Physician Assistance Technology in Image-guided Robotic Intervention of Prostate

图像引导机器人前列腺介入治疗的医师辅助技术

• 批准号: 10458457
• 负责人: GREGORY S FISCHER
• 金额: $ 66.75万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10458457
• 关键词: Address; Adopted; Animals; Antibiotics; Area; Automobiles; Biopsy; Biopsy Specimen; Clinical; Clinical Engineering; Clinical Research; Collection; Data; Detection; Devices; Diagnosis; Diagnostic; Dose; Engineering; Ensure; Escherichia coli; Excision; Financial compensation; Functional Imaging; Future; Goals; Guidelines; Gynecologic Brachytherapy; Image; Image Guided Biopsy; Infection; Information Systems; Intervention; Interventional Imaging; Knowledge; Learning; Lesion; Literature; Magnetic Resonance Imaging; Malignant Neoplasms; Malignant neoplasm of prostate; Manuals; Measurement; Measures; Medical Device; Methods; Modernization; Molecular; Motion; Needle biopsy procedure; Needles; Pathologic; Patients; Pelvis; Phenotype; Physicians; Precision Medicine Initiative; Precision therapeutics; Procedures; Prostate; Protocols documentation; Public Health; Radiology Specialty; Reporting; Research; Research Methodology; Research Personnel; Robot; Robotics; Safety; Sampling; Science; Site; Specific qualifier value; System; Techniques; Technology; Testing; Time; Tissues; Translating; Transrectal Ultrasound; Treatment Protocols; Ultrasonography; United States National Institutes of Health; Work; Yang; anatomic imaging; base; cancer diagnosis; cancer therapy; clinical practice; clinically significant; design; detection method; editorial; experience; fluoroquinolone resistance; image guided; image guided intervention; improved; individual patient; innovation; instrument; molecular imaging; next generation; novel; pre-clinical; prevent; programs; prostate biopsy; risk stratification; robot control; robotic device; technology development; tool; tumor; ultrasound

Recent advances in the multi-parametric MRI of the prostate have led to a surge in new research methods for the detection and diagnosis of prostate cancer - with the goal of accurate risk- stratification of prostate cancer. Specifically, a traditional Transrectal Ultrasound (TRUS)-guided biopsy tends to fail, as samples are randomly collected from the prostate without aiming at suspicious lesions often visible in MRI. Currently, several new MRI biopsy approaches have come to the forefront. They are being evaluated and adopted in clinical practice, including in-bore MRI- guided biopsy and TRUS-guided MRI-fusion biopsy, collectively called ‘MRI-targeted biopsy.’ While recent literature shows that MRI-targeted biopsies can detect more clinically significant cancer than a conventional TRUS-guided biopsy, there is still a substantial issue with the precision placement of the needle in these procedures particularly in transperineal approach, resulting in clinicians being overly conservative with the amount of tissue removal (Zhang et al., 2019). Need to address needle placement accuracy in transperineal biopsy is further heightened lately as the fluoroquinolone- resistant Escherichia coli is becoming a significant concern in public health, and clinicians are shifting to use transperineal biopsies to avoid post-biopsy infections and overuse of antibiotics. Literature, as well as our preliminary studies, found that needle deflection is a substantial obstacle for precision aiming in transperineal biopsies. Abundant literature on needle deflection analysis, needle steering, and image-guided robots are available in pre-clinical engineering studies. Yet, clinically viable or proven solutions to address the needle deflection is yet to be seen. Therefore, the objective of this application is to develop and test a cooperative robotic intervention with closed-loop error compensation in MRI targeted biopsies and focal therapies, resulting in more precisely targeted instrument placement. Accurately, we will aim to address needle deflection by the synergic use of advanced imaging and robotics. Guided by robust preliminary data, this objective is achieved by pursuing three specific aims: 1) We will develop novel tracking techniques and clinically deploy a cooperatively controlled, hands-on robotic needle placement manipulator to enable fine instrument control at the periphery of the MRI bore. 2) We will test the usefulness of a cooperatively controlled robot to increase the accuracy of needle placement in animal studies mimicking MRI-guided biopsies of the prostate. Our approach is innovative in its application of novel cooperative robotic control, in which the clinician maintains ultimate control with the direction of motion being autonomous to ensure the desired path is followed to the intended target. The proposed study is also clinically significant since the completion of this current engineering study will enable machine- assisted semi-autonomous percutaneous therapy, much discussed in the recent editorial article in Science Robotics (Yang et al., 2018). The impact of the study reaches beyond MRI-targeted prostate intervention; the technology developed can be translated into other forms of MRI-guided or ultrasound-guided intervention.

前列腺多参数MRI的最新进展导致了新的发展 用于检测和诊断前列腺癌的研究方法 - 目的是准确风险 - 前列腺癌的分层。具体而言，传统的转直肠超声（TRU）指导 活检往往会失败，因为样本是从前列腺中随机收集的，而无需瞄准 可疑病变在MRI中经常可见。目前，已经有几种新的MRI活检方法了 到最前沿。它们正在临床实践中进行评估和通过，包括孔内MRI- 指导的活检和TRU引导的MRI融合活检，统称为“ MRI靶向活检”。尽管 最近的文献表明，以MRI为目标的活检可以检测到比临床意义更大的癌症 常规的TRUS引导活检，精确放置仍然存在一个重大问题 这些程序中的针头特别是在跨性质方法中，导致临床医生是 过度保守的组织去除量（Zhang等，2019）。需要解决针头 随着氟喹诺酮 - 抗性大肠杆菌正在成为公共卫生的重要问题，临床医生是 转移到使用经跨性活检以避免生物后感染和过度使用抗生素。 文学以及我们的初步研究发现，针挠度是一个巨大的障碍 针对跨膜活检的精确性。有关针挠度分析的丰富文献， 针头转向和图像引导的机器人可以在临床前工程研究中使用。然而， 临床上可行或经过验证的解决方案可以解决针挠度。因此， 该应用的目的是开发和测试与闭环的合作机器人干预 MRI靶向活检和局灶性疗法中的错误补偿，使得更加精确 目标仪器放置。准确地说，我们将通过协同作用来解决针头挠度 使用高级成像和机器人技术。在强大的初步数据的指导下，实现了这个目标 通过追求三个具体目标：1）我们将开发新颖的跟踪技术并在临床上部署 合作控制的，动手的机器人针头操纵器以启用精美的乐器 在MRI孔的外围控制。 2）我们将测试合作控制的有用性 在模仿MRI引导的动物研究中，机器人提高针头放置的准确性 前列腺活检。我们的方法在应用新颖的合作机器人方面具有创新性 控制，其中临床保持最终控制，运动方向是 自主，以确保所需的路径遵循预期的目标。拟议的研究是 自当前工程研究的完成以来，也具有临床意义 辅助半自动经皮疗法，在最近的编辑文章中进行了广泛讨论。 科学机器人技术（Yang等，2018）。研究的影响超出了MRI的目标 前列腺干预；开发的技术可以转化为其他形式的MRI引导或 超声引导的干预措施。