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 的最新进展导致新的研究激增 前列腺癌检测和诊断的研究方法 - 目标是准确的风险 - 具体来说，是传统的经直肠超声 (TRUS) 引导的前列腺癌分层。 活检往往会失败，因为样本是从前列腺中随机采集的，而不是针对 MRI 中经常可见可疑病变 目前，已经出现了几种新的 MRI 活检方法。 它们正在临床实践中得到评估和采用，包括孔内 MRI- 引导活检和 TRUS 引导 MRI 融合活检，统称为“MRI 靶向活检”。 最近的文献表明，MRI 靶向活检可以检测出比活检更多的具有临床意义的癌症。 传统的 TRUS 引导活检仍存在一个实质性问题：活检的精确定位 这些手术中的针，特别是经会阴入路，导致 对组织去除量过于保守（Zhang et al., 2019）。 随着氟喹诺酮类药物的使用，经会阴活检的放置准确性最近进一步得到改善。 耐药性大肠杆菌正在成为公共卫生领域的一个重大问题，超级明星们正在 转向使用经会阴活检以避免活检后感染和过度使用抗生素。 文献以及我们的初步研究发现针偏转是一个重大障碍 用于经会阴活检的精确瞄准 有关针偏转分析的大量文献， 针转向和图像引导机器人可用于临床前工程研究。 因此，尚未找到临床上可行或经过验证的解决针偏转的解决方案。 该应用程序的目标是开发和测试具有闭环的协作机器人干预 MRI 靶向活检和局部治疗中的误差补偿，从而获得更精确的结果 准确地说，我们的目标是通过协同作用来解决针偏转问题。 在可靠的初步数据的指导下，使用先进的成像和机器人技术，这一目标得以实现。 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 协作控制、手动操作的机器人置针操纵器，以实现精密仪器 MRI 孔外围的控制 2) 我们将测试协作控制的有效性。 机器人在模拟 MRI 引导的动物研究中提高置针的准确性 我们的方法在新型协作机器人的应用方面具有创新性。 控制，临床医生通过运动方向保持最终控制 自主，以确保遵循所需的路径达到预期目标。 也具有临床意义，因为当前工程研究的完成将使机器 辅助半自主经皮治疗，在最近的社论文章中进行了大量讨论 Science Robotics（Yang 等人，2018）该研究的影响超出了 MRI 目标。 前列腺干预；所开发的技术可以转化为其他形式的 MRI 引导或 超声引导干预。