Robotic Haptic Feedback System for Bx/RFA of Breast Tumor under Continuous MRI

连续 MRI 下乳腺肿瘤 Bx/RFA 机器人触觉反馈系统

• 批准号: 7583633
• 负责人: JAYDEV P. DESAI
• 金额: $ 32.63万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-15 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7583633
• 关键词: Ablation; American Cancer Society; Area; Automobile Driving; Biopsy; Blood flow; Breast; Breast Cancer Detection; Breast Cancer Treatment; Cancerous; Cells; Chairperson; Characteristics; Clinical; Coagulative necrosis; Computer Simulation; Computer software; Contralateral; Coupling; Cryosurgery; Cytology; Cytolysis; Detection; Development; Device or Instrument Development; Devices; Diagnosis; Diagnostic; Differential Diagnosis; Dose; Edema; Effectiveness; Elements; Engineering; Enhancing Lesion; Ensure; Environment; Evaluation; Family suidae; Fatty acid glycerol esters; Feedback; Frozen Sections; Future; Goals; Hand; Head; Healthcare; Heating; Histocompatibility Testing; Histology; Human Resources; Human body; Image; Imagery; Ionizing radiation; Joints; Journals; Lasers; Lateral; Lead; Left; Lesion; Letters; Life; Liver neoplasms; Magnetic Resonance Imaging; Malignant Neoplasms; Mammary Gland Parenchyma; Mammary Neoplasms; Mammography; Maps; Maryland; Mastectomy; Measurement; Measures; Mechanics; Medicine; Methods; Microbubbles; Minor; Modality; Modeling; Modification; Monitor; Needles; New England; Noninfiltrating Intraductal Carcinoma; Nuclear Grade; Numbers; Operative Surgical Procedures; Other Imaging Modalities; Pathologist; Patients; Physicians; Placement; Play; Positioning Attribute; Predictive Value; Procedures; Process; Property; Public Health; Publishing; Puncture biopsy; Puncture procedure; Purpose; Radiation; Radiofrequency Interstitial Ablation; Radiology Specialty; Rate; Recurrence; Reporting; Resolution; Respiration; Robot; Robotics; Role; Sampling; Sampling Errors; Scheme; Sensitivity and Specificity; Side; Site; Skin; Staging; Standards of Weights and Measures; Structure; Sus scrofa; System; Techniques; Technology; Temperature; Testing; Time; Tissue Model; Tissues; Today; Touch sensation; Ultrasonography; United States; United States National Institutes of Health; Universities; Use of New Techniques; Woman; Wood material; Work; Workplace; X-Ray Computed Tomography; base; breast cancer diagnosis; cancer recurrence; computerized; design; desire; electric impedance; haptics; improved; in vivo; innovation; malignant breast neoplasm; medical schools; novel; phantom model; predictive modeling; prevent; radiologist; research study; response; soft tissue; statistics; tool; trend; tumor

DESCRIPTION (provided by applicant): The American Cancer Society estimates that 182,460 women will be diagnosed with breast cancer and that 40,480 women will die of breast cancer in the United States alone in 2008. One in 8 women born today is likely to be diagnosed with breast cancer during their lifetime. Although these statistics are discouraging, positive trends are evident as a result of innovations in diagnosis and treatment over the past decade. Recent, large scale studies reported in The Lancet and The New England of Journal of Medicine demonstrate the value of MRI as an effective tool in the diagnosis of breast cancer. Hence, coupling diagnosis with MRI based biopsy (Bx) will lead to better delineation of the tumor margin. For breast cancer treatment, radiofrequency ablation (RFA) has emerged as a promising approach for early stage breast cancer with maximum effectiveness and conservation of healthy breast tissue without full surgical intervention. While Ultrasound (US) and Computed tomography (CT) is the imaging modality for RFA, they are not without their drawbacks. In US, there is limitation on the precision with which a needle placement can be performed and the image distortion due to the formation of microbubbles during RFA obscures the visualization of the tumor. CT lacks the ability of providing soft tissue contrast as good as MRI and also exposes the patients to radiation dose. MRI on the other hand provides excellent soft-tissue contrast, no ionizing radiation, and accurate thermographic maps at the ablation site. Although the utility of RFA has been demonstrated in treating several types of lesion, the recurrence rate of tumors has not been as low as one would desire (8-47%). The recurrence of cancer after RFA or misdiagnosis in a breast biopsy using US, CT, or MRI could be a result of planning the trajectory towards the tumor based on images obtained earlier and not under continuous MRI guidance. Although a subjective evaluation is performed after the placement of the needle, even small errors in the trajectory could lead to sub- optimal results for biopsy and RFA. Hence, we propose a novel robotic approach with haptic feedback under continuous MRI with frontal access (from the head of the magnet bore) and oblique angle needle driving capability for both breast biopsy and RF ablation in a manner that minimizes sampling errors during biopsy and delivers optimal therapy during RF ablation. The proposed system will be a significant improvement of the current MRI 'guided' lateral (left or right side) approach with limited angle needle trajectory. At the very fundamental level, this project seeks to provide physicians with: 1) the ability to perform biopsy and accurate delivery of RFA probe under continuous MRI and 2) a teleoperated robotic system with haptic feedback capability to help the physician guide the biopsy and RFA needle with frontal access and oblique angle needle driving capability, enabling a wider access angle to various regions of the breast. To accomplish this, we have assembled an excellent team of engineers and clinicians from the University Of Maryland School Of Medicine and the NIH for this extremely important health-care project. PUBLIC HEALTH RELEVANCE: The American Cancer Society estimates that 182,460 women will be diagnosed with breast cancer and that 40,480 women will die of breast cancer in the United States alone in 2008. The purpose of this project is to develop a novel robotic system that will work under continuous magnetic resonance imaging for both breast biopsy (Bx) and radiofrequency ablation (RFA) of breast tumor.

描述（由申请人提供）：美国癌症协会估计，2008年仅在美国就有182，460名妇女被诊断患有乳腺癌，40，480名妇女将死于乳腺癌。今天出生的妇女中有八分之一可能在其一生中被诊断患有乳腺癌。虽然这些统计数字令人沮丧，但由于过去十年在诊断和治疗方面的创新，积极的趋势是显而易见的。最近，在《柳叶刀》和《新英格兰医学杂志》上报道的大规模研究证明了MRI作为诊断乳腺癌的有效工具的价值。因此，结合基于MRI的活检（Bx）诊断将导致更好地描绘肿瘤边缘。对于乳腺癌治疗，射频消融术（RFA）已成为治疗早期乳腺癌的一种有前途的方法，具有最大的有效性和保护健康的乳腺组织，而无需完全手术干预。虽然超声（US）和计算机断层扫描（CT）是RFA的成像模式，但它们并非没有缺点。在US中，可以执行针放置的精度存在限制，并且由于RFA期间形成微泡而导致的图像失真模糊了肿瘤的可视化。CT缺乏提供与MRI一样好的软组织对比度的能力，并且还使患者暴露于辐射剂量。另一方面，MRI提供了良好的软组织对比度，无电离辐射，并在消融部位提供了准确的热成像图。尽管RFA在治疗几种类型的病变中已被证明是有效的，但肿瘤的复发率并不像人们期望的那样低（8-47%）。RFA后癌症复发或使用US、CT或MRI进行乳腺活检时的误诊可能是基于早期获得的图像而不是在连续MRI引导下规划肿瘤轨迹的结果。尽管在放置针后进行主观评价，但即使轨迹中的微小误差也可能导致活检和RFA的次优结果。因此，我们提出了一种新的机器人方法，在连续MRI下具有触觉反馈，具有正面访问（从磁体孔的头部）和斜角针驱动能力，用于乳腺活检和射频消融，其方式是最大限度地减少活检期间的采样误差，并在射频消融期间提供最佳治疗。所提出的系统将是当前MRI“引导”侧向（左侧或右侧）入路的显著改进，其具有有限角度的针轨迹。在最基本的层面上，该项目旨在为医生提供：1）在连续MRI下进行活检和准确输送RFA探头的能力，以及2）具有触觉反馈能力的遥控机器人系统，以帮助医生引导活检和RFA针，具有正面进入和斜角针驱动能力，能够以更宽的进入角度进入乳房的各个区域。为了实现这一目标，我们从马里兰州大学医学院和美国国立卫生研究院组建了一支优秀的工程师和临床医生团队，以完成这一极其重要的医疗保健项目。 公共卫生相关性：美国癌症协会估计，2008年仅在美国就有182,460名妇女被诊断患有乳腺癌，40,480名妇女将死于乳腺癌。本项目的目的是开发一种新型的机器人系统，该系统将在连续磁共振成像下工作，用于乳腺肿瘤的乳腺活检（Bx）和射频消融（RFA）。