Performance of Robotic Assistance for Skull Base Biopsy: A Phantom Study

Abstract

Objectives This study aims to evaluate the feasibility of a custom robot system guided by optical cone beam computed tomography (CBCT)-based navigation for skull base biopsy.

Design An accuracy study was conducted.

Setting Platform for navigation and robot-aided surgery technology.

Participants Phantom skull.

Main Outcome Measures The primary outcome measure was to investigate the accuracy of robot-assisted needle biopsy for skull base tumors. A 14-gauge needle was automatically inserted by the five degrees of freedom robot into the intended target, guided by optical navigation. The result was displayed on the graphical user interface after matrix transformation. Postoperative image scanning was performed, and the result was verified with image fusion.

Results All 20 interventions were successfully performed. The mean deviation of the needle tip was 0.56 ± 0.22 mm (measured by the navigation system) versus 1.73 ± 0.60 mm (measured by image fusion) (p < 0.05). The mean insertion depth was 52.3 mm (range: 49.7–55.2 mm). The mean angular deviations off the x-axis, y-axis, and z-axis were 1.51 ± 0.67, 2.33 ± 1.65, and 1.47 ± 1.16 degrees, respectively.

Conclusions The experimental results show the robot system is efficient, reliable, and safe. The navigation accuracy is a significant factor in robotic procedures.

Keywords

robotics - image-guided biopsy - skull base - navigation

Note

Prof. Chuan-Bin Guo and Dr. Xiao-Jing Liu contributed equally to the article.

• References

• 1 Kronreif G, Fürst M, Kettenbach J, Figl M, Hanel R. Robotic guidance for percutaneous interventions. Adv Robot 2003; 17 (06) 541-560
• 2 Masamune K, Fichtinger G, Patriciu A. , et al. System for robotically assisted percutaneous procedures with computed tomography guidance. Comput Aided Surg 2001; 6 (06) 370-383
• 3 Masamune M, Hong J. Advanced imaging and robotics technologies for medical applications. Int J Optomechatronics 2011; 5 (04) 299-321
• 4 Kim H, Park CM, Lee SM, Goo JM. C-arm cone-beam CT virtual navigation-guided percutaneous mediastinal mass biopsy: diagnostic accuracy and complications. Eur Radiol 2015; 25 (12) 3508-3517
• 5 Maan ZN, Gibbins N, Al-Jabri T, D'Souza AR. The use of robotics in otolaryngology-head and neck surgery: a systematic review. Am J Otolaryngol 2012; 33 (01) 137-146
• 6 Cleary K, Melzer A, Watson V, Kronreif G, Stoianovici D. Interventional robotic systems: applications and technology state-of-the-art. Minim Invasive Ther Allied Technol 2006; 15 (02) 101-113
• 7 Koethe Y, Xu S, Velusamy G, Wood BJ, Venkatesan AM. Accuracy and efficacy of percutaneous biopsy and ablation using robotic assistance under computed tomography guidance: a phantom study. Eur Radiol 2014; 24 (03) 723-730
• 8 Solomon SB, Patriciu A, Bohlman ME, Kavoussi LR, Stoianovici D. Robotically driven interventions: a method of using CT fluoroscopy without radiation exposure to the physician. Radiology 2002; 225 (01) 277-282
• 9 De Ceulaer J, De Clercq C, Swennen GR. Robotic surgery in oral and maxillofacial, craniofacial and head and neck surgery: a systematic review of the literature. Int J Oral Maxillofac Surg 2012; 41 (11) 1311-1324
• 10 Caversaccio M, Zulliger D, Bächler R, Nolte LP, Häusler R. Practical aspects for optimal registration (matching) on the lateral skull base with an optical frameless computer-aided pointer system. Am J Otol 2000; 21 (06) 863-870
• 11 Luebbers HT, Messmer P, Obwegeser JA. , et al. Comparison of different registration methods for surgical navigation in cranio-maxillofacial surgery. J Craniomaxillofac Surg 2008; 36 (02) 109-116
• 12 Besl PJ, Mckay HD. A method for registration of 3-D shapes. IEEE Trans Pattern Anal Mach Intell 1992; 14: 239-256
• 13 Masuda T, Yokoya N. A robust method for registration and segmentation of multiple range images. Comput Vis Image Und 1995; 61: 295-307
• 14 Bae KH, Lichti D. A method for automated registration of unorganised point clouds. ISPRS J Photogramm 2008; 63 (01) 36-54
• 15 Umeyama S. Least-squares estimation of transformation parameters between twopoint patterns. IEEE T Pattern Anal 1991; 13 (04) 376-380
• 16 Xu N, Ahuja N, Bansal R. Object segmentation using graph cuts based active contours. Comput Vis Image Und 2007; 107: 210-224
• 17 Korb W, Kornfeld M, Birkfellner W. , et al. Risk analysis and safety assessment in surgical robotics: a case study on a biopsy robot. Minim Invasive Ther Allied Technol 2005; 14 (01) 23-31
• 18 Abolhassani N, Patel R, Moallem M. Needle insertion into soft tissue: a survey. Med Eng Phys 2007; 29 (04) 413-431
• 19 Zhou Y, Thiruvalluvan K, Krzeminski L, Moore WH, Xu Z, Liang Z. CT-guided robotic needle biopsy of lung nodules with respiratory motion - experimental system and preliminary test. Int J Med Robot 2013; 9 (03) 317-330
• 20 Dogangil G, Davies BL, Rodriguez y Baena F. A review of medical robotics for minimally invasive soft tissue surgery. Proc Inst Mech Eng H 2010; 224 (05) 653-679
• 21 Kettenbach J, Kronreif G, Figl M. , et al. Robot-assisted biopsy using computed tomography-guidance: initial results from in vitro tests. Invest Radiol 2005; 40 (04) 219-228
• 22 Tovar-Arriaga S, Vargas JE, Ramos JM, Aceves MA, Gorrostieta E, Kalender WA. A fully sensorized cooperative robotic system for surgical interventions. Sensors (Basel) 2012; 12 (07) 9423-9447
• 23 Aghayev E, Ebert LC, Christe A. , et al. CT data-based navigation for post-mortem biopsy--a feasibility study. J Forensic Leg Med 2008; 15 (06) 382-387
• 24 Penzkofer T, Isfort P, Bruners P. , et al. Robot arm based flat panel CT-guided electromagnetic tracked spine interventions: phantom and animal model experiments. Eur Radiol 2010; 20 (11) 2656-2662
• 25 Pollock R, Mozer P, Guzzo TJ. , et al. Prospects in percutaneous ablative targeting: comparison of a computer-assisted navigation system and the AcuBot Robotic System. J Endourol 2010; 24 (08) 1269-1272
• 26 Kettenbach J, Kara L, Toporek G, Fuerst M, Kronreif G. A robotic needle-positioning and guidance system for CT-guided puncture: Ex vivo results. Minim Invasive Ther Allied Technol 2014; 23 (05) 271-278
• 27 Yanof J, Haaga J, Klahr P. , et al. CT-integrated robot for interventional procedures: preliminary experiment and computer-human interfaces. Comput Aided Surg 2001; 6 (06) 352-359
• 28 Seifabadi R, Cho NB, Song SE. , et al. Accuracy study of a robotic system for MRI-guided prostate needle placement. Int J Med Robot 2013; 9 (03) 305-316
• 29 Zangos S, Melzer A, Eichler K. , et al. MR-compatible assistance system for biopsy in a high-field-strength system: initial results in patients with suspicious prostate lesions. Radiology 2011; 259 (03) 903-910
• 30 Song DY, Burdette EC, Fiene J. , et al. Robotic needle guide for prostate brachytherapy: clinical testing of feasibility and performance. Brachytherapy 2011; 10 (01) 57-63
• 31 Davies BL, Harris SJ, Dibble E. Brachytherapy--an example of a urological minimally invasive robotic procedure. Int J Med Robot 2004; 1 (01) 88-96
• 32 Schulz B, Eichler K, Siebenhandl P. , et al. Accuracy and speed of robotic assisted needle interventions using a modern cone beam computed tomography intervention suite: a phantom study. Eur Radiol 2013; 23 (01) 198-204
• 33 Simone C, Okamura AM. Modeling of needle insertion forces for robot-assisted percutaneous therapy. International Conference on Robotics & Automation 2002; 2: 2085-2091
• 34 Kataoka H, Washio T, Audette M, Mizuhara K. . A Model for Relations Between Needle Deflection, Force, and Thickness on Needle Penetration. Paper presented at: Medical Image Computing and Computer-Assisted Intervention-Miccai 2001, International Conference; October 14-17, 2001; Utrecht, the Netherlands
• 35 Okamura AM, Simone C, O'Leary MD. Force modeling for needle insertion into soft tissue. IEEE Trans Biomed Eng 2004; 51 (10) 1707-1716
• 36 Gerovichev O, Marayong P, Okamura AM. The effect of visual and haptic feedback on manual and teleoperated needle insertion. Lect Notes Comput Sc 2002; 2488: 147-154
• 37 Bao N, Chen Y, Yue Y. , et al. Fiducial markers configuration optimization in image-guided surgery. Biomed Mater Eng 2014; 24 (06) 3361-3371
• 38 Kettenbach J, Kronreif G. Robotic systems for percutaneous needle-guided interventions. Minim Invasive Ther Allied Technol 2015; 24 (01) 45-53