Needle-based interventions are pervasive in Minimally Invasive Surgery (MIS), and are often used in a number of diagnostic and therapeutic procedures, including biopsy and brachytherapy seed placement. Magnetic Resonance Imaging (MRI) which can provide high quality, real time and high soft tissue contrast imaging, is an ideal guidance tool for image-guided therapy (IGT). Therefore, a MRI-guided needle-based surgical robot proves to have great potential in the application of percutaneous interventions. Presented here is the design of reconfigurable fiducial-integrated modular needle driver for MRI-guided percutaneous interventions. Further, an MRI-compatible hardware control system has been developed and enhanced to drive piezoelectric ultrasonic motors for a previously developed base robot designed to support the modular needle driver. A further contribution is the development of a fiber optic sensing system to detect robot position and joint limits. A transformer printed circuit board (PCB) and an interface board with integrated fiber optic limit sensing have been developed and tested to integrate the robot with the piezoelectric actuator control system designed by AIM Lab for closed loop control of ultrasonic Shinsei motors. A series of experiments were performed to evaluate the feasibility and accuracy of the modular needle driver. Bench top tests were conducted to validate the transformer board, fiber optic limit sensing and interface board in a lab environment. Finally, the whole robot control system was tested inside the MRI room to evaluate its MRI compatibility and stability.

abstract: Presented in this thesis are two projects that fall under the umbrella of magnetically actuated electronics and robotics for medical applications. First, magnetically actuated tunable soft electronics are discussed in Chapter 2. Wearable and implantable soft electronics are clinically available and commonplace. However, these devices can be taken a step further to improve the lives of their users by adding remote tunability. The four electric units tested were planar inductors, axial inductors, capacitors and resistors. The devices were made of polydimethylsiloxane (PDMS) for flexibility with copper components for conductivity. The units were tuned using magnets and mobile components comprised of iron filings and ferrofluid. The characteristic properties examined for each unit are as follows: inductance and quality factor (Q-factor) for inductors, capacitance and Q-factor for capacitors, and impedance for resistors. There were two groups of tuning tests: quantity effect and position effect of the mobile component. The position of the mobile component had a larger effect on each unit, with 20-23% change in inductance for inductors (from 3.31 µH for planar and 0.44 µH for axial), 12.7% from 2.854 pF for capacitors and 185.3% from 0.353 kΩ for resistors. Chapter 3 discusses a magnetic needle tracking device with operative assistance from a six degree-of-freedom robotic arm. Traditional needle steering faces many obstacles such as torsional effects, buckling, and small radii of curvature. To improve upon the concept, this project uses permanent magnets in parallel with a tracking system to steer and determine the position and orientation of the needle in real time. The magnet configuration is located at the end effector of the robotic arm. The trajectory of the end effector depends on the needle’s path, and vice versa. The distance the needle travels inside the workspace is tracked by a direct current (DC) motor, to which the needle is tethered. Combining this length with the pose of the end effector, the position and orientation of the needle can be calculated. Simulation of this tracking device has shown the functionality of the system. Testing has been done to confirm that a single magnet pulls the needle through the phantom tissue. / Dissertation/Thesis / Masters Thesis Mechanical Engineering 2020

abstract: Needle steering is an extension of manually inserted needles that allows for maneuverability within the body in order to avoid anatomical obstacles and correct for undesired placement errors. Research into needle steering predominantly exploits interaction forces between a beveled tip and the medium, controlling the direction of forces by applying rotations at the base of the needle shaft in order to steer. These systems are either manually or robotically advanced, but have not achieved clinical relevance due to a multitude of limitations including compression effects in the shaft that cause undesired tissue slicing, torsional friction forces and deflection at tissue boundaries that create control difficulties, and a physical design that inherently restricts the workspace. While most improvements into these systems attempt to innovate the needle design or create tissue models to better understand interaction forces, this paper discusses a promising alternative: magnetic needle steering. Chapter 2 discusses an electromagnetic needle steering system that overcomes all aforementioned issues with traditional steering. The electromagnetic system advances the needle entirely magnetically so it does not encounter any compression or torsion effects, it can steer across tissue-interfaces at various angles of attack (90, 45, 22.5°) with root-mean-square error (RMSE) of 1.2 mm, achieve various radii of curvature as low as 10.2 mm with RMSE of 1.4 mm, and steer along complex 3D paths with RMSE as low as 0.4 mm. Although these results do effectively prove the viability of magnetic steering, the electromagnetic system is limited by a weak magnetic field and small 33mm cubic workspace. In order to overcome these limitations, the use of permanent magnets, which can achieve magnetic forces an order of magnitude larger than similarly sized electromagnetics, is investigated. The needle will be steered toward a permanent magnet configuration that is controlled by a 6 degree-of-freedom robotic manipulator. Three magnet configurations were investigated, two novel ideas that attempt to create local maximum points that stabilize the needle relative to the configuration, and one that pulls the needle toward a single magnet. Ultimately, the last design was found to be most viable to demonstrate the effectiveness of magnetic needle steering. / Dissertation/Thesis / Masters Thesis Mechanical Engineering 2020

Most robotic systems reported for MRI-guided prostate interventions use manual needle insertion, based on a previously acquired image, which requires withdrawing the patient from the scanner multiple times during the procedure. This makes the intervention longer, more expensive and elongating the discomfort to patient and, most importantly, less accurate due to the virtually inevitable motion of the target. As a remedy, automated needle placement methods were proposed, putting human supervision out of the control loop. This thesis presents the development of enabling technologies for human-operated in-room master-slave needle placement under real-time MRI guidance, while the patient is kept in the scanner and having the process of needle placement under continuos control of the physician. The feasibility of teleoperated needle insertion was demonstrated by developing a 1-DOF (degree of freedom) MRI-compatible master-slave system, which was integrated with a 4-DOF robot for transperineal prostate biopsy and brachytherapy. An accuracy study was conducted on a robotic system for MRI-guided prostate needle placement. Different error sources were identified and quantified. This study concluded that errors occurring during needle insertion have the most significant contribution to needle placement error. In order to compensate for these errors, teleoperated needle steering under real-time MRI guidance was proposed. A 2-DOF piezo-actuated MRI-compatible needle steering module was developed and integrated with the aforementioned 4-DOF transperineal robot, yielding a fully actuated 6-DOF (x, y, z, yaw, pitch, roll) robotic platform for MRI-guided prostate interventions. A novel MRI-compatible master robot was also developed to enable teleoperated needle steering inside the MRI room. MRI-compatible controller hardware and software were developed. A novel MRI-compatible force/torque sensor was devised using Fiber Bragg Grating for force measurement in MRI room. Phantom experiments proved the feasibility iii of teleoperated needle steering under real-time MRI guidance. A system was also developed for real-time 3D shape tracking of a bevel-tip needle with Fiber Bragg Grating sensors embedded along the needle shaft. The needle profile was overlaid on the real-time MR image, yielding real time navigation with accuracy better than 0.5 mm. The experimental system is presently being refitted for clinical safety and feasibility trials on real patients. / Thesis (Ph.D, Mechanical and Materials Engineering) -- Queen's University, 2013-05-30 12:26:18.732

Les travaux de cette thèse proposent une nouvelle approche pour le guidage assisté par robots d'aiguilles flexibles pour des procédures percutanées. La méthode est basée sur l'utilisation d'une rotation de l'aiguille avec un rapport cyclique variable pour réaliser une insertion avec des arcs de rayons de courbure différents. Elle combine un retour visuel avec une stratégie de planification adaptative pour compenser les incertitudes du système et les perturbations. Par rapport aux approches présentées précédemment dans la littérature, la stratégie de planification en boucle fermée est adaptée à des scènes dynamiques qui présentent des changements de position des obstacles et de la cible. Cette approche a été implémentée sur un système robotique et les résultats obtenus in vitro confirment tout l'intérêt de cette technique. / This thesis proposes a robot-assisted approach for automatic steering of flexible beveled needles in percutaneous procedures. The method uses duty-cycled rotation of the needle to perform insertion with arcs of adjustable curvature, and combines closed-loop imaging feedback with an intraoperative motion replanning strategy to compensate for system uncertainties and disturbances. Differently from previous approaches, the closed-loop replanning strategy is suitable for dynamic scenes that present changes of obstacles and target positions. Indeed, we implemented the proposed system using a robotic manipulator, and the results obtained from in vitro tests confirmed the viability of our method.

Image guided therapy procedures under MRI guidance has been a focused research area over past decade. Also, over the last decade, various MRI guided robotic devices have been developed and used clinically for percutaneous interventions, such as prostate biopsy, brachytherapy, and tissue ablation. Though MRI provides better soft tissue contrast compared to Computed Tomography and Ultrasound, it poses various challenges like constrained space, less ergonomic patient access and limited material choices due to its high magnetic field. Even after, advancements in MRI compatible actuation methods and robotic devices using them, most MRI guided interventions are still open-loop in nature and relies on preoperative or intraoperative images. In this thesis, an intraoperative MRI guided robotic system for prostate biopsy comprising of an MRI compatible 4-DOF robotic manipulator, robot controller and control application with Clinical User Interface (CUI) and surgical planning applications (3DSlicer and RadVision) is presented. This system utilizes intraoperative images acquired after each full or partial needle insertion for needle tip localization. Presented system was approved by Institutional Review Board at Brigham and Women's Hospital(BWH) and has been used in 30 patient trials. Successful translation of such a system utilizing intraoperative MR images motivated towards the development of a system architecture for close-loop, real-time MRI guided percutaneous interventions. Robot assisted, close-loop intervention could help in accurate positioning and localization of the therapy delivery instrument, improve physician and patient comfort and allow real-time therapy monitoring. Also, utilizing real-time MR images could allow correction of surgical instrument trajectory and controlled therapy delivery. Two of the applications validating the presented architecture; closed-loop needle steering and MRI guided brain tumor ablation are demonstrated under real-time MRI guidance.

Les techniques d'insertion d'aiguille font partie des interventions chirurgicales les plus courantes. L'efficacité de ces interventions dépend fortement de la précision du positionnement des aiguilles dans un emplacement cible à l'intérieur du corps du patient. L'objectif principal dans cette thèse est de développer un système robotique autonome, capable d'insérer une aiguille flexible dans une structure déformable le long d'une trajectoire prédéfinie. L’originalité de ce travail se trouve dans l’utilisation de simulations inverses par éléments finis (EF) dans la boucle de contrôle du robot pour prédire la déformation des structures. La particularité de ce travail est que pendant l’insertion, les modèles EF sont continuellement recalés (étape corrective) grâce à l’information extraite d’un système d’imagerie peropératoire. Cette étape permet de contrôler l’erreur des modèles par rapport aux structures réelles et ainsi éviter qu'ils divergent. Une seconde étape (étape de prédiction) permet, à partir de la position corrigée, d’anticiper le comportement de structures déformables, en se reposant uniquement sur les prédictions des modèles biomécaniques. Ceci permet ainsi d’anticiper la commande du robot pour compenser les déplacements des tissus avant même le déplacement de l’aiguille. Expérimentalement, nous avions utilisé notre approche pour contrôler un robot réel afin d'insérer une aiguille flexible dans une mousse déformable le long d'une trajectoire (virtuelle) prédéfinie. Nous avons proposé une formulation basée sur des contraintes permettant le calcul d'étapes prédictives dans l'espace de contraintes offrant ainsi un temps d'insertion total compatible avec les applications cliniques. Nous avons également proposé un système de réalité augmentée pour la chirurgie du foie ouverte. La méthode est basée sur un recalage initial semi-automatique et un algorithme de suivi peropératoire basé sur des marqueurs (3D) optiques. Nous avons démontré l'applicabilité de cette approche en salle d'opération lors d'une chirurgie de résection hépatique. Les résultats obtenus au cours de ce travail de thèse ont conduit à trois publications (deux IROS et un ICRA) dans les conférences internationales puis à un journal (Transactions on Robotics) en cours de révision. / Needle-based interventions are among the least invasive surgical approaches to access deep internal structures into organs' volumes without damaging surrounding tissues. Unlike traditional open surgery, needle-based approaches only affect a localized area around the needle, reducing this way the occurrence of traumas and risks of complications \cite{Cowan2011}. Many surgical procedures rely on needles in nowadays clinical routines (biopsies, local anesthesia, blood sampling, prostate brachytherapy, vertebroplasty ...). Radiofrequency ablation (RFA) is an example of percutaneous procedure that uses heat at the tip of a needle to destroy cancer cells. Such alternative treatments may open new solutions for unrespectable tumors or metastasis (concerns about the age of the patient, the extent or localization of the disease). However, contrary to what one may think, needle-based approaches can be an exceedingly complex intervention. Indeed, the effectiveness of the treatment is highly dependent on the accuracy of the needle positioning (about a few millimeters) which can be particularly challenging when needles are manipulated from outside the patient with intra-operative images (X-ray, fluoroscopy or ultrasound ...) offering poor visibility of internal structures. Human factors, organs' deformations, needle deflection and intraoperative imaging modalities limitations can be causes of needle misplacement and rise significantly the technical level necessary to master these surgical acts. The use of surgical robots has revolutionized the way surgeons approach minimally invasive surgery. Robots have the potential to overcome several limitations coming from the human factor: for instance by filtering operator tremors, scaling the motion of the user or adding new degrees of freedom at the tip of instruments. A rapidly growing number of surgical robots has been developed and applied to a large panel of surgical applications \cite{Troccaz2012}. Yet, an important difficulty for needle-based procedures lies in the fact that both soft tissues and needles tend to deform as the insertion proceeds in a way that cannot be described with geometrical approaches. Standard solutions address the problem of the deformation extracting a set of features from per-operative images (also called \textit{visual servoing)} and locally adjust the pose/motion of the robot to compensate for deformations \cite{Hutchinson1996}. [...]To overcome these limitations, we introduce a numerical method allowing performing inverse Finite Element simulations in real-time. We show that it can be used to control an articulated robot while considering deformations of structures during needle insertion. Our approach relies on a forward FE simulation of a needle insertion (involving complex non-linear phenomena such as friction, puncture and needle constraints).[...]