Smart Medical

Accurately targeting multi-adjacent points (MAPs) during image-guided percutaneous procedures is challenging due to needle deflection and misalignment. The associated errors can result in inadequate treatment of cancer in the case of prostate brachytherapy, or inaccurate diagnosis during biopsy, while repeated insertions increase procedure time, radiation dose, and complications. To address these challenges, we present an image-guided robotic system capable of MAP targeting of irregularly shaped volumes after a single insertion of a percutaneous instrument. The design of the compact CT-compatible drive mechanism is based on a nested screw and screw-spline combination that actuates a straight outer cannula and a curved inner stylet that can be repeatedly straightened when retracted inside the cannula. The stylet translation and cannula rotation/translation enable a 3-D workspace to be reached with the stylet's tip. A closed-form inverse kinematics and image-to-robot registration are implemented in an image-guided system including a point-and-click user interface. The complete system is successfully evaluated with a phantom under a Siemens Definition Flash CT scanner. We demonstrate that the system is capable of MAP targeting for a 2-D shape of the letter “H” and a 3-D helical pattern with an average targeting error of 2.41 mm. These results highlight the benefit and efficacy of the proposed robotic system in seed placement during image-guided brachytherapy.

In this paper we have rapidly prototyped customized, highly-sensitive, mm-scale multi-axis force sensors for medical applications. Using a composite laminate batch fabrication process with biocompatible constituent materials, we have fabricated a fully-integrated, 10×10 mm three-axis force sensor with up to 5 V/N sensitivity and RMS noise on the order of ~1.6 mN, operational over a range of -500 to 500 mN in the x- and y-axes, and -2.5 to 2.5 N in the z-axis. Custom foil-based strain sensors were fabricated in parallel with the mechanical structure, obviating the need for post-manufacturing alignment and assembly. The sensor and its custom-fabricated signal conditioning circuitry fit within a 1×1×2 cm volume to realize a fully-integrated force transduction platform with potential haptics and control applications in minimally-invasive surgical tools. The form factor, biocompatibility, and cost of the sensor and signal conditioning makes this method ideal for rapid-prototyping low-cost, mm-scale distal force sensors. Sensor performance is validated in a simulated tissue palpation task using a robotic master-slave platform.

Magnetic localization systems based on passive permanent magnets (PM) are of great interest due to their ability to provide non-contact sensing and without any power requirement for the PM. Medical procedures such as ventriculostomy can benefit greatly from real-time feedback of the inserted catheter tip. While the effects of the number of sensors on the localization accuracy in such systems has been reported, the spatial design of the sensor layout has been largely overlooked. Here in this paper, a framework for determining an optimal sensor assembly for enhanced localization performance is presented and investigated through numerical simulations and direct experiments. Two approaches are presented: one based on structured grid configuration and the other derived using Genetic Algorithms. Simulation results verified by experiments strongly suggest that the layout of the sensors not only has an effect on the localization accuracy, but also has an effect far more pronounced than improvements brought by increasing the number of sensors.

A handheld, portable cranial drilling tool for safely creating holes in the skull without damaging brain tissue is presented. Such a device is essential for neurosurgeons and mid-level practitioners treating patients with traumatic brain injury. A typical procedure creates a small hole for inserting sensors to monitor intra-cranial pressure measurements and/or removing excess fluid. Drilling holes in emergency settings with existing tools is difficult and dangerous due to the risk of a drill bit unintentionally plunging into brain tissue. Cranial perforators, which counter-bore holes and automatically stop upon skull penetration, do exist but are limited to large diameter hole size and an operating room environment. The tool presented here is compatible with a large range of bit diameters and provides safe, reliable access. This is accomplished through a dynamic bi-stable linkage that supports drilling when force is applied against the skull but retracts upon penetration when the reaction force is diminished. Retraction is achieved when centrifugal forces from rotating masses overpower the axial forces, thus changing the state of the bi-stable mechanism. Initial testing on ex-vivo animal structures has demonstrated that the device can withdraw the drill bit in sufficient time to eliminate the risk of soft tissue damage. Ease of use and portability of the device will enable its use in unregulated environments such as hospital emergency rooms and emergency disaster relief areas.

The small scale of minimally-invasive surgery (MIS) presents significant challenges to developing robust, smart, and dexterous tools for manipulating millimeter and sub-millimeter anatomical structures (vessels, nerves) and surgical equipment (sutures, staples). Robotic MIS systems offer the potential to transform this medical field by enabling precise repair of these miniature tissue structures through the use of teleoperation and haptic feedback. However, this effort is currently limited by the inability to make robust and accurate MIS end effectors with integrated force and contact sensing. In this paper, we demonstrate the use of the novel Pop-Up Book MEMS manufacturing method to fabricate the mechanical and sensing elements of an instrumented MIS grasper. A custom thin-foil strain gage was manufactured in parallel with the mechanical components of the grasper to realize a fully-integrated electromechanical system in a single manufacturing step, removing the need for manual assembly, bonding and alignment. In preliminary experiments, the integrated grasper is capable of resolving forces as low as 30 mN, with a sensitivity of approximately 408 mV/N. This level of performance will enable robotic surgical systems that can handle delicate tissue structures and perform dexterous procedures through the use of haptic feedback guidance.

Innovation in patient care requires both clinical and technical skills, and this paper presents the methods and outcomes of a nine-year, clinical-academic collaboration to develop and evaluate new medical device technologies, while teaching mechanical engineering. Together, over the course of a single semester, seniors, graduate students, and clinicians conceive, design, build, and test proof-of-concept prototypes. Projects initiated in the course have generated intellectual property and peer-reviewed publications, stimulated further research, furthered student and clinician careers, and resulted in technology licenses and start-up ventures.

Up to eight percent of patients develop steal syndrome after prosthetic dialysis access graft placement, which is characterized by low blood flow to the hand. Steal syndrome results in a cold hand, pain, and in extreme cases, loss of function and tissue damage. A practical and easy way of adjusting the fluidic resistance in a graft to attenuate the risk of steal physiology would greatly benefit both surgeons and patients. This paper describes the design and development of a device that can be attached to a dialysis access graft at the time of surgical implantation to enable providers to externally adjust the resistance of the graft postoperatively. Bench level flow experiments and magnetic setups were used to establish design requirements and test prototypes. The Graft Resistance Adjustment Mechanism (GRAM) can be applied to a standard graft before or after it is implanted and a non-contact magnetic coupling enables actuation through the skin for graft compression. The device features a winch-driven system to provide translational movement for a graft compression unit. We expect such a device to enable noninvasive management of steal syndrome in a manner that does not change the existing graft and support technologies, thus reducing patient complications and reducing costs to hospitals.