Ultrasound-Guided Robotic Needle Steering for Ablation of Liver Cancer

超声引导机器人针转向消融肝癌

• 批准号: 8818043
• 负责人: Allison Mariko Okamura
• 金额: $ 32.87万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-26 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8818043
• 关键词: Ablation; Address; Adoption; Anatomy; Animal Model; Area; Clinical; Comorbidity; Devices; Diagnosis; Diagnostic; Disease; Effectiveness; Electrodes; Environment; Excision; Failure; Family suidae; Feedback; Geometry; Goals; Hand; Health; Hemorrhage; Histologic; Human; Image; Imagery; Improve Access; Intervention; Interventional radiology; Lead; Learning; Life; Liver; Liver diseases; Liver neoplasms; Lobe; Location; Lung; Malignant neoplasm of liver; Manuals; Maps; Measures; Medical Imaging; Metastatic Neoplasm to the Liver; Methods; Modeling; Movement; Needles; Neoplasm Metastasis; Operative Surgical Procedures; Organ; Outcome; Patients; Positioning Attribute; Primary carcinoma of the liver cells; Procedures; Puncture procedure; Quality of life; Radiofrequency Interstitial Ablation; Risk; Robot; Robotics; Shapes; Solid; Specific qualifier value; Structure; Surface; System; Technology; Testing; Time; Tissues; Treatment Failure; Ultrasonography; United States; Vision; Visual; Work; base; cancer diagnosis; capsule; clinical practice; design; flexibility; imaging modality; improved; in vivo; instrument; killings; liver function; minimally invasive; novel; prevent; public health relevance; radiologist; reconstruction; research study; robot assistance; robotic device; soft tissue; technology development; tumor

DESCRIPTION (provided by applicant): An estimated 33,190 new cases of primary liver cancer and an even larger number of new cases of metastatic cancer to the liver will be diagnosed in the United States in 2014. Eradicating those tumors improves patient survival. Percutaneous radiofrequency ablation (RFA), which kills tumors via thermal damage, is a minimally invasive treatment appropriate for the many patients who are not eligible for surgical resection, particularly those with certain tumor type, location, or size; poor liver function; or oher comorbidities. However, technical limitations have precluded broader adoption of RFA as a means of eliminating liver tumors. Tumors in some portions of the liver cannot be accessed because the straight paths currently taken by RFA electrodes would traverse vasculature, lung, or other sensitive structures. Large tumors require multiple electrode insertions; the increased bleeding risk with each puncture through the liver capsule can be too great in patients with advanced liver disease or severe comorbidities. The long-term goal of this work is to significantly improve access, accuracy, and precision during percutaneous liver RFA procedures using robot-assisted needle steering. The following specific aims will enable the development of this technology and demonstrate feasibility, as a path to clinical adoption: Specific Aim 1: Optimize ultrasound-based localization of highly curved needles and closed-loop control of robotic needle steering. Specific Aim 2: Develop an interactive user control interface and enable teleoperated needle steering intervention. Specific Aim 3: Design a clinical robot-assisted needle steering system for percutaneous liver RFA, validated in an ex vivo liver model. Specific Aim 4: Validate the ultrasound-guided needle steering system in vivo in porcine liver. Needle steering enables the insertion of highly flexible needles or guidewires along controlled, curved, 3D paths through tissue. Thus, the needle can be actively steered to acquire tumors not accessible by a straight- line path, and unexpected deviations from the desired path can be corrected as the needle advances toward the tumor. A functional needle steering system appropriate for in vivo experimentation must be compatible with widely available medical imaging (here, ultrasound imaging), have the ability to deliver treatment (here, RFA through the use of a steerable needle electrode), and an appropriate user interface including visualization and human-in-the-loop teleoperation. This technology could extend the survival advantages of RFA to patients who may otherwise not have good treatment options, and in the long term, be used for accurate placement of diagnostic devices and treatment of diseases in other organs.

描述（由申请人提供）：2014年，美国估计将诊断出33，190例原发性肝癌新发病例和更多的肝转移癌新发病例。根除这些肿瘤可以提高患者的生存率。经皮射频消融术（RFA）通过热损伤杀死肿瘤，是一种微创治疗方法，适用于许多不适合手术切除的患者，特别是具有特定肿瘤类型、位置或大小;肝功能差;或其他合并症的患者。然而，由于技术上的局限性，射频消融无法作为消除肝脏肿瘤的一种手段。由于RFA电极目前采用的直线路径将穿过血管系统、肺或其他敏感结构，因此无法进入肝脏某些部分的肿瘤。大型肿瘤需要多次电极插入;在晚期肝病或严重合并症患者中，每次穿刺肝包膜会增加出血风险。这项工作的长期目标是在使用机器人辅助针转向的经皮肝脏RFA手术期间显著改善通路、准确性和精确度。以下具体目标将使该技术的开发成为可能，并证明其可行性，作为临床采用的途径：具体目标1：优化高度弯曲针的超声定位和机器人针转向的闭环控制。 具体目标2：开发交互式用户控制界面，并启用远程操作针转向干预。 具体目标3：设计用于经皮肝脏RFA的临床机器人辅助针转向系统，并在离体肝脏模型中进行验证。 特定目的4：在猪肝中体内验证超声引导针转向系统。针转向使得能够沿着沿着受控的弯曲的3D路径将高度柔性的针或导丝插入穿过组织。因此，可以主动地操纵针以获取直线路径不可接近的肿瘤，并且随着针朝向肿瘤前进，可以校正与期望路径的意外偏差。适用于体内实验的功能性针转向系统必须与广泛可用的医学成像（此处为超声成像）兼容，具有输送治疗（此处为通过使用可转向针电极进行RFA）的能力，以及适当的用户界面，包括可视化和人在环远程操作。这项技术可以将RFA的生存优势扩展到那些可能没有良好治疗选择的患者，从长远来看，可用于准确放置诊断设备和治疗其他器官的疾病。