Conformity of tumour volumes and dose plans in prostate brachytherapy (BT) can be constrained by unwanted needle deflections, needle access restrictions and visualisation limitations. This work validates the feasibility of teleoperated robotic control of an active steerable needle using magnetic resonance (MR) for guidance. With this system, perturbations can be counteracted and critical structures can be circumvented to access currently inaccessible areas. The system comprises of (1) a novel steerable needle, (2) the minimally invasive robotics in an MR environment (MIRIAM) system, and (3) the daVinci Research Kit (dVRK). MR scans provide visual feedback to the operator controlling the dVRK. Needle steering is performed along curved trajectories to avoid the urethra towards targets (representing tumour tissue) in a prostate phantom with a targeting error of 1.2 ± 1.0 mm. This work shows the potential clinical applicability of active needle steering for prostate BT with a teleoperated robotic system in an MR environment.

Steerable instruments allow for precise access to deeply-seated targets while sparing sensitive tissues and avoiding anatomical structures. In this study we present a novel omnidirectional steerable instrument for prostate high-dose-rate (HDR) brachytherapy (BT). The instrument utilizes a needle with internal compliant mechanism, which enables distal tip steering through proximal instrument bending while retaining high axial and flexural rigidity. Finite element analysis evaluated the design and the prototype was validated in experiments involving tissue simulants and ex-vivo bovine tissue. Ultrasound (US) images were used to provide visualization and shape-reconstruction of the instrument during the insertions. In the experiments lateral tip steering up to 20 mm was found. Manually controlled active needle tip steering in inhomogeneous tissue simulants and ex-vivo tissue resulted in mean targeting errors of 1.4 mm and 2 mm in 3D position, respectively. The experiments show that steering response of the instrument is history-independent. The results indicate that the endpoint accuracy of the steerable instrument is similar to that of the conventional rigid HDR BT needle while adding the ability to steer along curved paths. Due to the design of the steerable needle sufficient axial and flexural rigidity is preserved to enable puncturing and path control within various heterogeneous tissues. The developed instrument has the potential to overcome problems currently unavoidable with conventional instruments, such as pubic arch interference in HDR BT, without major changes to the clinical workflow.

Needle insertion procedures are commonly performed in current clinical practice for diagnostic and therapeutic purposes. Although prevailing technology allows accurate localization of lesions, they cannot yet be precisely targeted. Needle steering is a promising technique to overcome this challenge. In this paper, we describe the development of a novel steering system for an actuated-tip flexible needle. Strain measurements from an array of Fiber Bragg Grating (FBG) sensors are used for online reconstruction of the needle shape in 3D-space. FBG-sensor data is then fused with ultrasound images obtained from a clinically-approved Automated Breast Volume Scanner (ABVS) using an unscented Kalman filter. A new ultrasound-based tracking algorithm is developed for the robust tracking of the needle in biological tissue. Two experimental cases are presented to evaluate the proposed steering system. In the first case, the needle shape is reconstructed using the tracked tip position in ultrasound images and FBG-sensor measurements, separately. The reconstructed shape is then compared with the actual 3D needle shape obtained from the ABVS. In the second case, two steering experiments are performed to evaluate the overall system by fusing the FBG-sensor data and ultrasound images. Average targeting errors are 1.29±0.41 mm and 1.42±0.72 mm in gelatin phantom and biological tissue, respectively.