A new versatile MR-guided high-intensity focused ultrasound (HIFU) device for the treatment of musculoskeletal tumors.

Magnetic Resonance (MR) Imaging-guided High Intensity focused Ultrasound (MRgHIFU) is a non-invasive, non-ionizing thermal ablation therapy that is particularly interesting for the palliative or curative treatment of musculoskeletal tumors. We introduce a new modular MRgHIFU device that allows the ultrasound transducer to be positioned precisely and interactively over the body part to be treated. A flexible, MR-compatible supporting structure allows free positioning of the transducer under MRI/optical fusion imaging guidance. The same structure can be rigidified using pneumatic depression, holding the transducer rigidly in place. Targeting accuracy was first evaluated in vitro. The average targeting error of the complete process was found to be equal to 5.4 ± 2.2 mm in terms of focus position, and 4.7° ± 2° in terms of transducer orientation. First-in-man feasibility is demonstrated on a patient suffering from important, uncontrolled pain from a bone metastasis located in the forearm. The 81 × 47 × 34 mm3 lesion was successfully treated using five successive positions of the transducer, under real-time monitoring by MR Thermometry. Significant pain palliation was observed 3 days after the intervention. The system described and characterized in this study is a particularly interesting modular, low-cost MRgHIFU device for musculoskeletal tumor therapy.

Robotized High Intensity Focused Ultrasound (HIFU) system for treatment of mobile organs using motion tracking by ultrasound imaging: An in vitro study.

High Intensity Focused Ultrasound (HIFU) therapy is a very promising method for ablation of solid tumors. However, intra-abdominal organ motion, principally due to breathing, is a substantial limitation that results in incorrect tumor targeting. The objective of this work is to develop an all-in-one robotized HIFU system that can compensate motion in real-time during HIFU treatment. To this end, an ultrasound visual servoing scheme working at 20 Hz was designed. It relies on the motion estimation by using a fast ultrasonic speckle tracking algorithm and on the use of an interleaved imaging/HIFU sonication sequence for avoiding ultrasonic wave interferences. The robotized HIFU system was tested on a sample of chicken breast undergoing a vertical sinusoidal motion at 0.25 Hz. Sonications with and without motion compensation were performed in order to assess the effect of motion compensation on thermal lesions induced by HIFU. Motion was reduced by more than 80% thanks to this ultrasonic visual servoing system.

Motion prediction for computer-assisted beating heart surgery.

Off-pump totally endoscopic coronary artery bypass grafting is a milestone for cardiac surgery, and still a technical challenge. Indeed, the fast and complex cardiac motion makes this operating method technically demanding. Therefore, several robotic systems have been designed to assist the surgeons by compensating for the cardiac motion and providing a virtually motionless operating area. In the proposed systems, the servoing schemes often take advantage of a prediction algorithm that supplies the controller with some future heart motion. This prediction enlarges the control-loop bandwidth, thus allowing a better motion compensation. Obviously, improving the prediction accuracy will lead to better motion-compensation results. Thus, a current challenge in computer-assisted cardiac surgery research is the design of efficient heart-motion-prediction algorithms. In this paper, a detailed survey of the main existing prediction approaches is given and a classification is provided. Then, a novel prediction technique based on amplitude modulation is proposed, and compared with other techniques using in vivo collected datasets. A final discussion summarizes the main features of all the proposed approaches.

Towards robotized beating heart TECABG: assessment of the heart dynamics using high-speed vision.

Active robotic filtering is probably the solution for beating heart Totally Endoscopic Coronary Artery Bypass Grafting (TECABG). In this work, we assess the heart motion dynamics by simultaneous use of high-speed imaging of optical markers attached to the heart, ECG signals and ventilator airflow acquisitions. Our goal is to assess the heart motions (shape, velocity, acceleration) in order to be able to make more accurate specifications for a novel, dedicated robot that could follow these motions in real time. Furthermore, using two additional inputs (ECG and airflow), we propose a novel robust prediction algorithm that could be used with a predictive control algorithm to improve the tracking accuracy.

Toward robotized beating heart TECABG: assessment of the heart dynamics using high-speed vision.

Active robotic filtering is a promising solution for beating heart Totally Endoscopic Coronary Artery Bypass Grafting (TECABG). n this work, we assess the heart motion dynamics using simultaneously igh speed imaging of optical markers attached to the heart, ECG signals and ventilator airflow acquisitions. Our goal is to make an assessment of the heart motion (shape, velocity, acceleration) in order to be able to make more accurate specifications for a dedicated robot that could follow this motion in real-time. Furthermore, using the 2 additional inputs (ECG, airflow), we propose a prediction algorithm of the motion that could be used with a predictive control algorithm to improve the tracking accuracy.