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.

前列腺的多参数MRI的最新进展导致了新的前列腺疾病的激增。 前列腺癌的检测和诊断的研究方法-以准确的风险为目标- 前列腺癌的治疗具体而言，传统的经直肠超声（TRUS）引导 活检往往会失败，因为样本是从前列腺随机收集的， MRI中常可见可疑病变。目前，几种新的MRI活检方法已经出现， 到最前沿。它们正在临床实践中进行评估和采用，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”。而 最近的文献表明，MRI靶向活检可以检测出比MRI更有临床意义的癌症。 传统的TRUS引导活检，仍然存在精确放置的实质性问题， 针在这些程序中，特别是在经会阴的方法，导致临床医生 组织切除量过于保守（Zhang等，2019年）。需要解决针 经会阴活检的定位准确性最近进一步提高，因为氟喹诺酮- 耐药大肠杆菌正在成为公共卫生中的重要问题，临床医生正在 改用经会阴活检，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，针偏转是一个实质性障碍 用于经会阴活检的精确瞄准。关于缝针偏转分析的丰富文献， 针转向和图像引导机器人可用于临床前工程研究。然而， 解决针偏转的临床上可行的或经证实的解决方案还有待观察。因此 本申请的目的是开发和测试具有闭环的协作机器人干预 MRI靶向活检和病灶治疗中的误差补偿， 有针对性的器械放置。准确地说，我们的目标是通过协同作用解决针偏转问题。 使用先进的成像技术和机器人技术。在可靠的初步数据指导下，这一目标得以实现 通过追求三个具体目标：1）我们将开发新的跟踪技术和临床部署 协作控制的、动手操作的机器人针放置操纵器， 在MRI孔的外围进行控制。2)我们将测试一个合作控制的 机器人在动物研究中提高针放置的准确性， 前列腺活检该方法在新型协作机器人的应用中具有创新性 控制，其中临床医生保持最终控制，运动方向为 自主地确保沿着期望的路径到达预期目标。拟定研究 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讨论了很多， 科学机器人学（Yang等人，2018年）。该研究的影响超出了MRI靶向 前列腺介入;开发的技术可以转化为其他形式的MRI引导或 超声引导介入治疗