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Biomedical subjects

Kevin Cleary

Publications and source records attributed to Kevin Cleary.

14 recordsLinked to original sources
PubMed2006

Lung deformation estimation and four-dimensional CT lung reconstruction.

RATIONALE AND OBJECTIVES: Four-dimensional (4D) computed tomography (CT) can be used in radiation treatment planning to account for respiratory motion. Current 4D CT techniques have limitations in either spatial or temporal resolution. In addition, most of these techniques rely on auxiliary surrogates to relate the time of the CT scan to the patient's respiratory phase. We propose a 4D CT method for lung applications to overcome these problems. MATERIALS AND METHODS: A set of axial scans are taken at multiple table positions to obtain a series of two-dimensional images while the patient is breathing freely. Each two-dimensional image is registered to a reference CT volume. The deformation of the image with respect to the volume is used to synchronize the image with the respiratory cycle assuming that there is no phase variation along the craniocaudal direction. The reconstructed 4D dataset is a series of deformable transformations of the reference volume. RESULTS: A synthetic 4D dataset showed that the registration error is less than 5% of the image deformation. A swine study showed that the algorithm can generate better image quality than the image sorting method. A respiratory-gated 4D dataset showed that the algorithm's result is consistent with the ground truth. CONCLUSION: The algorithm can reconstruct good quality 4D images without external surrogates even if the CT scans are acquired under irregular respiratory motion. The algorithm may allow for reduced radiation dose to the patient with a limited loss of image quality. Although the phase variation exists along the craniocaudal direction, the 4D reconstruction is reasonably accurate.

Algorithms↗
PubMed2006

Magnetic resonance imaging compatible robotic system for fully automated brachytherapy seed placement.

OBJECTIVES: To introduce the development of the first magnetic resonance imaging (MRI)-compatible robotic system capable of automated brachytherapy seed placement. METHODS: An MRI-compatible robotic system was conceptualized and manufactured. The entire robot was built of nonmagnetic and dielectric materials. The key technology of the system is a unique pneumatic motor that was specifically developed for this application. Various preclinical experiments were performed to test the robot for precision and imager compatibility. RESULTS: The robot was fully operational within all closed-bore MRI scanners. Compatibility tests in scanners of up to 7 Tesla field intensity showed no interference of the robot with the imager. Precision tests in tissue mockups yielded a mean seed placement error of 0.72 +/- 0.36 mm. CONCLUSIONS: The robotic system is fully MRI compatible. The new technology allows for automated and highly accurate operation within MRI scanners and does not deteriorate the MRI quality. We believe that this robot may become a useful instrument for image-guided prostate interventions.

Brachytherapy↗
PubMed2006

Interventional robotic systems: applications and technology state-of-the-art.

Many different robotic systems have been developed for invasive medical procedures. In this article we will focus on robotic systems for image-guided interventions such as biopsy of suspicious lesions, interstitial tumor treatment, or needle placement for spinal blocks and neurolysis. Medical robotics is a young and evolving field and the ultimate role of these systems has yet to be determined. This paper presents four interventional robotics systems designed to work with MRI, CT, fluoroscopy, and ultrasound imaging devices. The details of each system are given along with any phantom, animal, or human trials. The systems include the AcuBot for active needle insertion under CT or fluoroscopy, the B-Rob systems for needle placement using CT or ultrasound, the INNOMOTION for MRI and CT interventions, and the MRBot for MRI procedures. Following these descriptions, the technology issues of image compatibility, registration, patient movement and respiration, force feedback, and control mode are briefly discussed. It is our belief that robotic systems will be an important part of future interventions, but more research and clinical trials are needed. The possibility of performing new clinical procedures that the human cannot achieve remains an ultimate goal for medical robotics. Engineers and physicians should work together to create and validate these systems for the benefits of patients everywhere.

Diagnostic Imaging↗
PubMed2006

Needle biopsy of anatomically unfavorable liver lesions with an electromagnetic navigation assist device in a computed tomography environment.

PURPOSE: Emerging interventional radiology assistance systems that incorporate electromagnetic navigation (EMN) can help the operator guide a needle or other instrument toward a target along preplanned oblique trajectories while avoiding critical structures. A proof-of-concept study was conducted to assess the use of EMN, and EMN was compared with the standard computed tomographic (CT) fluoroscopy guidance technique. MATERIALS AND METHODS: A total of 14 needle passes, seven each with EMN and CT fluoroscopy guidance, were performed into an artificially created liver lesion of a single swine. The accuracy of needle placement for each pass was verified with a confirmatory CT scan. The total radiation dose and time of procedure was compared between the EMN and conventional CT fluoroscopy methods. RESULTS: All needle passes were successful, and all passes conducted with EMN were completed with a single insertion, whereas multiple passes (mean, 2.9) with needle repositioning were required with CT fluoroscopic guidance. Statistically significant reduction in procedure time and overall radiation dose for EMN punctures was shown. Accuracy of needle placement was statistically equivalent for the two methods. CONCLUSIONS: This proof-of-concept study shows that EMN guidance has equivalent accuracy of needle placement to conventional CT fluoroscopy-guided methods in swine. EMN is also associated with favorable radiation-dose and time-of-procedure profiles for biopsy of liver lesions. Clinical studies are needed to evaluate the safety and efficacy of this technology in the biopsy of lesions in anatomically challenging locations that require steep angles of needle insertion.

Animals↗
PubMed2006

Electromagnetic tracking for abdominal interventions in computer aided surgery.

Electromagnetic tracking has great potential for assisting physicians in precision placement of instruments during minimally invasive interventions in the abdomen, since electromagnetic tracking is not limited by the line-of-sight restrictions of optical tracking. A new generation of electromagnetic tracking has recently become available, with sensors small enough to be included in the tips of instruments. To fully exploit the potential of this technology, our research group has been developing a computer aided, image-guided system that uses electromagnetic tracking for visualization of the internal anatomy during abdominal interventions. As registration is a critical component in developing an accurate image-guided system, we present three registration techniques: 1) enhanced paired-point registration (time-stamp match registration and dynamic registration); 2) orientation-based registration; and 3) needle shape-based registration. Respiration compensation is another important issue, particularly in the abdomen, where respiratory motion can make precise targeting difficult. To address this problem, we propose reference tracking and affine transformation methods. Finally, we present our prototype navigation system, which integrates the registration, segmentation, path-planning and navigation functions to provide real-time image guidance in the clinical environment. The methods presented here have been tested with a respiratory phantom specially designed by our group and in swine animal studies under approved protocols. Based on these tests, we conclude that our system can provide quick and accurate localization of tracked instruments in abdominal interventions, and that it offers a user-friendly display for the physician.

Abdomen↗
PubMed2005

Two-stage registration for real-time deformable compensation using an electromagnetic tracking device.

Electromagnetic tracking systems have the potential to track instruments inside the body because they are not limited by the line of sight constraints that characterize optical tracking systems. To integrate an electromagnetic tracking device into a surgical navigation system, accurate registration is required. We present a two-stage registration mechanism designed to be more accurate than the widely used global fiducial-based registration method. The first stage uses a hybrid Iterative Closest Point (ICP) registration method and the Simulated Annealing (SA) optimization algorithm, to increase the initial registration accuracy. The second stage exploits multiple implanted tracking needles that are used to calculate the affine transform based on the initial transform information, and thereby to compensate for the deformation in real time. Phantom and swine studies have demonstrated the utility of this technique.

Animals↗
PubMed2005

Lung deformation estimation and four-dimensional CT lung reconstruction.

Four-dimensional (4D) computed tomography (CT) image acquisition is a useful technique in radiation treatment planning and interventional radiology in that it can account for respiratory motion of lungs. Current 4D lung reconstruction techniques have limitations in either spatial or temporal resolution. In addition, most of these techniques rely on auxiliary surrogates to relate the time of CT scan to the patient's respiratory phase. In this paper, we propose a novel 4D CT lung reconstruction and deformation estimation algorithm. Our algorithm is purely image based. The algorithm can reconstruct high quality 4D images even if the original images are acquired under irregular respiratory motion. The algorithm is validated using synthetic 4D lung data. Experimental results from a swine study data are also presented.

Algorithms↗
PubMed2005

Navigation with electromagnetic tracking for interventional radiology procedures: a feasibility study.

PURPOSE: To assess the feasibility of the use of preprocedural imaging for guide wire, catheter, and needle navigation with electromagnetic tracking in phantom and animal models. MATERIALS AND METHODS: An image-guided intervention software system was developed based on open-source software components. Catheters, needles, and guide wires were constructed with small position and orientation sensors in the tips. A tetrahedral-shaped weak electromagnetic field generator was placed in proximity to an abdominal vascular phantom or three pigs on the angiography table. Preprocedural computed tomographic (CT) images of the phantom or pig were loaded into custom-developed tracking, registration, navigation, and rendering software. Devices were manipulated within the phantom or pig with guidance from the previously acquired CT scan and simultaneous real-time angiography. Navigation within positron emission tomography (PET) and magnetic resonance (MR) volumetric datasets was also performed. External and endovascular fiducials were used for registration in the phantom, and registration error and tracking error were estimated. RESULTS: The CT scan position of the devices within phantoms and pigs was accurately determined during angiography and biopsy procedures, with manageable error for some applications. Preprocedural CT depicted the anatomy in the region of the devices with real-time position updating and minimal registration error and tracking error (<5 mm). PET can also be used with this system to guide percutaneous biopsies to the most metabolically active region of a tumor. CONCLUSIONS: Previously acquired CT, MR, or PET data can be accurately codisplayed during procedures with reconstructed imaging based on the position and orientation of catheters, guide wires, or needles. Multimodality interventions are feasible by allowing the real-time updated display of previously acquired functional or morphologic imaging during angiography, biopsy, and ablation.

Angiography↗
PubMed2005

Precision targeting of liver lesions using a novel electromagnetic navigation device in physiologic phantom and swine.

Radiofrequency ablation of primary and metastatic liver tumors is becoming a potential alternative to surgical resection. We propose a novel system that uses real-time electromagnetic position sensing of the needle tip to help with precision guidance into a liver tumor. The purpose of this study was to evaluate this technology in phantom and animal models. Using an electromagnetic navigation device, instrumented 18 g needles were advanced into radioopaque tumor targets in a respiratory liver phantom. The phantom featured a moving liver target that simulated cranio-caudal liver motion due to respiration. Skin-to-target path planning and real-time needle guidance were provided by a custom-designed software interface based on pre-operative 1 mm CT data slices. Needle probes were advanced using only the electromagnetic navigation device and software display. No conventional real-time imaging was used to assist in advancing the needle to the target. Two experienced operators (interventional radiologists) and two inexperienced ones (residents) used the system. The same protocol was then also used in two anesthetized 45 kg Yorkshire swine where radioopaque agar nodules were injected into the liver to serve as targets. A total of 76 tumor targeting attempts were performed in the liver phantom, and 32 attempts were done in the swine. The average time for path planning was 30 s in the phantom, and 63 s in the swine. The median time for the actual needle puncture to reach the desired target was 33 s in the phantom, and 42 s in the swine. The average registration error between the CT coordinate system and electromagnetic coordinate system was 1.4 mm (SD 0.3 mm) in the phantom, and 1.9 mm (SD 0.4 mm) in the swine. The median distance from the final needle tip position to the center of the tumor was 6.4 mm (SD 3.3 mm, n=76) in the phantom, and 8.3 mm (SD 3.7 mm, n=32) in the swine. There was no statistical difference in the planning time, procedure time, or accuracy of needle placement between experienced and inexperienced operators. The novel electromagnetic navigation system allows probe delivery into hepatic tumors of a physiologic phantom and live anesthetized swine. The system allows less experienced operators to perform equally well as experienced radiologists in terms of procedure time and accuracy of needle probe delivery.

Animals↗
PubMed2002

Assessment of hepatic motion secondary to respiration for computer assisted interventions.

This article reviews the published efforts to characterize hepatic motion secondary to respiration, with the specific goal of defining the limitations and potential applications of image-guided systems in percutaneous liver interventions (computer assisted interventions). Hepatic motion and deformation due to respiration remain obstacles to applying stereotactic localization techniques to the liver. Respiratory-associated hepatic motion is complex. Nine studies using diagnostic imaging or modeling are reviewed, and their findings are tabulated herein. The significant variations in their findings are discussed, including cranio-caudal translation, anterior-posterior and lateral translation, movement secondary to tissue deformation, and motion with respect to surrounding tissue. Techniques for correcting for hepatic respiratory motion are then described, including gating techniques, modeling approaches, real-time liver tracking, and magnetic tracking technology.

Humans↗
PubMed2002

Robotically assisted nerve and facet blocks: a cadaveric study.

RATIONALE AND OBJECTIVES: This study was performed to evaluate the feasibility of using a joystick-controlled robotic needle driver to place a 22-gauge needle for nerve and facet blocks. MATERIALS AND METHODS: Biplane fluoroscopy and a robotic needle driver were used to place 12 needles into the lumbar paraspinal region of an embalmed female cadaver (age at death, 98 years). Small metal BB nipple markers (1 mm in diameter) were inserted percutaneously to serve as targets. Six needles were then placed near the nerve root, and six were placed near the facet root. Anteroposterior and lateral radiographs were obtained after each needle placement to assess its accuracy. RESULTS: All needles were placed within 3 mm of the target BB. The average distance was 1.44 mm +/- 0.66 (standard deviation). DISCUSSION: A robotic needle driver can be used to place needles accurately in the nerve and facet regions. Clinical studies are required to investigate the advantages and disadvantages of this system for interventional procedures involving needles.

Aged↗
PubMed2002

Technology improvements for image-guided and minimally invasive spine procedures.

This paper reports on technology developments aimed at improving the state of the art for image-guided minimally invasive spine procedures. Back pain is a major health problem with serious economic consequences. Minimally invasive procedures to treat back pain are rapidly growing in popularity due to improvements in technique and the substantially reduced trauma to the patient versus open spinal surgery. Image guidance is an enabling technology for minimally invasive procedures, but technical problems remain that may limit the wider applicability of these techniques. The paper begins with a discussion of low back pain and the potential shortcomings of open back surgery. The advantages of minimally invasive procedures are enumerated, followed by a list of technical problems that must be overcome to enable the more widespread dissemination of these techniques. The technical problems include improved intraoperative imaging, fusion of images from multiple modalities, the visualization of oblique paths, percutaneous spine tracking, mechanical instrument guidance, and software architectures for technology integration. Technical developments to address some of these problems are discussed next. The discussion includes intraoperative computerized tomography (CT) imaging, magnetic resonance imaging (MRI)/CT image registration, three-dimensional (3-D) visualization, optical localization, and robotics for percutaneous instrument placement. Finally, the paper concludes by presenting several representative clinical applications: biopsy, vertebroplasty, nerve and facet blocks, and shunt placement. The program presented here is a first step to developing the physician-assist systems of the future, which will incorporate visualization, tracking, and robotics to enable the precision placement and manipulation of instruments with minimal trauma to the patient.

Back Pain↗