Bronchoscopic Steerable Needles for Transparenchymal Access to Lung Nodules

项目摘要/摘要 这项提议的目标是创建一种新的机器人系统，该系统部署支气管镜可操纵的针头 可以引导肺实质安全地对目前无法通过支气管镜检查的结节进行活检- 在技术上。更好的肺活检方法的需要是由于肺癌导致超过15万人死亡的事实 美国人每年都能存活下来，这取决于早期诊断，而早期诊断需要活组织检查来清除fi。Cur- 用于获取可疑结节以进行活组织检查的RET方法也无法准确地到达许多结节 周围肺(即那些不靠近支气管者)或有气胸风险(肺塌陷)， 对于慢性阻塞性肺疾病患者来说，fi是一个特别显著的危险因素。扩大……的阶级 对于早期fi诊断准确和安全的患者，我们提出的新系统将得到利用 一种新型可转向针头扩大支气管镜检查范围和安全可靠的能力 肺内有活检结节。与经皮活检相比，新系统将降低 由于针头是从肺内展开的，不会刺破胸膜，因此会导致气胸。 我们的新系统将在临床上具有创新性，因为它将在整个过程中提供经支气管探查结节的途径。 肺部，通过转向和半自动控制提高瞄准精度，并能够避免重大 通过将针头绕着血管而流血。它将是技术上的创新，因为它的新颖的3阶段 该设计便于通过支气管镜将fl出口尖端可引导的针部署到肺实质中， 将首次将活检收集与可导向针集成在一起，并将利用人-机器人协作-fi。 定量，以优化针头转向，确保患者安全。 我们的方法是使用一个三级机器人装置。这位医生将首先引导支气管镜通过 然后将同心管针通过支气管镜的端口展开， 穿过支气管壁。这个同心管针将瞄准所需的结节，并作为发射 用于flExure-Tier可定向针头的指针，它将在图像引导下穿过肺实质 来自电磁跟踪的反馈。为了创建这个系统，我们的规范fic的目标是(1)设计和构建一个 通过支气管镜部署机器人控制的可定向针头，(2)开发直观的医生界面 以及(3)使用肺模体进行临床前系统验证研究， 体外猪肺和活体动物研究。这个项目汇集了一个跨领域的多学科团队 实现这些目标所需的专门知识领域，包括介入肺病学方面的专门知识， 心胸外科、放射学、医学图像分析、机械工程和计算机科学。这 拟议的研究有可能通过实现低风险、可靠的结核获取来加强公共卫生 对于全肺早期，Defi初步诊断为肺癌。

Project Summary/Abstract The objective of this proposal is to create a new robotic system that deploys bronchoscopic steerable needles that can steer through the lung parenchyma to safely biopsy nodules that are currently inaccessible bronchoscop- ically. The need for better lung biopsy approaches is motivated by the fact that lung cancer kills over 150,000 Americans each year and that survival depends on early diagnosis, which requires biopsy to be definitive. Cur- rent approaches for accessing suspicious nodules for biopsy either are unable to accurately reach many nodules in the peripheral lung (i.e., those not adjacent to a bronchial tube) or risk pneumothorax (lung collapse), which is a particularly significant risk for patients with chronic obstructive pulmonary disease. To broaden the class of patients for which early-stage definitive diagnosis is accurate and safe, the new system we propose will harness the capabilities of a new class of steerable needles to extend the range of bronchoscopes and reliably and safely biopsy nodules throughout the lung. Compared to percutaneous biopsy, the new system will decrease the risk of pneumothorax since the needles are deployed from within the lung, without puncturing the pleura. Our new system will be clinically innovative since it will provide transbronchial access to nodules throughout the lung, increase targeting accuracy through steering and semi-automatic control, and be able to avoid major bleeding by steering the needle around blood vessels. It will be technically innovative since its novel 3-stage design facilitates deployment of a flexure-tip steerable needle through a bronchoscope into the lung parenchyma, will integrate biopsy collection with a steerable needle for the first time ever, and will utilize human-robot collabo- ration to optimize needle steering and ensure patient safety. Our approach is to use a three-stage robotic device. The physician will first guide a bronchoscope through the airways to a desired exit point, then deploy a concentric tube needle through the bronchoscope's port and out through the bronchial wall. This concentric tube needle will aim at the desired nodule and be the launch point for a flexure-tip steerable needle that will travel through the lung parenchyma under image guidance with feedback from electromagnetic tracking. To create this system, our specific aims are to (1) design and build a robotically-controlled steerable needle deployed via a bronchoscope, (2) develop an intuitive physician interface with semi-automatic needle steering, and (3) conduct preclinical system validation studies using lung phantoms, ex vivo porcine lungs, and live animal studies. This project brings together a multidisciplinary team that spans the areas of expertise necessary to accomplish these aims, including expertise in interventional pulmonology, cardiothoracic surgery, radiology, medical image analysis, mechanical engineering, and computer science. This proposed research has the potential to enhance public health by enabling low-risk, reliable access to nodules throughout the lung for early-stage, definitive diagnosis of lung cancer.