Brachytherapy
Volume 10, Issue 1 , Pages 57-63, January 2011

Robotic needle guide for prostate brachytherapy: Clinical testing of feasibility and performance

Presented at 2008 World Congress of Brachytherapy, Boston, MA.

  • Danny Y. Song

      Affiliations

    • Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD
    • Corresponding Author InformationCorresponding author. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, The Harry and Jeanette Weinberg Bldg, 401 N Broadway, Ste 1440, Baltimore, MD 21231. Tel.: +1-410-502-5875; fax: +1-410-502-1419.
    • ,
  • Everette C. Burdette

      Affiliations

    • Acoustic Medsystems, Inc., Urbana-Champaign, IL
    • Computer Science, Johns Hopkins University, Baltimore, MD
    • ,
  • Jonathan Fiene

      Affiliations

    • Mechanical Engineering and Applied Mechanics, University of Pennsylvania, Philadelphia, PA
    • ,
  • Elwood Armour

      Affiliations

    • Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD
    • ,
  • Gernot Kronreif

      Affiliations

    • Austrian Center for Medical Innovation and Technology, Wiener Neustadt, Austria
    • ,
  • Anton Deguet

      Affiliations

    • Computer Science, Johns Hopkins University, Baltimore, MD
    • ,
  • Zhe Zhang

      Affiliations

    • Oncology Biostatistics, Johns Hopkins University, Baltimore, MD
    • ,
  • Iulian Iordachita

      Affiliations

    • Computer Science, Johns Hopkins University, Baltimore, MD
    • ,
  • Gabor Fichtinger

      Affiliations

    • Computer Science, Johns Hopkins University, Baltimore, MD
    • Computer Science, Queen’s University, Kingston, Ontario, Canada
    • ,
  • Peter Kazanzides

      Affiliations

    • Computer Science, Johns Hopkins University, Baltimore, MD

Received 30 November 2009; accepted 20 January 2010. published online 23 August 2010.

Abstract 

Purpose

Optimization of prostate brachytherapy is constrained by tissue deflection of needles and fixed spacing of template holes. We developed and clinically tested a robotic guide toward the goal of allowing greater freedom of needle placement.

Methods and Materials

The robot consists of a small tubular needle guide attached to a robotically controlled arm. The apparatus is mounted and calibrated to operate in the same coordinate frame as a standard template. Translation in x and y directions over the perineum ±40mm are possible. Needle insertion is performed manually.

Results

Five patients were treated in an institutional review board-approved study. Confirmatory measurements of robotic movements for initial 3 patients using infrared tracking showed mean error of 0.489mm (standard deviation, 0.328mm). Fine adjustments in needle positioning were possible when tissue deflection was encountered; adjustments were performed in 54 (30.2%) of 179 needles placed, with 36 (20.1%) of 179 adjustments of >2mm. Twenty-seven insertions were intentionally altered to positions between the standard template grid to improve the dosimetric plan or avoid structures such as pubic bone and blood vessels.

Conclusions

Robotic needle positioning provided a means of compensating for needle deflections and the ability to intentionally place needles into areas between the standard template holes. To our knowledge, these results represent the first clinical testing of such a system. Future work will be incorporation of direct control of the robot by the physician, adding software algorithms to help avoid robot collisions with the ultrasound, and testing the angulation capability in the clinical setting.

Keywords: Prostate, Brachytherapy, Robot, Template, Needle

 

 This work has been supported by Dept of Defense PC-050042, Dept of Defense PC050170, NIH 2R44 CA099374-02, NIH 5R44 CA088139-04, and the NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology under NSF EEC-9731748.1.

 Conflicts of interest notification: Gernot Kronreif and PROFACTOR Research and Solutions GmbH have a patent application pending for this technology. The remaining authors have no conflicts of interest to disclose.

PII: S1538-4721(10)00244-8

doi:10.1016/j.brachy.2010.01.003

Brachytherapy
Volume 10, Issue 1 , Pages 57-63, January 2011

Article Tools

* Image Usage & Resolution