement. Compared to open-heart surgeries, minimally invasive surgeries (MIS) using transcatheter approaches have become popular because of their notable benefits such as less postoperative pain, shorter hospital stay, and faster recovery time. However, commercially available catheters are manually actuated, causing over-exposure of clinical staff to radiation and increased risk of human error during medical interventions. To tackle this problem, in this letter, we propose a telerobotic transcatheter delivery system, which consists of a robotic catheter (5.7 mm OD), a reinforced guide tube (1.11m length), and an actuation system. We present the robotic system design, fabrication of key components, and static model of reinforced quadlumen tube. The robot interface design enables the user to intuitively control the robot. We demonstrate the effectiveness of the telerobotic transcatheter delivery system and reinforced quadlumen tube in a realistic human cardiovascular phantom for preclinical evaluation.