Robotic HIFU intervention under US guidance

Transcription

1 Focused Ultrasound Therapy Using Robotic Approaches FUTURA project Project ID: Objective: ICT Robotics, Cognitive Systems & Smart Spaces, Symbiotic Interaction WORKSHOP ON: Interventions Robotic HIFU intervention under US guidance LJUBLJANA (SLOVENIA) SELENE TOGNARELLI The BioRobotics Institute, Scuola Superiore Sant Anna, Pisa

2 Size: in the 1 mm range The Evolution of Surgery

3 What is High Intensity Focused Ultrasound (HIFU)? is an early-stage, non-invasive therapeutic technology with the potential to transform the treatment of many medical disorders by using ultrasonic energy to target tissue deep in the body without incisions or ionizing radiation. Yoav Medan, Insightec Transmission of high level of energy through the human body, non-invasively, causing tissue necrosis within few seconds, while preserving healthy tissues outside the target area.

4 Focused Ultrasound Surgery (FUS) State of the technology Aug 2013 Applications for FUS, in various stages of research, development and clinical use Aug 2015 increased number of clinical interventions in which FUS therapy is involved growing commercial interest from 2013 to August 2015 Data from

5 FUTURA expected outcomes The goal of FUTURA is to design, develop and assess an innovative robotic platform with cognitive capabilities for the delivery of non-invasive therapy by means of High Intensity Focused Ultrasounds, under Ultrasounds guidance. Merging surgical robotics and non-invasive ultrasound therapy to advance: 1. Interventional flexibility, procedural costs, treatment time and reliability of therapy while reducing reliance on medical skills 2. Widespread diffusion of FUS into routine clinical applications (starting from specific clinical targets) 3. Safety and acceptability of the robotic technologies into the operating rooms --> perception capabilities and understanding are augmented by sensor fusion and exploited by advanced control strategies Our focus is the flexibility. Robustness, accuracy and precision of the FUTURA platform has to be comparable with commercially available FUS systems

6 MRgFUS Advantages High soft tissue contrast Good for planning Clear 3D images High sensitivity for tumor detection Thermometry Confirm targeting with sub-lethal heating Follow lethal exposures to measure response Disadvantages High cost Labor intensive Slow imaging Focused Ultrasound Surgery (FUS): MrgFUS and USgFUS Sonalleve, Philips, USA USgFUS Advantages Low cost Real time High resolution Verify the acoustic window Disadvantages (Usually) only 2D Images are harder to interpret Quantitative temperature monitoring not yet available Gas bubbles and coagulated tissue distort the images ExAblate, Insightec, Israel Model-JC, Chongqing HAIFU, China Sonablate-500, Focus Surgery, USA

7 Example of MRgFUS combined with robotics HIFU treatment by exploiting a robotic arm for positioning and tracking 1. INNOMOTION TM system (Innomedic, Germany) The robot received CE mark in 2006 and is currently used for MRI-guided injections, biopsy, drainage, and tumor therapy. INNOMOTION TM system and the ExAblate MRgFUS system (InSightec, IMSAT lab, Dundee 6 degrees of freedom Monitoring of the intervention in real time INNOMOTION operates with the highest possible accuracy: the robotic system is capable of position of the FUS transducer exactly according to the MRI planning

8 Towards robotic assisted USgFUS HIFU treatment by exploiting a robotic arm for positioning and tracking 2. USgHIFU Echopulse (Theraclion, France) Articulated passive arm Motorized head US imaging probe for Targeting & visualization HIFU transducer for treatment Cooling membrane Skin Touch screen Target Mobile cabinet Ultrasound scanner Treatment and imaging probe (VTU)

9 Robotic assisted HIFU: FUTURA project - a step forward HIFU treatment by exploiting 2 separate robotic arms for accurate positioning and tracking HIFU treatment joined together with advanced tracking features and 2 US-imaging probes USgHIFU The Robot Assisted HIFU System FUTURA EU project robotic platform with two independent six degrees of freedom robotic manipulators for a flexible US-driven monitoring and treatment

10 FUTURA Platform: main features of the platform Sensor module: localization system & environment scanner Microsoft Kinect 3D US (4DC7-3/40) Convex probe & Ultrasonix SonixTablet Monitoring modules: 3D ecographic system & confocal 2D probe Ultrasonix PA7-4/12 phased array 2D probe NDI Polaris Spectra ABB IRB DoFs robotic arms with integrated ATI Mini45 F/T sensors Robotic module: diagnostic robot & therapeutic robot Therapeutic module: HIFU transducer Custom 16 channels phased array FUS generator In order to combine non-invasive features (US+HIFU) with accuracy, FUTURA focuses on: Multimodal reconstruction aspects 2016, MARCH 23 Sensors fusion TH algorithms EUROPEAN ROBOTICS FORUM 2016 and ERF safety 2016 strategies Machine learning implementation

11 FUTURA vs. Cyberknife system (Accuray Inc.) similarity Monitoring module Sensor module: Optical localization system & environment scanner Robotic arm 3D & 2D confocal US monitoring system HIFU Operating table HOW FUTURA WORKS

12 FUTURA Platform

13 FUTURA procedure pipeline Pre-operative phase Intra-operative phase Set-up and calibration CT/MRI scan Planning Model/ patient registration Pretreatment Treatment Evaluation of therapy for N sonications

14 Obtained results

15 Conclusions Design and assembly of a flexible robotic platform for the delivery of non-invasive therapy by means of HIFU Process driven and oriented by surgical needs (but potentially not limited to kidney cancer) Exploring paradigms in robotic control, HIFU design, simulation, machine learning, therapy delivery and monitoring for optimizing system integration of both in-house developed and commercial components A (potentially) high performance/low cost EU robotic platform to spread FUS adoption

16 THANK YOU FOR YOUR ATTENTION

17 6th Joint Workshop on New Technologies for Computer/Robot Assisted Surgery CRAS 2016 will be held on SEPTEMBER 12-14, Scuola Superiore Sant'Anna, PISA, ITALY