Bronchoscopic Steerable Needles for Transparenchymal Access to Lung Nodules

项目总结/摘要 该提案的目的是创建一种新的机器人系统，用于部署支气管镜可操纵针 它可以通过肺实质安全地对目前支气管镜无法触及的结节进行活检， 真的需要更好的肺活检方法的动机是肺癌导致超过15万人死亡 美国人每年死亡，生存取决于早期诊断，这需要活检来确定。Cur- 进入可疑结节进行活检的方法不能准确地到达许多结节 在外周肺中（即，那些不靠近支气管的人）或有气胸（肺萎陷）的风险， 对于慢性阻塞性肺疾病患者来说，这是一个特别重大的风险。扩大…的范围 对于早期确诊准确安全的患者，我们提出的新系统将利用 新型可操纵针扩展支气管镜范围的能力， 整个肺都有活检结节与经皮活检相比，新系统将降低 这是因为针是从肺内部署的，而不刺穿胸膜。 我们的新系统将是临床创新的，因为它将提供经支气管进入结节， 肺，通过转向和半自动控制提高瞄准精度，并能够避免重大 通过将针引导到血管周围而出血。这将是技术创新，因为其新颖的3阶段 该设计便于通过支气管镜在肺实质中部署穿刺尖端可操纵针， 将有史以来第一次将活检收集与可操纵的针相结合，并将利用人机协作， 定量，以优化针转向并确保患者安全。 我们的方法是使用一个三阶段的机器人设备。医生首先会引导支气管镜通过 将气管扩张到期望的出口点，然后通过支气管镜的端口部署同心管针， 穿过支气管壁这种同心管针将瞄准所需的结节， 用于在图像引导下穿过肺实质的可操控针头的尖端， 来自电磁跟踪的反馈为了创建这个系统，我们的具体目标是（1）设计和构建一个 通过支气管镜展开的机器人控制的可操纵针，（2）开发直观的医生界面 具有半自动针转向，以及（3）使用肺体模进行临床前系统验证研究， 离体猪肺和活体动物研究。该项目汇集了一个跨学科的团队， 实现这些目标所需的专业领域，包括介入肺病学的专业知识， 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众健康 肺癌的早期诊断，肺癌的早期诊断

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.