Person:

Loschak, Paul

This paper presents a modified controller and expanded algorithms for automatically positioning cardiac ultrasound imaging catheters within the heart to improve treatment of cardiac arrhythmias such as atrial fibrillation. Presented here are a new method for controlling the position and orientation of a catheter, smoother and more accurate automated catheter motion, and initial results of image processing into clinically useful displays. Ultrasound imaging (intracardiac echo, or ICE) catheters are steered by four actuated degrees of freedom (DOF) to produce bi-directional bending in combination with handle rotation and translation. Closed form solutions for forward and inverse kinematics enable position control of the catheter tip. Additional kinematic calculations enable 1-DOF angular control of the imaging plane. The combination of positioning with imager rotation enables a wide range of visualization capabilities, such as recording a sequence of ultrasound images and reconstructing them into 3D or 4D volumes for diagnosis and treatment. The algorithms were validated with a robotic test bed and the resulting images were reconstructed into 3D volumes. This capability may improve the efficiency and effectiveness of intracardiac catheter interventions by allowing visualization of soft tissues or working instruments. The methods described here are applicable to any long thin tendon-driven tool (with single or bi-directional bending) requiring accurate tip position and orientation control.

Intracardiac echocardiography (ICE) catheters enable high-quality ultrasound imaging within the heart, but their use in guiding procedures is limited due to the difficulty of manually pointing them at structures of interest. This paper presents the design and testing of a catheter steering model for robotic control of commercial ICE catheters. The four actuated degrees of freedom (4-DOF) are two catheter handle knobs to produce bi-directional bending in combination with rotation and translation of the handle. An extra degree of freedom in the system allows the imaging plane (dependent on orientation) to be directed at an object of interest. A closed form solution for forward and inverse kinematics enables control of the catheter tip position and the imaging plane orientation. The proposed algorithms were validated with a robotic test bed using electromagnetic sensor tracking of the catheter tip. The ability to automatically acquire imaging targets in the heart may improve the efficiency and effectiveness of intracardiac catheter interventions by allowing visualization of soft tissue structures that are not visible using standard fluoroscopic guidance. Although the system has been developed and tested for manipulating ICE catheters, the methods described here are applicable to any long thin tendon-driven tool (with single or bi-directional bending) requiring accurate tip position and orientation control.

We present an instrument tracking and visualization system for intra-cardiac ultrasound catheter guided procedures, enabled through the robotic control of ultrasound catheters. Our system allows for rapid acquisition of 2D ultrasound images and accurate reconstruction and visualization of a 3D volume. The reconstructed volume addresses the limited field of view, an inherent problem of ultrasound imaging, and serves as a navigation map for procedure guidance. Our robotic system can track a moving instrument by continuously adjusting the imaging plane and visualizing the instrument tip. The overall instrument tracking accuracy is 2.2mm RMS in position and 0.8◦ in angle

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.

A system for actively changing the stiffness of a long, thin, flexible robotic manipulator has been designed for cardiologists to use in a range of diagnosis and treatment procedures. Low-stiffness manipulators, such as catheters, are ideal for steering through vasculature with low risk of tissue injury. However, such instruments are not well-suited for applying force to tissue. The proposed system solves this problem by using a series of bead-shaped vertebrae containing pull wires to actively change the stiffness of the catheter, similar to gooseneck surgical retractors. Individual wires steer the catheter to a desired location. All wires are then tensioned to create friction between each vertebra and prevent sliding, therefore resisting motion. While this design concept has been implemented manually in various settings for decades, fine robotic control of the friction and stiffness of the system relies on a thorough understanding of the friction properties between vertebral segments. We have developed an analytical model to understand the interactions between vertebrae and determine the relationships between system parameters and the overall stiffness of the catheter. Experiments validated the calculations from the model and the functionality of the system by applying known loads to the tip of the catheter and measuring the catheter displacement. The catheter stiffness was measured to range from 100 N/m to 800 N/m, which is sufficient for performing many surgical tasks on tissue. This system can be useful in minimally invasive procedures involving direct instrument contact with tissue by improving accuracy, safety, and work flow.

Abstract— Cardiac catheterization with ultrasound (US) imaging catheters provides real time US imaging from within the heart, but manually navigating a four degree of freedom (DOF) imaging catheter is difficult and requires extensive training. Existing work has demonstrated robotic catheter steering in constrained bench top environments. Closed-loop control in an unconstrained setting, such as patient vasculature, remains a significant challenge due to friction, backlash, and physiological disturbances. In this paper we present a new method for closed-loop control of the catheter tip that can accurately and robustly steer 4-DOF cardiac catheters and other flexible manipulators despite these effects. The performance of the system is demonstrated in a vasculature phantom and an in vivo porcine animal model. During bench top studies the robotic system converged to the desired US imager pose with submillimeter and sub-degree-level accuracy. During animal trials the system achieved 2.0 mm and 0.65° accuracy. Accurate and robust robotic navigation of flexible manipulators will enable enhanced visualization and treatment during procedures.

A system for automatically pointing ultrasound (US) imaging catheters will enable clinicians to monitor anatomical structures and track instruments during interventional procedures. Off-the-shelf US catheters provide high quality US images from within the patient. While this method of imaging has been proven to be effective for guiding many interventional treatments, significant training is required to overcome the difficulty in manually steering the imager to point at desired structures. Our system uses closed-form four degree of freedom (DOF) kinematic solutions to automatically position the US catheter and point the imager. Algorithms for steering and imager pointing were developed for a range of useful diagnostic and interventional motions. The system was validated on a robotic test bed by steering the catheter within a water environment containing phantom objects. While the system described here was designed for pointing ultrasound catheters, these algorithms are applicable to accurate 4-DOF steering and orientation control of any long thin tendon-driven tool with single or bi-directional bending.

In this paper we present the design, fabrication, and testing of a robot for automatically positioning ultrasound imaging catheters. Our system will point ultrasound (US) catheters to provide real-time imaging of anatomical structures and working instruments during minimally invasive surgeries. Manually navigating US catheters is difficult and requires extensive training in order to aim the US imager at desired targets. Therefore, a four DOF robotic system was developed to automatically navigate US imaging catheters for enhanced imaging. A rotational transmission enables three DOF for pitch, yaw, and roll of the imager. This transmission is translated by the fourth DOF. An accuracy analysis was conducted to calculate the maximum allowable joint motion error. Rotational joints must be accurate to within 1.5° and the translational joint must be accurate within 1.4 mm. Motion tests were then conducted to validate the accuracy of the robot. The average resulting errors in positioning of the rotational joints were measured to be 0.28°-0.38° with average measured backlash error 0.44°. Average translational positioning and backlash errors were measured to be significantly lower than the reported accuracy of the position sensor. The resulting joint motion errors were well within the required specifications for accurate robot motion. Such effective navigation of US imaging catheters will enable better visualization in various procedures ranging from cardiac arrhythmia treatment to tumor removal in urological cases.

Advanced navigation of steerable flexible manipulators can enable a wider range of surgical procedures and interventions to be done less invasively. The techniques described here were designed for applications in cardiac catheterization, but can also be applied to other body systems. I present an investigation into orientation and positioning navigation of ultrasound imaging catheters, friction analysis for active stiffness changing, and catheter bracing solutions for left atrial interventions.